The keys to improving the prognosis and quality of survival of patients with head and neck cancer are early diagnosis and less invasive treatment. To achieve these goals, the availability of endoscopic techniques to detect head and neck cancer is essential. We have tried and reported several endoscopic techniques to detect oropharyngeal and hypopharyngeal cancer in the early stages. In this article, I shall discuss the history of the endoscopic technology and the endoscopic techniques that can be used to detect pharyngeal cancer. I shall focus on how we attempt to open the pharyngeal cavity. For oropharyngeal examination, transoral insertion of the scope with narrow-band imaging (Transoral NBI) is very important, especially for the diagnosis of human papilloma virus-related oropharyngeal cancer. We developed the modified Killian’s method to open the pharyngeal space widely, by which we could successfully detect early hypopharyngeal cancer of the post-cricoid area and posterior wall cancer; it was also very useful to define the tumor extent in the caudal direction. We discuss the importance of technical innovations for early cancer diagnosis.
We describe herein our hospital’s treatment policy for patients with otitis media cholesteatoma associated with a semicircular canal fistula and report the test results for semicircular canal fistula sites, fistula depths, postoperative bone conduction, and hearing.
All the patients had a semicircular canal fistula associated with otitis media cholesteatoma and underwent surgery between August 2010 and April 2016 at the Department of Otorhinolaryngology of Kansai Electric Hospital. The semicircular canal fistula depths were classified according to the Dornhoffer and Milewski classification as I, IIa, IIb, and III, and 17 ears with a depth classification of IIa or higher were investigated. Eleven ears were newly operated on, and the other 6 underwent re-operations. All the re-operated ears had been previously operated on at other hospitals. In principle, a canal wall up tympanoplasty was used as the operative method, in view of the importance of the patients’ postoperative quality of life. In all the cases, fistula treatment was conducted in a one-stage operation as the final step of the operation, and the fistula was covered with a piece of thinly sliced cartilage.
The fistula sites were the external semicircular canal in 15 ears and the external semicircular canal plus the anterior semicircular canal and external semicircular canal plus the posterior semicircular canal in 1 ear each. The fistula depths were IIa, IIb and III in 11, 2 and 4 ears, respectively.
Decreased postoperative bone conduction was observed in 5 (29.4%) of the 17 ears that were examined; the decrease in bone conduction in these 5 ears was within the range of 15 dB. Hearing was improved in 9 (56.3%) of the 16 evaluable ears; 1 ear was not evaluable. Postoperative dry eardrums were confirmed in all 17 ears.
Severe postoperative reductions in bone conduction can be prevented by careful and appropriate fistula treatment.
Ameloblastoma is a benign odontogenic tumor that predominantly occurs in the lower jaw, and this tumor arising from the upper jaw is relatively rare. Although the tumor is usually benign, some cases of recurrence or malignant transformation have been reported. We report a case of ameloblastoma that was treated by total maxillectomy.
A 67-year-old man was referred to our institute with a 2-month history of swelling of the left cheek. Examination at the first visit revealed swelling of the left hard palate and of the left nasal side wall. CT and MRI showed a polycystic tumor occupying the left maxillary sinus, with thinning and erosion of the sinus wall. We performed total maxillectomy based on the diagnosis, confirmed by biopsy. There has been no evidence of local or distal recurrence since the surgery.
Surgery is the only treatment option available for ameloblastoma, and radiation therapy/chemotherapy is ineffective. We wish to emphasize that maxillectomy is necessary in the cases with tumor expansion beyond the maxillary sinus.
Actinomycosis is a relatively rare infectious disease, with about half of all cases involving the face and neck region. The current authors encountered 2 cases of cervicofacial actinomycosis that followed different clinical courses, as reported here. The first case involved an acute form presenting with abscess formation that was diagnosed based on a culture of pus obtained by aspiration. The second involved a chronic form presenting with a mass in the neck that was diagnosed based on a finding of actinomyces in a histopathological examination of surgical specimens. Both patients were given oral amoxicillin for 6 months or longer after receiving definitive diagnosis. Recurrence has not been noted for 2 years.
Actinomycosis needs to be considered as part of any differential diagnosis of cases involving an abscess or inflammatory mass. Pus from an abscess and tissue from a resected mass should be sampled and anaerobically cultured.
Actinomycosis should be treated with penicillin for at least 2 months or longer, and penicillin should be administered for 6–12 months if surgical intervention is required.
In a review of 91 case reports of actinomycosis in Japan from 2004 to 2016, clinical samples were seldom cultured, and non-penicillin antibiotics or short-term antibacterial therapy were often administered. Clinicians need to be better informed of the aspects of this infectious disease.
In recent years, cases of sinusitis associated with dental implants (DIs) have increased in number in Japan. In fact, in some patients, the DI need to be surgically extracted. A 52-year-old man with three right maxillary DIs presented to our hospital complaining of right cheek pain. Sinus CT revealed right maxillary sinusitis with severe periodontitis and peri-implantitis. We made a diagnosis of odontogenic sinusitis and proposed extraction of the teeth and DIs causing the inflammation. We extracted two teeth, while the patient refused to undergo extraction of the DIs. He visited the hospital again after 2 months complaining of cheek pain; we ruled out a successful outcome with endoscopic sinus surgery (ESS) alone, and repeatedly proposed extraction of the DIs. Finally, he consented to undergo extraction of one DI showing severe peri-implantitis and ESS, following which he recovered.
Local infection of peri-implant tissue is the most common complication of DIs, and in such cases, extensive resorption of the bone surrounding the implant may occur. Odontogenic maxillary sinusitis may be caused by peri-implantitis, DI displacement, or maxillary sinus augmentation surgery. Patients at risk of odontogenic sinusitis can be identified by consultation between a rhinologist and dentist before DI therapy.
We treated a vascular malformation of the hypopharynx in a 37-year-old male patient by sclerotherapy.
He was referred to our department for further evaluation of a hypopharyngeal tumor. Fiberoptic endoscopic examination showed a dark red lesion covering the vocal cords and hypopharynx on both sides. From the characteristic findings, we diagnosed the lesion as a vascular malformation of the hypopharynx. Direct hypopharyngoscopy under general anesthesia revealed that the tumor extended from the postcricoid region to the arytenoids. Because the extent of the tumor was large, we selected sclerotherapy for treatment. After the second sclerotherapy session, the tumor reduced sufficiently in size, and until now, two years after the treatment, there has been no evidence of re-growth.
Peritonsillar abscess is rare in children. The common age of occurrence of peritonsillar abscess in children is around 13 years old, and its occurrence in younger children, especially infants, is very rare. Herein, we report a case of peritonsillar abscess developing in a 3-month-old infant, which we successfully treated by puncture aspiration and intravenous antibiotic administration. We report the case with consideration of the literature.
The patient was a 3-month-old female infant. Physical examination revealed fever and pharyngeal erythema, and laboratory examination showed an increase in the acute inflammatory marker response; the infant was hospitalized on the same day and treatment initiated with intravenous cefazolin (CEZ). The fever failed to resolve even by the third day after onset. The infant developed difficulty in breathing. As examination revealed leftward deviation of the uvula, we performed a contrast-enhanced CT examination, which revealed an abcess showing ring enhancement extending from the right tonsillar pole to the pharyngeal gap; based on the findings, the infant was diagnosed as having a right peritonsillar abscess.
Despite conservative treatment with intravenous antibiotics, the condition worsened, and considering the risk of complications narrowing of the airway by an enlarging abscess, we performed puncture aspiration of the abscess with an 18-G needle. We drainaged 1 ml of pus and the swelling reduced in size. We changed the antimicrobial agents to ceftriaxone (CTX)+clindamycin (CLDM), and also initiated administration of oral prednisolone administration (PSL 1 mg/kg). With this treatment, the infant recovered smoothly and was discharged from the hospital in a satisfactory general condition.
In case of peritonsillar abscess, the inflammation spreads to the loose tissues between the tonsillar surface and the pharyngeal contractile muscle to form an abscess. Due to these anatomic features, it is extremely rare in children, especially infants.
Patients with emergency diseases, including cardiovascular diseases, sometimes present with hoarseness of the voice. Such cardiovascular diseases occur mostly in the middle-aged or elderly with arteriosclerotic risk factors, and rarely in younger subjects. We encountered a rare case of vocal cord paralysis in a young patient who was eventually diagnosed as having a thoracic aortic aneurysm with impending rupture and required emergency surgery.
The patient was a 19-year-old woman who presented to us with a 2-week history of hoarseness of the voice. Fiberoptic laryngoscope examination revealed left vocal cord paralysis. Chest computed tomography revealed widening of the thoracic aorta, and we consulted a cardiologist. Dynamic enhanced computed tomography performed under the advice of the cardiologist revealed a thoracic aortic aneurysm with impending rupture. The patient was then referred to a cardiovascular surgeon at another hospital, where she underwent surgery under general anesthesia. The patient was diagnosed as having aortitis syndrome by histopathology, and was initiated on oral steroid therapy. She was discharged from the hospital on day 29 after the operation.
Sublingual gland carcinomas are very rare, comprising only 0.5% to 2% of all carcinomas of the major salivary glands. Because of the low frequency of occurrence, case reports of this condition are of interest. Herein, we report a patient with mucoepidermoid carcinoma of the sublingual gland who was followed up for four and a half years after the first treatment.
A 68-year-old female patient initially received radiotherapy for epipharyngeal cancer. She developed neither local nor metastatic recurrence after the treatment. However, 2 years later, she was detected to have a tumor in the floor of the mouth on the right side. Clinical examinations revealed that the tumor was a malignant tumor involving the sublingual gland. We resected the tumor via the oral approach and postoperative histopathology confirmed the diagnosis of low-grade mucoepidermoid carcinoma of the sublingual gland. Until the end of her four and a half years’ follow-up after the first treatment, the patient showed no evidence of recurrence.
In regard to the malignancy grade, most patients with this carcinoma have lowgrade malignant tumors. However, patients should be carefully followed up for possible local recurrence.
We report two cases of spontaneous pneumomediastinum. In both cases, the pneumomediastinum was caused by exposure to loud voices. We made the diagnosis of spontaneous mediastinum based on clinical examination and the presence of subcutaneous and mediastinal emphysema on the chest radiograph and chest computed-tomographic images. Both patients were treated with bed rest, and both showed complete recovery within a week. No recurrence was observed in either case.
Spontaneous pneumomediastinum is a relatively rarely encountered condition in clinical practice, and usually occurs in healthy young men without any underlying disease. Many patients complain of neck pain and consult an otolaryngologist.