Free jejunal flap transfer in hypopharyngeal reconstruction is an established method, but it is true that it has unavoidable complications, such as total necrosis or fistula formation. A total of 360 jejunal flap transfers with multiple vascular pedicles were performed at our institute from 2001 to 2017 without total necrosis, and fistula formation occurred in 12 cases （3.3％）. To reduce postoperative complications, one of the most important points is team practice among head and neck surgeons, plastic surgeons and digestive surgeons. Preserving cervical vessels and surgical margins in good condition enables reconstructive surgeons （not only plastic surgeons but all members of the team） to perform safe and reliable reconstruction.

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In the 13 years from 2005 to 2018, we have performed tracheoesophageal puncture （TEP） surgery along with Provox voice prosthesis insertion for 266 patients after total laryngectomy or total laryngo-pharyngectomy due to larynx or hypopharynx cancer, and conducted pre/post-operative instructions for those patients. During the pre-operative period, we observe and assess the patient’s adherence to our instructions as well as their self-management capability for daily maintenance after TEP. During the post-operative instruction, it is important to teach the patient how to use a voice prosthesis cleaning brush to make sure they do not break the one-way valve of the Provox, which can easily happen. A clear and thorough explanation is also considered very important.

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This retrospective study investigated the treatment outcomes of patients with hypopharyngeal cancer. The study included 100 patients who were treated at our institution from August 2008 to July 2015. The three-year overall survival （OS） rates for Stage 0, Ⅰ, Ⅱ, Ⅲ, and Ⅳ were 100％, 68.6％, 100％, 56.3％, and 42.3％, respectively. An analysis of 82 patients who were treated curatively （median follow-up period: 37 months） revealed that T status was a significant factor for OS and disease-specific survival （DSS）; and N status was significant for DSS and distant metastasis-free survival. The sub-group analysis of the patients with Stage Ⅲ and Ⅳ disease showed that surgery and radiotherapy had comparable oncologic outcomes for T1 and T2 disease, whereas, for T3 and T4 disease, surgery had significantly improved outcome in OS and local control as compared to radiotherapy. Although some previous studies have reported that radiotherapy with concurrent chemotherapy had a comparable outcome to surgery even for advanced hypopharyngeal cancer, especially for T3 disease, the current results were inconsistent with those reports. The discrepancy might be caused by differences in the selection of patients for radiotherapy and in the amount of cumulative cisplatin dose in concurrent chemoradiotherapy.

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Tracheotomy prior to definitive cancer treatment is sometimes needed for those patients with airway obstruction due to laryngeal cancer. However, it might have a negative impact on the clinical outcome during and after total laryngectomy. Here we report a retrospective analysis of the effects of tracheotomy prior to surgery.
Patients with laryngeal squamous cell carcinoma who underwent total laryngectomy were selected. Eighty-three consecutive patients who were operated between 2002 and 2017 at Nippon Medical School Hospital were included. Of these 83 patients, 26 underwent prior tracheotomy. The remaining 57 patients who did not suffer airway obstruction did not undergo tracheotomy prior to total laryngectomy. In this study, we compared these two groups from the point of view of the surgical strategy, preservation of the thyroid and parathyroid glands, adverse events and recurrence of cancer.
In cases with prior tracheotomy, more patients underwent extended total laryngectomy with pharyngeal reconstruction. More functional preservation of the thyroid and parathyroid glands was possible in the non-tracheostomy group. There were no significant differences between the two groups regarding adverse events and cancer recurrence.

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We reviewed patients with locally advanced squamous cell carcinoma of the tongue （LASCCT） treated by standard treatment modalities including irradiation followed by surgery （① RT＋surgery group）, surgery without neoadjuvant therapy （② surgery group）, and neoadjuvant chemotherapy followed by surgery （③ NAC＋surgery group）.
No significant differences in 5-year locoregional control （LRC）, disease-free survival （DFS）, or overall survival （OS） rates were shown among the three groups. Furthermore, subgroup analysis by T, N, and clinical stage showed no significant differences of LRC, DFS, or OS among the three groups. The NAC＋surgery group tended to have much locoregional recurrence compared to the other groups, although no significant difference of rates of locoregional or distant recurrence was shown among the three groups. Furthermore, the NAC＋surgery group, including a higher proportion of advanced T or N stage, tended to have a lower proportion of distant recurrence and a favorable OS compared to the other groups. However, overall survival of the NAC＋surgery group was better even though the group included advanced T and N cases. There were some limitations of this study; further analysis is required for neoadjuvant therapy.

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Dysphagia is one of the most common problems of dissection of retropharyngeal lymph nodes （RPN）. However, there are few reports about this problem in patients with total laryngectomy. We assessed swallowing function by videofluoroscopic examination after total pharyngolaryngectomy and free jejunal flap reconstruction in 70 patients with hypopharyngeal cancer. In addition, the postoperative period until the start of oral intake and the postoperative period until withdrawal from tube feeding were assessed.
We evaluated swallowing function using the scores of pharyngeal contraction, reflux into the nasopharynx and oropharyngeal residue. The RPN dissection group had a significantly lower score of pharyngeal contraction and reflux to the nasopharynx than the non-RPN dissection group, but no difference in the oropharyngeal residual score. There was no difference in postoperative period before the start of oral intake. The postoperative period required for tube feeding withdrawal tended to be longer in the RPN dissection group, and the number of cases requiring more than 30 days before withdrawal was significantly greater in the RPN dissection group.

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We performed laryngeal preservation surgery in 71 of 159 patients（45％）with hypopharyngeal cancer, the T-stages of whom were T1（n＝5）, T2（n＝32）, T3（n＝22）, and T4（n＝12）. Locational subtypes were pyriform sinus（n＝50）, postcricoid pharynx（n＝7）, and posterior pharyngeal wall（n＝14）. The 5-year disease-specific survival rate and overall survival rate among the 71 patients were 74.1％ and 61.0％, respectively. The principal treatment option was surgery alone, but pre- or post-operative treatment was administered as necessary. The treatment outcome in terms of 5-year survival was: 87.2％ for early cancer T1, T2（n＝37）and 60.1％ for advanced cancer T3, T4（n＝34）. In cases of laryngeal preservation surgery for advanced cancer, unlike those for early cancer, post-operative swallowing function became a major problem. Swallowing disturbance was found in none of the early cancer cases but in 9 of the 34 advanced cancer cases. Although laryngeal preservation surgery is indicated for cases of hypopharyngeal cancer that are treatable with surgery alone, it is considered necessary to perform adjunct therapy for locally advanced cases as well as cases with multiple cervical lymph node cancer, which are considered a high-risk group.

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There are few reported cases of head and neck cancer occurring during pregnancy. In such cases, the safety of the mother and fetus is the top priority in making decisions about treatment. In our department, we have treated four patients who developed head and neck cancer during pregnancy. Three of the patients underwent surgical treatment during pregnancy and had a successful delivery. The remaining one patient received surgical treatment after artificial termination of pregnancy. When treating head and neck cancer patients with pregnancy, it is essential to provide an individualized treatment course, as well as sufficient relevant information for the patients and their families.

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The present report describes the treatment of 12 patients with primary mucosal malignant melanoma of the head and neck who visited our department between 2011 and 2017. There were 6 men and 6 women, aged 61-90 years （median, 76.5 years）, and the observation period was 7-165 months （median, 37 months）. Further, 11 patients （92％） presented with primary lesions located in the nasal/paranasal cavities and 1 patient （8％） with the primary lesion located in the oral cavity. The 3-year overall survival rate, as assessed using the Kaplan-Meier method, was 56％. Among 8 patients with primary malignant melanoma of the nasal/paranasal cavities who underwent carbon-ion radiotherapy or surgery as a radical treatment, the 3-year local control and 3-year recurrence-free survival rates were 56％ and 38％, respectively. The local control rate was higher in the carbon-ion radiotherapy group. In 12 patients, the 5-year incidence of distant metastasis was as high as 75, and the time to late distant metastasis ranged from 3 to 77 months （median, 17 months）. Distant metastasis was observed in ＞50％ of the patients within 2 years, and the survival rate tended to decrease with an early appearance of metastasis. The control of distant metastasis remains a challenge, and the establishment of an adjuvant therapy is required to improve prognosis.

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We performed a retrospective analysis of the prognosis and surgical complications of seven patients who underwent mediastinal tracheostomy at Saitama Medical University International Medical Center between April 2010 and March 2016. Primary sites and histopathological types were: cervical esophageal squamous cell carcinoma （n＝3）, hypopharyngeal squamous cell carcinoma （n＝1）, poorly differentiated papillary thyroid carcinoma （n＝1）, and undifferentiated thyroid carcinoma （n＝2）. Three out of four cases of squamous cell carcinoma had poor prognosis with recurrence and metastasis 3 months after surgery. Two patients with cervical esophageal carcinoma and undifferentiated thyroid carcinoma have survived for over 5 years. Wound dehiscence of the tracheostoma was seen in two patients. One of these, who received concurrent chemoradiotherapy before surgery, improved with conservative treatment. The other patient, who received postoperative radiotherapy followed by chemotherapy, underwent re-mediastinal tracheostomy because of tracheal necrosis, but bleeding from the brachiocephalic artery occurred 2 years after the initial surgery. Failure of tracheostoma wound healing associated with radiation therapy or chemotherapy requires special attention, and it is important to create a wide and flat tracheostoma and fill the peritracheal space with tissue that has a good blood supply to prevent complications.

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The lateral border of the tongue is the most common site for tongue cancers. Chronic mechanical irritation from misalignment of the teeth or ill-fitting dental prostheses is considered to cause tongue cancers. In cases with no misalignment of teeth, persistent irritation of the lateral border of the tongue because of inconsistencies between the dental arch and tongue size can be a factor for the onset of tongue cancers. Orthodontic treatments are considered effective for patients with misaligned teeth or a narrow tongue space that mechanically stimulates the oral mucosa. However, orthodontic treatments are not appropriate for all patients due to age or economic burden.
In this study, we attempted to reduce mechanical stimulation of the oral mucosa with a removable prosthetic device to prevent recurrence after primary treatment in three cases of tongue cancer, which may have been caused by chronic mechanical stimuli. The use of this prosthetic device alleviated local physical stimulation in all cases, and so may be useful for preventing recurrence of tongue cancer. This prosthetic device is simple to use and removable. It is an effective barrier against mechanical stimulation of the oral mucosa. Patient education is important because indentations caused by mechanical stimulation easily relapse when the device is not used.

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Distant metastasis occurs occasionally in differentiated thyroid cancer patients, with the lungs and bones being the most frequent locations. An extremely rare location of distant metastasis is the pancreas, as reported in only 16 published cases.
In this article we report a case with pancreatic metastases from thyroid papillary carcinoma. A 71-year-old woman underwent total thyroidectomy for thyroid papillary carcinoma with lung metastases. While the patient was undergoing TSH suppression therapy, the thyroid cancer spread to the pancreas. She began receiving Lenvatinib, a molecular-targeted drug, which was very effective, and the lung and pancreatic metastases diminished during 15 months.
In rare cases like pancreatic metastasis from differentiated thyroid cancer, the standard of care is unclear. If the case has a condition that cannot be removed with surgery, or cannot be treated by RAI therapy, we believe that molecular-targeted drugs might be a good treatment as one of the choices.

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Primary chondrosarcoma of the larynx is a rare tumor accounting for less than 1％ of all laryngeal malignancies. Laryngeal chondrosarcoma shows slow growth, and the occurrence of distant metastases and lymph node involvement is rare. Here we report a case of chondrosarcoma arising in the thyroid cartilage, and review and discuss the management of this laryngeal chondrosarcoma. The patient was a 52-year-old woman with an anterior cervical tumor which had been followed as a tumor in the right thyroid lobe for 5 years. The tumor then showed sudden and rapid growth, at which point she consulted our department. CT and MRI scans showed a mass in the right thyroid cartilage with cartilage destruction. The results from needle biopsy indicated a malignant cartilaginous tumor. We performed thyroid cartilage tumor resection and laryngeal reconstruction with a titanium plate, and a diagnosis of chondrosarcoma arising in the right thyroid cartilage was made. Subsequent to the surgery, recurrence in the right cervical lymph node was observed and she received adjuvant radiotherapy after right neck dissection. A local recurrence with multilocular cystic lesions appeared from the right nasopharynx to the right hypopharyngeal piriform fossa 1 year and 8 months after irradiation. It was decided that the arytenoid cartilage and vocal cord on the healthy side could be preserved, and pharyngeal malignant tumor resection, near-total laryngectomy and rectus abdominis flap reconstruction were performed to preserve vocal function. Eight months have passed since this last surgery and no recurrence has been observed. Laryngeal chondrosarcoma generally has a good prognosis; if possible, it is important to select a treatment method on a case-by-case basis with the aim of preserving the larynx.

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We report a case of unclassified sarcoma of the parotid gland. An 84-year-old woman visited our hospital because of swelling of her left neck. An MRI scan revealed a tumor of the parotid gland. No facial paralysis was observed. We resected her tumor completely under general anesthesia. Pathological examination revealed that the tumor was an unclassified sarcoma.

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Transoral videolaryngoscopic surgery （TOVS） for pharyngeal and laryngeal cancer is a function-preserving surgery with low invasion and risk. However, it remains unclear whether TOVS is suitable as salvage surgery. We report a case that suffered severe postoperative hemorrhage after TOVS for recurrent tumor after chemoradiotherapy despite the intention of minimally invasive salvage surgery.
A 68-year-old man underwent TOVS due to T1 recurrent oropharyngeal cancer of the anterior wall after 8 years of initial treatment by chemoradiotherapy. However, the patient suffocated from severe hemorrhage on the 16th postoperative day, requiring emergency tracheotomy in a hospital ward and hemostasis in an operating room. He has been followed for 18 months after surgery with functional preservation and no disease.
TOVS might be applicable for salvage treatment as well as initial treatment as a function-preserving surgery. However, because it can lead to life-threatening postoperative bleeding especially in cases after radiotherapy, careful case selection and surgical planning are necessary.

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