Photodynamic therapy (PDT) is recognized as one of the treatment options for early stage cancers. This treatment is a first-line treatment for carcinoma based on a photochemical reaction in which a photosensitizer is excited by laser irradiation, causing selective death of tumor tissue. PDT greatly differs from other cancer treatments particularly because the function of organs and tissues can be preserved. We have applied the PDT using porfimer sodium activated with an excimer dye laser for head and neck cancer since 1988 and have reported the results. Since 2003, PDT using NPe6 which was synthesized from the extract from chlorophyll and activated with a diode laser, has been applied in head and neck cancer patients. Furthermore, we proved the remaining NPe6 concentration in tumor tissue was about 2 to 5 times higher than that in normal tissue in human subjects. Having already treated 100 or more cases of the head and neck cancer, we consider early stage cancer of the larynx, the tongue, mouth and oropharynx as good target indications for PDT. According to the latest treatment results of laryngeal cancer, rate of the complete remission (CR) and recurrence rates were 100% and 9.1%, respectively, and as for tongue, mouth and oropharynx cancer, the CR and recurrence rates were 100% and 8.0%, respectively, which are almost comparable with conventional treatments. No adverse experience/event was seen in terms of critical photosensitivity and blood biochemical toxicity. The pain associated with medical treatment was also slight and controllable by internal use of NSAIDs only, the healing process was also good and ingestion was possible from the first post-treatment day. PDT is a cancer treatment method which could be associated with same-day surgery, or a short-term hospital stay. Moreover, PDT has relevance for head and neck cancer patients not only as one of the treatment options for early stage cancer patients but also as a potential application to improve patients’ QOL, by decreasing the tumor size, in those patients whose tumors are inoperable, or in cases treated using combination therapy with radiation and surgery.
Multiple sclerosis patients sometimes complain of vertigo as one of their symptoms. We experienced a case in which vertigo was seen as the chief complaint. MRI and neurootological examinations led to the diagnosis that the vertigo was caused by recurrent multiple sclerosis lesions of the posterior cranial fossa. We then considered five earlier multiple sclerosis patients who had vertigo. Their pure tone audiogram and caloric tests were almost normal. However, neurootological examinations ETT, OKP and gravicorder showed abnormalities. Therefore, in addition to MRI T2 and T2 FLAIR image examinations, neurootological examinations are valuable for diagnosis, especially in order to detect posterior cranial fossa lesions.
A 34-year-old man seem for bilateral hearing loss and headache due to intractable chronic otitis media (OMC) caused by methicillin-resistant Staphylococcus aureus (MRSA). He had a OMC recurrence despite microsurgery, irrigation, and antibiotics. After conventional treatment, we attempted hyperbaric oxygen therapy (HBO), which succeeded in symptoms after 8 attempts. His hearing recovered completely. This case is, to our knowledge, the first to demonstrate HBO efficacy in treating intractable OMC. We assume that HBO encouraged antibacterial oxidation and new capillary formation in wound healing.
We report a case of foreign body granuloma caused by heavy-metal tungsten alloy outside of the nostril. A 72-year-old woman seen for subcutaneous nostril swelling had the granuloma completely resected. Histopathologically, the granuloma was caused by heavy-metal tungsten alloy that coagulatively necrosed fibrous skeletal muscular and fibrovascular tissue. The rim of the granuloma consisted of spindle cells and epithelioid cells surrounded by small lymphocytes. No foreign-body reaction was seen. The woman had no memory of when and why the foreign substance was injected or implanted. To date, ten cases of foreign body granuloma involving heavy-metal tungsten alloy, including this case, have been reported in Japan. Clinical manifestations, histopathological findings, and treatment of this lesion are discussed.
Despite many antihistamine drugs available for use in nasal allergy treatment, no concrete drug selection guidelines exist. We report the results of a nasal allergy treatment questionnaire distributed to Toyama Prefecture otolaryngologists. Fexofenadine was most widely used in the early treatment of cedar pollinosis, but most otolaryngologists later changed drugs, especially second-generation antihistamines, based on patient condition and the type of perennial nasal allergy. Actual steroid treatment was thought to be proper and the various drugs were used in children’s medical treatment. Results were similar to those of past reports. We discuss concrete suggestions for selecting of second-generation antihistamine drugs based on these results.
We report a case of leiomyosarcoma of the nasal cavity with neurofibromatosis type 1 (NF1). Leiomyosacoma accounts for 5-7% of all soft-tissue sarcomas and occurs most often in the gastrointestinal tract and uterus. Leiomyosarcoma of the sinonasal tract is rare. A 66-year-old man with NF1 and reporting left nasal obstruction and recurrent epistaxis was found in endoscopic observation to have a reddish tumor of the left nasal cavity. Computed tomography (CT) of the paranasal sinuses showed an oval tumor arising from the inferior turbinate and filling the left nasal cavity. T1-weighted magnetic resonance imaging (MRI) showed the homogenous enhanced tumor to have almost the same signal intensity as a subcutaneous neurofibroma of the scalp. The nasal tumor was surgically removed by Deker’s method. Immunohistochemical staining of the resected tumor showed tumor cells positive for α-smooth muscle actin and neuron-specific enolase, but negative for S-100 protein, CD34, and CD56. The tumor was diagnosed as a leiomyosarcoma. The patient was discharged without postsurgical treatment and is being followed up, showing no recurrence or metastasis as of this writing. NF1 is an autosomal-dominant hereditary disorder that occurs in every 3,000 live births in Japan. The risk of malignancy among NF1 patients is higher than among the general population, i.e., the NF1 gene is a tumor suppressor gene of which mutation involves a fourfold increased risk for cancer. The NF1 gene product neurofibromin is thought to deliver much of its function by downregulating the oncogene ras. Leiomyosarcoma pathogenesis in our subject may thus be associated with the NF1 gene. Our case is, to the best of our knowledge, the first clinical report of leiomyosarcoma in the head and neck region with NF1.
We report a case of isolated oculomotor nerve paresis due to sphenoiditis. A 33-year-old woman reporting mild left-side ptosis and diplopia had no signs of brain aneurysm or diabetes mellitus. Despite her left-side ocular movement disturbance and ptosis, ophthalmological examination showed neither visual impairment nor pupil dilation. Symptoms were due to isolated left-side oculomotor nerve paresis. Computed tomography (CT) showed soft tissue density in the sphenoid sinus, fielding a definitive diagnosis of sphenoiditis necessitating endoscopic surgery under general anesthesia. All symptoms disappeared within 2 months postoperatively.
The efficacy of the common practice in Japan of recommending gargling to prevent post-tonsillectomy infection and to reduce throat soreness remains to be scientifically and quantitatively confirmed. In an attempt to remedy this, we had 108 subjects—48 men and 60 women aged 17 to 79 years (mean: 33.8 years)—gargle with povidone-iodine (PI) or sodium guaiazulen-3-sulfonate (AZ) following bilateral tonsillectomy. We measured the clinical effects on a pain scale and pain-medication score for comparison between the two groups. Results indicated by the medication score and pain scale demonstrated that gargling with AZ significantly reduced pain compared to gargling with PI, especially right after surgery. AZ also showed an antipyretic effect, suggesting that gargling with AZ is superior to PI as a post operative gargle.
Salivary duct cyst (SDCy) is more frequent in Europe than in Japan, where the incidence is reported to be 0.5% of all salivary gland cysts. We report two such cases. Case 1: A 62-year-old woman seen for right throat pain starting at the end of 2006, was found in magnetic resonance imaging (MRI) to have a large cystic mass in the right parapharyngeal space. Surgery yielded a pathological diagnosis of SDCy. SDCy of the parapharyngeal space has not been previously reported to our knowledge. Case 2: A 60-year-old woman with left neck discomfort was found in MRI to have a dumbbell-shaped mass spanning the superficial and deep parotid gland lobe. Superficial parotidectomy yielded a pathological diagnosis of SDCy. We observed no malignancy in either case, although SDCy may arise from malignant tumors such as adenoid cystic carcinoma or mucoepidermoid carcinoma.
A case of chondrosarcoma of the larynx is reported. Chondrosarcoma of the larynx is known to be very rare. A 59-year-old man presented with hoarseness and difficulty in swallowing. On laryngoscopic examination, stenosis of the laryngeal lumen by the tumor was observed in the posterior part of the subglottic lesion. Computed tomography (CT) demonstrated a mass arising from the cricoid and thyroid cartilage. Biopsy was performed twice after tracheostomy. Histopathological examination showed suspected chondrosarcoma for which we performed total laryngectomy. There was no evidence of recurrence postoperatively.
Radiation therapy in those with head and neck malignancies often triggers painful mucositis poorly controlled by nonsteroidal antiinflammatory drugs (NSAIDs). To better understand how radiation-induced pain develops over time, we studied the numerical rating scale (NRS 0-5) pain scores from 32 persons undergoing radiation therapy of 60-72 Gy for newly diagnosed laryngeal cancer. The degree of mucositis was evaluated using Common Terminology Criteria for Adverse Events version3.0 (CTCAE v3.0). We divided the 32 into a conventional fractionation (CF) group of 14 and a hyperfractionation (HF) group of 18, and further divided laryngeal cancer into a small-field group of 23 and a large-field group of 9. The mucositis pain course was similar in CF and HF, but mucositis pain was severer in the HF group, which also required more NSAIDs. Those in the large-field group had severer pain and mucositis and required more NSAIDs than those in the small-field group. We therefore concluded that small/large-field radiation therapy, rather fractionation type, was related to the incidence of radiation-induced mucositis pain.
Toxoplasmic lymphadenopathy is the most common clinical manifestation of acute acquired toxoplasma infection in normal individuals. The diagnosis is established by serologic methods. Acute toxoplasmic lymphadenopathy manifests many symptoms. We report a case of toxoplasmic lymphadenopathy presenting with hepatic dysfunction. The patient was a 37-year-old woman. On February 2008, she consulted the previous hospital with a two-day history of swelling in the retroauricular region. Laboratory examination showed slight hepatic dysfunction but did not show elevation of either leukocytes count or serum C-reactive protein (CRP). Although cephem antibiotic was administered, the symptoms did not resolve and she further developed fever and general fatigue. Twenty-one days after, she was referred to our hospital for further evaluation and treatment. The patient had nine cats. Laboratory examination performed in our hospital did not detect elevation of either leukocytes count or serum CRP but elevated serum aspartate aminotransferase (AST) and alanine aminotransferase (ALT) levels were noted. The specific IgM and IgG for toxoplasma gondii were positive, suggesting toxoplasma infection. Acetylspiramycin was administered 1,800 mg daily for fifty days. The symptoms resolved soon after the treatment. The serum AST and ALT levels also decreased with improving symptoms. We conclude that in case of toxoplasma infection presenting with hepatic dysfunction, the serum levels of ALT and AST suggest a marker of progression of this disease.
Five cases of mediastinal abscess complicated with deep neck abscess were treated in our department, and clinically analyzed. The primary etiology was suggested as an odontogenic lesion in three cases, and unknown in two cases. All cases immediately underwent surgical drainage of the involved cervical region and mediastinum by a team of otolaryngologists and thoracic surgeons. The form of mediastinal drainage was a standard posterolateral thoracotomy in two cases, subxyphoid excision in two, and the cervical approach alone in one. All five cases survived, though in one case, in whom mediastinal drainage via the subxyphoid approach was performed as the primary operation, a second operation was required via thoracoscopic drainage. Anaerobic bacteria were identified in four cases, and Streptococcus anginosus, one of the Streptococcus milleri group being a common inhabitant of the mouth and gastrointestinal tract, was isolated from all five cases. The S. milleri group should be recognized as a major pathogen in severe deep neck infection and mediastinitis. The form of the surgical drainage of the mediastinum should be selected on the basis of both the severity and the extension of the abscess. The use of thoracoscopy enables more effective and less invasive surgery for the management of mediastinitis.
Cases of deep neck abscess have decreased thanks to the use of antibiotics, but remain life-threatening and potentially mortal when gas forms. We report four cases of gas-forming deep neck abscess—one each in the region of submandibular bone, the submandibular space, the parapharyngeal space, and in the thyroid gland. All four had other diseases such as carcinoma or diabetes that weakened their physical conditions. Both aerobic and anaerobic bacteria were detected in all four. We found computed tomography (CT) to be very useful in early diagnosis and treatment. Emergency surgery combined with antibiotic therapy and local irrigation enabled all four to recover. We therefore recommend prompt surgical drainage if CT detects a gas-forming abscess.