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Abstract. Background Among head and neck squamous cell carcinomas (HNSCCs), the incidence of oropharyngeal SCC (OSCC) is increasing compared with carcinomas of other origins, thereby attracting public attention (1, 2). Like other malignancies in the upper gastrointestinal tract, OSCC is attributed to the carcinogenic effects of tobacco and alcohol (3). Prediagnosis cigarette smoking can be a prognostic factor for overall survival (OS) in OSCC patients (4). Therapeutic options for early stage OSCC include both surgery and radiotherapy as single treatment modality, while those for advanced stage include surgery, chemoradiation and chemotherapy (5, 6).On the other hand, in recent years, human papillomavirus (HPV) is known to be involved, in addition to drinking and smoking, in oropharyngeal carcinogenesis (1, 7-10). HPV is the most common sexually transmitted disease. However, the overwhelming majority of patients with HPV clear the infection. A small percentage of patients with HPV develop oncogenic HPV types, especially HPV-16, and consequently, SCCs can develop in such patients. HPV causes more than 5% of malignancies worldwide (1, 7-10). Over 70% of OSCCs are currently thought to be linked to oncogenic HPV infection. Immunohistochemistry for p16 protein is often used as a surrogate marker for oncogenic HPV in the oropharyngeal tissues (11, 12). The clinical profile of patients with HPV-related OSCC differs quite notably from that of non-HPV-related OSCC, and the clinical outcome for HPV-related OSCC is reported to be significantly better due to high sensitivity for radiation therapy (2,7,8).Numerous clinical studies have examined the role of transoral surgical resection (SR) for the treatment of oropharyngeal malignancies and have shown similar clinical outcomes and improved functional outcomes compared with chemoradiation therapies (5, 13). However, the relationship between p16 expression and prognosis in OSCC patients undergoing surgery has not been fully examined. Thus, there is urgent need for elucidating these issues. The aims of this study are therefore to clarify the relationship between p16 expression and prognosis in patients with OSCC undergoing surgery. 927

A 10-month-old boy with Alexander disease is described. He was clinically characterized by early onset of megalencephaly, psychomotor retardation, spasticity and recurrent seizure attacks. Pathological examination of the biopsied cerebrum revealed a large number of Rosenthal fibers in the white matter and beneath the pia in association with advanced demyelination. The motor nerve conduction velocity was remarkably delayed, suggesting a possible change of the peripheral nerve. The computerized tomography demonstrated megalencephaly and bilateral symmetrical low density areas in the cerebral white matter, particularly in the frontal region. The preferential involvement of frontal lobes was also confirmed by electroencephalogram and brain scan. The preferential damage of the frontal region in the early stage of the disease may be an important clue to a diagnosis of Alexander disease by computerized tomography, brain scan and electroencephalogram.

Malignant tumors during pregnancy are rarely seen by otolaryngologists, and they cause various problems which require special treatment with careful consideration of both the mother and fetus. Cases of tongue carcinoma resection and reconstruction with a microsurgical free flap during pregnancy have not previously been reported in Japan. We report herein on a case, in which the mother and her child made satisfactory progress after surgery. A-33-year-old female at 25 weeks and 4 days of pregnancy was referred to our department for the treatment of a tumor on the right edge of her tongue. Examinations including biopsy revealed SCC (T2N0M0). We performed an operation to remove the tongue carcinoma with the pull-through method and reconstruct the tongue with an ALT flap at just 28 weeks of pregnancy. The postoperative recovery was favorable, and she gave natural birth to a girl safely at 38 weeks and 6 days of pregnancy. She is currently free of disease and her child is growing normally, at 2 years and 10 months after surgery.

Objectives: It is important for surgery to keep up with new technologies. Current skull-base techniques use stereotactic navigation, assisted by magnetic resonance (MRI) and computed tomography (CT) compilation. Our objective is to assemble a normalized CT database for three-dimensional (3D) endocranial renderings. This database can provide preoperative information for assistive mapping and intraoperative land marking during procedures.Methods: 222 CT studies were pooled between October 2011and December 2012. These studies were then deidentified and loaded into third party software, Osirix (Pixmeo, Switzerland), and reconstructed into 3D renderings. The Osirix program is a freeware-based Apple-only-program capable of volumetric analysis, metrics, and 3D space manipulation. The database was then encrypted for patient information protection.Results: A total of 179 studies(101 males and 78 females) were ultimately used. Two-hundred gigabytes of hard-disk space was used. An Apple (Cuptertino, CA) laptop, running Mac OSX, was used for computation. The Osirix software was downloaded as freeware, requiring no payment. The hard-disk was purchased at a local electronics store for $100.00 USD. The computer was approximately $1300.Conclusions: Radiologic imaging drives preoperative surgical planning. This can be augmented by new technology and creative applications of current innovations. There has not been an explanation process on how to assemble this data for departments and individuals. We provide a simple, reproducible, and inexpensive guide to CT head databases. Once the database is assembled, it may be used for such projects as mapping the parapharyngeal carotid, estimating endocranial volumes, and surgical diagrams.