Practica Oto-Rhino-Laryngologica

Treatment of Advanced Head and Neck Cancer

-Problems and Management-

Yoshitaka OKAMOTO

2001 Volume 94 Issue 7 Pages 577-585
Published: July 01, 2001
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.94.577

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The results of planned combination therapy in patients with advanced head and neck cancer, particularly maxilla and hypopharynx, at Akita University School of Medicine (-1996), and at Yamanashi Medical University (1996-) were reviewed. Combination therapy consisted of a full dose irradiation together with chemotherapy followed by en bloc resection and primary reconstruction. Retrospective analysis of the patients with maxillary cancer showed that en bloc resection seemed to be adequate, but in some cases, irradiation combined with chemotherapy without maxillectomy was useful. In the treatment of advanced hypopharyngeal cancer, the histopathological effects (pT, pN) of preoperative chemotherapy and radiotherapy were the most important factors in prognosis. In paticular, the presence of pN predicted a very low possibility of survival and a very high incidence of distant metastasis. The advantages and disadvantages of preoperative radiotherapy are also discussed.
Finally, the treatment of head and neck carcinoma involving the carotid artery was also reviewed; Carotid artery resection is the only modality therapy offering the potential for care. However, aggressive resections involving the carotid artery should include the reconstruction of this vessel with a graft, particularly in cases where extensive resection of the skull base including the carotid canal and sigmoid sinus is performed. Preoperative temporary occlusion of the carotid artery is not necessarily an accurate predictor of morbidity after permanent occlusion. In extracranial-intracranial bypass surgery, temporary occlusion of middle cerebral artery also may induce serious brain ischemia, but our finding show that two-stage extracranial-intracranial bypass surgery may minimize this risk.

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The Therapy for OSAS with Harmonic Scalpel*

[in Japanese], [in Japanese]

2001 Volume 94 Issue 7 Pages 586-587
Published: July 01, 2001
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.94.586

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Investigation of Recurrent Perilymph Fistula

Hitome Kobayashi, Hajime TERAO, Takashi TOKUMARU, Harumi SUZAKI

2001 Volume 94 Issue 7 Pages 589-594
Published: July 01, 2001
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.94.589

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Five patients underwent exploratory surgery for perilymph fistula between 1992 and 1999 at Showa University Hospital. Two patients were cured but one patient's symptoms continued after surgery. In two patients and another introductory patient, their symptons recurred after initial recovery.
Vertigo and unsteadiness were noticed in all patients 1 to 5 months after the first exploratory surgery, and hearing losses also deteriorated. Fistula tests were positive in all patients with recurrent symptons, two of whom exhibited no caloric response. Caloric irregularity was noted in one patient.
Re-explorations were performed for patients with recurrent symptons, and after these re-explorations, no patients experienced further vertiginous attacks or unsteadiness. Two patients showed normal caloric response after the re-explorations, however, hearing losses were not improved after the re-explorations.

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Parapharyngeal Aneurysm of Internal Carotid Artery Causing Otitis Media with Effusion; A Case Report

Tatsuhisa HASEGAWA, Hiroki WATANABE, Masakatsu TAKI, Satoshi YAMAMOTO, ...

2001 Volume 94 Issue 7 Pages 595-599
Published: July 01, 2001
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.94.595

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A 65-year-old female was referred to Kyoto Pref ectural University of Medicine with a tumorous lesion revealed by nasopharyngeal fiberscopy on June 7th, 1999. Angiography of the carotid artery revealed a large aneurysm in parapharyngeal space that resulted in right otitis media with effusion. Ligation and embolization with GDcoil of the aneurysm was performed by the Neurosurgery Department of Kyoto Pref ectural University of Medicine.
Interventional radiology was useful for treating a case of aneurysm in the Parapharyngeal space.

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A Giant Epidermal Cyst of the Ear Lobe

Eiji TAKEUCHI, Hisao IZUKURA, Hiroya KITANO, Kazutomo KITAJIMA

2001 Volume 94 Issue 7 Pages 601-604
Published: July 01, 2001
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.94.601

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We report a case of a giant epidermal cyst of the ear lobe. Epidermal cysts are commonly observed on the face, neck and upper back. To the best of our knowledge, there have been no reports of a giant epidermal cyst of the ear lobe. A 48-year-old female exhibited painless swelling on the left ear lobe, which progressed over a period of several years. The giant tumor was resected under general anesthesia. Histopathology confirmed the diagnosis of a typical epidermal cyst. Epidermal cysts are thought to result from the proliferation of surface epidermal cells or to originate in the infundibular hair sheath. In recent years, epidermal cysts of the ear lobe have been reported due to ear piercing, and it is of note that this epidermal cyst was of a markedly large size.

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Clinical Outcome of 19 Patients with Nasopharyngeal Cancer A Review of Neo-Adjuvant Chemotherapy

Masayuki SAKAMOTO, Nobuo KITHARA, Keiichi ICHIMURA, Satoshi ASANUMA, K ...

2001 Volume 94 Issue 7 Pages 605-609
Published: July 01, 2001
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.94.605

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We clinically examined 19 cases of nasopharyngeal cancer in which primary care was administered in the Department of Otolaryngology, Tokyo Metropolitan Fuchu Hospital between September 1990 and August 1999. The subjects consisted of 11 males and 8 females. Histophathological study revealed 17 cases of WHO type III tumors (14 cases were poorly differentiated squamous cell carcinoma and 3 cases were lymph-epithelioma). The accumulated 5-year survival rate by the Kaplan-Meier method was 50% in T1, 75% in T2, 0% in T4, and 36% overall. Neo-adjuvant chemotherapy was administered in 15 cases and distant metastasis appeared in 3 cases (21%) after definitive radiotherapy. The biological characteristic of WHO type TIE tumors is a tendency towards early metastasis, and we speculated that this might be the cause of the lower level of effectiveness of the neo-adjuvant chemotherapy in these cases. At present, this therapy is not effective and further improvement is required.

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MALT Type Lymphoma in the Base of the Tongue

Takashi GOTO, Akihito WATANABE, Shinichi KAWABORI, Yasuaki HARABUCHI

2001 Volume 94 Issue 7 Pages 611-616
Published: July 01, 2001
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.94.611

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A 64-year-old woman was referred to our hospital, exhibiting xerostomia and complaining of a feeling foreign body in her tongue. A submucosal swelling on the left side in the base of the tongue was subsequenctly resected. Histopathological examination showed a marginal zone B-cell lymphoma of MALT type. Treatment consisted of local radiotherapy. To our knowledge, only one case of MALT lymphoma in the base of tongue has been reported. The clinical behavior of MALT lymphomas is quite distinct from other types and requires proper recognition in order to prevent misdiagnosis or overtreatment.

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Effects of Radiotherapy on the Sense of Taste

Masayoshi Uneyama, Harumi Suzaki

2001 Volume 94 Issue 7 Pages 617-625
Published: July 01, 2001
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.94.617

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The adverse effects of radiotherapy for cancer in the head and neck region include impairment of the sense of taste and smell and dry mouth. The present study was conducted to examine the effects of such radiotherapy on the sense of taste, in view of its influence on the quality of life of patients with malignant tumors of the head and neck following treatment.
In 18 patients with malignant tumors of the head and neck (mean age, 59.9 years) the sense of taste was tested using the filter-paper disc method, serially before and after radiotherapy with ⁶⁰Co γ rays, in order to analyze the changes in gustatory threshold after radiotherapy. The patients were also observed for subjective symptoms, including dry mouth and impairment of the sense of taste, and changes in the lingual surface over the course of radiotherapy.
No increase in the gustatory threshold or subjective impairment of the sense of taste was noted after radiotherapy when the field of irradiation did not include the tongue (4 cases of laryngeal cancer). When the field of irradiation included a part of the tongue (3 cases of maxillary cancer, 3 cases of hypopharyngeal cancer, 1 case of epipharyngeal cancer) or the entire tongue (2 cases of lingual cancer, 2 cases of cancer of the floor of the mouth, 3 cases of mesopharyngeal cancer), dry mouth was noted after irradiation at 7.2-39.6 Gy, and the gustatory threshold increased after irradiation at 12-40 Gy. Subjective impairment of the sense of taste was also reported after irradiation at 10-25.2 Gy, which was restored to normal within 2-3 months after the end of radiotherapy. In relation to the quality of taste, the gustatory threshold for sweet tastes increased the slowest, and was restored rapidly. In contrast, the gustatory threshold for sour tastes increased most rapidly, and was restored slowly. The relationship between the serum zinc level and the increase in gustatory threshold was unclear. There was a tendency for the lingual surface to become dry with associated redness, swelling of the lingual papillae, and coating of the tongue as the radiation dose increased.
The increase in gustatory threshold after radiotherapy appeared to depend on the surface area of the tongue included in the field of irradiation. Based on the results of the present study we suggest that impairment of the sense of taste following radiotherapy is attributable to a disorder of the taste buds occurring at the level of the peripheral nervous system.

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Epiglottic Pleomorphic Adenoma and Hypopharyngeal Lipoma Causing Airway Obstruction

Yayoi SUZUKI, Hitoshi TOJIMA, Keiichi ICHIMURA

2001 Volume 94 Issue 7 Pages 627-633
Published: July 01, 2001
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.94.627

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Only a few cases of benign tumors in the larynx and hypopharynx have been reported in the literature. Benign tumors in this area can take prolonged courses and may cause serious consequences. This report discusses a case of pleomorphic adenoma of the larynx and a case of large hypopharyngeal lipoma both of which resulted in sudden airway obstruction.
Case 1 was a 47-year-old male who complained of a sore throat while swallowing. A yellow, large smooth tumor in the epiglottis expanding from glottic surface to laryngeal surface was revealed using fiberscopy. Immunohistochemistry of the biopsy specimen suggested the tumor was a pleomorphic adenoma, and subsequently a treacheostomy was performed to relieve the airway obstruction. The tumor was completely excised via a horizontal laryngectomy.
Case 2 was a 58-year-old female who experienced suffocation while eating. Fiberscopy showed a yellow, large smooth tumor expanding from hypopharynx to aryepiglottic fold. Biopsy and an emergency tracheostomy was performed. The tumor was removed completely via a lateral pharyngotomy approach. The 5.5×4.3×2.7cm tumor was pathologically diagnosed as lipoma, and was contained within the thyropharyngeal muscle, intramuscular type.

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Primary Malignant Lymphoma of the Thyroid

Kimiko NAITOH, Katsunari YANE, Hirokazu UEMURA, Hiroaki NAITOH, Hirosh ...

2001 Volume 94 Issue 7 Pages 635-638
Published: July 01, 2001
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.94.635

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Out of 78 cases of non-Hodgkin's lymphoma (11.5%) and 263 cases of thyroid cancer (3.4%), 9 cases of primary malignant lymphoma of the thyroid were treated at our hospital from 1986 to 1996. These patients comprised 5 males and 4 females ranging in age from 44 to 84 years (median, 68 years). Histopathologically, 5 cases were diffuse mixed type, 3 cases were diffuse large type, and only one case was small lymphocytic type according to the Working Formulation classification. The clinical stage was classified as stage I in 2 cases, stage II in 5 cases and stage III in 2 cases.
In 7 cases rapid enlargement of tumor within 3 months was observed and in 4 cases Hashimoto's thyroiditis was performed.
We performed fine needle aspiration biopsy (FNA) in 8 patients, but only 2 cases were diagnosed accurately, and ultrasonography was used in 5 patients, but only 2 cases were diagnosed accurately; thus, FNA and ultrasonography were not useful to detect and diagnose thyroid malignant lymphoma. Patients with Hashimoto's thyroiditis and rapid enlargement of the tumor should be considered to have malignant lymphoma and immediate open biopsy should be performed.
Of our 9 patients, 4 patients were treated with combined chemotherapy and radiation, 2 with surgery, chemotherapy and radiation, 2 with radiation only, and one with chemotherapy only, and two patients in stage III died soon after treatment. Thyroid malignant lymphoma does not always show a good prognosis, and it is important to diagnose in the early stage and to start radiotherapy combined with chemotherapy immediately.

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Clinical Outcome of Thyroid Occult Carcinoma Revealed by Lymph Node Metastasis

Keiichi CHIJIWA, Shinsuke IZUMARU, Yasuo TOYOZUMI, Youichi MATSUDA, Hi ...

2001 Volume 94 Issue 7 Pages 639-643
Published: July 01, 2001
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.94.639

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We retrospectively reviewed thyroid occult carcinomas that were first detected as cervical lymph node metastasis at our hospital. Between 1980 and 1999, and found that of 481 patients with thyroid carcinomas who underwent treatment at the Kurume University Hospital 11 cases (2.3%) were diagnosed as thyroid occult carcinoma based on cervical lymph node biopsy. Histologically 10 of these patients were diagnosed with papillary carcinoma and 1 patient with follicular carcinoma. Preoperative ultrasonography was performed in 10 patients with papillary carcinoma, and in 2 cases, small high echoic spots were detected but there was no evidence of tumors. In the other 8 cases, there were no abnormal findings in the thyroid.
Unilateral neck dissection with thyroid lobectomy was performed in seven cases and unilateral or bilateral neck dissection with total thyroidectomy was performed in four cases. In all the cases, postoperative pathological examination confirmed at least one microcarcinoma 1.0cm or less in diameter in the thyroid. In 5 cases, multif ocal tumors were proven histologically.
Nine patients were alive at between 1 year and 13 years postoperatively and two patients died from other diseases without any evidence of recurrence of the thyroid carcinoma.

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A Case of Granulocytic Sarcoma Occurring as Neck Lymph Node Swelling

Yuko KATAOKA, Hirofumi AKAGI, Nobuhiko KIMURA, Tomoko NAKASHIMA, Teruh ...

2001 Volume 94 Issue 7 Pages 645-648
Published: July 01, 2001
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.94.645

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Granulocytic sarcoma was first described by Burns in 1811 and it is known to be an extramedullary tumor composed of immature precursor cells. It sometimes occurs with acute myeloid leukemia or myeloproliferative disorders, but there have been reports of cases occurring without such hematological disorders. A 40-year-old female with a chief complaint of neck swelling was examined in our department in 1997. CT scan showed bilateral neck lymph nodes swelling. Histological examination of open biopsy confirmed myeloblastic-type tumor cells, but peripheral blood and bone marrow examination showed no evidence of leukemia. The final diagnosis of this case was granulocytic sarcoma without hematological disorder.

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Genetic Testing to Identify the Common GJB2 233delC Mutation

Yuka FUSE, Katsumi DOI, Naoki MATSUSHIRO, Hiroshi HIBINO, Takayuki KAW ...

2001 Volume 94 Issue 7 Pages 649-656
Published: July 01, 2001
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.94.649

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Mutations in the GJB2 gene are the most common cause of prelingual deafness, accounting for approximately half of all nonsyndromic recessive deafness. Among Japanese, the 233delC mutation, in which one cytosine (C) residue is deleted from a run of 3 Cs at necleotide position 233-235, with a carrier frequency of 1% is particularly common. The 233delC mutation is found in 50-70% Japanese patients with nonsyndromic recessive deafness. We have developed a genetic testing/technique that consists of Apa I and Bsp1286 I restriction analysis of polymerase chain reaction (PCR)-amplified 371 base pair DNA fragment of GJB2 gene, to identify this common mutation. This test provides a quick and reliable screening method for the common 233delC mutation. Genetic testing should be added to audiometric screening to identify children with prelingual deafness.

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The Effects of Livostin on Treatment of Patients with Seasonal Grass Pollinosis

Nobuo OHTA, Naoko KASAJIMA, Akihiro ISHIDA, Masaru AOYAGI

2001 Volume 94 Issue 7 Pages 657-663
Published: July 01, 2001
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.94.657

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The clinical effects of Livostin on patients with seasonal grass pollinosis were investigated by compairing the symptom, medication and symptom-medication scores before and after treatment, we found that the scores after treatment were significantly lower than those before treatment.
These findindgs indicate that levocabastine hydrochloride is useful for the treatment of seasonal grass pollinosis.

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Anatomical Morphology in Posterior Hypotympanotomy

[in Japanese]

2001 Volume 94 Issue 7 Pages 664-665
Published: July 01, 2001
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.94.664

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