Kazuo Yao

Multiple primary malignancies in the head and neck: a clinical review of 121 patients.

A total of 121 multiple primary malignancies (quadruple, n ¾ 2; triple, n ¾ 11; and double, n ¾ 108) were treated at the Department of Otorhinolaryngology, Kitasato University Hospital between July 1972 and December 1998. Of the 108 patients with double primary malignancies, 18 had synchronous double primary malignancies (SDPM), which were defined as occurrence of the index tumor and second malignancy within 6 months of each other, and 90 had metachronous double primary malignancies (MDPM), which were defined as occurrence of the index tumor and the second malignancy separated by a period of >7 months. MDPM was subdivided into MDPM-F (head and neck malignancy occurred as the first tumor; n ¾ 55) and MDPM-S (head and neck malignancy occurred as the second tumor; n ¾ 35). Of the 55 patients with MDPM-F, 27 (49.1%) of the second malignancies were found in the digestive tract, 12 in the stomach (21.8%), 8 in the esophagus (14.5%) and 7 in lower digestive tract tumors (12.7%). The 3- and 5-year survival rates of MDPM-F were 79.2% and 62.3%, respectively. Differential diagnosis between multiple primary malignancy (MPM) and multicentric tumors is often difficult when the lesions involve the oral cavity, pharynx and esophagus. We suggest that it is beneficial to follow patients for as long as possible in order to facilitate diagnosis of tumor recurrence, metastasis and MPM.

Long-term result of the new endoscopic vocal fold medialization surgical technique for laryngeal palsy

Objective: The conventional surgical method for a case of unilateral laryngeal nerve paralysis with large glottal gap requires an external cervical incision. In the present study, we developed an endoscopic technique of vocal fold medialization that can make the external incision unnecessary. This procedure of autologous transplantation of fascia into the vocal fold (ATFV) was developed for the successful treatment of unilateral laryngeal nerve paralysis. However, the method seemed to be effective only for patients with a relatively mild glottal gap.

Cemento-ossifying fibroma of maxillary and sphenoid sinuses: case report and literature review.

We report a case of cemento-ossifying fibroma (COF) involving the maxillary and sphenoid sinuses and review the literature in order to study the clinical features, imaging findings and histopathologic characteristics of COF. Special care was taken to distinguish this lesion from cemento-osseous dysplasia (COD). It is almost inevitable that differential diagnosis of COD and COF will be complicated by the fact that some pathologic features are shared by both lesions. A combined study incorporating clinical, radiographic and pathologic findings is important in order to ensure an accurate diagnosis. Postoperative follow-up is essential, especially in cases where incomplete removal of the COF was performed.

Chemosurgery with Trichloroacetic Acid for Allergic Rhinitis

The use of 80 w/v% solution of trichloroacetic acid (TCA) for the treatment of allergic rhinitis was reported. The solution was applied to the inferior turbinates only once bilaterally. The result of the treatment in 77 nonselected cases of perennial allergic rhinitis for over 3 years showed that an improvement was obtained in 72% for nasal obstruction, 60% for sneezing, and 50% for watery nasal discharge. The result of provocation tests after treatment showed an improvement in 77% of the cases, and the histamine concentration in the nasal wash decreased. These results were discussed with reference to the result of our previous histological studies. We concluded that our method of treatment using TCA was simple and effective for allergic rhinitis without any serious side effects.

Malignant fibrous histiocytoma of the nasal cavity and paranasal sinuses: review of the last 30 years.

The clinical and pathologic features of four patients with malignant fibrous histiocytoma of the maxillary sinus were studied. All patients were male, with an age range of 43-71 years at the time of diagnosis. The main symptoms were pain in the facial region, swelling of the cheek and nasal bleeding. Pathologically, three patients were subclassified with the striform-pleomorphic type of malignant fibrous histiocytoma and one with the myxoid type. All patients were operated on and received various combinations of pre- and postoperative irradiation and intra-arterial chemotherapy given via the temporal artery. In the patient with the best prognosis, tumor extension within the maxillary sinus was minimal. Two patients developed local recurrences and died. None of the patients developed locoregional lymph node or systemic metastases.

Clinical impact of using chemoradiotherapy as a primary treatment for hypopharyngeal cancer

Eighty-eight patients with hypopharyngeal cancer who received chemoradiotherapy as the primary treatment between 1979 and 1997 were investigated. Forty-six patients who received surgery as the primary treatment were analyzed as a control group. There were no statistically significant differences regarding TN classification, tumor stage, tumor site, age or sex between the radiation and surgery groups. The 5-year cumulative survival rate of primary chemoradiotherapy was 47% and this did not differ significantly from that for the primary surgery group. The larynx was preserved in 74% of cases in the primary chemoradiotherapy group, a far better preservation rate than that in the surgery group. After primary chemoradiotherapy, complete remission (CR) was observed in 59% of cases and the average period of CR was 38 months. Among patients with residual tumor, a salvage operation was employed in 31 cases, 13 patients refused to receive surgery and 8 were inoperable. A salvage operation was performed in 35% of all cases and the 5-year cumulative survival rate was 50%. Based on the 5-year survival, primary CR, salvage and laryngeal preservation rates, we conclude that chemoradiotherapy is a good primary treatment for hypopharyngeal cancer

Evaluation of Activated Eosinophil Infiltration for the Assessment of the Effect of Chemosurgical Treatment for Allergic Rhinitis Using Trichloroacetic Acid

An immunohistochemical study was made on the degree of activated eosinophil (EG2) infiltration in the inferior turbinate of 20 cases of perennial allergic rhinitis who underwent septal reconstruction and bilateral inferior turbinectomy approximately 5 months after the unilateral application of trichloroacetic acid (TCA). The distribution of EG2 was also evaluated in nasal smears obtained from the same subjects, and a comparison was made between TCA-applied and nonapplied sides. It was found that the number of EG2 was significantly decreased in the TCA-applied side. It was assumed that TCA application successfully suppressed reagin-dependent allergic reaction in the tissues.

Combined Therapy for Hypopharyngeal Cancer

We studied 69 hypopharyngeal cancer patients who were treated between 1979 and 1992. The 5-year cumulative survival rate was 53%. There were five stage I, seven stage II, 20 stage III and 37 stage IV patients; survival rates for stages I, II, III, and IV were 80%, 54%, 61% and 47%, respectively. The 5-year survival rate for the 25 patients who received preoperative radiotherapy (fewer than 40 Gy) followed by total pharyngo-laryngo-esophagectomy was 59%. Forty-four patients received radical radiotherapy as a main treatment. From the standpoint of preserving vocal function, we recommend using the radical radiation as a first-choice treatment. The 5-year survival rate was 48%. There were 16 radiation failure patients after radical radiotherapy and two of them refused to have surgery. Fourteen patients (36%) received a salvage operation and the survival rate was 36%. The survival rate for the 30 patients who did not receive surgery was 61%; the patients who received surgery as a palliative purpose and the patients who refused to undergo surgery were included in this group. Both treatment regimens of the present study showed higher survival rates compared to the results of previous studies. We concluded that the improved results were due to the proper selection of the treatment, especially the attention given to the patients immune response and the minimum death as a result of neck node metastasis.

Limited surgery for cancer of the larynx and hypopharynx: Options and consequences

We reviewed surgical options for laryngeal preservation (limited surgery) in laryngeal and hypopharyngeal cancers and the consequences of the options. Of 44 patients with laryngeal cancer, 11 (25%) received limited surgery and 33 (75%) received total laryngectomy. The survival rates were 91% for the limited surgery group and 73% for the total (radical) surgery group. Of 31 patients with hypopharyngeal cancer, 7 (23%) received limited surgery and 24 (77%) received total laryngopharyngectomy. The survival rates were 53% for the limited surgery group and 40% for the total (radical) surgery group. The survival rates associated with limited surgery were thus better than those for total (radical) surgery for cancers of both the larynx and hypopharynx. This was attributed to the limited surgery group comprising well-selected patients with confined lesions. Organ preservation surgery should be technically simple, reliable in terms of its functional impact and, above all, should not jeopardize the patients survival. Supracricoid subtotal laryngectomy with cricohyoidoepiglottopexy or cricohyoido-pexy has great potential for laryngeal preservation and will become the major limited surgery modality for treating cancer of the larynx. Limited surgery, however, needs to be performed with great care and is indicated only for very well-selected patients with cancer of the hypopharynx.

Distribution of two types of mast cells in the nasal mucosa after chemosurgical treatment of allergic rhinitis using trichloroacetic acid.

To evaluate the efficacy of chemosurgery using trichloroacetic acid (TCA)for allergic rhinitis, two types of tissue mast cells [tryptase-positive, chymase-negative mast cells (MCT) and tryptase-positive, chymase-positive mast cells (MCTC)] in the nasal turbinate mucosa were immunohistochemically identified and their distribution was assessed in clinical cases of patients who underwent unilateral TCA treatment. A comparison of the number of MCT and MCTC between the treated and nontreated sides indicates that both types of mast cells are significantly decreased in number in the treated side both in epithelial and lamina propria layers. The results indicate that TCA treatment was effective in suppressing MCT infiltration, regarded as a major cause of antigen-dependent allergy.