[in Japanese]

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[in Japanese]

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[in Japanese]

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Accessory parotid gland tumors are relatively rare; hence, adequately detailed clinical analyses of these tumors are difficult to perform at a single institution. In this report, we describe the findings for 65 patients [29 men, 36 women; median age, 51 (9-81) years] with accessory parotid gland tumors, consisting of 4 cases documented by us and 61 cases previously reported by other Japanese authors.
Approximately 50% of the patients were treated in an otolaryngology department, while the remaining patients were treated in plastic surgery, oral surgery, or dermatology departments. In 4 patients, the results of preoperative fine-needle aspiration cytology indicated that the tumor was benign; however, the postoperative histopathology results revealed malignant tumors. The frequencies of malignant and benign tumors were 44.6% (n=29) and 55.4% (n=36), respectively. Mucoepidermoid carcinoma and pleomorphic adenoma were the most frequent types of malignant and benign accessory parotid gland tumors, respectively. Among the various surgical methods that were used, such as direct cheek and intraoral incisions, a standard parotidectomy incision was the most preferred treatment approach for these tumors. Recently, an endoscopic approach has also been found to yield satisfactory results. An optimal approach should be selected after evaluating the advantages and disadvantages of these methods. No definite guidelines are available regarding the choice of elective neck dissection and postoperative radiation therapy for malignant accessory parotid gland tumors. Although tumor resection (plus elective neck dissection) and postoperative radiation therapy have been frequently performed for various kinds of malignant accessory parotid gland tumors to date, additional studies are needed regarding the criteria for selecting elective neck dissection and postoperative radiation therapy.
Since the malignancy rate for accessory parotid gland tumors is higher than that for parotid gland tumors, the possibility of malignancy (especially mucoepidermoid carcinoma and carcinoma ex pleomorphic adenoma) should be considered when resecting accessory parotid gland tumors, even if the results of preoperative fine-needle aspiration cytology indicate that the tumor is benign.

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We report herein on the use of the Body Tracking Test (BTT), which is a method for quantitatively evaluating dynamic body balancing function, and how the body center moves during tracking by healthy subjects. We investigated 779 healthy subjects with no history of vertigo or balance disorder and a mean age of 37.9 years. Breakdown is as follows. Under 10 years old is 81 (37 boy and 44 girl), 10 years of age is 162 (73 boy and 89 girl), 20 years of age is 110 (43 men and 67 women), 30 years of age is 73 (44 male, 29 female), 40 years of age is 79 (49 men and 30 women), 50 years of age is 77 (40 men and 37 women), 60 years of age is 100 (53 men and 47 women), 70 years of age is 73 (27 men and 46 women), 80 years of age is 24 (15 men and 9 women). For the visual stimulus, we used a constant-speed antero-posterior (A-P) stimulus BTT and a constant-speed lateral BTT. BTT analysis involved principal axis analysis, in which the principal axis was the first principal component according to a principal component analysis technique. The axis tilt in the principal axis direction was assessed by calculating the coordinate Y-axis and X-axis tilt. In the antero-posterior (A-P) BTT, subjects of all ages exhibited an angle of tilt in the clockwise direction (the“plus” direction), together with the position vector and velocity vector. In the lateral BTT, we observed that the subjects tracked with a tilt in the counter-clockwise direction (the “minus” direction), together with the position vector and velocity vector. In terms of the subjects' ages, the angle of tilt from 0° in the antero-posterior (A-P) BTT showed the clockwise direction (the“plus” direction). In the lateral BTT, subjects 10 to 30 years of age exhibited tracking along the X-axis, with no observable tilt. Movement of the center of gravity may be a major acquired ability (practice) with respect to the direction of tilt of the tracking axis. Spatial sensory ability primarily involves the right parietal lobe of the brain, and somatosensory information from the left side of the body is believed to be used more for the positional relationships between the legs and the torso. Deviation of the principal axis appears to be related to the relationship between the dominant foot and the pivot foot, as well as to the functions of the parietal lobe that are involved in spatial sensing.

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We report a case of papillary carcinoma of the thyroid gland and cervical lymph node metastases with concurrent tuberculous lymphadenitis that was diagnosed preoperatively. A 35-year-old woman presented with multiple lymph node swellings and an anterior neck mass. No findings suggesting the coexistence of pulmonary tuberculosis were present. The patient underwent a total thyroidectomy with bilateral neck dissection together with medication. Measures to prevent tuberculosis were undertaken during the perioperative period. The histopathological diagnosis was papillary carcinoma with both metastatic and tuberculous lymphadenitis of the lymph nodes in the neck. The possible coexistence of tuberculous lymphadenitis must be ruled out when lymph node swellings are observed in patients with head and neck cancer, including thyroid carcinoma.

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Although endoscopic ear surgery (EES) has been used to perform middle ear surgery since 1993, it has not become as common in otologic surgery as it is in endoscopic sinus surgery. This report discusses the problems and the indications for EES in traumatic ossicular disruptions in two cases. Case 1 was a 33-year-old man with a left longitudinal temporal bone fracture who presented with mixed hearing loss, with an average hearing level of 45.0 dB in the left ear. He underwent EES, which revealed incudostapedial joint disrutption. Repositioning of the incus resulted in an improvement in hearing to 18.3 dB postoperatively. Case 2 was a 30-year-old man with a right mixed hearing loss of 56.7 dB. Computed tomography showed a right longitudinal temporal bone fracture and dislocation of the incus. EES revealed dislocation of the incus and fracture of the anterior crus of the stapes. A type IV tympanoplasty was performed, interpositioning the autologous incus between the footplate and the malleus handle. Postoperatively, the average hearing level was 18.3 dB, with a 1.7-dB air-bone gap. Traumatic ossicular disruptions are considered to be a good indication for EES.

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Osteomyelitis is one of the most severe late complications of radiation therapy. The condition can arise from osteoradionecrosis and can be fatal if it occurrs in vertebrae. A 71-year-old woman, who had undergone chemoradiotherapy for hypopharyngeal cancer 6 months previously, presented with severe neck pain. An MRI examination revealed pyogenic spondylitis and an epidural abscess of the neck. Neurological disturbance in the extremities developed despite the administration of antibiotics for 5 days. Drainage and a laminectomy were performed to control the infection and to relieve spinal cord compression. The patient had no postoperative complications at 15 months after surgery. Previous case reports of osteomyelitis and epidural abscess following radiation therapy for head and neck cancer with surgical treatment tended to have a good clinical course. Severe neck pain and a limitation in the range of motion of the neck are considered to be serious clinical features of osteomyelitis. Since infection in the necrotic mucosa leads to pyogenic spondylitis, a repeated cultivation survey of the mucosa is nessesary for adequate antibiotics therapy. For osteomyelitis and epidural abscess following radiation therapy, immediate specific surgical treatment of the involved region is strongly suggested if antibiotics are not effective or spinal cord compression develops.

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