[en] This review focuses on two topics of salivary gland diseases regarding xerostomia. First, the pathogenesis and treatment of xerostomia after radiotherapy against head and neck cancer is discussed. It is well known that the extent of radiation-induced salivary dysfunction and mucositis depends on the radiation dose and field. Moreover, the balance in the defense system of oropharyngeal cavity alters after radiotherapy. This altered balance may impair the ability to maintain the stable immunological control mechanism. Second, the newly established concept about Mikulicz's disease is discussed. Recently, elevated IgG4 concentration in serum and prominent infiltrating by plasmacytes expressing IgG4 in the salivary glands in Mikulicz's disease were revealed. Mikulicz's disease is different from Sjoegren's syndrome, and may be a systemic IgG4-related plasmacytic disease. (author)

[en] We reviewed 55 cases of previously untreated malignant tumors arising in the parotid gland treated between Jan 1989 and May 2008. Histopathologically, we observed 13 tumor types, the most frequent histological type being mucoepidermoid carcinoma (12), followed by adenoid cystic carcinoma (11). According to clinical stage, 5 subjects were classified as T1, 18 as T2, 10 as T3, and 22 as T4. N+ cases numbered 7, and were staged as N2. Six had distant metastasis (5 lung and 1 axillary). Nineteen exhibited facial nerve palsy before treatment. Among major therapies, surgery was conducted in 50 subjects, radiation therapy in 3, and chemotherapy, and percutaneous ethanol injection therapy in each. Overall five-year survival determined using the Kaplan-Meier method was 73%. Among major histopathological types, five-year survival was 33% for undifferentiated carcinoma, 40% for adenocarcinoma, 62% for mucoepidermoid carcinoma, 67% for carcinoma in pleomorphic adenoma, and 100% for adenoid cystic carcinoma and acinic cell carcinoma. By T classification, five-year survival was 100% for T1, 88% for T2, 90% for T3, and 44% for T4. Five-year survival was 36% for those exhibiting facial nerve palsy and 94% for non palsy. Factors influencing poor outcome were T4 (p=0.001) and facial nerve palsy (p=0.001). (author)

[en] Twenty-eight patients with tongue squamous cell carcinoma were treated with superselective intra-arterial chemotherapy with docetaxel (DOC), cisplatin (CDDP), and fluorouracil (5-FU). Twenty-seven patients obtained complete response (CR) histologically. The response rate was 100% and CR rate was 96.4%. The one patient who did not attain CR was a patient who had already received radiation therapy and surgery. By the median follow-up period of 1,815 days (range was 382-3,383 days), the survival rate was 85.8% and the organ preservation rate was 82.5%. These data suggest that the primary tumors can be controlled by superselective intra-arterial chemotherapy alone for T2 and T3 which is close to T2 and superselective intra-arterial chemotherapy with concomitant radiation therapy for most of T3 and T4a cases. For cervical lymph node metastasis, it may be dependent on the neck dissection. This therapy is believed to be useful as a treatment for the purpose of 'organ preservation · non-surgical treatment'. (author)

[en] The purpose of this study was to evaluate the efficacy of rapid superselective high-dose cisplatin infusion with concomitant radiotherapy for previously untreated patients with advanced hypopharyngeal cancer. Fifteen patients for whom surgery was contraindicated or who rejected radical surgery were given superselective intra-arterial infusion of cisplatin (100-120 mg/m²/week) with simultaneous intravenous infusion of thiosulfate to neutralize cisplatin toxicity and conventional extra-beam radiotherapy (66 Gy/33 fr/6.6 weeks). There were nine patients whom surgery was contraindicated and six patients who rejected radical surgery. During the median follow-up period of 13 months, the 2-year overall survival and preservation rates of larynx were 53.4% nad 78.3%, respectively. Nine (60.0%) patients experienced grade 3 to 4 toxicity, including mucositis (n=7), leukopenia (n=3), anemia, fever, dermatitis (n=2), and thrombocytopenia, neurologic sign, nausea (n=1). There are 12 surviving patients without evidence of desease, 11 of whom are able to have oral intake without feeding-tube support. We confirmed the efficacy of superselective intra-arterial infusion and concomitant radiotherapy. All arterial catheterizations should accomplished transcutaneously through the femoral artery, and the selection of artery should be decided by angio-CT. (author)

[en] Preoperative parotid gland tumor diagnosis is important, especially regarding the grade of malignancy. We studied histopathology magnetic resonance imaging MRI findings and apparent diffusion coefficient (ADC) values in 81 patients with parotid gland tumors. Mean ADC in Warthin tumor and cancer was significantly lower than in pleomorphic adenoma. Three of 4 cases with high-grade malignancy had lower ADC (<1.0), whereas 17 of 18 with pleomorphic adenoma had higher of ADC (>1.0). We found ADC to be useful in distinguishing pleomorphic adenoma from high-grade malignancy. (author)

[en] From 1985 to 2006, six children underwent surgical management for a cyst at the base of the tongue. Their ages ranged from 3 months to 13 years old. A 3-month-old infant was complaining of inspiratory stridor. Another five children were complaining of abnormal sensation in the pharynx or had no symptoms. Four children underwent total resection of the outer portion of the cystic walls by oral approach. In two of four cases, children have shown cyst recurrence, and one underwent complete removal of the cyst wall by suprahyoid surgical approach. Two children underwent total removal of the cyst by suprahyoid surgical approach. No recurrence has been observed in these two cases. (author)

[en] There is great variability in the MR findings of pleomorphic adenoma, which are the most common tumors of the parotid gland, reflecting the various proportions of cellular, myxoid, and fibrosis components. The purpose of our study was to correlate the magnetic resonance (MR) features and histopathological findings of pleomorphic adenoma and to interpret these findings. We reviewed MR studies of 60 pathologically proven pleomorphic adenoma. Forty-five cases (75%) showed high signal intensity for the normal parotid gland on T2-weighted images. The diagnostic clue of pleomorphic adenoma is to find the myxoid component, which shows a high intensity on T2-weighted images. Nine cases (15%) showed iso or hypo intensity on T2-weighted images. Six cases (10%) showed hypo intensity on T2-weighted images, reflecting fibrosis. We speculated that hypercellularity with less myxoid stroma reduced the intensity on T2-weighted images. Although it has been reported that pleomorphic adenomas typically have a high signal intensity on T2-weighted images, 25% cases of pleomorphic adenoma demonstrated iso intensity or hypo intensity in this study. It is likely that understanding these relationships between T2-weighted signal in MRI and pathological findings will improve diagnosis of parotid pleomorphic adenoma. (author)

[en] We evaluated the surgical skill of uvulopalato pharyngo plasty (UPPP) done in 35 cases in our hospital and discussed its efficacy. Our method of UPPP has three characteristics. First, a mattress suture was applied in the tonsillar bed. As a result there was no failure of the suture. Second, we made a raw surface at a little upper part of the root of the uvula and applied the mattress suture to it. This suture has efficacy of soft palate upword to the oral side. Third, no continuous suture has advantage to present scar formation. We also examined the dynamic MRI for obstructive site and images were divided some morphological obstructive pattern, and assess about efficacy of improvement rate of AHI. The efficacy was over 80% in tonsillar type. But there was 31% efficacy not only soft palate but also tongue rotation type. We concluded that the important factor to have good result of UPPP are surgical skill and adequate indication. (author)

[en] Post-traumatic dysnosmia and dysgeusia are often caused by head injury. They were disregarded by both the patients and physicians because of the head injury and the frequent co-occurrence of other visceral or orthopedic injuries requiring immediate treatment. Since there have been so few reports about such cases, the those mechanisms have not been clear. In this study, 6 patients who complained of dysnosmia and dysgeusia after head injury were analyzed. They consisted of 3 males and 3 females, and their ages ranged from 29 to 63 years with a mean of 48.0 years. At the first visit, an olfactory and taste function test, SDS (sell-rating depression scale), measurement of serum zinc, iron and copper, and head MRI were performed. Two thirds cases (66.7%) had changes at the frontal lobe and 1/3 cases (33.3%) had changes at the temporal lobes in head MRI. The recognition thresholds were worse than detection thresholds in both the olfactory and taste function test. It indicated that post-traumatic dysnosmia and dysgeusia were caused by damage not only of direct neurotransmission system but also central nervous including limbic system damage. In half the patients, the taste function tended to improve, but there was no recovery of olfactory function in any case. Post-traumatic dysgeusia improves more frequently than post-traumatic dysnosmia. Post-traumatic dysgeusia is often caused by inc and iron deficiency after fasting. In these cases, it could be improved with administration of zinc and iron. More data will be needed for resolution of post-traumatic dysnosmia and dysgeusia. (author)

[en] Superselective intraarterial infusion enables high-dose chemotherapeutic agents to be administered via tumor feeding vessels to neutralize and limit the adverse cisplatin effects acceptable. Between 1998 and 2008, we evaluated the efficacy of first-line therapy and adverse events in 30 subjects with oral squamous cell cancer undergoing simultaneous superselective intra arterial high-dose chemotherapy and radiotherapy. The 30 subjects- 23 men and 7 women aged 40 to 72- consisted of 3 T2, 12 T3, and 15 T4. Four patients had N0, 8 N1, 7 N2b, 8 N2c, and 3 N3 disease. Two were in CS II, 6 III, 17 IVa, and 5 IVb (III>93%, IV: 73%). Superselective intra arterial chemotherapy delivered through the femoral artery used the Seldinger technique. A single cisplatin dose of 100-550 mg/m² (mean 440 mg/m²). Five minutes after intra arterial infusion, sodium thiosulphate (9 g/m²) was administered via a peripheral cutaneous vein in the contralateral forearm. Concurrent radiotherapy started on Day 2 at 2 Gy per session for a total of 60 Gy. Two to 3 weeks later, 15 under went the second course of superselective intra arterial chemotherapy after tumor feeding vessels were visualized angiographically. Four (13.3%) subjects with Grade 3 or greater myelosuppression required granulocyte-colony stimulating factor (G-CSF). Grade 3 or greater mucositis was observed in 57% and Grade 4 mucositis occurred in 5 (16.7%). All adverse effects were reversible and no serious adverse events were prolonged. Among those responding to first-line therapy, 24 of the 30 (80%) achieved complete response (CR) and 6 (20%) partial response (PR), but no stable disease (SD) or no change (NC). Overall response was 100%. Histopathologically, 2 of 9 undergoing postchemoradiotherapy had no tumors. Clinical and pathological CR was 86.7%. Adverse events associated with this therapy associated events were considered relatively mild and within allowable limits. (author)