Selected Papers Vol. 106 No. 7-12
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Toshifumi Sakata, Satoru Ohba, Takashi Nakagawa
2014 Volume 138 Pages
1-
Published: 2014
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As suitable practice guidelines have not yet been established for acute low-tone sensorineural hearing loss (ALHL), many doctors feel unsure about making a diagnosis based on their own methods for judgment. We administered questionnaire surveys on the conditions surrounding ALHL diagnoses to otolaryngologists in the Fukuoka area in Japan for the purpose of sharing medical practice-related information and to identify controversial issues. The results showed that suspected cases of ALHL had been treated as certain cases. During the year-long survey period, it was also estimated that about 50% of the total diagnosed patients completed treatment within 2 months, about 30% continued treatment for 2 months or more, and about 20% elected to discontinue treatment. For the treatment drug, isosorbide was used less frequently than steroids. When making a diagnosis, doctors did not limit themselves to diagnostic criteria, and aggressively tried to treat symptoms as ALHL when that was the suspected diagnosis. As criteria for determining the end of treatment, the survey results showed that treatment was sometimes concluded despite instability in either subjective symptoms or hearing impairment, and that it was sometimes concluded based on the patient’s wishes. Half of the patients referred from another hospital did not have actual written referrals, and some patients dropped out of treatment on their own accord, suggesting that some patients were concerned about the course of ALHL.
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Masakazu Hamamoto, Yukiyoshi Hyo, Hiroki Tanaka, Toshihiro Tachi, Nori ...
2014 Volume 138 Pages
2-3
Published: 2014
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Kawasaki disease (KD) is an idiopathic systemic vasculitis common in infants and children that affects predominantly small and medium-sized extraparenchymal muscular arteries. KD manifests various clinical symptoms, of which coronary aneurysms are the most important complication. However, the association of sensorineural hearing loss with KD is rare. A 7-year-old girl with KD was referred to our department with a chief complaint of hearing loss. In her hearing test, she showed a high degree of bilateral sensorineural hearing loss. Although the patient was treated with steroid pulse therapy (methylprednisolone), her hearing level deteriorated. Two weeks after steroid therapy, a slight improvement was seen. Thereafter, the patient started to use hearing aids. About one year has elapsed since the onset of hearing loss, but her hearing level has not improved.
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Yumiko Hikida, Atsuro Seki, Hiroyuki Mineta
2014 Volume 138 Pages
4-
Published: 2014
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We report two cases of intracranial hypotension. In one case, MRI showed typical findings, including diffuse thickening, enhancement of the dura mater, and pseudocyst at the level of C6 and 7 resulting from the leakage of CSF. In the other case, treatment with an epidural blood patch (EBP) improved his symptom, almost completely, although no typical findings were pointed out in MRI. The patient presented with bilateral mild hearing loss and abnormal eye movements before the application of the EBP, while the symptoms disappeared after the EBP application. Not all cases show typical findings, therefore, obtaining a proper history, including of any head injury, is important for the diagnosis of intracranial hypotension.
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Seiichiro Kamimura, Aki Endo, Koji Abe, Yoshiaki Kitamura, Noriaki Tak ...
2014 Volume 138 Pages
6-
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We report herein on an intractable case of MPO-ANCA-associated middle ear disease with sensorineural hearing loss and facial palsy. A 73-year-old female complained of otitis media-like symptoms, but the treatment for otitis media with effusion was ineffective. She then showed bilateral progressive sensorineural hearing loss and facial palsy. PR3-ANCA was negative, but MPO-ANCA was positive in the serum. CT imaging revealed that the lesion was limited to the middle ear cavity without lesions in the lung and kidney. Non-specific findings were obtained in the histopathological examination of granular tissue of the mastoid cavity. She was diagnosed as having MPO-ANCA-associated middle ear disease with sensorineural hearing loss and facial palsy on the basis of the clinical findings and we administered cyclophosphamide in addition to a steroid. Discontinuance of the immunosuppressive therapy was, however, forced because of bacterial infection. Thereafter, steroid therapy alone failed to improve the left deafness, right moderate sensorineural hearing loss and right facial palsy.
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Hiroshi Inui, Takashi Inui
2014 Volume 138 Pages
8-9
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The postoperative results for the simple myringoplasty with fibrin glue (Yuasa method) performed as a day surgery under local anesthesia between August 2000 and December 2012 were analyzed in 82 cases (75 cases of chronic otitis media, 4 cases of traumatic tympanic membrane perforation and others). The mean operating time was 37.4 minutes. The total rate of closure was 89.0%, and the total rate of successful hearing improvement was 91.5%. The perforations were classified into 4 groups. The rates of closure and successful hearing improvement were dropped in patients with large tympanic membrane perforation. In 4 patients with hearing aids who experienced the tympanic membrane perforations, the Yuasa method was performed to reduce the influence of conductive hearing loss. The patients’ subjective hearing levels all improved. Furthermore, for 32 cases who underwent the Yuasa method between January 2007 and December 2012, the patient satisfaction was examined using a questionary survey. During the postoperative stage, none of the patients experienced anxiety after their going home.
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Emiko Inuzuka, Satoshi Yoshioka, Seiji Horibe, Kensei Naito
2014 Volume 138 Pages
10-11
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We conducted a retrospective epidemiological survey to clarify the current status of otitis media with effusion (hereafter, OME) at the time of primary cleft palate surgery at our otorhinolaryngology department. We selected a total of 227 patients (118 boys [52%], 109 girls [48%], mean age: 1.89±0.4 years old) who had undergone primary cleft palate surgery at the oral surgery department of our hospital during the 5-year period from December 2006 to November 2011. At our hospital, two-stage surgery is adopted for palatoplasty, and the primary surgery is usually performed when a patient is around one and half years old. Basically, all the patients undergo medical examination at the otorhinolaryngology department before palatoplasty, and any patients detected to have OME are subjected to myringotomy or ventilating tube insertion at our department.
The prevalence of OME during the primary cleft palate surgery was about 60%. No relation was observed between the presence or absence of OME and any factors, such as the type of cleft palate, gender, height, weight, or associated malformation. The morbidity of OME was significantly higher in the patients who had consulted a previous otorhinolaryngologist before visiting our department. Thus, the effectiveness of preoperative diagnosis was demonstrated. There were many cases of myringotomy, while cases of ventilating tube insertion accounted for only 16%, less than that reported from many other facilities.
Since our department has conventionally limited medical treatment of OME to myringotomy, we actually had a low rate of ventilating tube insertion. The pros and cons of tube insertion are controversial, therefore, further consideration would be necessary to identify the factors influencing the occurrence of OME and to decide or validate the treatment course.
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Kengo Nishimoto, Yoichiro Tanimoto, Mikio Ogita, Tsutomu Matsuzaki
2014 Volume 138 Pages
12-13
Published: 2014
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Patients with carcinoma of the middle ear usually have a poor prognosis even after multidisciplinary treatment. We describe the rare case of a patient with bilateral middle ear carcinoma who was treated by stereotactic radiosurgery using the Cyberknife, and remained tumor free for more than five years after the therapy.
The patient was sorely afflicted with persistent left otorrhea despite having undergone surgery for bilateral chronic otitis media and was diagnosed (confirmed by histopathological examination) as having carcinoma of the middle ear on the left side. FDG-PET imaging revealed accumulation in the right side ear also, however, the diagnosis of right middle ear carcinoma was finally made after five months by histopathological examination.
He underwent stereotactic radiosurgery using the Cyberknife on two occasions, had no remarakable complications, and survived without tumor recurrence for more than five years. We suggest that stereotactic radiosurgery using the Cyberknife may be useful for the treatment of middle ear carcinoma, especially bilateral middle ear carcinoma, because of the reservation around the restriction by the surrounding organs.
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Naoko Momiyama, Masatoki Takahashi, Yoshihiro Noguchi, Ken Kitamura
2014 Volume 138 Pages
14-15
Published: 2014
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Traumatic perforation of the tympanic membrane caused by hot water is a rare entity. We report herein on a 65-year-old male who accidentally poured hot water over his head, and suffered from a second-degree burn on his left face, chest, and upper arm. He recognized left hearing loss and otorrhea, and was found in an ENT clinic to have severe stenosis of the external auditory canal (EAC). He was referred to our department three weeks after the injury. On examinations, swelling of the EAC, total perforations of the eardrum and mixed hearing loss were demonstrated in his left ear. Ear wicks were applied to prevent EAC re-stenosis. Antibiotic eardrops were also used, but his otorrhea persisted for 9 months after the injury. Fourteen months after the injury, when the middle ear infection disappeared, we performed tympanoplasty. The post-operative course was uneventful. The perforation had closed and his hearing had improved 17 months after the surgery. A burn of the tympanic membrane is often accompanied by repeated bacterial infections and an extensive burn of EAC, and therefore the prognosis of a tympanoplasty is not necessarily good. Although otorrhea repeats or persists for a long period, it is recommended that we consider surgical treatment only after confirmation of the resolution of the EAC and middle ear infections.
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Noboru Yamanaka, Rinya Sugita, Yoshifumi Uno, Shigeki Matsubara, Yasuh ...
2014 Volume 138 Pages
16-17
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Children under the age of 2 years are in a functionally and immunologically immature state and are likely to have a refractory course when diagnosed with acute otitis media (AOM). To clarify the clinical characteristics of AOM in children under 2 years of age (AOM<2), the clinical backgrounds and bacterial pathogens were compared between AOM<2 and AOM in children aged 2 years or older (AOM≧2). Furthermore, the clinical efficacy of treatment with tosufloxacin (tosufloxacin tosilate hydrate, TFLX) on acute otitis media was evaluated in these two age groups.
The AOM<2 group had a higher incidence of recurrent and prolonged infections over 3 weeks compared with the AOM≧2 group. In the AOM<2 group,
Haemophilus influenzae and
Streptococcus pneumoniae, the 2 major pathogenic bacteria, were responsible for 66.7% and 25.6% of the cases, respectively, while in the AOM≧2 group,
Haemophilus influenzae and
Streptococcus pneumoniae were responsible for 41.1% and 70.5% of the cases, respectively. More than 90% of the isolates were antimicrobial-resistant strains, i.e., β-lactamase non-producing ampicillin resistant
Haemophilus influenzae (BLNAR) or penicillin-resistant
Streptococcus pneumoniae (PRSP).
The present study showed that TFLX was highly effective for the treatment of acute otitis media in both age groups.
Based on these results, AOM in patients who are under 2 years of age is likely to be more refractory and to be frequently caused by BLNAR and PRSP. We confirmed that TFLX is effective in patients with a recurrent and prolonged course and should be the drug of choice for children with pretreated and refractory AOM.
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Yukari Kano, Hiroaki Shimogori, Kazuma Sugahara, Shunsuke Tarumoto, Hi ...
2014 Volume 138 Pages
18-19
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Congenital cholesteatoma of the external auditory canal is a rare disease. We report a 3-year-old male child with congenital cholesteatoma of the left external auditory canal. A white mass existed at 10-12 o’clock of the canal. In computed tomography (CT) of the temporal bone, a low-density lesion was located in contact with the tympanic membrane, but not clearly invaded the middle ear cavity. Treatment consisted of removal using an endoscope. At the 7-month postoperative follow-up there was no evidence of any relapses. We discuss herein the indication of surgery for congenital cholesteatoma of the external auditory canal.
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Masako Kitano, Kazuhiko Takeuchi
2014 Volume 138 Pages
20-21
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Keloids and hypertrophic scars often present difficulties in treatment. Patients have cosmetic and psychological problems from the shape, pain and itching, so keloids are referred to as a ‘psycological malignant tumor’. We herein present a case of an auricular keloid of 25 mm in diameter which developed from a pierce hole. The tumor was treated with surgical excision, postoperative irradiation (16Gy/4fr) and oral administration of tranilast. At ten months after the treatment, no recurrence of the keloid has been seen. Excision should be carefully performed to give perfect obliteration followed by precise suture closure. Postoperative irradiation is effective for prevention of recurrence. Optimal total doses and fractions have been discussed in many papers, and we should treat on the basis of the fact that auricular keloids tend to relapse more than ear lobe keloids. Many treatments for keloids and hypertrophic scars have been reported, but the combination of the above therapeutic approaches is necessary to treat keloids and hypertrophic scars successfully and obtain a better therapeutic result. It is important to keep in mind that keloids tend to recur and need long term follow up.
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Haruo Hirakawa, Yasuyuki Nishi, Taisuke Watanabe, Makoto Tada, Tsutomu ...
2014 Volume 138 Pages
22-23
Published: 2014
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Extraskeletal osteosarcoma (ESOS) is an extremely rare malignancy arising from the soft tissue. The predominant site of origin of ESOS is the lower limbs, the thigh. ESOS arising in the head and neck region is extremely rare. This is the first report of ESOS of the ear, to the best of our knowledge. We describe a case of ESOS arising from the subcutaneous tissue in the cartilaginous external acoustic meatus.
A 53-year-old man consulted our ENT department in the end of May 2009, complaining of inability to insert a cotton bud into the external acoustic meatus. Examination revealed an elastic-hard tumor arising from the posterior wall of the meatus, occluding the cartilaginous meatus. The eardrum was intact. Plain CT of the temporal bone showed calcification of the lesion arising from the meatus. There was no evidence of bone involvement. Biopsy performed in the middle of July revealed suspected chondrosarcoma. At the beginning of August, an operation was performed; the tumor was removed
en bloc with the surrounding tissues including a part of the auricular cartilage, the temporal periosteum, and the meatus skin. Pathological examination confirmed the diagnosis of ESOS. At present, the patient is still alive with no evidence of recurrence of the disease.
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Yoshihiko Endo
2014 Volume 138 Pages
24-25
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Hereditary hemorrhagic telangiectasia (HHT), also known as Osler-Weber-Rendu disease, is an autosomal dominant disease that is characterized by repetitive nasal bleeding with familial occurrence, and is frequently associated with difficulty in treating the nasal bleeding. We treated cases of refractory nasal bleeding, consisting of 4 cases of hereditary hemorrhagic telangiectasia and one case of renal cell carcinoma, metastasized to the paranasal sinus, on an out-patient basis with local injection of the esophageal varices sclerosing agent, polidocanol. Following injection sclerotherapy in all five cases, the frequency of nasal bleeding decreased. Since this procedure was able to be performed on an out-patient basis without requiring hospitalization, it was useful in improving patient QOL.
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Kei Ashizawa, Keiji Tabuchi, Shuho Tanaka, Yuki Hirose, Akira Hara
2014 Volume 138 Pages
26-27
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The glomangiopericytoma (a sinonasal-type hemangiopericytoma) is a rare tumor arising from the pericytes surrounding capillaries and shows variable malignant potential. We describe herein a case of a 60-year-old female with a glomangiopericytoma of the nasal cavity. After preoperative embolization, it was successfully treated with endoscopic excision. Histological examination showed multiplication of short spindle-shaped cells which reacted to immunostaining for α-smooth muscle actin. She had an uneventful postoperative course and remains well 12 months after surgery, without any tumor recurrence. Endoscopic surgery can be considered an effective treatment for the resection of this tumor type, when the tumor base can be visualized and the disease extent accurately defined.
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Ryo Kanamura, Masakazu Goda, Seiichiro Kamimura, Hideyuki Nakagawa, Ji ...
2014 Volume 138 Pages
28-29
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We report herein on a case with pyoderma gangrenosum in the nasal root associated with ulcerative colitis. Pyoderma gangrenosum is characterized by progressive skin necrosis and is often associated with chronic bowel inflammatory diseases such as ulcerative colitis and Crohn’s disease. Although it bears a clinical resemblance to self-destructive abscesses or bacterial infection of the soft tissues, no bacteria and non-effects of antimicrobial agents were observed and the drainage of the abscess and debridement of necrotic tissue is contraindicated in patients with pyoderma gangrenosum. The treatment of the underlying disease is also effective for the treatment of pyoderma gangrenosum. In the present case, a steroid and mesalazine were effective for both the pyoderma gangrenosum and ulcerative colitis.
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Hiroshi Gomibuchi, Yuko Shimotatara, Taisuke Nakamura, Yoichi Ikenoya, ...
2014 Volume 138 Pages
30-31
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We report a case of multiple cranial neuropathy caused by nasopharyngeal necrosis occurring long after radiotherapy for nasopharyngeal carcinoma. The patient was a 63-year-old male with the chief complaint of headache. He had received chemoradiotherapy for nasopharyngeal carcinoma 27 years earlier and for paranasal sinus cancer 19 years earlier. Endoscopy revealed nasopharyngeal necrosis, and a contrast-enhanced CT of the neck revealed a low-density area across a wide region from the skull base to the nasopharynx. The patient was also found to have paralysis of the left glossopharyngeal nerve, right vagus nerve, left accessory nerve, and the hypoglossal nerves bilaterally. Although systemic administration of antimicrobial agents and steroids halted the progression of the necrosis, the cranial neuropathy remained. Treatment with appropriate radiation doses is necessary to mitigate the adverse events of radiotherapy, and adequate consideration must be given to radiation exposure, particularly in cases of relapse and cases such as this one, in which adjacent areas are also involved.
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Koichiro Wasano, Yuichi Ikari, Sayuri Hashiguchi, Noriomi Suzuki, Taij ...
2014 Volume 138 Pages
32-33
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Malignant tumors of the minor salivary glands are very rare and most cases occur in the oral cavity, e.g., the palate, tongue, cheek and lip. We report herein on an extremely rare case of carcinoma ex pleomorphic adenoma arising in the fossa of Rosenmuller.
An 83-year-old man, who had consulted another clinic with a complaint of hemosputum, was referred to our hospital because of the presence of a nasopharyngeal tumor. The tumor was resected via a transnasal endoscopic procedure without any major complications. The tumor was found to have arisen in the fossa of Rosenmuller and extended to superior lateral side behind the Eustachian tube cartilage.
Histological examination showed that the main part of the tumor consisted of a pleomorphic adenoma, however, capsular invasion, nuclear atypia and mitosis were observed in a limited area where the MIB-1 index was high. We diagnosed the lesion as a carcinoma ex pleomorphic adenoma.
We did not perform any postoperative therapy, because the area containing malignancy was far from the surgical margin and the patient was rather elderly.
Three years and 10 months after the surgery, he remains in follow-up and has not shown any recurrence of the tumor.
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Yoshitaka Okamoto, Itsuo Suzuki
2014 Volume 138 Pages
34-36
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Background: Intranasal glucocorticoids effectively and safely alleviate the symptoms of allergic rhinitis, but treatment options from this drug class are still limited for the Japanese pediatric population. Objective: To evaluate the efficacy and tolerability of mometasone furoate nasal spray (MFNS) at a once-daily dosage compared with a placebo spray (placebo) in Japanese children with perennial allergic rhinitis (PAR). Methods: In this randomized, double-blind, multicenter study, subjects aged 5~15 years with PAR were randomly assigned to MFNS or the placebo for 2 weeks. The once-daily morning dosage of MFNS was 100 μg (50 μg per nostril) in subjects aged 5~11 years and 200 μg (100 μg per nostril) in those aged 12~15 years. The primary end point consisted of change from baseline in the total nasal symptom score (TNSS) at week 2 or discontinuation. Other efficacy end points included investigator-assessed measures of individual nasal symptoms, interference with daily activities, and global improvement. Results: Of the 333 randomized subjects, 330 completed the full 2 weeks of treatment. The between-treatment difference in TNSS at week 2 or discontinuation indicated the superiority of MFNS vs the placebo (
P<0.0001). Scores for individual symptoms, interference with daily activities, and global improvement were significantly superior with MFNS vs the placebo at week 1 and week 2 or discontinuation. The overall incidence of adverse events was similar between MFNS (30.5%) and the placebo (36.3%), and all adverse events were mild to moderate. Conclusions: MFNS provided effective and rapid relief for PAR in a Japanese pediatric population while exhibiting tolerability similar to that of the placebo.
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Atsuyoshi Asahi, Keiichi Kubota, Yasuaki Harabuchi
2014 Volume 138 Pages
38-39
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We encountered four cases of pediatric linear orbital floor fractures with entrapment of the muscle and/or fascial connective tissue. Preoperative CT scan showed the missing rectus sign in two cases, consistent with the intraoperative findings of inferior rectus entrapment. In the other two cases, CT showed an enlarged inferior rectus muscle. All of the patients presented with nausea, vomiting and ocular pain. The surgery had to be delayed in one of the patients with entrapment of the muscle, because of initial treatment at another hospital. This patient who underwent surgery 28 hours after the injury showed persistent upward gaze disturbance for 30 months after the surgery. All the other patients, in whom surgery was carried out as soon as possible, experienced complete recovery. Early operation as soon as possible is recommended for obtaining prompt relief of symptoms and avoidance of permanent sequelae such as upward gaze disturbance.
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Kosuke Akiyama, Masafumi Yonezaki, Rieko Goto, Masayuki Karaki, Hirosh ...
2014 Volume 138 Pages
40-41
Published: 2014
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A 67-year-old man presented with left nasal obstruction and mucopurulent discharge. CT showed shadows at his left sinuses, and implant extension into the left maxillary sinus cavity with an osteolytic lesion around that equivalent to the left side maxillary second molar. Our diagnosis in this case was left maxillary sinusitis related to a dental implant, and we performed endoscopic sinus surgery with implant extraction. Postoperatively, a concomitant sinonasal inverted papilloma (IP) was diagnosed with a histopathological examination. Residual lesion or recurrence has not occurred so far and all patient symptoms disappeared during the follow-up period. Dental implants are widely used and their use is increasing rapidly. On the other hand, cases of maxillary sinusitis caused by inadequate dental implant treatment have been reported. IP is one of the most frequent sinonasal benign tumors, and there are various differential diagnoses, including antrochoanal polyp, and odontogenic maxillary sinusitis. We should keep in mind that IP may occur in unilateral nasal polypoid cases, including cases suspected as being odontogenic maxillary sinusitis. Such masked lesions might not be detected if the treatment is performed by a dentist alone; therefore, we think it is important that dentists and otolaryngologists should make the diagnosis and perform the treatment together.
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Ryo Ikoma, Sayaka Sakane, Kazutomo Niwa, Nobuhiko Oridate
2014 Volume 138 Pages
42-43
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We report herein on our experience of a case of IgD multiple myeloma with cavernous sinus syndrome and an orbital tumor. Left blepharoptosis and left eye movement disorder were observed associated with the cavernous sinus syndrome in a 59-year-old female. The orbital tumor was biopsied using the endoscopic endonasal transparanasal technique and was diagnosed as an IgD multiple myeloma. The left blepharoptosis and left eye movement disorder recovered fully following ROAD-IN therapy. Based on our experience we believe that the endoscopic endonasal transparanasal technique can be applied as an approach to orbital lesions.
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Akihisa Tasaki, Keiji Honda, Tomoko Kamada, Akio Hatanaka
2014 Volume 138 Pages
44-45
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Wegener’s granulomatosis is characterized by necrotising granulomas of the respiratory tract, renal failure and necrotising angitis. We report herein on a case of a 53-year-old man who presented with visual disturbance of the right eye. He had also presented with visual disturbance one year previously, and underwent endoscopic sinus surgery at another hospital. We considered that the visual disturbance was caused by a sinus cyst. Although we performed endoscopic sinus surgery, the patient’s visual loss did not improve. About one month after the surgery, bilateral visual disturbance and nasal septum perforation appeared, the p-ANCA titer was elevated, and pachymeningitis became apparent, but the left paranasal sinus was intact. Finally we diagnosed that the visual loss was due to pachymeningitis based on Wegener’s granulomatosis, and we therefore administered prednisolone and cyclosporin. The eyesight in the patient’s right eye was still poor but his left eyesight recovered.
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Hiroyuki Iuchi, Hiromi Nagano, Junichiro Ohori, Yuichi Kurono
2014 Volume 138 Pages
46-47
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Arteriovenous malformations (AVMs) of the deep lobe of the parotid gland are relatively rare. It is a structural vascular abnormality with no proliferation of cellular components.
A 63-year-old woman presented to the ENT service with a three-month history of swelling and pain on the left side of the parotid area. Enhanced CT revealed a high density spot and diagnostic angiography revealed a high-flow AVM in the deep lobe of the parotid gland. The operation was performed via the parotid gland approach, and the tumor was removed by transecting the superficial temporal artery and the retromandibular vein without massive bleeding.
Histological analysis of the nodule revealed that the proliferating cellular area was composed of endothelial cells and pericytes in addition to the area of dilated vessels. As mentioned above, it was diagnosed an arteriovenous malformation. The AVM showed no evidence of recurrence on CT imaging at about six months after the operation.
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Tomohiro Jimura, Hiromi Nagano, Yuichi Kurono
2014 Volume 138 Pages
48-49
Published: 2014
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Pemphigus is an intractable disease of the oropharyngeal mucosa and is classified into vulgaris and foliaceus. The incidence is relatively low and early diagnosis of pemphigus vulgaris is difficult due to the clinical and pathological diversity of this disease.
We report herein on a case of mucosal dominant pemphigus vulgaris occurring in the oropharyngeal and laryngeal mucosa. A 73-year-old woman complaining of a blister on oral mucosa visited an otolaryngologist and was diagnosed as having stomatitis. Despite standard treatment, the lesion did not improve and skin erosion was observed. The patient then visited a dermatologist and was referred to the dermatology department of our hospital with the diagnosis of pemphigus vulgaris. Since she complained of a sore throat, swallowing pain and hoarseness, she was asked to have an examination at our department.
Local examination showed multiple erosion in the oropharyngeal and laryngeal mucosa. A lower lip biopsy was performed and the anti-desmoglein antibody titer in the serum was examined. The histopathological findings were consistent with pemphigus vulgaris and an increased anti-desmoglein antibody 3 titer was observed. The patient then underwent corticosteroid treatment and her symptoms remarkably improved. Although pemphigus vulgaris is rarely seen by otolaryngologists, it is suggested that pemphigus vulgaris should be considered as one of the differential diagnosis when intractable stomatitis is observed.
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Tomoyasu Tachibana, Michihiro Nakada, Yuya Ogawara, Yuko Matsuyama, Ik ...
2014 Volume 138 Pages
50-51
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The histopathology of submandibular gland tumors is diverse, and in many cases, it is also difficult to make a correct diagnosis preoperatively. A clinical study was performed on 38 cases of submandibular gland tumor surgically resected between 1995 and 2011. There were 33 benign and 5 malignant tumors. The most common benign tumor was pleomorphic adenoma (97.0%). Three of the 5 malignant tumors were low-grade mucoepidermoid carcinomas, and two were adenoid cystic carcinomas. We compared the preoperative diagnosis with final diagnosis. We considered that fine-needle aspiration (FNA) biopsy was very useful for the surgical management of submandibular gland tumor, and in malignant cases, the use of both FNA and frozen section biopsy (FSB) could improve the precision of the preoperative diagnosis. We performed supraomohyoid neck dissection in patients with clinically negative neck metastasis, and total neck dissection in patients with clinically positive neck metastasis. Postoperative radiotherapy was performed in patients with perineural invasion, a narrow safety margin, high-grade malignancy, multiple neck metastasis and extranodal extension. Following extirpation of the submandibular gland and tumor, facial paresis occurred in 8 (27.6%) cases. We compared postoperative complications following the non-identified method with the identified method. Facial paresis occurred in 1 (5.9%) cases following the non-identified method, and occurred in 7 (50.0%) cases following the identified method. Our results suggested that the non-identified method was safer and more useful in preventing postoperative complications following extirpation of the submandibular gland and associated tumors.
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Yoshiki Watanabe, Ryo Asato, Jun Tsuji, Tomoko Kanda, Keigo Honda, Tak ...
2014 Volume 138 Pages
52-53
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Squamous cell carcinoma of the submandibular gland is an extremely rare salivary gland cancer ranging from 0.015 to 0.045 percent of all head and neck cancers, and is associeted with a poor prognosis. Granulocyte-colony stimulating factor (G-CSF) producing tumors also have a poor prognosis. This type of tumor produces G-CSF itself, which promotes tumor growth, thereby potentially accelerate the clinical progression of the disease through an additional synergic effect. The present study describes our experience in treating a 59-year-old male patient who was thought to have a G-CSF-producing squamous cell carcinoma of the submandibular gland.
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Yasunori Kawai, Tomonori Terada, Nobuhiro Uwa, Kosuke Sagawa, Kota Kid ...
2014 Volume 138 Pages
54-55
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Amyloidosis is a condition in which amyloid, a specific protein with a fibrous structure, is deposited extracellularly. We report herein on a case of localized amyloidosis of the tongue. A 50-year-old female presented with a small mass on the dorsal tongue. Histopathological examination revealed that tumor was formed by amyloidosis containing an amyloid protein, ALκ protein. It is classified as systemic or localized amyloidosis according to the degree of spread of the disease. Examination of the whole body showed no sign of amyloid deposit in other organs.
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Yukihiro Hiraga, Junichi Kou
2014 Volume 138 Pages
56-57
Published: 2014
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Two patients of IgG4-related Mikulicz’s disease (IgG4-RD) with progressive transformation of germinal centers (PTGC) arising in the submandibular glands are reported.
The patients were a 58-year-old male and 39-year-old female who fulfilled the clinico-pathological diagnostic criteria for IgG4-RD, including (1) markedly elevated serum IgG4 level, (2) bilateral swelling of the submandibular and lacrimal glands, and (3) microscopic finding of an IgG4
+/IgG
+ plasma cell ratio of more than 40% in the germinal centers.
Histopathologically, PTGCs are characterized by hyperplastic germinal centers composed of mantle zone lymphocytes and remnant of large germinal center cells with follicular lysis.
Complete resection is the only treatment for PTGC. However, in patients with IgG4-RD, administration of a corticosteroid might be recommended and efficacious. Because of the possibility of recurrence or malignant transformation after surgery or other treatments, close follow-up is mandatory.
To the best of our knowledge based on a thorough search of the literature, there is only one report other than ours of PTGC arising in the submandibular glands in a patient with IgG4-RD.
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Takuya Yoshida, Masaaki Higashino, Ryo Kawata, Yoshitaka Kurisu, Motom ...
2014 Volume 138 Pages
58-59
Published: 2014
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The accessory parotid gland tissue has been described as salivary tissue adjacent to Stensen’s duct that is distinctly separate from the main body of the parotid gland. It is said that approximately 21% of human parotid glands have an accessory component.
We report herein on a case of an accessory parotid gland tumor in the left mid-cheek. A 35-year-old woman presented with over 20-year history of a slowly growing and painless tumor in the left mid-cheek. The diagnosis of a pleomorphic adenoma arising from the accessory parotid gland was suggested based on the examination of MRI findings and fine needle aspiration cytology. The following surgical approaches for removing mid-cheek masses have been reported: a direct incision over the mass; the intraoral approach; and the standard parotidectomy approach. We chose s-shaped incision approach which allows safe preservation of the facial nerve, although it requires a large skin incision. This approach has advantages of providing a wide operation field to preserve the facial nerve and avoiding enucleation of the pleomorphic adenoma. After removal of the tumor, despite the appearance of slight transient facial nerve weakness in the buccal region, there were no other postoperative complications.
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Yoshifumi Fujita, Kazumasa Suzuki, Yoshiaki Mori, Ai Suzuki, Takashi H ...
2014 Volume 138 Pages
60-61
Published: 2014
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Lambert-Eaton myasthenic syndrome (LEMS) is an immunological disease known to be associated with malignant disease, and is characterized by muscle weakness and autonomic neuropathy. Small cell lung cancer is one of the most important causes of this condition. We encountered a case of LEMS associated with small cell lung cancer presenting with dry mouth.
A 65-year-old man visited to our hospital with the complaints of dry mouth, muscle weakness of the lower limbs and gait disturbance. The patient showed significant hyposalivation, but the diagnosis of Sjogren’s syndrome could not be established based on the results of minor salivary gland biopsy and blood tests. Chest CT showed a nodular lesion in the left lung and swollen lymph nodes in the mediastinum. In regard to the neurological findings, the patient showed hyporeflexia, and lower limb weakness. Therefore, we suspected the possibility of LEMS associated with lung cancer. Video-assisted thoracic surgery was performed, and small cell lung cancer was diagnosed based on histopathological examination of the resected specimen. Five courses of chemotherapy (cisplatin+etoposide) and concurrent radiotherapy at a total dose of 45 Gy were administered, which resulted in a complete response.
Autonomic neuropathy such as that associated with LEMS should be borne in mind in the differential diagnosis of dry mouth.
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Hiroki Hasegawa, Makoto Ito, Tomokazu Yoshizaki, Toshiaki Tsukatani
2014 Volume 138 Pages
62-63
Published: 2014
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We retrospectively examined the bacterial isolates, tolerance to antibiotics, and clinical course in 88 patients with peritonsillar abscess who were treated at the Matto Ishikawa Public Central Hospital between October 2007 and December 2012. Peritonsillar pus was collected by needle aspiration in 57 cases, and 90 strains of bacteria were detected and tested for drug sensitivity. In 16 cases (32%), only anaerobes were cultured. In 18 cases (35%), only aerobes were cultured. And in 16 cases (28%), both anaerobes and aerobes were cultured. In 3 cases (5%), neither anaerobes nor aerobes were detected. Overall, 6 of the 41 anaerobic strains (14.6%) and 8 of the 35 aerobic strains (22.9%) were resistant to clindamycin(CLDM). None of the 25 anaerobes were resistant to ampicillin/sulbactam (ABPC/SBT). The rate of resistance to ABPC/SBT among the aerobes was less than or equal to the rate of the resistance of aerobes to ABPC (9.8%). Against carbapenem (CBP), all 42 anaerobic strains did not have any tolerance, and only 2 of the 42 aerobes were resistant (4.8%). Judging from the above, ABPC/SBT might be suitable as a first-line antibiotic for the treatment of peritonsillar abscess, rather than CLDM, because of the low rate of drug resistance and the narrow spectrum. CBP should be regarded as a second-line treatment, since CBP abuse can induce tolerance.
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Hirofumi Shibata, Hisamitsu Hayashi, Bunya Kuze, Mitsuhiro Aoki, Keisu ...
2014 Volume 138 Pages
64-65
Published: 2014
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Peritonsillar abscesses are the most common deep neck infection in adults. However, pediatric cases are very rare. Pediatric patients have a small anatomy which often impedes cooperation with examination and treatment. In this article, we examine four cases of pediatric peritonsillar abscess, and discussed its treatment, concentrating in particular on abscess tonsillectomy. We performed abscess tonsillectomy in one of our cases. This method allows complete drainage of the abscess, and can decrease the recurrence rate.
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Sayaka Sakane, Ryo Ikoma, Kazutomo Niwa, Nobuhiko Oridate
2014 Volume 138 Pages
66-67
Published: 2014
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A 54-year-old woman complained of anterior neck pain. Computed tomography showed a calcification at the base of the tongue. Her symptoms had appeared just after a meal, so we suspected that the calcification was from a foreign body. Direct laryngoscopic extirpation was performed under general anesthesia. We diagnosed the condition as lingual tonsil lithiasis, because the calcified body was composed mostly of calcium phosphate.
The etiology of palatine and lingual tonsil lithiasis is discussed with reference to the literature.
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Tomohisa Kato, Norikuni Kasuya, Kumiko Takezawa, Takeshi Shimizu
2014 Volume 138 Pages
68-69
Published: 2014
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Ganglion cyst in the head and neck region is rare. We describe a case of ganglion cyst in the retropharyngeal region in a 79-year-old man. The patient complained of an uncomfortable feeling in the throat while swallowing. On physical examination, a submucosal mass was found in the posterior pharyngeal wall. Computed tomography and magnetic resonance imaging revealed a 16×13×12 mm cystic mass protruding into the pharynx. A well-circumscribed cystic mass was completely removed by surgery via the transoral approach. The histological diagnosis was ganglion cyst. The postoperative course was uneventful and follow-up has revealed no recurrence until date, more than 2 years since the surgery.
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Yushi Ueki, Nao Takahashi, Kunihiro Sato, Sugata Takahashi
2014 Volume 138 Pages
70-71
Published: 2014
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The clinical data of 56 patients with hypopharyngeal squamous cell carcinoma who were seen between 1991 and 2011 were evaluated at our department. The overall 5-year disease-free survival rate was 43.6%. The survival rates in the patients with stage I (n=3), stage II (n=13), stage III (n=3), stage IV (n=37) disease were 66.7%, 83.8%, 0%, and 31.4%, respectively. Among the patients with stage III/stage IV disease, the survival rate in those who underwent surgery (n=8) was 83.8%, while that in those who underwent concurrent chemoradiotherapy (CCRT) (n=30) was only of 22.3%. The survival rate in patients who underwent adjuvant chemotherapy with S-1 (n=16) was 46.3%, and that in patients who underwent adjuvant chemotherapy without S-1 (n=24) was 20.5%. These results suggest that surgery plays a very important role in the treatment of advanced hypopharyngeal carcinoma and that appropriate adjuvant chemotherapy improves the outcome in these patients.
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Yoshiki Watanabe, Ryo Asato, Jun Tsuji, Tomoko Kanda, Keigo Honda, Tak ...
2014 Volume 138 Pages
72-73
Published: 2014
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Mucosa-associated lymphoid tissue (MALT) lymphoma is a low-grade B-cell lymphoma which arises from a complex organization of mucous membranes and lymphoid tissues. Such lymphomas have been reported as occurring in the head and neck region, including the major salivary glands, thyroid gland and the Waldeyer ring, but there are no reports on hypopharyngeal MALT lymphomas in Japan. We encountered a very rare case of hypopharyngeal MALT lymphoma that we were able to treat with curative resection via the endoscopic transoral surgery.
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Kayoko Hattori, Takeshi Morita, Kosaku Yamada, Nobuya Fujiki, Takatosh ...
2014 Volume 138 Pages
74-75
Published: 2014
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Metastasis of a tumor to the tonsil is a rare event. We report herein on a case of tonsillar metastasis from small cell lung cancer. A 70-year-old woman had been in our hospital for treatment of her lung cancer. She complained of pharyngalgia, and was referred to our division for examination. The right palatine tonsil was swelling, rubescent and covered with pus plugs. She was treated with antibiotics on the basis of having acute tonsillitis. The swollen right palatine tonsil reduced in size for a while, but enlarged again, and was partially ulcerated. She was afraid to undergo any biopsy, so a right tonsillectomy was done under general anesthesia. The histopathological examination resulted in the diagnosis of a metastatic tonsillar tumor from lung cancer (small cell carcinoma). Intravenous chemotherapy was performed, but ineffective. She died due to progression of the primary lesion and other metastasizing lesions (right adrenal gland, and abdominal lymph nodes) 5 months after the diagnosis of tonsillar metastasis.
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Atsushi Imai, Katsuyoshi Suzuki, Sho Morita
2014 Volume 138 Pages
76-77
Published: 2014
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A 30-year-old man fractured his thyroid cartilage while participating in
Kendo, which is a Japanese sport that involves fighting with wooden swords. He complained of hoarseness and slight pain in the upper neck. Laryngoscopy revealed no vocal cord palsy but slight intralaryngeal hematoma and endolaryngeal swelling. 3-dimentional computed tomography (3D-CT) showed a fracture line in the left thyroid cartilage plate. Seven days after the injury, the inflammation and hematoma had reduced, however, the voice disorder remained. Decreased tension and shortness of the left vocal fold were also clearly revealed. Open reduction was performed with rigid internal fixation of the thyroid cartilage fracture using titanium miniplates under general anesthesia on the 16
th day. The patient’s voice disorder fully recovered after 2 months.
External blunt injury to the larynx can cause not only acute airway trouble but also long-term voice or swallowing dysfunction. It is important to evaluate laryngeal injuries carefully and determine appropriate treatment in order to repair them appropriately.
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Yasuhiro Kise, Akiko Katoh, Fumiko Takenaga, Tetsuro Wakasugi, Gunji N ...
2014 Volume 138 Pages
78-79
Published: 2014
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Amyloidosis is a metabolic disorder where insoluble fibrous protein aggregates, so-called amyloid proteins, are deposited in the extracellular space in a variety of organs and tissues, leading to organ- or tissue-specific dysfunctions. Herein, we report a rare case of laryngeal amyloidosis. A 54-year-old woman was referred to our department with a 9-month history of hoarseness. Laryngeal endoscopic examination revealed orange-colored uneven edematous swelling of the left false cord, with intact vocal cord mobility. An endoscopic biopsy was performed under local anesthesia. Histopathologically, the specimen showed submucosal deposition of amyloid, with positive Congo red staining. Immunohistochemically, the lesion was positive for immunoglobulin λ light chain, but negative for amyloid A. There were no other abnormal findings on systemic examination. The patient was diagnosed as having localized AL-type laryngeal amyloidosis, and eventually, debulking surgery was performed using a CO
2 laser via a direct laryngoscope. The postoperative clinical course was uneventful. The lesion macroscopically disappeared, and the voice quality improved. The clinical characteristics, pathogenesis, diagnosis and treatment of amyloidosis were bibliographically reviewed.
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Takashi Taniyama, Tomonori Sugiyama, Mamika Araki, Kouhei Fukukita, Hi ...
2014 Volume 138 Pages
80-81
Published: 2014
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Between 2005 and 2010, we treated 30 cases of Reinke’s edema by surgery. The subjects were 9 men and 21 women aged 33 to 83 years (mean: 57.5 years). Besides the 5 patients whose smoking history was not clear, 22 patients (88%) were smokers and 3 patients (12%) were non-smokers. Among the 20 patients who answered a questionnaire, the voice condition finally improved in 13 patients (65%), while it improved by 1 week after the surgery in 5 patients (25%). In cases of Reinke’s edema, we must be careful in making the right choice of operation, and in addition to perfoming careful operation, must also try to motivate the patients for smoking cessation.
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Keishin Go, Takayuki Taruya, Kentarou Imon, Takaharu Tatsukawa, Sachio ...
2014 Volume 138 Pages
82-
Published: 2014
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We experienced the case of a 56 year-old female with malignant lymphoma of the larynx. She presented with a 4-month history of hoarseness of the voice. Examination revealed a tumor in the right false cord. Laryngeal biopsy obtained under direct laryngoscopy yielded the pathological diagnosis of inflammation. A second biopsy was performed through a cervical incision, and the pathological diagnosis was revised to B-cell lymphoma. The patient was treated by R-CHOP therapy, i.e., standard CHOP regimen plus rituximab, which produced a complete response. Thus, the laryngeal tumor was well-controlled by treatment.
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Yu Saito, Akira Hagiwara, Noriko Kobayashi
2014 Volume 138 Pages
84-85
Published: 2014
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While hemangioma is a common tumor in the head and neck region, it rarely occurs in the larynx. Herein, we report a case of laryngeal hemangioma that occurred in the arytenoid region. The patient was a 33-year-old woman who presented with the chief complaint of throat discomfort. Endoscopy showed a tumor in the larynx of blue-violet color with an irregular surface, occupying the arytenoid region bilaterally. Bolus of food was confirmed in the right pyriform sinus. CT confirmed the presence of the tumor in the arytenoid region bilaterally. Some calcification was observed within the tumor. On MRI, the tumor was visualized as an iso-intensity on T1-weighted images and as a hyperintensity on T2-weighted images. We performed direct dissection under laryngomicroscopic observation. During the operation, it was difficult to see the entire tumor within the same visual field under the laryngomicroscope. The tumor was diagnosed histopathologically as a cavernous hemangioma. There are several reports of the necessity of an external incision with tracheotomy in cases with giant tumors. Dissection under a laryngomicroscope, without tracheotomy and the attendant dysfunction of vocalization and swallowing, is a better option for the treatment of cavernous hemangioma.
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Ryosuke Kitoh, Takuya Yano, Kouji Okamura, Yutaka Takumi, Shin-ichi Us ...
2014 Volume 138 Pages
86-87
Published: 2014
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The saccular cyst is one of the classifications of laryngeal cysts as described by De Santo. We report herein on one case of congenital laryngeal cyst treated with the transoral endoscopic approach.
A 7-month-old girl visited our hospital in whom stridor in the night had occurred from two weeks postnatally. Flexible fiberoptic laryngoscopy was performed, which revealed a submucosal swelling of the left laryngeal ventricle to the pyriform sinus. A magnetic resonance imaging (MRI) scan of the neck confirmed a cystic mass and was considered to be a saccular cyst.
During the observation period, the stridor did not improve, and the cyst volume gradually increased from the MRI findings. At the age of eighteen months, endoscopic marsupialization was therefore performed. After the operation, the stridor improved immediately, and there has been no obvious recurrence for three months to date.
Reports on saccular cysts are not uncommon in the foreign literature, but are especially rare in Japan. As treatment options for a laryngeal saccular cyst, the transoral endoscopic approach and extra-laryngeal approach have been reported. We found that the endoscopic transoral approach is minimally invasive, and appropriate as a choice for first time treatment especially in infants.
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Haruo Hirakawa, Yasuyuki Nishi, Taisuke Watanabe, Makoto Tada, Atsushi ...
2014 Volume 138 Pages
88-89
Published: 2014
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Multiple myelomas arise from neoplastic plasma cells growing in the bone marrow, plasmacytomas arise from neoplastic plasma cells growing in the bone except the bone marrow, or the soft tissues, and plasmacytic leukemia arises from plasma cells growing in the peripheral blood. Neoplastic plasma cells localized within the soft tissue are particularly called extramedullary plasmacytomas. The exramedullary plasmacytoma often arises in the head and neck. There are some reports on extramedullary plasmacytomas arising from the nasal cavity, the paranasal sinus, the pharynx, and the larynx, while it is a very rare case in which multiple myeloma involves the larynx and the trachea.
A 72-year-old woman consulted the department of otorhinolaryngology in NHO Kure Medical Center complaining of hoarseness. She had been treated for multiple myelomas for two years previously at the department of hematology in our hospital. An angiogenic-like tumor almost obstructed the larynx and an emergency tracheotomy was performed. The subsequent biopsy revealed the tumor was a plasmacytoma. The patient received radiotherapy (50Gy) on the larynx. The tumor size was almost unchanged just after the end of the radiotherapy whereas the tumor had completely disappeared a month after the radiation. Another lesion arose from the trachea a year after the treatment of the larynx. Radiotherapy (50Gy) was performed on the tracheal lesion as well. The patient is currently surviving without any recurrences in either the larynx or the trachea.
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Yasuhiko Tanaka, Shigeki Sato, Hideo Tomisawa, Manabu Nakamura, Masahi ...
2014 Volume 138 Pages
90-91
Published: 2014
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Ectopic hamartomatous thymomas (EHT) is an extremely rare disorder.
We report herein on a case of EHT occurring in the neck with a review of the literature. A 35-year-old man first noticed a swelling in his left cervical region at the beginning of March, 2005, and he came for a checkup in our department in March. In the initial examination, palpation revealed a 3×5 cm soft mass with a somewhat indistinct border in the left supraclavicular area. There was no subjective symptom except swelling, and palpation revealed no anomaly in the cervical lymph nodes, and no other lesion was seen in the head and neck area.
A tumor was present between the sternocleidomastoid muscle and the left lobe of the thyroid gland, and the MRI imaging did not show any involvement of the thyroid gland.
We performed a tumorectomy under general anesthesia. There was a tumor right under the sternocleidomastoid, there was no adhesions seen at the periphery of the tumor, and tumor removal went smoothly. The histological diagnosis was an ectopic hamartomatous thymoma.
In 1984, Rosai et al. proposed the concept of the EHT as a lesion having the character of both a hamartoma and a tumor also comprising cervical ectopic thymic tissue. No recurrence has been reported in cases where the tumor has been totally extirpated. In our present case, no recurrence has been seen in a 7-year postoperative follow-up.
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Takashi Taniyama, Tomonori Sugiyama, Mamika Araki, Kouhei Fukukita, Hi ...
2014 Volume 138 Pages
92-93
Published: 2014
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Between 2000 and 2009, we surgically treated 25 patients with primary hyperparathyroidism and 15 patients with secondary hyperparathyroidism. We used a combination of ultrasonography, CT scans, and MRI for preoperative imaging. The preoperative diagnostic accuracy was 51% for ultrasonography, 46% for CT scans, and 76% for MRI. Postoperative complications occurred in 6 cases: 3 cases of temporary recurrent laryngeal nerve palsy, 1 case of permanent recurrent laryngeal nerve palsy, and 2 cases of postoperative bleeding. Parathyroid function increased again after surgery in 1 patient with primary hyperparathyroidism and 3 patients with secondary hyperparathyroidism. We could not remove all the morbid parathyroid tissue in these cases. Further efforts to increase the accuracy of preoperative diagnosis and study discrimination using pigments and an intraoperative intact PTH assay are needed.
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Nayuta Tsushima, Toru Kuroda
2014 Volume 138 Pages
94-95
Published: 2014
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Between July 2008 and November 2012, we treated 4 patients with cervical node metastasis from unknown primary sites (CUP) and 1 patient suspected as having CUP.
Every patient who was diagnosed as having CUP underwent random biopsy, bilateral tonsillectomy, neck dissection and radiotherapy. No primary lesion was detected by the random biopsy or tonsillectomy.
Two patients died of distant metastasis and the other 3 patients are surviving, including 1 patient in whom investigation is ongoing. In all five cases, the histopathological diagnosis of cervical lymph node was squamous cell carcinoma. Extracapsular spread was found in 3 cases. The 2 patients who died of distant metastasis had invasion of the blood vessels.
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Akiyuki Yamato, Kenji Hattori, Kayoko Shingai
2014 Volume 138 Pages
96-97
Published: 2014
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We experienced a case of bilateral chylothorax following left neck dissection. The patient was a 70-year-old woman. For cancer of the left side of tongue base, the tongue was totally resected and reconstructed with a pectoralis major muscle flap. At the same time, a left modified radical neck dissection was performed. We found intraoperative chyle leakage, so we ligated the thoracic duct and covered it with muscle. The next day, the patient complained of dyspnea, and chylothorax was observed at both sides. Conservative treatment, such as thoracostomy tube placement, perenteral nutrition, and percutaneous administration of octreotide improved the chylothorax. Tissues around the thoracic duct should be carefully handled during neck dissection. When post-operative respiratory discomfort is found, chylothorax must also be carefully taken into consideration.
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Yoichi Yokota, Yusuke Naito, Natsuko Ueda, Masato Takiwaki, Hiromichi ...
2014 Volume 138 Pages
98-99
Published: 2014
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Papillary and follicular carcinomas arise from thyroid follicle cells, whereas medullary carcinoma originate in parafollicular cells. Since the origin of these tumor types differs, their coexistence within the same thyroid gland is rare. Mixed medullary follicular cell carcinoma is a tumor in which a follicular tumor (papillary carcinoma or follicular carcinoma) and medullary carcinoma are intermingled in the same tumor, and is furthermore considered to be a very rare disease. We report herein on a case of mixed medullary follicular cell carcinoma in which high serum Carcinoembryonic antigen (CEA) levels offered a diagnostic method.
A 66 year-old woman was introduced to our hospital with high CEA levels, and a tumor of left thyroid lobe with involvement of multiple lymph nodes of the left supraclavicular fossa was discovered on CT images. We operated on the tumor under the diagnosis of a medullary carcinoma based on the high CEA and calcitonin levels. The postoperative pathology result was mixed medullary follicular cell carcinoma. Both CEA and calcitonin levels quickly normalized after the operation, and at the time of writing no recurrence of the tumor has been seen.
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Hajime Ishinaga, Kazuya Otsu, Tomotaka Miyamura, Kazuhiko Takeuchi
2014 Volume 138 Pages
100-
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We performed a retrospective review of 1265 surgical procedures performed at our department between January 2007 and December 2011. We identified 20 patients with post-operative hemorrhage in head and neck surgery. The procedure most often complicated by wound bleeding was parotidectomy (6.5%), followed by laryngectomy (3.9%). Symptoms of hemorrhage was observed within 12 hours in 85% of the patients. However, delayed hemorrhage, more than 24 hours after the operations, was found in two cases. In our study, two cases of laryngeal edema were found after re-operation, with tracheostomy necessitated in one case.
Careful hemostasis and early recognition with immediate intervention are required to prevent severe complications after head and neck surgery.
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