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Malignant tumors of the salivary glands [4,16] may arise in the parotid, submandibular, sublingual glands or accessory glands which are scattered throughout the buccal cavity and pharyngo-larynx.

The clinical history, epidemiology and evolution of cancers of the nasopharynx differ from the other cancers of the aerodigestive tract.

Malignant cervico-facial tumors consist of lesions of the paranasal sinuses or cancers of the upper aerodigestive tracts. These require a precise therapeutic approach to achieve the best chance of cure, minimize disfigurement and maintain function. Tumor extension of few millimeters in a critical zone will radically change the treatment, prognosis of these lesions and the quality of life of the patients. Close collaboration [43] between the surgeon, pathologist, radiotherapist, chemotherapist and radiologist will achieve the best result for the patient. Imaging is the indispensable complement of clinical endoscopic examination [36]. The use of ultrasound, CT and MRI [64] provides essential information about the localization, size and extent of these tumors. Technological improvements such as high resolution ultrasound with color doppler imaging, ultra high definition CT [59], improvement in contrast agents, use of automatic injection devices and progress in image reconstruction in 2 or 3 dimensions [50] have resulted in an extremely accurate assessment of tumor volume and spread. Magnetic resonance imaging has further transformed the diagnostic algorithm by its high sensitivity in the assessment of normal and pathological soft tissues. In France, access to MRI is still very limited and the resultant delays for an appointment are incompatible with the provision of fast, efficient treatment in oncological practice. MRI has an increasingly important role in the investigation of malignant lesions in the field of otorhinolaryngology.

Cancers of the paranasal sinuses exhibit particular characteristics which distinguish them from other cancers of the upper aerodigestive tract. These characteristics include their great histological variability, epidemiology, the severity of a local disease, the rarity of metastases or lymphadenopathy and the infrequent presence of a second coexistent lesion.

Simultaneously, we realised a randomized trial neo-adjuvant chemotherapy concerning tumors T3T4 and compared two groups of tumors T2 (study non randomized) one receiving a neo-adjuvant chemotherapy in association with (CDDP, 100 mg/m2 and 5-FU, 1,000 mg/day, continuously during 5 days); the other receiving surgical treatement from the start.

In a previous trial performed from 1981 to 1987 in the oncology and medical stomatology department and the radiation department of the Salpetriere Hospital in Paris (with a grant of INSERM), we studied 114 patients with T3T4 unoperable cancers of the oral cavity and oropharynx. Neo-adjuvant chemotherapy and 3 different modalities of radiotherapy (time and doses) were randomised. We concluded that a good response to chemotherapy was predictive of better efficiency of radiotherapy and we don’t find any difference between the 3 tested modalities of radiotherapy especially for complete response.

We presented in 1987, a randomized trial for neo-adjuvant chemotherapy before radiotherapy, called INSERM [1] trial, dealing with 14 patients with oral and oro-pharyngeal T3/T4 carcinomas. Then, we concluded that chemotherapy did not rise the number of remissions achieved after radiotherapy (about 50 % in each group); also, that chemotherapy was predictive of the short term result, as the patients responding to chemotherapy had four times more chances to achieve remission after radiotherapy than non-responders. Unfortunately, after remission, the evolution remains the same and disappointing, with only 2 out of 114 patients who survive, one in each group.

Summary A scanning electron microscopic study of 40 oral mucosal smears from healthy controls or patients with cancer of the mouth has enabled a comparison of the “external” characteristics of normal, malignant and dysplastic (post-radiotherapeutic) cells. Normal cells, particularly the cells of the superficial epithelial layers, were characterized by well-defined polarized external protrusions with ridges on the upper surface and microvilli on the under surface. In cancer cells, both the shape and arrangement of these formations were profoundly altered. Dysplastic cells presented an intermediate appearance which was sufficiently characteristic to allow them to be distinguished from neoplastic cells.

Chemotherapy of head and neck cancers gives objective responses in about 30% of the cases, sometimes spectacular but never durable enough to significantly after prognosis. One of its limitations seems to be related to the tumor mass. It is, therefore, important to test chemotherapy on the residual cells, which are not visible, but are responsible for local, regional, or distant relapses after apparently satisfactory local treatment. These residual cells are also the proposed target for adjuvant immunotherapy.

73 minor salivary gland biopsies (lip biopsy) were performed in patients with primary and secundary Sjögren's syndrome and other collagen diseases without sicca syndrome were studied by means of immunohistochemistry. The results were compared to those obtained in sarcoidosis, sialadenitis and normal glands. In all cases of Sjögren's syndrome and of other sialadenites, we could note predominance of T-lymphocytes with an increase of T-Helpers and a T-suppressor ratio superior to 1. Besides, HLA-DR antigen was present in all the activated cells of lymphocytic infiltrates, in endothelial cells and in some epithelial ductal and acinous cells around the infiltrates. This method cannot permit to differentiate Sjögren's syndrome from the other sialadenites. But, it is very useful to appreciate the evolutivity of the disease (increase in B-lymphocytes in the initial period and in evolutive phases) and to detect its change into pseudolymphoma (polyclonal cells with increase in B-cells) and into malignant lymphoma (usually monoclonal B-lymphocytes proliferation).