Despite recent advances in surgical technology and chemoradiation regimens, no significant improvement has been seen in the survival rate of head and neck squamous cell carcinoma (HNSCC) in more than 3 decades. Examples of new and remarkable clinical strategies such as epidermal growth factor receptor(EGFR) targeted therapy and the status of human papilloma virus (HPV) infection in oropharyngeal carcinoma have attracted attention over the years. Molecular-targeted therapy has been approved in Europe and the United States as standard treatment for HNSCC and has shown significant effect with conventional chemotherapy and radiotherapy. However, the therapeutic effect is heterogeneous as is the case with other cancers, and problems have also been highlighted such as acquired resistance associated with long-term treatment. Recent studies have shown that a subset of HNSCC, especially in the oropharynx, is caused by HPV infection and that the clinical outcome of patients can be clearly distinguished based on their HPV status. Patients with HPV(+) tumors have a more favorable prognosis compared to HPV(−) patients. The use of the HPV status as a marker for personalized treatment has been anticipated. In this paper, we show our recent data on EGFR-targeted therapy and the clinical outcome of patients depending on their HPV status, and we discuss the future of translational research in HNSCC.
Studying clinical features and prognosis in 101 children diagnosed with psychogenic hearing loss and treated by team care, we found 74 (73.3%) were girls averaging 9.3 years old (SD=2.6). Psychogenic symptoms were found in 70 (69.3%), among whom psychogenic blindness and pain were factors in poor-prognosis. Developmental problems were found in 12 (11.9%), most involving weak hearing recognition. Mental problems were found in 8 (7.9%), including severe auditory hallucination in those of junior high school age or older. Most reported problems at home and school. Family problems mostly involved parental divorce and family conflict. School problems mostly involved bullying, threatened or actual school absenteeism, and learning maladjustment. Team care resulted in 83.6% gaining a good prognosis of these 50.7% recovered in an average of 8.5 months. We therefore recommend considering psychotherapy treatment in hearing-loss cases involving multiple symptoms, severe hearing loss, unilateral hearing loss, and psychological problems such as school absenteeism.
We evaluated endolymphatic-sac surgery efficacy in 9 subjects for 9 to 30 years (average; 23 years). Due to difficulty in evaluating such surgery, only the 1985 AAO-HNS guideline, which covers 24 months, was used. Endolymphatic-sac surgery was conducted from 1980 to 1990 in 142 subjects with intractable Meniere’s disease, some of whom were treated from 1990 at our clinic. Results showed that definitive spells were “fairly relieved” in 55%, “relieved” in 45%, but worse in no subjects. Hearing was “improved or unchanged” in 67% but remained “worse” in 33%.
A 25-year-old man experiencing abruptly increased right-ear pressure when jumping into a swimming pool was referred for pain and continuous bleeding. Daily antibiotics failed to stop bleeding necessitating tympanoplasty and mastoidectomy on day 4 after consultation. Extensive bleeding was found throughout the mastoid and tympanic cavities with edematous tympanic mucosa. The incus was removed and used as a columella. Purulent discharge and swelling prevented revision tympanoplasty untill 19 days after initial surgery. Infected mastoid and tympanic mucosa was removed. The postoperative course was uneventful, resulting in a dry, healthy ear drum. Acute extensive bleeding within the mastoid cavity is rare. In our case, sudden pressure increase in the middle ear and mastoid cavity probably disrupted middle ear and the mastoid mucosa blood capillaries. This pressure change was most likely due to abrupt increase pressure in the ear canal and nasopharyngeal space due to glottal closure when the man hit the water. Increased intracranial pressure may also have caused the bleeding.
Skull base osteomyelitis, an uncommon, bone marrow infection involves potential facial nerve and lower cranial nerve palsies, is commonly caused by Pseudomonas aeruginosa. It mainly plagues the elderly or those with diabetes. Skull base osteomyelitis requires prolonged treatment with antibiotics, and it is conceivable that hyperbaric oxygen therapy enhances the effect of antibiotics. We report a case with multiple cranial nerve palsies caused by multidrug-resistant Pseudomonas aeruginosa, treated by combing antibiotics, debridement, and hyperbaric oxygen.
Nasal dermoplasty is currently the treatment of choice in severe epistaxis in those with hereditary hemorrhagic telangiectasia. The Japanese literature dose not, to our knowledge, report the combination of inferior tubinectomy and nasal dermoplasty in such treatment. A 69-year-old woman with hereditary hemorrhagic telangiectasia and recurrent epistaxis treated combining tubinectomy and dermoplasty and who had required 174 units of blood 1 year before dermoplasty enjoyed a decrease to 18 units 1 year after dermoplasty.
Atresia of the anterior nares is a rare disease caused by a congenital or acquired disorder. Car accidents, burns, postoperative scar, iatrogenic damage, and so on reportedly induce acquired atresia of the anterior nares. This report describes a rare case of nasal alar deformity and anterior nasal atresia caused by scar tissue formation following zona facialis. An 80-year-old woman was infected with herpes zoster at the right trigeminal nerve second division and intravenous acyclovir was administered. After treatment, increasing deformity of the right ala was gradually noted. The right nostril had closed completely in 10 months. She was treated with surgical enlargement of the stenosis using a nasolabial skin flap. Stenosis has not recurred during the six months since the nasolabial skin flap reconstruction. Various techniques have been used for reconstruction related to anterior nasal atresia: scar excision, skin graft, Z-plasty, V-Y advancement flap, composite graft, nasolabial skin flap, and others. It is important to choose an appropriate operative method for prevention of postoperative recurrence.
We report a case of a 17-year-old adolescent man with intracranial complications due to acute rhinosinusitis. Intracranial sinusitis complications may be challenging, but prognosis can be made favorable in adolescents using aggressive medical and surgical management. He reported headache, fever, vomiting, and fainting. Computed tomography (CT) and magnetic resonance imaging (MRI) indicated an epidural abscess and sinus opacification. Aggressive antibiotic treatment did not relieve suppuration. Although a modified Lothrop procedure contributed to drain frontal sinuses. The formation of intracranial abscess resulting in neurologic deficit occurred. Craniotomy and a ventriculoperitoneal shunt were required to relieve the neurological disturbance.
Hematoceles are benign hemorrhagic masses. We report three cases of nasal and paranasal sinus hematocele involving prolonged nasal bleeding. Computed tomography (CT) showed an expanding enhanced lesion with a bone defect at the maxillary sinus and magnetic resonance imaging (MRI) varied lesion intensities. We conducted preoperative angiography and selective embolization to be controlled very effectively enabling surgical bleedings. We conducted endoscopic sinus surgery in 1 case and Caldwell-Luc or Denker procedure in 2 cases. We found preoperative imaging to be vital in determining surgical procedures, with preoperative embolization providing an adjunct in estimating vascular proliferation.
Sinonasal inverted papilloma, an uncommon benign neoplasm, tends to recur and is associated with malignancy. As endoscopic visualization has improved, inverted papilloma has been managed endoscopically through a transnasal approach, with recurrence rate similar to that in extranasal surgery. Transnasal endoscopic medial maxillectomy (TEMM) enables tumors to be removed completely, and lets the nasal cavity be better visualized postoperatively without skin or sublabial incision. Thus preserving the unaffected sinonasal framework, such as the anterior maxillary sinus wall, helps keep recurrent tumors from finding a preformed gateway for invading extranasal tissue. Our analysis of 5 such cases surgically resected with TEMM showed that. All tumors had been extirpated endoscopically and no recurrence was observed in follow-up. We find TEMM to be efficacious in treating inverted papilloma. Avoiding possible complications requires appropriate experience in endoscopic sinus surgery, and long-term follow-up is crucial to reporting long-term results.
Parotid gland carcinosarcoma, a very rare malignant salivary gland tumor, has carcinomatous and sarcomatous elements. Invasion and locoregional and distant metastasis are common, and monomodal therapy is usually inadequate, necessitating multimodal treatment. A 29-year-old man underwent surgery for a right parotid gland tumor showing no enlargement in the 4 months preceding the operation. Intraoperative histopathological examination showed the tumor to be malignant, involving the facial nerve. We conducted total parotidectomy, facial nerve resection, and nerve reconstruction. Histologically, the tumor involved two malignant cell types-mucoepidermoid carcinoma and chondrosarcoma, yielding a final diagnosis of carcinosarcoma. He underwent postoperative radiotherapy and adjuvant chemotherapy with ifosfamide and paclitaxel. He has had no recurrence or metastasis at the 10-month follow-up, and will require long-term monitoring, which should be recommended in all such cases.
Congenital aplasia of the major salivary glands is very rare. Some authors have reported that most congenital aplasia of a major salivary gland is assosiated with multiple other developmental anomalies, especially in the case of craniofacial lesions. Other authors have reported on some cases of aplasia of the partial major salivary glands involved only the parotid glands or submandibular glands without other malformations. Here we report on a very case of aplasia of the bilateral submandibular glands and compensatory hypertrophy of the bilateral lingual glands.
IgG4-related plasmacytic disease is associated with the dissemination of CD4 or CD8 positive T lymphocytes and IgG4-positive plasma cells in numerous internal organs. Mikulicz’s disease has been characterized by bilateral swelling of the lacrimal glands, parotid and submandibular glands, whereas Küttner’s tumor has been reported as bilateral submandibular gland swelling, and has been referred to as chronic sclerosing sialadentis. Mikulicz’s disease has recently been categorized as a systemic IgG4-related disease. In the present study, 31 cases of Mikulicz’s disease and 20 cases of chronic sclerosing sialadentis were investigated from various points of view such as by visual confirmation, laboratory findings, histopathological findings, and coexisting diseases. Laboratory findings showed that total IgG and IgG4 levels were significantly higher in both diseases. Histopathologically, IgG4 positive plasma cell infiltration with fibrosis was remarkable in both diseases. These results suggest that Küttner’s tumor is also categorized in Mikulicz’s disease as an IgG4-related disease.
Mumps virus infections primarily involve the parotid glands and most frequently affect school-aged children. Mumps has many complications, such as meningitis, but laryngeal edema is not a common one. We present four cases of mumps with laryngeal edema. The patients were a 39-year-old male, 23-year-old female, 29-year-old female and 31-year-old female. They came to our hospital complaining of submandibular and subaural regional swelling and dyspnea. In every case, fiberscopic findings revealed edema of the arytenoid. Laboratory examination showed normal WBC, slightly high CRP and high serum amylase. Their mumps titers were positive for immunoglobulin M and G. The patients were admitted to our hospital and were started on intravenous steroids. In one case, because of progressive dyspnea, a tracheotomy was needed. All symptoms of laryngeal edema improved within 3 days. In previous reports in the literature, there were four cases of mumps with laryngeal edema which required a tracheotomy because of aggravation of dyspnea. If a patient with mumps complains of dyspnea, examination of the respiratory airway is important.
Improved long-term disease prognosis has led to the otolaryngologist sometimes seeing a remote history of congenital esophageal atresia repair. We report a case of esophageal foreign body impaction with post congenital esophageal atresia repair over 10 years after the fact. A 13-year-old boy reported a globus feeling—a ‘lump in the throat’—and dysphagia after eating fried chicken. Despite diagnostic difficulty, we identified and removed a chicken bone through esophagogastroduodenoscopy 2 days later without complications. The chicken bone was 98 mm long. This impaction after such repair is due both to anastomotic stricture and to esophageal dysmotility. Such impaction is usually accidental, and its recurrence should be prevented by working with the subject and caretakers.