Head & Neck Surgery, Plastic Surgery and Dental Divisions

Introduction
The strategy of head and neck cancer treatment is to improve the patient s survival rate while preserving the significant functions including speech, mastication, swallowing, and cosmetic appearance. In order to achieve this strategy, we have tried to select the best treatment modality and devise new surgeries based on the clinico-pathological findings and large database of our head and neck cancer patients.
We have developed and performed original surgical procedures of partial laryngectomy for early glottic cancer, partial hypopharyngectomy for early hypopharyngeal cancer and total glossectomy for advanced tongue cancer. These therapies can be performed without sacrificing the larynx. Compared with the results of conventional surgery, the wound apparently heals with fewer complications. Patients can resume social activities
more easily when they maintain their ability to communicate by speech.
We recently start a new treatment trial of chemo-radiotherapy for advanced head and neck cancer in cooperation with clinical oncologists at the National Cancer Center Hospital East.

Routine Activities
The head and neck division consists of a head and neck surgeon, a plastic surgeon, and an oral surgeon as regular staff. In our outpatient service, 4 head and neck surgeons of NCCHE are also engaged in ordinary outpatient activities, including regular follow-up care, general and local anesthetic operations, and supportive care of the inpatients. General and local anesthetic operations without major microsurgical reconstructive surgical requirement are performed at NCCH, since most of the head and neck service has shifted to the NCCHE 9 years ago.
In 2001, 131 patients with head and neck tumors were treated under general anesthesia in our division. Twenty-two of these patients were over 75 years old, ranging from 75 to 92. There were no serious postoperative complications. Since the proportion of high-risk patients is growing, we need to establish a treatment policy for these patients in due course.
We performed neck dissection, total pharyngo-laryngo-esophagectomy with or without micro-surgical reconstructive surgery and various kinds of surgery in cooperation with other divisions. We operated 25 patients for other divisions in this year, and the case load is increasing.
Our outpatient service is open from Monday to Friday, and the total number of newly registered patients exceeds 200 annually. The number of new patients in 2001 was about 100 cases more than last year. Endoscopic exami-nations, cervical echography, and x-ray pharyngo-graphy are routinely performed once a week. A weekly clinical head and neck conference is held among head and neck surgeons, radio-oncologists, and plastic surgeons to discuss challenging cases. To clarify and comprehend the oncological behavior of head and neck tumors, a clinico-pathological meeting is held every Friday.
The dentist, who works in cooperation with the head and neck division, plays the roles of a maxillo-facial prothodontist, oral surgeon, and general practitioner at NCCH. However, the main purpose of this dentistry is to contribute to improve the quality of life of patients after ablative head and neck surgery by fabricating maxillofacial prostheses. We include prosthetic rehabilitation whenever we proceed with oral and maxillary cancer treatment. This year we are also instituting an oral hygiene program with the bone marrow transplant ward in an attempt to avoid severe odontogenic infection following bone marrow transplantation. Dental implant service is to be started in 2002.
The plastic and reconstructive surgery division plays an important role in restoring patients natural appearance and maintaining postoperative functions following head and neck surgery and various kinds of operation of other divisions (see the description of the Plastic and Reconstructive Surgery Division of the NCCHE).

Research Activities
We are taking part in multi-institutional studies related to the standardization of neck dissection and the standardization of function preservation therapeutic strategy for head and neck carcinoma. Although neck dissection in our field is a very popular surgical procedure, the standard therapy has not been established until recently. We investigated the neck dissection area of mesopharyngeal carcinoma. A standardized function preservation treatment for head and neck carcinoma that considers improvement of survival, loco-regional control, and preservation of various functions necessary for life has not yet been established. We conducted a research on treatment procedure and the pattern of recurrence and metastasis of various primary sites of head and neck carcinoma, and came up with the best treatment method with function preservation for each ase.

Clinical Trials
We treated four advanced cases of hypopha-ryngeal carcinoma and laryngeal carcinoma (T3, T4) using chemo-radiotherapy (CDDP+5-FU+RT) in cooperation with gastrointestinal oncology division from 2000. Total laryngectomy was necessary for all cases, but as chemo-radiotherapy was very effective, all patients could preserve larynx (voice and laryngeal function). Although the observation period is still short, the possibility was suggested that the patient s quality of life could preserved by this method.

W. OHYAMA

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