The purpose of this study was to assess the presence of dendritic cell phenotypic antigens in the cervical lymph nodes of patients with hypopharyngeal and laryngeal carcinoma, and to assess the significance of such antigens in the tumour immune reaction.

Immunohistochemical staining of cervical lymph nodes was performed using antibodies against cell surface markers such as S-100 protein and cluster of differentiation 1a and 83 glycoproteins. Two hundred and seventy-four cervical lymph nodes obtained at surgery from 37 patients with hypopharyngeal carcinoma and 31 patients with laryngeal carcinoma were thus evaluated.

The number of dendritic cells positive for each phenotypic antigen was significantly greater in non-metastatic lymph nodes than in metastatic lymph nodes. In the metastatic lymph nodes, cluster of differentiation 1a glycoprotein positive dendritic cells were predominantly detected in the cancer ‘nest’, whereas mature dendritic cells staining for cluster of differentiation 83 glycoprotein were prominent in the peritumour area. In the metastatic lymph nodes, in contrast to the cluster of differentiation 1a glycoprotein positive dendritic cells, the degree of infiltration of cluster of differentiation 83 glycoprotein positive dendritic cells was significantly higher in the peritumour area than in the cancer nest. There was a significant difference in survival status, comparing patients with different degrees of dendritic cell infiltration for each type of phenotypic antigen.

Dendritic cells may play different roles in tumour immunity against hypopharyngeal and laryngeal carcinoma. The phenotypic antigens of dendritic cells may thus constitute important indices with which to predict the prognosis of patients with hypopharyngeal and laryngeal carcinoma.

This study aimed to determine the expression of the Cap43 gene in supraglottic laryngeal squamous cell carcinoma, and to evaluate any correlation between Cap43 gene expression and tumour-associated macrophage infiltration.

Four human head and neck squamous cell carcinoma cell lines were cultured (Hep2, KB, Ca9-22 and HSC-3) and expression of the Cap43 gene was analysed by Western blotting. In addition, paraffin-embedded samples of supraglottic laryngeal squamous cell carcinoma and normal supraglottic laryngeal mucosa from 84 patients were analysed immunohistochemically using antibodies to Cap43 and cluster of differentiation 68 glycoprotein. Patients' clinical status was compared with their immunohistochemical results.

All four head and neck squamous cell carcinoma cell lines exhibited Cap43 expression. The Hep2, Ca9-22 and HSC-3 cells showed a markedly higher level of Cap43 protein than the KB cells. A statistically significant difference was found in Cap43 expression, comparing different differentiation levels and comparing different metastasis stages, for supraglottic squamous cell carcinoma. The number of tumour-associated macrophages correlated with expression of Cap43, not only in the tumour area (r = 0.3708, p = 0.0005) but also in the peritumour area (r = 0.2847, p = 0.0087).

In supraglottic laryngeal squamous cell carcinoma, overexpression of the Cap43 gene is associated with tumour differentiation and acts an important suppressive factor in the process of tumour metastasis. The Cap43 gene may be a cancer-specific marker. High expression of the Cap43 gene appeared to correlate with infiltration of tumour-associated macrophages.

The subtotal laryngectomy procedure enables the patient to avoid some of the serious consequences of total laryngectomy without having to relinquish oncological effectiveness. However, the important complication of aspiration may still seriously affect some patients. Many methods of reconstruction have been described in an attempt to avoid or minimise this complication.

Thirty-nine patients (15 with supraglottic laryngeal cancer and 24 with hypopharyngeal cancer) who had undergone subtotal laryngectomy between 2000 and 2006 were included in this study. In all patients, a sternohyoid muscle flap has been used for primary, one-stage reconstruction of laryngopharyngeal defects, following resection of advanced stage lesions. Patients' times to oral intake and decannulation, their speech function and their post-operative complications were reviewed.

The patients' three-year overall survival rate was 46.1 per cent. Their mean time to oral intake was 14 days. Twenty-six patients were decannulated (66.7 per cent). Almost all patients regained their speech function post-operatively, although their voice quality was not as good as before surgery.

Sternohyoid muscle fascia reconstruction leads to optimal repair of subtotal laryngectomy defects and restored laryngeal function.

The effectiveness of autologous fat injection laryngoplasty may be reduced by resorption of injected fat tissue. The aim of the present study was to clarify the efficacy of fat injection laryngoplasty using autologous fat plus a replication-defective adenoviral vector expressing hepatocyte growth factor, regarding reduction of injected fat tissue resorption.

Four female beagle dogs were used in this study. After sedation, a direct laryngoscope was introduced to enable visualisation of the larynx. In each dog, harvested autologous fat plus an adenoviral vector expressing hepatocyte growth factor was injected into the right true vocal fold, and harvested fat plus an adenoviral vector expressing no gene was injected into the left true vocal fold. A total laryngectomy was performed one year after the intracordal fat injection. Coronal sections of the resected whole larynges were made and the following parameters assessed using light and electron microscopy: size of fat area; number of vasculoendothelial cells surrounding adipocytes; and shape of injected adipocytes in the vocal fold.

The fat area was significantly larger and the number of vasculoendothelial cells surrounding adipocytes significantly greater in the intracordal fat injection containing adenoviral vector expressing hepatocyte growth factor, compared with the control intracordal fat injection containing adenoviral vector expressing no gene. When viewed under electron microscopy, the injected adipocytes were observed to have grafted better in the intracordal fat injection with hepatocyte growth factor adenoviral vector, compared with the control intracordal fat injection with adenoviral vector expressing no gene.

Injection into the vocal fold of autologous fat containing an adenoviral vector expressing hepatocyte growth factor can reduce subsequent resorption of injected fat.

We had previously treated patients with advanced stage laryngeal cancer by laryngectomy with or without post-operative radiotherapy. In order to improve such patients' quality of life, we sought to preserve the larynx by selective (intra-arterial), rapid infusion chemotherapy combined with radiotherapy.

Chemotherapy was administered intra-arterially in the angiography suite via transfemoral catheterisation of the superior thyroid artery. Patients received up to four once-weekly infusions of cisplatin (75 mg/patient) with simultaneous intravenous administration of sodium thiosulphate, a neutralising agent. Patients also received external radiation simultaneously at a dose of 1.8 or 2.0 Gy per fraction, once daily for five days a week for 7 weeks.

Intra-arterial infusion chemo-radiotherapy was performed in eight patients with advanced laryngeal carcinoma (four glottic, three supraglottic and one subglottic type carcinoma). A complete response was achieved at the primary site and at lymph node metastases in all eight patients. Overall toxic side effects were modest. No catheter-related thrombo-embolic complications were observed during any of the chemotherapy sessions.

Selective (intra-arterial), rapid infusion chemo-radiotherapy may enable laryngeal preservation in patients with advanced laryngeal carcinoma.

To evaluate differences between the functional results of framework surgery and autologous fat injection laryngoplasty, for patients with unilateral vocal fold paralysis.

Sixty-two patients underwent framework surgery, while 64 received autologous fat injection laryngoplasty. Voice function before and after both procedures was assessed using aerodynamic and acoustic analysis, with differences evaluated using paired t-test in both groups.

In both groups, all parameters improved significantly after surgery, compared with before surgery. Post-operative improvement in all parameters was significantly greater after fat injection laryngoplasty, compared with framework surgery.

Autologous fat injection laryngoplasty was thus found to be a more effective and reliable therapy for improving voice function in patients with vocal fold paralysis, compared with framework surgery.

Double-probe, 24-hour pH monitoring remains the ‘gold standard’ for the diagnosis of laryngopharyngeal reflux disease, even though there is no consensus on how to interpret the data collected.

Tetra-probe, 24-hour pH monitoring was performed in 56 patients with suspected laryngopharyngeal reflux, in order to investigate patterns of laryngopharyngeal and gastroesophageal reflux.

The number of reflux episodes and the total and percentage time periods spent with pH < 4.0 were correlated with the distance of the probe from the lower oesophageal sphincter. The number of reflux episodes and the total and percentage time periods with pH < 4.0 were greater when patients were upright (i.e. during the daytime). There were few laryngopharyngeal reflux events recorded for pH levels of <4.0; however, there were a significant number of laryngopharyngeal reflux events recorded for pH levels of <5.0, a level capable of causing laryngopharyngeal reflux disease. When a pH level of <5.0 was used, the number, total time and percentage time of laryngopharyngeal reflux episodes was greater during the supine period (i.e. during sleeping) in a quarter of the cases, compared with results when a pH of <4.0 was used.

It is valid to use a pH level of 5.0 as indicative of laryngopharyngeal reflux in the hypopharynx.

The paraglottic space and cricoid area of the larynx are made up of loose, areolar tissue composed of loose elastic and collagenous fibres and adipose tissue. They contain the main blood vessels of the larynx. We examined the correlation between the histopathological extension of glottic carcinoma into the paraglottic space or cricoid area and the development of cervical lymph node metastasis.

We reviewed the medical charts of 45 patients (44 men and one woman) who had undergone total laryngectomy for squamous cell carcinoma of the glottis between 1991 and 2003.

Macroscopic and microscopic study of the removed larynges of the same patients was performed, and the histopathological evidence for invasion of the paraglottic space or cricoid area was analysed.

Eight of the 24 patients (33 per cent) with invasion of the paraglottic space or cricoid area had cervical lymph node metastasis. In contrast, only one of the 21 patients (5 per cent) without any evidence of invasion of either space had lymph node metastasis. This difference was statistically significant (p < 0.05). In the 36 patients free of cervical lymph node metastasis, recurrence in the neck occurred in six (38 per cent) of the 16 patients with paraglottic space or cricoid area invasion, but in only one (5 per cent) of the 20 patients without paraglottic space or cricoid area invasion (p < 0.05).

In patients with glottic carcinoma, invasion of cancer into the paraglottic space or cricoid area is an important prognostic factor for the development of cervical lymph node metastasis.

This study aimed to clarify the significance of cluster of differentiation 9 glycoprotein gene expression in human parotid gland tumours.

We retrospectively analysed immunohistochemical staining for cluster of differentiation 9 glycoprotein in parotid gland tumours.

Cluster of differentiation 9 glycoprotein was consistently detected in the normal parotid gland. Regarding benign parotid gland tumours, cluster of differentiation 9 glycoprotein was present in 13 of 18 pleomorphic adenomas, in all Warthin tumours tested (21/21) and in all cases of basal cell adenoma tested (four of four). In contrast, positive staining for cluster of differentiation 9 glycoprotein was less often observed in malignant parotid tumours. Cluster of differentiation 9 glycoprotein was present in 11 of 14 mucoepidermoid carcinomas, in two of five acinic cell carcinomas and in two of five adenoid cystic carcinomas.

There was a statistically significantly reduced expression of cluster of differentiation 9 glycoprotein in malignant parotid gland tumours, compared with benign parotid gland tumours (p < 0.05). These results suggest that a low level of cluster of differentiation 9 glycoprotein expression in parotid gland tumours may be associated with malignancy.

Recurrent dislocation of the temporomandibular joint is difficult to treat with nonsurgical methods. A new nonsurgical method for the treatment of this condition is presented.

Routine dental arch bars were applied to the teeth, and two latex elastic bands were placed between the two arch bars on either side of the dental arch. Muscular exercises (i.e. active mouth opening) were then performed regularly over approximately three months.

Patients were followed up for two to five years, and the treatment proved successful in five of five cases (i.e. no recurrence was seen). The advantages of this treatment are its simplicity and the lack of special equipment needed. No surgery is required, although patients must perform regular muscular exercises. Surgical complications such as trismus and facial nerve palsy are avoided. The disadvantages of this method are the requirement for patient compliance, and its lack of usefulness in patients without teeth.

The described method is useful for patients complaining of recurrent dislocation of the temporomandibular joint.