Three-field (neck, mediastinal, abdominal) lymphadenectomy (3FL) following esophagectomy for esophageal cancer may sometimes cause swallowing dysfunction, with a risk of severe pulmonary complications. Early determination and prevention of aspiration may reduce or prevent these potential complications. We first demonstrated by a videofluoroscopic swallowing study (VFSS), that pharyngeal swallowing dysfunction in post-esophagectomy patients who undergo 3FL is significantly correlated with impaired laryngeal elevation, and consequently, reduced pharyngeal clearance and upper esophageal sphincter (UES) opening. In another VFSS, use of the chin-down maneuver following 3FL helped accelerate swallowing function recovery by improving the pharyngeal contraction, possibly by altering the position of the base of the tongue in relation to the pharyngeal wall, reducing pharyngeal residue, stretching the UES, and improving laryngeal closure. The mechanism of swallowing dysfunction following esophagectomy + 3FL has been well investigated by VFSSs, but not sufficiently investigated by fiberoptic endoscopic evaluation of swallowing (FEES). With respect to the time and effort involved in the screening of the aspiration status post-esophagectomy without radiation exposure, FEES could be considered to be easier, more useful, and safer. Interestingly, we demonstrated that FEES performed for evaluation of the aspiration status post-esophagectomy + 3FL is as reliable as a VFSS. The chin-down maneuver is especially useful for reducing the degree of aspiration and improving pyriform sinus clearance in vocal fold paralysis patients postoperatively. Finally, by high-resolution manometric (HRM) examination, we demonstrated that the chin-down maneuver after esophagectomy + 3FL may improve bolus passage by prolonging the duration of the lowered swallowing pressure at the UES, possibly by enhancing laryngeal elevation. Overall, obtaining confirmatory evidence by multi-directional examination techniques, such as VFSS, FEES and HRM, would be useful to precisely understand the beneficial effects of certain rehabilitation maneuvers in patients with dysphagic pathologies.
Frey’s syndrome after submandibular gland surgery is uncommon. We present herein on a rare case of a 60-year-old man with Frey’s syndrome after submandibular gland surgery. He noticed right submandibular skin moisturization during meals 6 years following surgical treatment for a recurrent submandibular pleomorphic adenoma. The iodine starch reaction test revealed Frey’s syndrome. The patient is currently treated with antiperspirants as needed.
Frey’s syndrome after submandibular gland surgery is extremely rare, but the possibility of Frey’s syndrome cannot be ruled out if submandibular gland excision is performed in a case where tissue damage around the submandibular gland has to be considered. When submandibular gland excision is performed in such cases, it is important to perform layer-to-layer closure and submandibular ganglion treatment to prevent Frey’s syndrome.
We should keep Frey’s syndrome in mind as one of the postoperative complications not only in parotid gland surgery but also in submandibular gland surgery.
Non-tuberculous mycobacterial (NTM) infections of the parotid gland are very rare, and present mainly in young children. We report herein on a clinical case of a 75-year-old woman with an NTM infection of the right parotid gland. She presented with a mass in front of the right ear. In this case, the result of fine-needle aspiration cytology (FNAC) was inflammatory changes, so we performed surgery for a definitive diagnosis. Thereafter the culture examination detected Mycobacterium avium comlex. After that, drug treatment was performed at the infectious disease department. If the result of FNAC is inflammatory changes, or if there are signs of inflammation such as swelling or any fistula in the skin, we should suspect mycobacterial infection.
Primary tracheal tumors are a rare disease, accounting for 0.89% of primary lung tumors. In particular, tracheal leiomyomas have been reported to account for about 1% of primary tracheal tumors and are an extremely rare disease. Leiomyomas most frequently arise in the uterus or alimentary tract and rarely occur in the head and neck region. We report on a case of subglottic leiomyoma of the trachea.
A 64-year-old woman presented with dyspnea. Laryngeal fiberoscopy and computed tomography (CT) showed a subglottic tumor. After tracheostomy, we reached a diagnosis of leiomyoma based on laryngoscopic biopsy findings. The tumors were removed via a laryngofissure and no recurrence was seen after the operation. The histopathological diagnosis was a leiomyoma. At the time of writing, more than 4 years have passed since the surgery, without recurrence. We had exenterated the subglottic tracheal leiomyoma safely.
Because it is important to choose the surgical procedure according to the size of the lesion and the pedicle, together with the site of tracheal leiomyomas, we present our case with some discussion and a review of the relevant literature.
Sweet syndrome is characterized by fever, neutrophilia and painful skin lesions that appear mostly on the arms, neck, head and trunk. Sweet syndrome sometimes causes laryngopharyngeal lesions, and subglottic stenosis is very rare. We report a case of Sweet syndrome with subglottic stenosis.
The patient was a 69-year-old female who complained chiefly of fever, skin lesions and inspiratory stridor. She had fever and neck pain for 4 weeks prior to hospitalization. One or two weeks after the onset of symptoms, she developed painful erythema on her limbs. Her symptoms worsened, and inspiratory stridor appeared a few days before her visit to our hospital. A dermatologist at our hospital suspected Sweet syndrome based on the skin rash and consulted with us to examine the stridor. The patient’s subglottis was stenosed, and we conducted a tracheotomy. Steroid administration was very effective, and the airway narrowing improved. As of 10 months after her discharge from the hospital, the airway stenosis had not recurred; however, Sweet syndrome recurred 2 months ago, and the patient is presently receiving treatment.
Treatment for Sweet syndrome consists of corticosteroid medications, such as prednisone. Antibiotics have no effect on the disease. It is difficult to treat Sweet syndrome properly if the characteristic skin rash is missed. As in this case, Sweet syndrome can cause airway narrowing. Proper diagnosis and treatment are important.
Differentiated thyroid cancer can be treated using surgical resection, TSH suppression therapy, and radioactive iodine therapy. For patients who are resistant to these therapies, the molecularly targeted drug lenvatinib is now available as a treatment option. Although lenvatinib is highly effective against these tumors, this treatment results in a high rate of adverse events. Although rare, some adverse events, such as cardiovascular toxicity, can be fatal. A 71-year-old woman had undergone a total thyroidectomy for thyroid cancer with lung metastasis. Afterwards, she developed a pancreatic metastasis. Lenvatinib treatment was initiated, and a good antineoplastic effect was observed. However, she developed heart failure eight months after the start of lenvatinib treatment. Lenvatinib was discontinued, and the patient’s heart failure recovered. She was able to restart lenvatinib treatment and has survived for 15 months after the restart of lenvatinib. Therapies targeting vascular endothelial growth factor increase the risk of cardiotoxicity by 2- to 3- fold. However, lenvatinib therapy has a very low frequency of cardiotoxicity, since the present case of drug-induced-cardiotoxicity caused by lenvatinib is, to our knowledge, the first report.
Liposarcoma is one of the most common soft-tissue sarcomas in adults, but the head and neck region, especially the larynx and hypopharynx, is rarely involved. We present a case of a dedifferentiated liposarcoma in a man of 80s. He presented at our ENT service with a three-month history of dysphagia and a one-month history of dyspnea. On endoscopic examination, a tumorous lesion was observed in the hypopharynx. A CT scan showed an abnormal lesion extending from the hypopharynx to the esophagus with a density greater than that of fat. A histological analysis showed variant cells that stained positive for CDK4 and MDM2, and negative for CD34. Taking these findings into consideration, we diagnosed the patient as having a dedifferentiated liposarcoma in the hypopharynx. Transoral videolaryngoscopic surgery was performed. The tumor occupied the arytenoid cartilage, piriform sinus and postcricoid area. As of six months postoperatively, the patient is now able to consume food orally. For patients with dedifferentiation-type liposarcoma of the laryngopharynx who do not wish to undergo a laryngectomy, oral resection is possible. When deciding on an operative strategy, the wishes of the patient, the patient’s age, the local existence of the lesion, and the pathology type should be considered, generally after an explanation of the risks has been given to the patient.
Rosai-Dorfman disease is a rare histiocytic disorder characterized by accumulation of histiocytes in the affected tissue. Herein we report on a case of Rosai-Dorfman disease with multiple lymphadenopathy and multiple extranodal lesions. A 22-year-old woman was referred to our hospital with bilateral submandibular swelling and a localized swelling in the root of the nose. Endoscopic examination revealed mass lesions in both nasal cavities and the subglottic area. A full-body CT revealed multiple nasal masses, cervical lymphadenopathy, and an intrathymic mass. We diagnosed her as having Rosai-Dorfman disease based on the histopathological findings of accumulation of histiocytes and emperipolesis in the nasal lesion and cervical lymph node specimens. Histopathological examination is required for the diagnosis of Rosai-Dorfman disease. After steroid treatment for 3 months, reduction in the size of the lymph nodes in the neck, nasal cavity lesions, and intrathymic mass was noted. However, the size of the subglottic mass remained almost unchanged. In this case, steroid treatment was mostly effective on the lesions. In case of airway obstruction due to increase in the size of the subglottic mass, surgical resection should be indicated.
In the present study, the records of patients diagnosed as having suspected acute low-tone sensorineural hearing loss (ALHL) from among all the patients with hearing loss who visited a single clinic over a recent 6-year period were extracted, and a retrospective analysis of the recovery rate, recurrence, and tendency to progress to Ménière’s disease was performed. A total of 35 cases (6 men, 29 women) were diagnosed as having suspected ALHL. The 16 cases that were given isosorbide, Wu-Ling-San (Goreisan), and ATP as an initial treatment all recovered. The 19 patients who did not respond to this initial treatment were given steroids and vitamin preparations, and 7 of these cases recovered. The overall recovery rate was 65.7%. No improvement (no change) was seen in 12 cases (34.2%). Out of the 35 cases, a one-year follow-up examination was performed in 14 cases (40%). Out of the cases who underwent a one-year follow-up, recurrences had occurred in 3 (8.6%) cases. Out of the patients with recurrences, 1 case (2.9%) had progressed to Ménière’s disease.