Selected Papers Vol. 106 No. 1-6
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Haruka Kodama, Yoshihiko Kumai, Momoko Ise, Eiji Yumoto
2013 Volume 137 Pages
102-103
Published: 2013
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Although the presence of a non-recurrent inferior laryngeal nerve (NRILN) is rare, surgeons occasionally encounter this anomaly during thyroid and parathyroid surgery. It is usually due to anomalous nerve and blood vessel development from the embryonic branchial arches.
We recently encountered two patients with NRILN. One represented type 1 branching from the vagus trunk at the level of the inferior thyroid artery, and the other, type 2 branching at the level of the superior pole of the thyroid gland.
Avoiding injury to the inferior laryngeal nerve is a major consideration during thyroid and parathyroid surgery. Because in most cases, including our two cases, NRILNs are associated with anomalous origin of the right subclavian artery from the aortic arch, this anomaly can be predicted by imaging procedures. Therefore, surgeons must pay careful attention to the preoperative examination findings in order to reduce the risk of injury of this nerve.
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Atsuyoshi Asahi, Akihiro Katada, Yasuaki Harabuchi
2013 Volume 137 Pages
104-105
Published: 2013
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We recently encountered a case of laryngeal amyloidosis. The patient was a 58-year-old man who presented with the complaint of stridor. Fiberoptic laryngoscopy revealed yellow smooth-surfaced tumors in the left arytenoid and in the subglottis. The biopsy findings were consistent with amyloidosis. The mass in the arytenoid was treated by laryngomicrosurgery, and the mass in the subglottis was treated by endoscopic surgery with tracheostomy. There have been no remarkable signs of recurrence since the surgeries.
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Toshikazu Shimane, Kenichiro Ikeda, Kenichiro Kawaguchi, Yuko Shimotat ...
2013 Volume 137 Pages
106-107
Published: 2013
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Schwannomas are tumors arising from schwann cells and typically occur in the cranial, autonomic and peripheral nerves. It is difficult to diagnose schwannomas prior to surgery, and it is not unusual to find a different tumor during the actual surgery. The differential diagnosis of a mass in the head and neck region is broad, and patients referred with a suspected schwannoma require careful review of the findings and clinical scenario because of the presence of other rare tumors. Surgery was performed in accordance with the working diagnosis for patients referred to our hospital with suspected schwannoma, but a histopathological examination indicated that rather than schwannoma, the patients had abdominal wall desmoid tumors, malignant lymphomas, hemangiomas, angiosarcomas or relatively rare carotid body tumors. Therefore, in this study, we examined whether a differential diagnosis might have been possible prior to surgery. The results revealed factors important for differential diagnosis as follows: clinical course, tumor mobility and pain and hard, MRI, ultrasound, fine-needle aspiration cytology and FDG-PET. If all these fundamental factors are reconfirmed during the initial examination of referred patients, we believe that clues will appear that will discount schwannoma in many cases. However, with rare tumors, there were still cases where it was difficult to make a definitive diagnosis that it was not schwannoma.
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Takahiro Kitamura, Takayuki Kawashima, Yoshinori Koike, Hironori Takeb ...
2013 Volume 137 Pages
108-109
Published: 2013
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We report herein on 15 cases of pulmonary metastases from squamous cell carcinoma of the head and neck (SCCHN) treated with modified TPF chemotherapy (docetaxel combined with nedaplatin and 5-FU). TPF chemotherapy is known as a neoajuvant chemotherapy regimen. We modified the TPF chemotherapy using nedaplatin as a substitute for cisplatin. We tried 4 courses of modified TPF chemotherapy every 3 weeks, docetaxel 60 mg/m
2 on day 1; nedaplatin 75 mg/m
2 on day 1 and 5-FU 1000 mg/body by continuous infusion on days 1 to 4. 11 patients received 4 courses, and the remaining of 4 patients recieved 1-3 courses because of their poor general condition. Of the 15 patients, 13 were males and 2 were females with ages ranging from 43 to 73 years (mean, 59.1 yr). Two of the primary sites were in the nasopharynx, 2 in orophanrynx, 4 in the hypopharynx, 2 in the larynx and 4 in the oral cavity. Clinically there were 7 complete responders, 4 partial responders, 2 with no change, and 2 with progressive disease. The mean overall survival was 46.5 months. TPF chemotherapy may improve the overall survival.
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Risa Tona, Shogo Shinohara, Masahiro Kikuchi, Keizo Fujiwara, Hiroshi ...
2013 Volume 137 Pages
110-111
Published: 2013
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In the period from April, 2004 to March, 2010, we retrospectively reviewed 286 patients who were newly-diagnosed as squamous cell carcinoma of the head and neck (HNSCC), in order to investigate the incidence of multiple primary malignancies and the overall survival rate of such patients, and the therapeutic strategy to deal with them.
In 83 patients (29%) other primary malignancies were revealed, 35 patients (12%) synchronously and 48 patients (17%) metachronously. The 5-year overall survival rates shown with the Kaplan-Meier method were 74% for single primary malignancy, and 49% and 70% for synchronous and metachronous multiple malignancies, respectively. The overall survival of patients with synchronous multiple malignancies was significantly worse than those with single primary malignancy, while the difference between single and metachronous cases was not significant. The therapeutic strategies for synchronous multiple malignancies were decided according to the following policies. 1) Treatment of more advanced cancer went ahead when simultaneous treatments of both malignancies were difficult. 2) As simultaneous operation for both lesions was considered if safely possible. 3) An endoscopic resection for the other gastrointestinal tract malignancy could be performed at a convenient time for HNSCC treatment. 4) The choice of synchronous or metachronous radiation for multiple lesions depended on the total range of radiation fields and the purpose of treatment. Upper gastrointestinal endoscopy and FDG-PET are recommended in patients with untreated HNSCC, because the ratio of synchronous primary malignancy was as high as 12%. Although synchronous multiple malignancies including HNSCC should be considered according to the stage and the location of each lesion, we discuss the relevant therapeutic strategies.
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Shinji Takebayashi, Takushi Miyoshi, Chiaki Suzuki, Nao Hiwatashi, Hir ...
2013 Volume 137 Pages
112-113
Published: 2013
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Formation of thyroid nodules is a common clinical problem. Fine-needle aspiration biopsy (FNAB) is the most useful examination to triage patients for surgical treatment. On the other hand, Hashimoto′s thyroiditis is often associated with thyroid nodules and presence of autoantibodies against the thyroid gland. The present study examined whether autoantibodies against the thyroid could affect the distribution of the FNAB diagnosis. We retrospectively studied 817 patients who underwent FNAB and measurement of serum antibodies against thyroglobulin (Tg) and thyroid peroxidase (TPO) between July 2008 and December 2011. Statistical analysis was performed to determine the relationship between FNAB results and the presence of autoimmune antibodies against thyroid. FNAB results were classified into 4 categories: unsatisfactory material, benign, indeterminate and malignant cytology. The rate of unsatisfactory material was less from the patients with either Tg or TPO antibodies than from those without Tg and TPO antibodies. There was no statistical difference in the rate of indeterminate or malignant cytology between the patients with and without these autoantibodies. Moreover, although no significant difference in the frequency of papillary carcinoma was found between with and without autoantibodies against the thyroid, malignant lymphoma was found only in the patients with these autoantibodies. In conclusion, although autoimmune antibodies against Tg or TPO decreased the rate of unsatisfactory material during FNAB diagnosis, they did not affect the rate of indeterminate or malignant cytology.
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Akiko Wakatsuki, Akira Nishikado, Shinpei Ichihara, Koutetsu Lee, Ryo ...
2013 Volume 137 Pages
114-115
Published: 2013
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Paraganglioma represent vascular neoplastic tumors that arise from chemoreceptors located in the wall of blood vessels or are associated with specific nerves. The site of origin defines the name given to these tumors, and they most commonly occur at the carotid bifurcation where they are known as carotid body tumors (CBT). A malignant form of CBT, malignant CBT is uncommon. We report herein on a case of malignant CBT in a 70-year-old woman. The patient complained of a lateral cervical mass on the right side four years previously. The tumor had become gradually larger and tender. Enhanced CT scan and carotid angiography revealed a vascular-rich tumor of the right carotid bifurcation. Fine-needle aspiration biopsy of the mass showed variation in nuclear size. A resection was performed after vascular embolization. Histopathologically, the tumor cells were positive for chromogranin A, synaptophysin and CD56. Scattered sustentacular cells were positive for S-100 protein. Moreover the specimens showed vessel invasion and extracapsular tumor invasion. This case was diagnosed as malignant CBT taking both the clinical findings and the histopathological sides into consideration. The patient had no problem after the operation. Observation of the patient’s progress is due to be performed carefully in the future.
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Yukihiro Hiraga, Junichi Kou
2013 Volume 137 Pages
116-117
Published: 2013
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Anaplastic thyroid carcinoma is a rare and lethal human malignancy. In this paper, we report on a case of a 55-year-old man who had undergone radiation therapy on the cervical region for malignant lymphoma at 14 years of age, and had been consulting our hospital for 19 years. He underwent a left hemithyroidectomy for papillary thyroid carcinoma at the age of 35, and 11 years after that a total thyroidectomy was performed for cervical nodal disease. After the operation he underwent radioiodine therapy twice. Five years after radiotherapy, anaplastic carcinomas arose in the left cervix and the cranium. Soon after complete resections of the tumors, systemic metastases were detected with FDG-PET. Finally, 11 months after the operation, he died in our palliative care unit at the age of 55 due to frequent bleeding from a palatal carcinoma.
A review of the literature showed that the age at which the tumor arose, namely the peak of the patient’s life, was earlier than was usually reported. The survival time of 11 months observed in our patient was more than that generally observed in patients with anaplastic carcinoma.
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Akihiro Uemura, Miki Takahara, Toshihiro Nagato, Seigo Ueda, Tatsuya H ...
2013 Volume 137 Pages
118-119
Published: 2013
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We report a rare case of papillary carcinoma of the thyroglossal duct. A 30-year-old woman visited our hospital with the chief complaint of a mass in the anterior neck. Although a cyst of the thyroglossal duct was suspected on physical examination, imaging examinations, including ultrasound, CT, and MRI revealed a solid pattern of the tumor mass. Fine needle aspiration cytology revealed malignant cells of papillary carcinoma origin. Surgical resection of the tumor mass along with a part of the hyoid bone was performed. Papillary carcinoma of the thyroglossal duct was confirmed by histopathological examination.
Papillary carcinoma originating from the thyroglossal duct is relatively rare. However, it is important to keep the possibility of carcinoma of the thyroglossal duct in mind.
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Masaki Kawabata, Kosuke Yoshifuku, Hiromi Nagano, Yuichi Kurono
2013 Volume 137 Pages
120-121
Published: 2013
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Amyloidosis comprises a diverse group of disorders characterized by the deposion of amyloid protein in various organs and extracellular tissues. Clinically, it has been classified into systemic and localized forms. Amyloidoma, a very uncommon presentation of amyloidosis, could be defined as a solitary localized tumor-like deposit of amyloid in the absence of systemic amyloidosis. We present a case report of amyloidoma of the neck in an 83-year old man with laryngeal carcinoma. Localized deposits of amyloid occurring throughout the upper aerodigestive tract have been described, but such deposits have rarely been reported in the soft tissues of the neck.
On physical examination, an immobile and elastic hard mass was palpable in the neck. A CT of the neck region revealed a poorly enhancing mass in the right submandibular region. On MRI, the mass was visualized as a hypointensity on both T1 and T2-weighted images.
18FDG PET-CT revealed a high FDG uptake in the mass, with a maximum standardized uptake value (SUV
max) of 5.9. The mass was surgically removed. Histopathological examination revealed AL amyloidosis. Systemic amyloidosis was excluded by several examinations. The patient was still disease-free at the 12-month follow-up.
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Isaku Okamoto
2013 Volume 137 Pages
122-123
Published: 2013
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The pleura is the most common site of solitary fibrous tumors (SFTs), while such tumors are relatively rare in the head and neck region. This report documents two cases with SFTs developing in the parapharyngeal space. In total, 76 patients with tumors of the parapharyngeal space were operated on under general anesthesia between 2005 and 2012 at the Department of Head and Neck Oncology and Surgery, International University of Health and Welfare. SFT accounted for 2.6% of the cases (2 patients).
The two patients were a 77-year-old man and a 57-year-old woman. Their conditions were diagnosed as SFTs based on postoperative immunohistological test results showing the lesions to be positive for CD34, bcl-2, and vimentin and negative for S-100. Only 11 cases with SFT in the parapharyngeal space have been reported in the literature, to date. Hence, SFT is an extremely rare disease.
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Takeshi Kusunoki, Toshio Monjyu, Katsuhisa Ikeda
2013 Volume 137 Pages
124-125
Published: 2013
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At the otorhinolaryngology out-patient clinic of our hospital, from April 2011 to March 2012, voice therapy was performed based on a simple method of voice training which placed great importance on the abdominal type of respiration. Eight cases with vocal fold nodules, 6 cases with vocal fold polyps and 6 cases with laryngeal granulomas underwent our method of voice training. The results are summarized as follows. From the 8 cases with vocal fold nodules who followed our method of voice training, disappearance was seen within 3 months in 7 cases and reduction in 1 case. In 5 of 6 cases with vocal fold polyps and 3 of 6 cases with laryngeal granulomas, reduction or disappearance was seen. Voice therapy is recognized as the first choice for treatment of vocal fold nodules. These results suggested that our method of voice training could be useful for some cases of vocal fold polyps and laryngeal granulomas, in addition to vocal fold nodules.
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Takayuki Ota, Koichiro Nishiyama, Kazuo Matsui, Kouichi Kure, Yoshihik ...
2013 Volume 137 Pages
126-127
Published: 2013
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In recent years, there are many reports about percutaneous dilatational tracheostomy (PDT). This procedure has been reported as being simple to perform and has less complications. However, we experienced a case in which a tracheostoma stenosis and granulation hyperplasia occurred due to PDT, and dysphagia occurred because of the defective laryngeal elevation.
A 79 years old woman presented with disturbance of consciousness due to a subarachnoid hemorrhage and PDT was performed at an intensive care unit. Following the procedure she was quadriplegic with dysphagia and had to continue rehabilitation. Because of the dysphagia and difficulty in the management of the tracheotomy tube, she was referred to us.
We selected laryngeal closure as preventive surgery against aspiration, and obtained a good result.
PDT complications have also been reported in several studies.
As the procedure is performed blindly, the tube may not be placed medially in the trachea or it may happen to break tracheal cartilages. When particularly long-term breathing management is necessary, we think that surgical tracheotomy associated with very few occurrences of tracheostoma stenosis and granulation hyperplasia is desirable.
In addition, the operation that we performed was useful because it was hard to make a diastasis and it was easy to make a permanent tracheal stoma. In those patients with a tracheostoma and dysphagia, we would like to recommend a laryngeal closure operation.
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Morimasa Kitamura, Shigeru Hirano, Ichiro Tateya, Shinpei Kada, Seiji ...
2013 Volume 137 Pages
128-129
Published: 2013
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Intratracheal ectopic thyroid tissue is a rare cause of upper respiratory obstruction. The first symptom may be a wheeze, so it can be mistaken for asthma.
A 45-year-old female was admitted to our hospital with gradually progressive dyspnea over a period of 1 year. CT scan showed a tumor in the tracheal lumen subglottically with about 90% narrowing. The patient underwent bronchoscopy which demonstrated a broad-based, smooth, round and submucosal mass from the left posterolateral tracheal wall. A biopsy was deferred because the tumor demonstrated hypervascularity. A tracheostomy was performed, and a biopsy was undertaken via an open tracheal approach under general anesthesia. Histopathology confirmed benign thyroid tissue. The tumor was diagnosed as intratracheal ectopic thyroid and resected from trachea. The patient has done well for 2 years after surgery.
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Midori Hayama, Hiroyuki Enomoto, Nozomu Tamaki, Ai Yoshitomi, Masahiro ...
2013 Volume 137 Pages
130-131
Published: 2013
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Actinomycosis is an unusual inflammatory disease caused primarily by
Actinomyces israelii, which is one of the Gram-positive anaerobic bacteria. The disease is characterized by an unclear border, board-like swelling and multiple abscess, so it is similar to a malignant tumor and the diagnosis of the disease is difficult. We report on a suspected case of actinomycosis in the neck based on an abscess smear. The patient, a 67-year-old man, visited our hospital with a swelling on his right neck. A smear of the neck abscess was characteristic of
Actinomyces, but the smear culture showed no bacteria. We resected the neck mass under general anesthesia, and diagnosed this case as actinomycosis based on the pathological findings. After surgery, we prescribed amoxcillin (AMPC) for 3 months, and the patient has shown no sign of recurrence.
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Hitoshi Nishikawa, Toshimitsu Kobayashi
2013 Volume 137 Pages
132-133
Published: 2013
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Tocilizumab, an anti-interleukin (IL)-6 receptor antibody, has shown clinically therapeutic effectiveness against rheumatoid arthritis (RA). However, this agent can potentially cause severe infection during treatment, and reportedly suppresses early symptoms of infection and laboratory findings, in a phenomenon known as masking. In the field of otolaryngology, reported cases with severe infection and masking are almost nonexistent. We report herein on the case of a patient who developed acute and severe deep neck infection with septic shock during tocilizumab treatment for RA. A 61-year-old woman with a 21-month history of treatment with tocilizumab for RA was referred to our emergency department with acute neck swelling shock, and a systolic blood pressure of 60 mmHg on day 2 after onset. Wide neck swelling and stenosis of the upper respiratory tract due to severe swelling of the pharyngolaryngeal mucosa necessitated emergency intubation and hospitalization in the intensive care unit. Although the patient was treated with antibiotics (meropenem and clindamycin), stenosis of upper respiratory tract became aggravated again and she required re-intubation and a tracheostomy. Multidrug-resistant
Staphylococcus epidermidis (MRSE) infection developed during treatment and she needed 46 days in hospital until discharge. Body temperature and C-reactive protein levels during this episode were relatively low compared with local findings such as swelling. This discrepancy is probably attributable to the suppression of IL-6. The growing use of anti-IL-6R therapy might result in an increased frequency of masked acute, and severe infections such as in our present case. Clarifying any history of tocilizumab use and, if such a history is present, placing an emphasis on local findings might help to prevent and manage such adverse events.
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Momoko Kageyama, Yoshinori Takizawa, Kenichi Sugiyama, Goro Takahashi, ...
2013 Volume 137 Pages
134-
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Most cases of deep neck infection are due to oral and pharyngolaryngeal inflammation. Descending necrotizing mediastinitis (DNM) can be occasionally caused by deep neck infection and has a high mortality rate, so rapid diagnosis and treatment are essential. We experienced a case of DNM. The patient was a 76-year-old male with sore throat. CT imaging revealed a neck abscess, so we started antibiotic administration. Despite improvement in the patient’s general condition and inflammatory response, he had difficulty in swallowing during the course of the treatment and we performed CT imaging again. An abscess was confirmed in the mediastinum, but a neck abscess was not found at the time. Thoracotomic drainage was performed with antibiotic treatment, and the patient recovered. This case suggests that we should take note of swallowing disturbance as the sign of a potential abscess. CT imaging is very useful for determining whether to perform surgery, including transcervical, mediastinal, or thoracotomic drainage.
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Sawako Tanke, Yumi Ohta, Taro Hasegawa, Atsuhiko Uno, Takao Imai, Tets ...
2013 Volume 137 Pages
136-137
Published: 2013
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We report herein on a 6-year-old girl with atlanto-axial rotatory fixation (AARF) which occurred after cochlear implantation under general anesthesia. The cochlear implantation procedure appeared normal, and took 3 hours and 50 minutes. On the 1
st postoperative day, the patient complained of neck and shoulder pain but she could rotate her head. On the 4
th postoperative day, she had torticollis without any neurologic damage and neither active nor passive rotation of the head could be achieved. She was diagnosed as having AARF on the basis of the computed tomographic findings. She was treated with Glisson’s traction for 4 days to correct the deformity.
AARF is a rare disorder and its diagnosis is often difficult and delayed. CT scans, especially 3-D reconstruction, are useful to diagnose AARF. It is suggested that AARF can occur after a cervical injury or an upper respiratory tract infection. AARF is also occasionally caused after head and neck surgical procedures such as pharyngeal flap plasty, ear surgery, and plastic surgery for microtia. It is important to be aware of the possible occurrence AARF and to start appropriate treatment as soon as possible.
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Koichi Hashida, Shoji Ikezaki, Fumiko Takenaga, Toshiaki Sanka, Hiroki ...
2013 Volume 137 Pages
138-139
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The extracranial carotid artery pseudoaneurysm is a rare vascular lesion. We report herein on such a case caused by bacterial infection. A 70-year-old man presented with a 2-week history of left-sided painful cervical swelling. Enhanced CT and ultrasonography examinations revealed a low density and hypoechoic lesion with ring enhancement surrounding the left carotid artery bifurcation. A deep neck abscess was suspected, and the patient received antimicrobial chemotherapy. The mass decreased in size, but did not disappear. Ultrasonography was then performed again, and a blood stream flowing into the mass was identified. Considering the results of serological tests and other imaging findings, the lesion was finally diagnosed as an extracranial carotid artery pseudoaneurysm. The patient underwent carotid artery stenting, and is currently free from disease 7 months after treatment. The clinical characteristics, diagnosis and management of carotid artery pseudoaneurysm were bibliographically reviewed.
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Masami Nakajima, Masami Osaki, Osamu Hida, Mutsuko Hara, Eikichi Tokun ...
2013 Volume 137 Pages
140-141
Published: 2013
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Patients with rheumatoid arthritis (RA) have a tendency towards an increased incidence of oral disease, and the use of steroids or immunosuppressive drug to treat RA exacerbates their infections and, sometimes even causes serious infections. We present two cases of deep neck infection in RA patients who had a long history of RA treatment. In both patients septic shock occurred with serious early stage infection, however there were remarkable differences between the patients regarding their treatment periods and complications. The patient who underwent steroid therapy at the early stage of their infection had a particularly shorter treatment period and milder complications. It would appear from our limited results that steroid therapy is essential for immunosuppressed patients, such as our two cases, when serious infections occur.
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Ai Kawamoto, Masaki Ogura, Yukio Katori
2013 Volume 137 Pages
142-143
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We report herein on three cases of tuberculosis in the neck region experienced during a recent 1-year period. Two cases started with lymphadenopathy and the other started with subcutaneous abscess. Examinations and diagnosis for the tuberculosis were delayed for several weeks, because neither respiratory symptoms nor past and family histories for the tuberculosis were seen in any of the cases. In the examinations to make a diagnosis of tuberculosis, QuantiFERON
® TB-2G (QFT) was effective in all three cases. After the diagnosis, all cases were treated with combination chemotherapy of four anti-tuberculosis drugs and the clinical symptoms gradually decreased. Bearing tuberculosis in mind is important in patients with extended lymphadenopathy and infectious regions in the neck.
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Hirotatsu Ohara, Shuho Tanaka, Masae Komeno, Akira Hara
2013 Volume 137 Pages
144-145
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Primary ciliary dyskinesia (PCD) is a rare, autosomal recessive disease with abnormalities of the ciliary structure and function, which causes impaired mucociliary clearance. Patients with PCD present with rhinitis, sinusitis, otitis media with effusion, recurrent lower respiratory tract infections, and/or bronchiectasis. Approximately half of PCD patients have situs inversus totalis, called Kartagener’s syndrome. The absence of clinical or laboratory signs makes PCD difficult to be diagnosed. However, it is important to recognize this disease in order to make the correct diagnosis so as to start appropriate therapy for the respiratory tract infections and to minimise lung damage. Early diagnosis and effective treatment result in prevention of PCD progression. The diagnosis of PCD has relied on analysis of ciliary ultrastructure anomalies with electron microscopy. However, taking biopsy specimens from the conchal mucosa or bronchus mucosa is not easy for general doctors. Therefore, the diagnosis of PCD is often delayed or missed or made incorrectly. In two of the three patients with PCD presented herein, we obtained biopsy specimens from the inferior turbinate mucosa under local anesthesia. Consequently, the patients were diagnosed as having PCD. Another patient who had been diagnosed as having Kartagener’s syndrome had pneumonia, and we performed a tracheostomy. In this article, we emphasize the role of the otolaryngologist in the diagnosis and treatment of PCD.
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Tatsuya Furukawa, Naoki Otsuki, Hidetoshi Matsui, Ken-ichi Nibu
2013 Volume 137 Pages
146-147
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Impalement injuries of the head and neck are extremely rare. We report herein on a 62-year-old man with an impalement injury in the head and neck region from the branch of a tree. He fell into a ditch and a tree branch penetrated through his left cheek to the posterior region of his neck. Contrast enhanced CT showed that it had penetrated through the parotid gland and passed near the retromandibular vein. The tree stick was successfully removed under general anesthesia without cervical incision. Although a salivary fistula occurred temporally after removal, no other sequela was observed. Preoperative contrast enhanced CT is useful to prevent complications in removal of foreign bodies in the parotid gland.
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Isao Suzaki, Ryuzaburo Higo, Taisuke Hamasaki, Go Takahashi, Harumi Su ...
2013 Volume 137 Pages
148-149
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We report herein on an impalement injury in a 76-year-old woman caused by a wooden chair accessory that penetrated through her neck into the oral cavity.
The penetrating object had already been removed when the patient was brought to our clinic. Enhanced CT showed emphysema from the retropharyngeal space to the right lateral neck, but there was no damage to major vessels or submandibular gland.
Under general anesthesia, the wound was debrided. After the operation, the patient received administration of antibiotics. On day 12 after the surgery a videofluorographic study showed no leakage of the wound, and she started feeding orally. The postoperative course was good and the patient was discharged 18 days after surgery without any complications.
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Kayoko Hattori, Takeshi Morita, Kosaku Yamada, Nobuya Fujiki, Takatosh ...
2013 Volume 137 Pages
150-151
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We encountered a case of a cervical and mediastinal hematoma after a stellate ganglion block (SGB) which had been performed on a 64-year-old man with trigeminal herpetic pain. Thirty minutes after the first SGB, he noticed a swelling on his neck, which worsened gradually. Computed tomography revealed a hematoma extending in the retropharyngeal space from the cervical to the mediastinal area. We removed the hematoma via a transcervical approach and performed a tracheostomy. He underwent decannulation 5 days after the operation, and was discharged from hospital 16 days postoperatively. A cervical and mediastinal hematoma occurring after an SGB is a rare complication, but it causes airway obstruction and necessitates emergency airway management.
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Kazuhiro Ogi, Yasuhiro Manabe, Yukihiro Kimura, Shigeharu Fujieda
2013 Volume 137 Pages
152-153
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Recently, octreotide has been reported to be effective in the treatment of some cases of chylothorax and chylous peritoneal effusion. However, there are few reports on the use of octreotide in the fields of otorhinolaryngology and head-and-neck surgery. Herein, we present a case in which octreotide treatment was found to be beneficial to arrest chylous fluid leakage following neck dissection.
A 59-year-old woman with thyroid cancer and neck lymph node metastasis underwent total thyroidectomy with bilateral conservative D3a neck dissection. During the operation, the thoracic duct was cut and the tissue surrounding the chylous leakage was sutured and ligated. The patient was started on a low-fat diet on the third postoperative day (POD), and immediately, a large quantity of chylous fluid was found to drain out of the drainage tube. Intermittent subcutaneous administration of octreotide at a dose of 100 μg twice a day was started on the fourth POD. The chylous leakage from the drainage tube started to decrease noticeably from the day after the start of octreotide administration, almost stopping completely on the seventh POD. On the 12th POD, oral intake was resumed, however, no chylous fluid leakage was detected. The patient was discharged from the hospital on the 24th POD.
Thus, octreotide appears to be extremely effective for controlling chylous leakage after operation, and treatment with octreotide should be considered before attempting any surgical intervention.
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Kohichiro Shigeno
2013 Volume 137 Pages
154-155
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We examined efficient cleaning methods for steel instruments, i.e., aural speculum, nasal speculum, tongue depressor and forceps, and whether the use of any of these methods could skip cleaning instruments by hand at an otolaryngology outpatient clinic. The steel instruments that were used in the outpatient area and instruments contaminated with blood were cleaned either by hand, dipping in detergent, in a desk top washer-disinfector, or using an ultrasonic device. Before and after the cleaning, the remaining protein was measured by the Coomassie brilliant blue method. There were no significant differences in the residual amount of protein among the cleaning methods. The amount of residual protein was up to 60 μg per instrument. Except for those cleaned by hand, the amount of residual protein was below 30 μg per instrument for more than 90% of the instruments. Thus, steel instruments used at an otolaryngology outpatient clinic can be washed effectively by dipping them in detergent containing an enzyme cleaner, with no need for cleaning by hand. Instruments contaminated with blood can be expected to be cleaned securely and safely by both dipping in detergent containing an enzyme cleaner and ultrasonic cleaning.
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