Maxillary Cancer Research Articles

Clinical Investigation of 99mTc-MIBI Imaging in Head and Neck Tumors

Objective: To investigate the diagnostic potential value of 99mTc-MIBI imaging in head and neck tumors. Methods: Ninety-one patients with malignant and benign head and neck lesions were subjected to 99mTc-MIBI tomography, and 20 healthy volunteers served as control group. Results: The overall sensitivity, specificity, accuracy and positive predictive accuracy of early/delay 99mTc-MIBI imaging in diagnosis of head and neck malignant tumors were 78.7%/72.3%, 72.1%/88.4%, 75.6%/80.0% and 75.5%/87.2% respectively. The results of 99mTc-MIBI Imaging in diagnosis of nasopharyngeal cancer and sinonasal non-Hodgkin's lymphoma were more satisfactory than those in maxillary sinus cancer. In distinguishing recurrent/residual nasopharyngeal carcinoma and sinonasal non-Hodgkin's lymphoma, 99mTc-MIBI scintigraphy was superior to CT/MRI. Conclusion: 99mTc-MIBI imaging is a promising useful tool in identifying head and neck tumor, and it has a special value to evaluate the local invasion and metastasis involved.

血液系腫よう随伴症候群を伴った上顎へん平上皮癌例

We report a case of maxillary cancer that caused a marked systemic inflammatory reaction including leukocytosis and high blood levels of C-reactive protein. The production of Granulocyte-colony stimulating factor (G-CSF) by tumor cells was demonstrated by immunohistochemical staining. Despite the reported poor prognosis of G-CSF producing tumors, chemoradiotherapy was highly effective and all of the inflammatory indexes settled to within normal limits. The patient is under close follow-up and has been in complete remission for eleven months after the completion of chemoradiotherapy.

Two Cases of Maxillary Cancer with a Similar Clinical Course and Imaging Findings but Markedly Different Levels of FDG Uptake

We report two cases of poorly differentiated squamous cell carcinoma of the left maxillary sinus. Both patients had a similar clinical course and similar imaging findings. However, FDG uptake by the 2 lesions was very different. The SUVs of the tumor lesions of patient 1 and 2 were 20.67 and 7.56, respectively. Histopathologically, hematoxylin and eosin (H&E) stained sections (X200) were packed with tumor cells, with many more inflammatory cells seen in patient 1. When dealing with cases of carcinoma of the head neck region where tumors are often accompanied by inflammation, we should bear in mind that FDG uptake by tumors is strongly influenced by the activity and timing of inflammation within the tumor lesions.

Inhibition of histone deacetylase 3 stimulates apoptosis induced by heat shock under acidic conditions in human maxillary cancer

To elucidate the molecular mechanisms for the enhancement of heat-induced apoptosis on exposure to acidic conditions, human maxillary carcinoma IMC-3 cells were heat-shocked at 44 degrees C for 30 min at either pH 7.4 or 6.7. Analyses with cDNA arrays, the reverse transcription-polymerase chain reaction (RT-PCR), and Western blotting were performed. We found that histone deacetylase 3 (HDAC3) was specifically induced after hyperthermia at 44 degrees C for 30 min at pH 6.7. Although the cytotoxicity of heating at 44 degrees C for 30 min was enhanced by decreasing the pH from 7.4 to 6.7, it was enhanced even more by antisense RNA oligonucleotides for HDAC3. The induction of G2/M arrest after heating occurred earlier at pH 6.7 than at pH 7.4. The inhibition of HDAC3 by the antisense RNA oligonucleotides suppressed partially the induction of G2/M arrest, resulting in an enhancement of the apoptosis caused by the heating under acidic conditions. Antisense RNA oligonucleotides for HDAC3 enhanced apoptosis 48 h after hyperthermia at 43 degrees C for 30 min in vivo. Analyses of p65 activity suggested that NF-kappaB is involved in this enhancement of hyperthermia. HDAC3 may be a novel target enhancing hyperthermia and combined treatment with hyperthermia and HDAC inhibitors is a possible modality for cancer therapy.

Sulindac sulfide-induced apoptosis in sinonasal cancer cells

ConclusionsThese results demonstrate that sulindac sulfide can induce cell death in maxillary cancer cells, and that sulindac sulfide-induced apoptosis is related to the extracellular signal-regulated kinase/p38 MAPK--caspase 3 signaling pathway.ObjectiveHead and neck cancer is the sixth commonest cancer in the human body. Squamous cell carcinoma accounts for most sinonasal cancers. However, little is known regarding the biochemical mechanism(s) of cell death in sinonasal cancers. Recently, human epidemiological and clinical intervention studies have indicated that sulindac, a non-steroidal anti-inflammatory drug, exhibits chemopreventive activity in colorectal cancer. In this study, we aimed to investigate whether sulindac sulfide can induce apoptosis in sinonasal cancer cells and what type of molecular mechanisms induces the death of sinonasal cancer cells.Material and methodsSinonasal cancer cells (Asan Medical Center—Head and Neck Cancer 5) were treated with various concentrations of sulindac sulfide. The degree of cell death was determined by means of a fluorescence-activated cell scan and the signal transduction pathway for cell death was examined.ResultsHuman nasal cavity cancer cells treated with sulindac sulfide underwent cell death, and the induction of apoptosis occurred in a dose-dependent manner. Moreover, sulindac sulfide-induced apoptosis was abolished by treatment with the caspase inhibitor Z-VAD-fmk and the mitogen-activated protein kinase (MAPK) inhibitors PD98059 and SB203580.

PD.190 Intrarterial infusion of boronophenylalaninein boron neutron capture therapy for patient with maxillary cancer: A case report of new strategy for cancer treatment

PD.190 Intrarterial infusion of boronophenylalaninein boron neutron capture therapy for patient with maxillary cancer: A case report of new strategy for cancer treatment

Use of real‐time magnetic resonance image guidance in endoscopic sinus surgery

We evaluated the effectiveness of magnetic resonance image (MRI) guidance using an optical tracking system (MRI‐guided therapy: MRT) in performing endoscopic sinus surgery (ESS). The profiles of the fourteen patients in the present study were as follows: eleven with mucocele in the paranasal sinus, one with recurrent chronic sinusitis, one with maxillary cancer, and one with Graves' ophthalmopathy. Preparation of the MRT system required an additional 54 min in cases involving general anesthesia, and an additional 17 min in cases involving local anesthesia, in comparison with corresponding control groups undergoing ESS in a traditional operating room. We developed nonmetal probes that were visualized in a real‐time mode and assistive devices for the optical tracking system that were equipped to avoid obstruction caused by surgical instruments as well as by the hands of surgeons. Using these unique devices, anatomic landmarks were visualized using the present MRT system. The prognosis of patients was favorable, and in particular, no patients with sinus mucocele showed a recurrence of their lesions. We concluded that the MRT system used here for performing ESS was beneficial, especially in terms of the intranasal marsupialization of sinus mucoceles and for the verification of orbital contents.

P.174 A case of maxillary reconstruction with avascularized iliac osteocutaneous flap after resection of maxillary cancer

P.174 A case of maxillary reconstruction with avascularized iliac osteocutaneous flap after resection of maxillary cancer

組織型の異なる両側異時性上顎洞癌の１例

We report a rare case of bilateral carcinomas of the maxillary sinuses. In 1987, the patient received irradiation therapy (60Co 50.4Gy) and partial maxillectomy for left maxillary squamous cell carcinoma (SCC, T3NOMO). Because of tumor recurrence in the left cheek 2 months after operation, he received excision of the tumor and had been free from tumor for 16 years thereafter. In 2003, he was referred to our clinic because of diffuse swelling, hypoesthesia of the right cheek, and the induration of the right upper gingiva and buccal mucous membrane. A biopsy specimen was histologically diagnosed as mucoepidermoid carcinoma, and he received chemoradiation (40Gy/20fr and TXT 18mg×3, CDDP 7.2mg×10), followed by subtotal maxillectomy and microvascular reconstruction with a free rectus abdominis muscle flap. To our knowledge, this is the second case of bilateral maxillary cancers (SCC and mucoepidermoid carcinoma) to be reported in Japan.

En bloc resection of the primary tumour and cervical lymph nodes through the parapharyngeal space in patients with squamous cell carcinoma of the maxilla: a preliminary study

We retrospectively studied 72 patients with maxillary carcinoma (48 of the gingiva, 22 of the antrum, and one each of the hard palate and maxillary bone). The 5-year survival was 73% for those with gingival carcinoma, and 45% for those with antral carcinoma. Nine patients died of local recurrence, three of cervical metastases, six of distant metastases, and five died of metastases in lateral retropharyngeal nodes despite successful control of local and regional disease. We have recently done en bloc resections of the maxilla and cervical lymph nodes through the parapharyngeal space for patients with posteriorly invasive maxillary cancer accompanied by lymph node metastases in the upper jugular region.

A significance of navigation system in temporal bone and head and neck surgery

Objectives: Navigation surgery has allowed for advantage in nasal surgery. But the significance of this system especially in accuracy for temporal bone is considered to be still controversial. On the other hand, actual indication of navigation system for head and neck lesion is also still controversial. This study evaluated the accuracy of this system for temporal bone lesions and the significance of this system for head and neck lesions. Methods: Fifty patients with temporal bone lesions (28 cholesteatoma, 6 congenital aural atresia, 6 cochlear implant including ossified cochlea, 4 facial nerve lesion, 3 re-operative chronic otitis media, and 3 petrous apex lesions) were operated with the use of navigation system. We also applied this system for 3 trigeminal schwannoma, 3 osteoma and fibrous dysplasia, and 2 maxillary cancer cases. Results: The accuracy in our temporal bone series was 0.32 mm on an average. So, it was significantly useful to recognize and observe the target points and aimed structures accurately. Also it was useful in head and neck surgery to determine the accurate bone resection line and to recognize the target points, so we enter more straightly to the lesion. Conclusion: In conclusion, this navigation system ensures supplemental safe, accurate, and reliable surgery and also is considered to be useful for academic explanation to medical students and academic training for residents. A congenital anomaly, re-operative cases, petrous apex lesion and some head and neck lesion are regarded as a good indication.

Interventional magnetic resonance image-guided endoscopic endonasal surgery

We evaluated the advantages and disadvantages of interventional magnetic resonance (IVMR) image-guided endoscopic endonasal surgery for several diseases. Twelve patients, including nine with paranasal mucoceles, one with recurrence of chronic sinusitis, one with maxillary cancer, and one with dysthyroid ophthalmopathy were endonasally operated on with IVMR image guidance from May 2000 to April 2002. When the anatomy was distorted by previous surgery and the surgeons felt difficulty in orientating the lesions endoscopically, the usefulness of IVMR image-guided endoscopic endonasal surgery was sufficiently recognized. The following disadvantages, however, were also pointed out. The images on real-time were rougher than the usual MR images. Additional time was necessary for us to set up equipment and instruments, unless the surgeon and the room-staffs were familiar with the system. Furthermore, each instrument must be individually manufactured, often by hand, involving expense to the companies and a small potential market. It is concluded that the system is useful as a surgical supporting device for endoscopic endonasal surgery; the intranasal marsupialization of complicated paranasal mucoceles and verification of the position of the orbital contents in particular.

State of Mastication Affects Quality of Life in Patients With Maxillary Sinus Cancer

The quality of life of head and neck cancer patients after treatment is poor compared with a typical population sample. However, little is known about patients with maxillary sinus cancer. The identification of symptoms that are most troublesome for these patients and the development of strategies to minimize these negative sequelae should be matters of high priority. A restrospective study of patients with maxillary sinus cancer who underwent maxillary bone resection. Thirty patients with maxillary sinus squamous cell carcinoma participated in the study. The relationships among the degree of masticatory ability, the extent of the surgically resected area, and quality of life after combined treatment of maxillary cancer were evaluated. Scores of all physical and mental factors as assessed by the Short Form-36 questionnaire decreased as the masticatory ability of patients worsened. In edentulous cases, the masticatory ability was higher in the reduced operation group than in the extensive operation group. Maintaining adaptability to a denture is essential to preserve quality of life, particularly in patients with anodontia.

Maxillary cancer in a child: a case report

Cases with maxillary cancer are most frequently found in the 5th to the 7th decades of life, and then rarely occur in adolescence, even less so in a children. One does not expect to encounter this tumor in children, considering that most have a non-epithelial origin. However, we had a case of maxillary squamous cell carcinoma which appeared in a 12-year-old boy. He was initially considered to have sinusitis, and received conservative treatment for a while. After diagnosis, a combination therapy consisting of preoperative irradiation along intra-arterial administration of 5-FU and CBDCA was followed by total maxillectomy and primary reconstruction. Unfortunately about 2 months later, distant metastasis developed along with local recurrence, and the boy died about 1 year 6 months after the initial presentation. The clinical details of this rare case will be discussed in conjunction with some important considerations in dealing with this type of malignancy in a child.

Infratemporal Fossa Dissection for Cancer Extending to Masticator Space

The local control of oral, oropharyngeal, and maxillary cancers extending to the masticator space is poor because the surgical approach to the deep margin is difficult. We present an inf ratemporal f ossa approach for en bloc surgical resection of the masticator space. Seven cases involving the masticator space were surgically treated. Five cases were resected with inf ratemporal f ossa dissection (dissected group). Two cases were resected with the mandibular swing approach (non-dissected group). The local control rate of the dissected group was 80% and that of the undissected group was 0 %. The dissected group had functional problems of malocclusion and chewing, however they kept fair to good oral intake. To obtain better local control of deeply invaded cancers, en bloc dissection of the involved space is important.

Metastasis of maxillary carcinoma to the parapharyngeal space: Rationale and technique for concomitant en bloc parapharyngeal dissection

Purpose: En bloc resection of the primary tumor and regional lymph nodes is the classic method of surgery in cases of head and neck cancer, but it is not performed in cases of carcinoma of the maxillary gingiva or antrum for anatomic reasons. One of the reasons for the poor prognosis of patients with maxillary cancer and N+ stage necks is thought to be recurrence in the parapharyngeal space, which is out of the surgical field in radical neck dissection. The purpose of this study was to discuss the rationale and indication for en bloc resection and parapharyngeal dissection for maxillary cancer. Patients and Methods: Ninety-nine patients with maxillary cancer (54 in the gingiva and 45 in the antrum) treated at our institution between 1980 and 2000 were studied retrospectively. Results: In 4 patients, there was recurrence in the parapharyngeal spaces despite good control of tumors in the maxilla and the neck. These 4 patients had all undergone resection of maxilla and neck lymph nodes separately. We also report the case of a patient with carcinoma of the maxillary antrum who underwent en bloc resection of the maxilla and neck. After radical neck dissection, parapharyngeal dissection was performed with a mandibular ramus osteotomy approach, and the maxilla and neck tissue were resected en bloc. Conclusions: Although en bloc resection causes more extensive surgical damage, it may be useful in patients with maxillary cancer who have metastasis in the upper jugular lymph nodes. © 2002 American Association of Oral and Maxillofacial Surgeons J Oral Maxillofac Surg 60:408-413, 2002

肩甲骨付遊離広背筋皮弁による上顎癌の再建

Reconstruction after total maxillectomy for maxillary cancer remains difficult. The procedure offers a stable form, preserving the facial figure and several functions closely related to the QOL of the patients. In order to satisfy the demand for three dimensional, anatomical reconstruction, a reliable flap with skin paddles and bone segments is needed. Some functions such as visual acuity, deglutition and smelling, also should be preserved.The scapular region is well established as an excellent source of expendable skin, fascia, muscle, and bone for use in free-flap reconstruction of defects requiring bone and soft tissue in complex three dimensional relationships. The inferior border of the scapular bone is independently perfused by the angular branch. This vessel originates from the serratus branch or the thoracodorsal artery.In this article, three cases of reconstruction after total maxillectomy for squamous cell carcinoma using a free latissimus dorsi myocutaneous (LDMC) flap with scapular bone perfused by the angular branch are reported.Although this technique takes a long time for one stage reconstruction because it is necessary to change the position of the patient, the advantages include the ability to design the myocutaneous flap on a separate vascular pedicle from the bone and minimal donor site morbidity.

Appearance of Bax Protein After Preoperative Chemoradiotherapy is a Prognostic Factor in Maxillary Cancer

Appearance of Bax Protein After Preoperative Chemoradiotherapy is a Prognostic Factor in Maxillary Cancer

Acidic environment modifies heat- or radiation-induced apoptosis in human maxillary cancer cells

Purpose: The effects of hyperthermia or irradiation on cell killing and induction of apoptosis were evaluated using human maxillary carcinoma IMC-3 cells and low pH (pH 6.8) adapted cells (IMC-3-pH). Methods and Materials: Cellular heat-sensitivity or radiosensitivity was determined using the clonogenic assay. Apoptosis was assessed on the basis of a flow cytometric determination of the DNA content, DNA fragmentation, and poly(ADP-ribose)polymerase cleavage. Results: When IMC-3 cells or IMC-3-pH cells were exposed to heat at 44°C in pH 6.8 medium, an increase in thermosensitivity was observed compared with when the IMC-3 cells were exposed to heat at 44°C in pH 7.4 medium. However, the selective reduction in survival was not observed after irradiation. In IMC-3 cells, apoptosis after heating at 44°C for 60 min in pH 7.4 medium occurred earlier than that after 8 Gy irradiation, although both thermal and irradiated doses decreased the cell count to 10%. The degree of apoptosis after heating at pH 6.8 in IMC-3 cells or IMC-3-pH cells was greater than that at pH 7.4 in IMC-3 cells. However, the degree of apoptosis after 8 Gy irradiation at pH 6.8 in IMC-3 cells or IMC-3-pH cells was smaller than that at pH 7.4 in IMC-3 cells. Conclusion: Hyperthermia treatment is more effective at inducing apoptosis than radiation is in tumors that contain a population of low pH adapted cells.

セラタイト<sup>®</sup>による再建を行った進行上顎癌の一例

The reconstruction of zygomatic bone after extensive resection in maxillary cancer is important to the postoperative quality of life in patients. We conducted en bloc resection of maxillo-zygomatic lesions and concurrent by reconstructed the area with Ceratite®. Achieving a satisfactory facial shape, CERETITE® has excellent biocompatibility and was useful in reconstruction facial bone.We made a reconstruction model of Ceratite® using a 3-D solid model that reproduced the shape of zygomatic bone correctly and produced good aesthetic results.