Practica Oto-Rhino-Laryngologica
Online ISSN : 1884-4545
Print ISSN : 0032-6313
ISSN-L : 0032-6313
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Volume 103, Issue 7
Displaying 1-16 of 16 articles from this issue
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Editorial
  • Clinical Significance of FDG-PET in Evaluating of Head and Neck Cancer
    Hidenori Inohara
    2010 Volume 103 Issue 7 Pages 595-604
    Published: 2010
    Released on J-STAGE: July 01, 2010
    DOIhttps://doi.org/10.5631/jibirin.103.595
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    Fluorine-18-fluorodeoxyglucose positron emission tomography (FDG-PET) has been widely used in evaluating head and neck cancer. Here we describe its utility in staging and restaging of head and neck cancer, especially when treated by concurrent chemoradiotherapy (CCRT). Of patients with hypopharyngeal cancer treated by CCRT, those with a high FDG-uptake at primary site on posttreatment restaging PET showed significantly poorer local control and cause-specific survival than those with a low FDG-uptake. In contrast, neither local control nor cause-specific survival differed significantly between the patients with a high FDG-uptake and those with a low FDG-uptake on pretreatment baseline PET. High FDG-uptake on restaging PET but not on baseline PET served as an adverse prognostic factor for patients with oropharyngeal cancer treated by CCRT. Restaging PET less well identified persistent nodal disease in patients with node-positive head and neck cancer treated by CCRT, as compared to restaging CT. Baseline PET served to detect synchronous second primary cancer, especially of the colon, but not of the esophagus and stomach at early stage. We conclude that post-CCRT restaging PET serves to identify a subset of patients potentially benefiting from adjuvant therapy, and that restaging CT, not restaging PET, serves to identify a subset of patients at a high risk of persistent nodal disease requiring planned neck dissection. Lugol chromoendoscopy, which is very sensitive for detecting synchronous upper gastrointestinal tract cancer, should be included in work-up of head and neck cancer patients, together with baseline PET.
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Original articles
  • Facial Nerve Paralysis Due to Middle Ear Cholesteatoma
    Ryoji Hirai, Minoru Ikeda, Hiroyuki Kishi, Atsuo Ikeda, Yasuyuki Nomur ...
    2010 Volume 103 Issue 7 Pages 609-613
    Published: 2010
    Released on J-STAGE: July 01, 2010
    DOIhttps://doi.org/10.5631/jibirin.103.609
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    Facial nerve paralysis associated with middle ear cholesteatoma, although well known, is only occasionally encountered and its clinical features and management have been evaluated in only a few studies. We studied its clinical features associated with facial paralysis.
    Subjects numbered 20 [15 males and 5 females] from 3-82 years old (mean: 42.6 years) with facial nerve paralysis due to middle ear cholesteatoma undergoing surgery between 1990 and 2008. After cholesteatoma lesion resection, a limited area of the fallopian canal in which facial nerve edema or redness was evident was opened, although the epineural sheath was not incised for nerve decompression.
    Initial paralysis was incomplete in 13 (65%). Paralysis onset was sudden in 16 (80%). The facial paralysis outcome was favorable in 14 (70%).
    Facial paralysis outcome was largely favorably, although poor outcomes were observed in cases with petrosal cholesteatoma and in those undergoing surgery ≥2 months after paralysis onset.
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  • External Auditory Canal Carcinoma Treatment
    Yoichi Matsuda, Yoshihisa Ueda, Tomoyuki Kurita, Tadashi Nakashima
    2010 Volume 103 Issue 7 Pages 615-622
    Published: 2010
    Released on J-STAGE: July 01, 2010
    DOIhttps://doi.org/10.5631/jibirin.103.615
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    External auditory canal (EAC) carcinomas are relatively rare conditions lack on established treatment strategy. We analyzed a treatment modalities and outcome in 32 cases of EAC squamous cell carcinoma treated between 1980 and 2008. Subjects-17 men and 15 women ranging from 33 to 92 years old (average: 66) were divided by Arriaga’s tumor staging1) into 12 T1, 5 T2, 6 T3, and 9 T4. Survival was calculated by the Kaplan-Meier method. Disease-specific 5-year survival was 100% for T1, T2, 44% for T3, and 33% for T4. In contrast to 100% 5-year survival for T1+T2 cancer, the 5-year survival for T3+T4 cancer was 37% with high recurrence due to positive surgical margins. The first 22 years of the 29 years surveyed, we performed surgery mainly, and irradiation or chemotherapy was selected for early disease or cases with positive surgical margins as postoperative therapy. During the 22-years, 5-year survival with T3+T4 cancer was 20%. After we started superselective intra-arterial (IA) rapid infusion chemotherapy combined with radiotherapy in 2003, we achieved negative surgical margins for advanced disease, and 5-year survival for T3+T4 cancer rise to 80%.
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  • Inflammatory Myofibroblastic Tumor of the Nasal Cavity
    Ichiro Fukumasu, Seiko Akagi, Kazunori Senoh, Ayako Takeuchi
    2010 Volume 103 Issue 7 Pages 623-627
    Published: 2010
    Released on J-STAGE: July 01, 2010
    DOIhttps://doi.org/10.5631/jibirin.103.623
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    We report a case of inflammatory myofibroblastic tumor of the nasal cavity. An 8-year-old boy seen for a tumor of the right nasal cavity and epistaxis had the tumor rapidly reduced by antibiotics and antiallergics but surgery failed to extract the tumor completely. The fined diagnosis was inflammatory myofibroblasic tumor. Postoperatively, the residual tumor disappeared naturally, and the boy currently lives with no signs of recurrence.
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  • A Case of Chondrosarcoma of the Nasal Septum
    Junichi Ohkubo, Takuro Kitamura, Tetsuro Wakasugi, Koichi Hashida, Nob ...
    2010 Volume 103 Issue 7 Pages 629-635
    Published: 2010
    Released on J-STAGE: July 01, 2010
    DOIhttps://doi.org/10.5631/jibirin.103.629
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    Chondrosarcoma is rare, accounting for 0.2% of all malignant head and neck tumors. We report a case of chondrosarcoma arising from the nasal septum. A 63-year-old woman seen for 15-month of nasal obstruction and headache was found in rhinoscope, to have a bilaterally bulging posterior nasal septum. Computed tomography (CT) confirmed a tumorous mass extending to the sphenoid sinus and partially to the right posterior ethmoid sinus. T1- and T2-weighted magnetic resonance imaging (MRI) showed low and high intensity in spotty gadolinium enhancement. Transnasal endoscopic biopsy under general anesthesia yielded a histopathological diagnosis of chondrosarcoma. The woman refused proposed wide tumor resection for religious reasons but alternatively underwent carbon ion radiotherapy of 70.4 Gy, markedly reducing the tumor without severe complications. She has been remaining fairly well without recurrence in the 13 months since irradiation.
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  • Oral Steroid Therapy Evaluation and Histopathological Changes in Suspected Eosinophilic Sinusitis
    Hidenori Yokoi, Tatsuya Saito, Noritsugu Ono, Katsuhisa Ikeda
    2010 Volume 103 Issue 7 Pages 637-641
    Published: 2010
    Released on J-STAGE: July 01, 2010
    DOIhttps://doi.org/10.5631/jibirin.103.637
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    To assess oral steroid therapy in treating suspected an eosinophilic sinusitis, we found that, as reported elsewhere oral steroid therapy is effective by inducing eosinophil apoptosis. We confirmed that oral steroid therapy significantly decreases eosinophil count in tissues.
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  • Clinical Study of Mycosis and Caseous Sinusitis
    Hiroshi Matsubara, Kenzo Tsuzuki, Hironori Takebayashi, Hideki Oka, Ke ...
    2010 Volume 103 Issue 7 Pages 643-649
    Published: 2010
    Released on J-STAGE: July 01, 2010
    DOIhttps://doi.org/10.5631/jibirin.103.643
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    We retrospectively reviewed clinical features of subjects with sinusitis retaining fragile massive caseous materials, divided into fungal (mycosis) and non fungal infection (caseous sinusitis). Sinus caseous materials were found during sinus surgery in 50 with sinusitis, 17 men and 33 women, 23-83 years old (mean: 62), between April 1995 and March 2009. Of these 50, 34 (68%) were diagnosed with mycosis and 16 (32%) were with caseous sinusitis based on histopathological and/or bacteriological findings. The most frequent mycosis etiology was aspergillosis (53%, 18/34). Histopathological findings were more useful in diagnosing mycosis than bacteriological findings. Nasal symptoms were most widely seen (42%, 21/50), followed by buccal pain (20%, 10/50). Caseous materials were mostly seen in unilateral maxillary sinus (86%, 43/50), followed by sphenoid sinus (10%, 5/50). Treatment involved endoscopic sinus surgery (ESS) in 43 (86%), with an external approach (Caldwell-Luc procedure) in 7 (14%). Nasal septum deviatomy was also required in 14% (7/50) to improve nasal ventilation. Postoperatively, 16 with caseous sinusitis and 31 with non invasive myocetoma recovered uneventfully. In 3 with acute invasive cases, two survived with ongoing visual impairment. One with invasive candidiasis died of brain invasion. In conclusion, half of sinusitis retaining caseous materials was caused by fungal infection. Clinical courses varied, but early diagnosis and treatment was critical.
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  • A Case of Submandibular Gland Salivary Duct Carcinoma
    Eiju Kanagawa, Osamu Horiike, Kazuma Sugahara, Hiroshi Yamashita
    2010 Volume 103 Issue 7 Pages 651-655
    Published: 2010
    Released on J-STAGE: July 01, 2010
    DOIhttps://doi.org/10.5631/jibirin.103.651
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    Salivary duct carcinoma, first reported by Kleinsasser et al. in 1968, histologically features, resembles ductal carcinoma of the breast. We report a case of salivary duct carcinoma of the submandibular gland. A 65-year-old man reporting an 8-year history of right submandibullar swelling was found to have. Multiple bone and lung metastasis necessifafing submandibullar sialoadenectomy and right-neck dissection. Skin metastasis was found four months later. Histologically, this tumor was diagnosied as salivary duct carcinoma based on the presence of comedo necrosis. The man is well and metastasis-free, 8 months after surgery.
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  • Radiation-Induced Mucositis Pain in Mesopharyngeal and Hypopharyngeal Cancer
    Atsuhito Takahashi, Kazuhiko Shoji, Takehiro Iki, Masanobu Mizuta, Mam ...
    2010 Volume 103 Issue 7 Pages 657-663
    Published: 2010
    Released on J-STAGE: July 01, 2010
    DOIhttps://doi.org/10.5631/jibirin.103.657
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    Radiation therapy in head and neck malignancy often triggers painful mucositis poorly controlled by nonsteroidal antiinflammatory drugs (NSAIDs). To better understand how radiation-induced pain develops over time, we studied numerical rating scale (NRS 0-5) pain scores in 27 subjects undergoing 60-72 Gy radiation therapy for newly diagnosed cancer—13 with mesopharx and 14 with hypopharynx. Mucositis severity was evaluated using Common Terminology Criteria for Adverse Events version3.0 (CTCAE v3.0) based on mucositis pain, analgesic administration, and oral feedings of our subjects, with 8 mesopharyngeal and 10 with hypopharyngeal cancer had been pain-free before radiation therapy. The mucositis and pain course was severer in mesopharyngesl than in hypopharyngeal cancer.
    NSAIDs and opioid use was similar in both cancer types, which also required tube feeding in 7 subjects (38.9%).
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  • A Case Report of Pharyngoesophageal (Zenker’s) Diverticulum with Abnormal Throat Sensation
    Toshimitsu Ohashi, Masami Ohnishi, Michinori Murai, Keiichi Izuhara, S ...
    2010 Volume 103 Issue 7 Pages 665-668
    Published: 2010
    Released on J-STAGE: July 01, 2010
    DOIhttps://doi.org/10.5631/jibirin.103.665
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    We report a case of abnormal throat sensation confirmed by contrast esophagogram play to be Zenker’s diverticulum. A 50-year-old man reporting strongly abnormal throat sensation was found in contrast esophagogram play to have a diverticulum of the cervical esophagus. He requested surgery to halt the increasingly abnormal sensation. The diverticulum was excised through an external cervical approach under general anesthesia, using an EndoGIA Universal linear stapler cutter and EndoGIA II cartridge. The men reported no abnormal postoperative symptoms.
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  • A Case of Methotrexate (MTX)-Associated Lymphoproliferative Disorders Presenting as Sore Throat
    Shingo Takano, Makoto Kinoshita, Masayuki Kabeya
    2010 Volume 103 Issue 7 Pages 669-676
    Published: 2010
    Released on J-STAGE: July 01, 2010
    DOIhttps://doi.org/10.5631/jibirin.103.669
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    We report a case of unusually long rheumatoid arthritis (RA) with methotrexate (MTX) and related factors. A 60-year-old woman with a 35-year RA history and 2 weeks of sore throat. For 19 years before presentation, she had been administrated oral MTX weekly at 7.5 mg. Laryngofiberscopy showed a tumor on the oropharynx, at the left tongue root. Enhanced computed tomography (CT) showed neck swelling and axillary, lateroabdominal subcutaneous, and inguinal lymph nodes, nodular thyroid lesion, lung, and liver. Gastroscopy showed a gastric tumor and uteroscopy a uterine tumor. Fine needle aspiration from a neck lymph node and thyroid showed malignant lymphoma and oropharyngeal, gastric, and uterine biopsy showed diffuse large B cell lymphoma. She was diagnosed elsewhere with MTX-associated lymphoproliferative disorders (MTX-LPD), and MTX was discontinued. Neck lymph node and oropharyngeal tumor shrank 2 weeks after MTX withdrawal, and CT 4 months later showed all lesions had disappeared. One year after MTX withdrawal, the woman had no evidence of recurrence.
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  • A Case of Giant Neck Schwannoma Causing Hemiplegia
    Masayuki Asai, Keisuke Mizuta, Kenichi Ando, Mitsuhiro Aoki, Yatsuji I ...
    2010 Volume 103 Issue 7 Pages 677-681
    Published: 2010
    Released on J-STAGE: July 01, 2010
    DOIhttps://doi.org/10.5631/jibirin.103.677
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    A 60-year-old man seen for a giant right cervical mass and hemiplegic gait disturbance was found in computed tomography (CT) and magnetic resonance imaging (MRI) to have a large cervical tumor pressing laterally on the carotid artery in the right parapharyngeal space and an intracranial tumor destroying the first cervical spine and cranial base. Cervical tumor biopsy identified schwannoma. Fluid volume from the cervical tumor discharged after biopsy and relieving left arm and leg weakness indicated that the cervical tumor, deriving from the sympathetic nerve, had adversely affected neurological signs via the intracranial mass derived from the cervical spinal radix. We removed the cervical tumor prior to the intracranial lesion, after which he could walk independently.
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  • Hyoid Bone Chondrosarcoma: A Case Report
    Kazuyuki Kainuma, Ryosuke Kitoh, Shinichi Usami
    2010 Volume 103 Issue 7 Pages 683-686
    Published: 2010
    Released on J-STAGE: July 01, 2010
    DOIhttps://doi.org/10.5631/jibirin.103.683
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    We present a case of chondrosarcoma of the hyoid bone, a rare condition with only 17 cases reported in the English literature. A 71-year-old woman whose only symptom was a painless mass in the upper right neck was diagnosed with lymph node metastasis from endometrial stromal uterine sarcoma based on her medical history and fine-needle aspiration cytology (FNAC) results. We resected the tumor in modified radical neck dissection with right hemihyoidectomy. The final histological diagnosis was grade 2 chondrosarcoma. No evidence of recurrence has been seen in the 21 months after surgery, but long-term follow-up is essential because recurrence has been reported even after five years. We discuss the clinical characteristics and management including diagnosis and treatment and review the literature of this rare tumor.
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  • A Case of Parapharyngeal-Space Basal Cell Adenoma
    Kazuhiko Minami, Takashi Fukaya
    2010 Volume 103 Issue 7 Pages 687-691
    Published: 2010
    Released on J-STAGE: July 01, 2010
    DOIhttps://doi.org/10.5631/jibirin.103.687
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    Tumors arising in the parapharyngeal space, while relatively rare are difficult to extirpate due to their site, which includes important nerves and vessels. Most such tumors originate in the parotid gland and are neurogenic. Basal cell adenomas of the parapharyngeal space are rare.
    A 67-year-old man found incidentally in magnetic resonance imaging (MRI) to have basal cell adenoma of the parapharyngeal space underwent surgical resection in an external cervical approach. No evidence of tumor recurrence has been seen in the year since surgery.
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