Shigeru Hanazawa

Neurogenic Neoplasms in the Head and Neck Region

Thirteen cases of neurogenic tumor in the head and neck region experienced during the past fifteen years were reported. Six of them were neurilemmomas, three neurofibromas associated with von Recklinghausens disease, two ganglioneuromas and two paragangliomas (chemodectomas). Representative cases were reported in detail in conjunction with considerations regarding diagnosis, treatment, and histopathologic findings by reviewing pertinent papers.

Analysis of the long-term results of our combination therapy for maxillary cancer, with particular reference to treatment of T4 and N1-3 maxillary cancer.

To evaluate how far the long-term survival rate could be improved by maximum combination of chemotherapy, radiotherapy, and surgery, we have performed a trial combination therapy consisting of Linac X-ray irradiation (200 rads X 30) and intraarterial infusion chemotherapy (5-fluorouracil 250 mg X 15), followed by sufficiently extensive maxillectomy and primary reconstruction. The 5-year crude and relative survival rate of 70 patients were 64.2 and 72.1% respectively. The 5-year crude survival rate in cases with squamous cell carcinoma was 73.1%. Twelve out of 70 patients died of cancer. Local recurrence was seen in 6 cases and the most frequent cause of death was distant metastasis which was seen in 25% of T4N0 cases and in 57% of T2-3N1-3 cases. The elderly patients over 71 years occupied 29.1% of the total cases. The 3-year and 5-year crude survival rates in these elderly patients were 75 and 50% respectively. Death due to cancer was seen only in 3 patients and the most frequent cause of death was due to senility and other unrelated causes. As far as squamous cell carcinoma is concerned, the post-therapeutic courses of our combination therapy have been satisfactory. However further revision of the trial therapy was deemed necessary in T4 and N1-3 maxillary cancer. By covering the entire wound surface after total and extended total maxillectomy by a thick flap, the post-operative facial deformity and functional impairment due to scar contracture of the wound could be effectively prevented.(ABSTRACT TRUNCATED AT 250 WORDS)

A Giant Juvenile Nasopharyngeal Angiofibroma

A 10-year-old male with giant juvenile angiofibroma with a suspicion of intracranial extension is reported. Preoperative embolization of the bilateral maxillary arteries was performed 7 days before tumor resection at another institution and the operation was performed under hypothermic anesthesia. A transfacial approach through an extended Moure incision was undertaken. The tumor was completely resected under high magnification using wide field high power ( x 4.5) loops. Blood loss totalled 1218 g. The patient has remained asymptomatic with no evidence of recurrence for the 2 years since surgery. Appropriate treatment for patients with juvenile nasopharyngeal angiofibroma (JNA) is discussed in the context of a literature review.