After traversing the internal acoustic meatus, the facial nerve enters the bony fallopian canal, and then passes through the temporal bone. The facial nerve is often involved in cholesteatoma, ear tumors and trauma. A good understanding of the anatomical pathway of the intratemporal facial nerve is prerequisite for preventing iatrogenic injury, and adjunctive use of nerve monitoring is useful to identify the nerve. Total removal of lesions without injuring the facial nerve is the final goal of temporal bone surgery. However, management of the facial nerve in intricate cases sometimes diverges; whether to preserve the facial nerve or not. The facial nerve should be preserved in cases with normal or mild palsy preoperatively. In contrast, cases with severe palsy and/or longstanding palsy require resection of the facial nerve with the lesion, following nerve reanimation. Nerve grafting is adequate in cases with both detectable proximal and distal stump of the nerve, while hypoglossal facial interpositional jump graft is adequate in cases with missing proximal stump of the nerve.

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[in Japanese]

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[in Japanese]

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[in Japanese]

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We present two cases of infratemporal fossa abscess. The first case was a 64-year-old male who was referred to us with pericoronitis of the right wisdom tooth. CT revealed an abscess in the right infratemporal fossa, extending to the pterygopalatine fossa, and to the parapharyngeal space. The second case was a 65-year-old male with diabetes mellitus. He had pericoronitis pain but left it untreated for several months. He visited a dentist in our hospital and was diagnosed with a pericoronitis abscess of the right wisdom tooth. Although the abscess was drained from the submaxillary space and also from the gingiva, the abscess increased in size, the patient complained of stridor, and was referred to us. CT revealed an extensive gas-forming abscess that spread from the right temporal fossa to the neck. In each case, the abscess was drained from the submaxillary space and also from the temporal space by periauricular incision. We attached the draining tubes and irrigated repeatedly. Both patients got well soon. Adequate abscess drainage is important for effective treatment of infratemporal fossa abscess.

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The present status of short stay surgery for nasal and paranasal sinus diseases in our hospital is reported. Candidates for short-stay surgery received necessary instructions at the Same-Day Surgery Center of the hospital before admission, and were admitted to the special ward on the day of surgery. During the period from May 2005 to May, 2007, 169 cases of nasal and paranasal diseases were operated according to our regimen for short stay surgery. The surgery was performed under general anesthesia, and the operating time was shortened by the introduction of recently developed instruments such as harmonic scalpel and Coblator II. Short-stay surgery is considered to be effective to meet the differing needs of patients, and is expected to become more popular in Japan.nose and paranasal sinus disease

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There have been some reports on positioning of a T tube in the nasofrontal duct after common extranasal or endonasal frontal sinus surgery. There have been, however, no such reports on positioning a T tube after endoscopic modified Lothrop procedure (EMLP). We placed a transient T tube in the nasofrontal duct after EMLP in 7 patients. The duration of the follow-up period after surgery was 13 months on average. The T tube was removed generally in 2 or 3 months in most cases, but its permanent positioning was intended in 2 intractable cases. The nasofrontal duct was patent at fiberoptic examination in the 5 cases in which a stent had been removed. The shape of the T tube seemed to conform to united bilateral frontal sinuses and the nasofrontal duct. Spontaneous stent ejection was not observed in our cases, indicating that positioning of the T tube into the nasofrontal duct after EMLP was stable.

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Pleomorphic adenomas most commonly arise in the major salivary glands, and only rarely in the nasal cavity. We report a case of pleomorphic adenoma originating from the nasal septum. A 66-year-old woman complained of nasal obstruction. Endoscopic examination revealed a tumor in the left nasal cavity that was covered with smooth mucosa and showed vasodilatation. Computed Tomography showed an enhanced round mass in the left nasal cavity. Magnetic Resonance Imaging showed no infiltration of the tumor. We performed a biopsy before excision, and perioperative pathology led to a diagnosis of spindle cell carcinoma. We were able to observe the tumor intranasally, so decided on endoscopic sinus surgery. Taking into consideration the fact that it was a spindle cell carcinoma, we established sufficient margins of safety. We resected the perpendicular plate and mucosa of the right nasal septum together with the tumor using a CO2 laser. The tumor was 20 × 25mm in diameter, and consisted of a white solid mass. Pathologically, it was diagnosed as a Pleomorphic adenoma of the nasal septum. There has been no recurrence at 9 months. Case of pleomorphic adenoma of the nasal cavity have characteristics unlike those of major salivary gland adenomas in that symptoms such as nasal obstruction and epistaxis appear early, and sufficient resection is possible. The treatment of choice for pleomorphic adenoma is resection. In cases involving the nasal cavity, this can be done either by intranasal or extranasal surgery, according to the type, size and location of the tumor.

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The authors conducted a review of 25 patients who had undergone resection of the oropharyngeal cancer of lateral wall type during the period from 2002 to 2007. The patients consisted of 18 males and 7 females, and the average age was 58.8 years old. We divided the surgical approach used to treat the oropharyngeal cancer of lateral wall type into 3 types: 1. Trans-oral method, 2. Combined method, and 3. mandibular swing approach. Five patients had been treated with the trans-oral meth-od, 11 patients with the combined method, and 9 patients with the mandibular swing approach. All of the patients who had undergone the trans-oral method treatment were performed raw surface. Eight of the 11 patients who had undergone the combined method underwent microsurgical recon-struction, while the remaining 3 patients underwent primary closures. All patients who had under-gone the mandibular swing approach had microsurgical reconstruction performed. When we decide upon a surgical approach to use in the treatment of oropharyngeal cancer of lateral wall type, it is necessary to pay particular attention to the development range of the tumor as well as invasion to the root of the tongue and the internal pterygoid muscle.

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The patient was a 62-year-old male. He visited our hospital after having undergone an operation and radiation due to esophageal cancer in 1998 and a total laryngectomy due to laryngeal carcinoma in 2001. He visited our hospital on February 13 in 2006 and was operated by endoscope on February 22 just over one week later. Pathologically, the condition was diagnosed as a carcinoma in situ. Overlapping head and neck carcinomas are frequent from the standpoint of field cancerization, so it is not uncommon that hypopharyngeal carcinoma occurs after laryngectomy. Squamous cell carcinomas occurring after laryngectomy or radiotherapy are often treated as local recurrent or radiation induced carcinomas, but we believe that they include overlapping carcinomas.

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A 76-year-old man was referred to our hospital claiming progressive dysphagia and hoarseness after consulting his general physician, who thought that his symptoms were due to the cerebral infarction which he had had three years before. Laryngeal fiberscopy revealed protrusion of the posterior wall of the pharynx, left vocal cord paralysis and right vocal cord paresis. Cervical X-rays demonstrated typical thickening of the frontal osteophytes, which suggested Forestier's disease. He was sent to the orthopedics department, and underwent surgical resection of the osteophytes. After the surgery, his dysphagia was much improved. Laryngeal fiberscopy showed improvement of the mobility of the right vocal cord. The literature of other similar cases is discussed.

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MALT lymphoma is generally thought to be a low-grade malignancy that progresses slowly. We report a case of airway stenosis caused by primary thyroid MALT lymphoma that was successfully treated with emergency radiotherapy. The case involved a 60-year-old male who visited our department because of neck swelling and an airway sound resulting from stenosis. CT scan showed significant swelling of both thyroid lobes, a minimum tracheal diameter of 4.1 mm, with the extent of tracheal stenosis ranging up to 59.0 mm. Hyperfractionated radiotherapy for the emergency condition and subsequent rotational conformal radiotherapy were performed. These dilated the airway considerably and prevented asphyxiation. MALT lymphoma was diagnosed upon biopsy. We conclude that MALT lymphoma, which is thought to have a mild prognosis, can be life-threatening in certain cases such as this one. Such patients require careful attention.

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The patient was a 77-year-old woman who complained of a mass in the neck. Total thyroidectomy and left D2a neck dissection were performed (tall cell variant papillary carcinoma, pT4a pNlb pEX2-left recurrent nerve, no invasion to trachea). Two months after the operation, she felt progressive dyspnea. A tracheal tumor just under the crycoid cartilage was shown by neck CT examination and poorly differentiated papillary carcinoma was suggested by fine needle aspiration biopsy. Laryngotracheal resection to the level of the top of the sternum with cleidotomy, right neck dissection and local esophagectomy with reconstruction by a forearm free flap were performed. Because a histopathological examination showed squamous cell carcinoma and stain of TTF-1 and thyroglobulin were negative, we diagnosed the case as double primary cancer. Postoperative radiation of 50Gy was performed, but half a year later lung and multiple bone metastases were detected.

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We analyzed 15 patients with thyroid carcinomas with mediastinum involvement treated by our department between 1991 and 2006. These patients consisted of six males and nine females. The average age was 60 years old. Five patients had primary diseases, and ten patients had relapse diseases. Fourteen patients presented mediastinal lymph node metastases from thyroid carcinomas and one patient presented an extended primary tumor involving the mediastinum. Seven patients underwent mediastinum dissection via median sternotomy. Both 5-year and 10-year survival rates of the patients who underwent mediastinum dissection were 85.7%. Six of the remaining eight cases did not undergo mediastinum dissection due to inoperabilities. All cases died within four years. The remaining two cases did not undergo mediastinum dissection due to patients' refusal of mediastinal surgery. One of these refusal cases lived with carcinoma for 89 months after the diagnosis. The other refusal case lived with carcinoma for 120 months after the diagnosis. As complications of the mediastinum dissection, mediastinitis and recurrent laryngeal nerve paralysis were seen in one patient respectively. For advanced thyroid carcinomas with mediastinum involvement, mediastinum dissection via median sternotomy by a medical treatment team of head and neck surgeons and thoracic surgeons is useful for improving the prognosis, and can be conducted safely.

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Fifty-one patients with Graves' disease were operated on Yamada Red Cross Hospital. Total thyroidectomy was performed in 21 patients, and subtotal thyroidectomy in 30 patients. In our hospital, subtotal thyroidectomy is different from the conventional subtotal thyroidectomy, with total resection of the unilateral lobe with subtotal resection of the contralateral lobe. This procedure is a modified technique of Hurtly-Dunhil's operation. Bilateral recurrent laryngeal nerves are exposed as far as the orifice into the larynx, and parathyroid glands are preserved as far as possible. From two to four grams of the thyroid is a preferred residual volume. The residual volume was under 2 grams in 5 patients, 2 4 grams in 19 patients, 4 6 grams in 5 patients, and over 6 grams in 1 parient. Postoperatively, there was normalized thyroid function in 13 patients and hypothyroidism in 16 patients who underwent subtotal thyroidectomy. Recurrence of hyperthyroidism was observed in only one patient, who was reoperated safely and postoperative complications were not observed. In 51 patients operated on our hospital, recurrent laryngeal nerve paresis was not observed in all cases. Postoperative hypoparathyroidism was observed in 2 cases. In view of postoperative thyroid function and safe reoperation, our procedure for subtotal thyroidectomy is valuable.

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In the reconstruction of a pharyngeal defect after ablative surgery for head and neck cancer, free flaps are currently the most common method because of their versatility. However, elderly patients or debilitated cases sometimes hesitate to have free flaps applied because morbidity can lead to critical results. We present a case of hypopharyngeal carcinoma in which we performed total laryngectomy with partial pharyngectomy followed by reconstruction using a cervical pedicled flap, a submental island flap. Case: An 81-year-old man presented with T4aN1M0 squamous cell carcinoma of the right pyriform sinus that extended to the posterior wall of the hypopharynx, larynx, and infrahyoid muscles over the lamina of thyroid cartilage. Additionally, the patient had preoperative severe malnutrition and anemia. Right selective neck dissection, total laryngectomy with partial pharyngectomy, and reconstruction using a submental island flap were performed. The patient was ambulatory the day after surgery and resumed oral intake on the 10th postoperative day. Neither flap necrosis nor anastomotic leakage has been recognized. The submental island flap is thought to be a useful option for pharyngeal reconstruction as an alternative to free flaps.

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