During the last three decades, we have experienced a dramatic paradigm shift in the treatment of head and neck cancers. Instead of wide resection, concomitant chemoradiotherapy or conservative surgery are increasingly applied with radical intent in the treatment of advanced cancers for the purpose of organ preservation. Indeed, now, larynx and/or pharynx are preserved in much more cases than before with satisfactory oncological results. However, it is still questionable whether preserved organs functionate as expected. In this article, we introduce tools for evaluating the functional results of the patients with head and neck cancers. The University of Washington Head and Neck Measure and Medical Outcomes Short Form 36 are representative questionnaire to measure the general status of the patients with head and neck cancer. Voice Handicap Index-10 and Voice-Related Quality of Life are originally developed for benign laryngeal diseases, but also useful for laryngeal cancers. Blowing test, which has been used to evaluate the velopharyngeal function of the patients with cleft palate, is proved to be useful for patients with oral and oropharyngeal cancers. To evaluate the quality of life after neck dissection, the Japanese Clinical Study Group on Standardization of Treatment for Lymph Node Metastasis of Head and Neck Cancer has developed a self-administered neck dissection questionnaire (NDQ) and Arm Abduction Test (AAT).
A 35-year-old man who was referred to our hospital 6 days after diplopia, dizziness and left hemifacial palsy had experienced left facial palsy 8 years earlier. Ocular movement showed typical left one-and-a-half (OAH) syndrome; conjugate left-side lateral gaze palsy and impaired left-eye adduction and for the right eye, gaze nystagmus induction in the right-side gaze. Vertical eye movement and convergence were not disturbed. Pure-tone audiometry, auditory brain stem response (ABR) and vestibular evoked myogenic potential (VEMP) were within the normal range, while caloric tests showed canal paresis on both sides. T2-weighted magnetic resonance imaging (MRI) showed multiple high-intensity lesions in the paramedian pontine tegmentum and white matter close to the lateral ventricles, yielding a diagnosis of multiple sclerosis based on recurrent facial palsy and multiple lesions seen on MRI. Methylpredonisolone pulse therapy effectively removed left facial palsy completely within a week and ocular movement had normalized one month later. Careful evaluation of eye movement is a key in suspected brain lesion symptoms such as multiple sclerosis presenting a variety of neurological signs and symptoms.
Seven hundred and eighty-four patients who underwent ossiculoplasty performed by a single surgeon were reviewed in this paper. We previously reported a similar study in another journal using the 1995 American Academy of Otolaryngology Head and Neck Surgery guidelines. In the present paper, hearing outcomes were estimated based on the 2000 Japan Otological Society guidelines. The prognostic factors were analyzed using a multivariate analysis with logistic regression. Hearing outcomes were successful in 517 patients (65.9%). Type III tympanoplasty, stapes with normal mobility, children, patients without cholesteatoma and ossiculoplasty with non-cartilaginous materials were significantly favorable predictive factors. A multivariate analysis should be performed to investigate prognostic factors of ossiculoplasty. Better knowledge of these predictive factors contributes to the surgeon's judgment and the information given to patients.
Burow’s solution is reported effective in treating chronic suppurative ear disease and to be side-effect-frees. We report a case of facial palsy occurring during treatment of chronic suppurative otitis media with Burow’s solution. Since the solution is strongly acidic, it appeared to have caused paralysis by directly stimulating the facial nerve through facial canal bone dehiscence. The fact that Burow’s solution may potentially invade the facial nerve in a tympanic membrane perforation must be taken into consideration during treatment.
Chronic sinusitis is often caused by radiotherapy for nasopharyngeal carcinoma (NPC). In addition, reports have appeared in the literature on cases of massive bleeding from pseudoaneurysms of the internal carotid artery induced by invasive fungal sinusitis. We report on a case of rapture of a pseudoaneurysm of the internal carotid artery caused by invasive fungal sinusitis following chemoradiotherapy for NPC which was successfully treated with microcoil embolization therapy. A 69-year-old man had received concurrent chemoradiotherapy for NPC. Two years after the radiotherapy, the bleeding occurred from the superior lateral wall of the nasopharynx. Based on the enhanced neck CT scan findings, rapture of a pseudoaneurysm of the internal carotid artery was suspected. Microcoil embolization using the Seldinger method was performed on the internal carotid artery and the bleeding was stopped. The patient was then diagnosed as having invasive aspergillosis based on the pathological examination of the paranasal sinus. The fungal sinusitis was treated with Voriconazole resulting in a good outcome. In terms of the cranial symptoms after the radiotherapy for NPC, not only the recurrence of the cancer but also the possibility of fungal sinusitis and a carotid artery aneurysm should be considered.
Advanced endoscopy has become preferred modality in treating sinonasal inverted papilloma (IP) with Krouse staging T3 case. We applied maxillary swing approach to the nasolacrimal duct and inferior turbinate for IP because it provides a wide surgical field for the maxillary sinus without damaging for the nasolacrimal duct or inferior turbinate mucosal function. This is easily switched perioperatively to endoscopic medial maxillectomy (EMM) in cases of nasolacrimal duct or inferior turbinate invasion. Since 2006, we have treated 23 subjects in 27 cases of IP surgery, including 5 using the Swing Method and 3 EMM classified as Krouse staging T3. Most T3 cases can be managed with one of these modalities.
Large submandibular gland stone has always been a therapeutic challenge. When they cannot be accessed in a simple transoral approach necessitate gland removal. The advent of external lithotripsy gave hope for a conservative treatment, but the success rates ranged from 40% in the submandibular glands with specifically poor results in case of large stones. Sialendoscopy, initially described in 1990 for diagnosis and now used in sialendoscopy, cannot always extract large submandibular gland stones. To avoid submandibular gland excision, we report a technique combining sialendoscopy and a transoral approach.
Pleomorphic adenoma is the most common benign tumor arising in major salivary glands and is rare in minor salivary glands. The most common site is the palate, and only 9 have been recorded occurring at the base of the tongue. A 85-years-old woman seen for month-long dysphagia was found in Magnetic resonance imaging (MRI) to have a large round mass on the left side of the oropharinx, the lesion showed high intensity in T2 weighted imaging. The tumor and, adjacent muscle tissues 5 mm wide were transorally resected by harmonic scalpel. Histological examination showed a benign pleomorphic adenoma originating in the minor salivary gland at the tongue base.
We report an unusual case of bilateral synchronous tonsillar carcinoma. A 48-year-old Japanese man admitted for a firm, growing left cervical mass. In the left tonsil, a firm mass was noted, but a macroscopically normal right tonsil was found. Magnetic resonance imaging (MRI) demonstrated a moderately enhanced tumor of the left tonsil. Multiple cervical lymphadenopathy was also seen in the left jugular chain. On positron emission tomography (PET) scan, the maximum standard uptake value (SUV) for the left tonsil mass was 11.3 and for the left cervical lymph node was 4.1. The maximum the right tonsil SUV was 4.5. Biopsy intraorally from the left tonsil yielded a histopathologically diagnosis of squamous cell carcinoma (SCC). Excisional biopsy from the right level II cervical node under general anesthesia, yielded a diagnosis of metastatic SCC. Biopsy was followed by bilateral neck dissection and bilateral tonsillectomy. The right tonsil did not have any tumor macroscopically, but the bilateral paratine tonsil showed microscopical SCC invasion with some keratinization. Post operative radiotherapy was conducted for the bilateral neck and both tonsillar fossa. When contralateral cervical SCC metastasis occurs in those with a primary head and neck lesion, synchronous contralateral head and neck cancer may also be present. So bilateral tonsillectomy is recommended in T1 or T2 tonsillar carcinoma with bilateral cervical SCC metastasis.
Laryngocele remains rare in Japan, with just 14 cases—10 combined, 3 internal, and 1 unknown—reported in the Japanese literature. We report a case of laryngocele in a 72-year-old woman seen for right submandibular swelling. Cervical x-ray and computed tomography (CT) showed an air-filled mass in the right upper neck and paraglottic space, suggested combined laryngocele. Following tracheotomy, the laryngocele was removed in an external approach. Such cases require prompt attention, however due to the possibility of respiratory distress developing from laryngeal edema.
Congenital epiglottic cyst, although rare, may potentially cause severe airway obstruction. Major symptoms include mild stridor, trouble eating, chest retraction, apnea, and cyanosis. We report a case presenting with hydramnios in which a congenital epiglottic cyst caused severe airway obstruction and asphyxiation at birth. After surgical removal of the cyst, no airway obstruction has recurred in the half year of follow-up. It appears likely that a large congenital epiglottic cyst caused hydramnios with dysphagia. We therefore suggest that hydramnios is considered a possible sign of congenital epiglottic cyst, and that it is necessary to prepare to maintain the airway in cases of airway obstruction at birth.
A 48-year-old man seen for painless anterior neck and bilateral subauricular masses was found in computed tomography (CT) to have a ring-enhanced cystic anterior neck lesion containing a small calcification. Subauricular masses were positive in both fluorodeoxyglucose positron emission tomography (FDG-PET) and 99mTc-pertechnetate scintigraphy showing hypo- and hyperintensity in T1- and T2-weighted magnetic resonance imaging (MRI). Based on a preoperative diagnosis of thyroglossal duct carcinoma, not a benign cyst, associated with Warthin’s parotid glands tumors, not lymph node metastasis, the man underwent resection of the masses. Histopathologically surgical specimens confirmed our preoperative diagnosis. The man’s postoperative clinical course was uneventful and he remains currently disease-free in the 29 months after surgery.
Combination therapy such as chemotherapy and radiotherapy is often used for head and neck cancer to maintain potency, but may trigger undesirable adverse effects. A 60-year-old man suddenly developing shock and multiple organ failure during chemoradiotherapy for hypopharyngeal carcinoma required intensive treatment. Bacterial translocation was thought to have caused shock. We discuss clinical features and the diagnostic process.
Mohs’ paste used in skin cancer chemosurgery was used palliatively to treat unresectable cervical lymph node metastasis in hypopharyngeal carcinoma. A 54-year-old man had suffered from repeated bleeding and malodorous discharge from an ulcer from cervical metastasis. After Mohs’ paste was applied, the ulcer coagulated relieving his distress. Mohs’ paste is useful in such treatment in for improving the quality of life in such subjects.