One of the most difficult problems in head and neck reconstructive surgery is the long duration. Especially, microvascular anastomotic surgical procedures take most of the time. We use the VCS clip for microvascular anastomosis under microscope and report the technique in this article. This technique is easier and faster than the suture technique in the anastomosis of vessels of larger than 2 mm in diameter. The VCS clips have potential applications for many other surgeries of the head and neck, and more studies need to be done.

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Sixty-three patients with hypopharyngeal carcinoma were treated by pharyngolaryngectomy at our institution between 1996 and 2000. There were the following two types of defects resulting from resection of carcinomas : 37 circumf erential pharyngeal defects and 26 partial pharyngeal defects. For the partial pharyngeal defect, 7 patients were reconstructed with primary closure of pharynx, and 19 patients with skin flap for patch reconstruction : 18 pectoralis major myocutaneons flaps (PMF) and one radial forearm flap. For the circumf erential defect, 12 patients were reconstructed with gastric pull-up (with esophageal carcinoma) and 19 patients with free jejunal autograf t (FGA). For the circumf erential defect in high-risk patients we utilized skin flaps (3 pectoralis major myocutaneous flaps, one radial forearm flap and 2 D-P flaps). Reconstructions with D-P flap were performed at the second-stage operation. Fistula formation occurred in 11.1% for all cases, and occurred more frequently in the PMF group than in the FGA group. About 5% of the patients had necrosis of grafts or flaps ; 8.3% in the gastric pull-up group, 5.3% in the FGA group, and 4.8% in the PMF group. In the circumf erential defect cases PMF was useful for the high-risk patients however, when pharynx was extensively resected including both tonsils, we recommended other flaps, especially PMF flaps. because partial necrosis of the flap easily occurs at the distal end of it.

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Analysis of preoperative risk factor for delirium is important to identify patients at risk of it after head and neck cancer surgery. This study shows the results of 257 cases with head and neck cancer surgery at Nippon Medical School Hospital. Postoperative delirium developed in 34 of 257 patients (13.4%). Incidence of it after major operation including free flap head and neck reconstruction was 25.4%. Risk factors were a history of psychiatric disease, poor cognitive state and postoperative respiratory dysfunction due to lung edema. From this point of view, we made an original predictive score using five criteria : male sex, psychiatric disease history, poor cognitive state, living alone and respiratory complication just after surgery. We suggest that this scoring method may be useful in the identification of high-risk patients and for planning further treatment for postoperative delirium.

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Clinical studies of 36 patients with papilloma of the nasal and sinonasal sinuses were performed. We treated 25 men and 11 women with an average age of 55.1 years. Chief complaints were nasal obstruction. Histology showed 11 cases of squamous cell papilloma and 25 cases of sinonasal papilloma. Sinonasal papilloma were classified into three histopathological types : exophitic papilloma, inverted papilloma and cylindrical cell papilloma. In this study, inverted papilloma was the most common type. Inverted papilloma occurred primarily in the internal wall of the maxillary sinus. The recurrence rate was 9.7% (3 cases), one case was squamous cell papilloma with sinonasal papilloma, and two cases were inverted papilloma. Four cases (11.1 % ) showed malignant transformation.

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From 1996 to 2000, 13 patients with hyperparathyroidism were operated on our department. This report evaluates the new system of the department of head and neck surgery for increasing the operation cases with hyperparathyroidism. Of the 13 patients, 9 patients were introduced from medical departments, 2 patients from psychologists, and 1 patient from renal medicine. This disease was detected in only one patient by our department. Preoperative imaging examinations were not so usefull for these patients. Simple extirpation of an enlarged parathyroid adenoma was conducted for 5 patients, and in the other patients more than 2 parathyroid glands were resected. Postoperative serum calcium and intact-PTH were within the normal range in all cases. For the increase of the patients with hyperparathyroidism who operated by head and neck surgions, correct detection of this disease from the patients with unfixed symptomes.

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Myoepithelial carcinoma of the salivary gland is a rare tumor, comprising only about 0.1 to 0.7 percent of all salivary gland tumors. The present paper reports a case of myoepithelial carcinoma arising from the right parotid gland, approximately 7 cm in diameter. The patient was a 58-year-old Japanese male who underwent deep parotidectomy with marginal resection of the mandibula. This case illustratas several distinctive clinical and pathological characteristics of the rare tumor. Histological examination showed a malignant spindle cell neoplasm with an inf iltrative growth pattern and a moderately mitotic rate. The immunohistochemical findings were myoepithelial differentation of tumor cells stained positively with a smooth muscle actin and EMA.

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We report a case of deep vein thrombosis after surgery for mesopharyngeal cancer (T4N3M0). The patient showed swelling of the thigh on the right side and was diagnosed as deep vein thrombosis using RI venoscintigraphy. Heparin as an anticoagulant was effective for the disease. The number of cases of the disease may increase in the field of otorhinolaryngology and head and neck surgery. We emphasize the importance of selection of high risk patients and preventive treatment for these patients as well as early detection and therapy for deep vein thrombosis.

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Schwannoma is not uncommon elsewhere in the body, but it is rare in the oral cavity. We report a case of schwannoma that occurred in the buccal submucosa. The patient was a 47-year-old Japanese man complaining of a painless lump in the right buccal region. The clinical diagnosis was a benign tumor of the salivary gland. Histopathological examination revealed schwannoma. Six cases of schwannoma in the buccal submucosa have been reported in Japanese literature. These cases as well as the present case are reviewed.

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