[in Japanese]

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There is ample evidence to indicate that the use of concurrent chemoradiotherapy (CCRT) has improved larynx preservation outcomes in recent years not only for early but also for advanced laryngeal cancer, without compromising local disease control. Several randomized controlled trials have been performed in western countries to assess the impact of CCRT on larynx preservation. Although CCRT is considered to be the standard organ-preservation treatment for patients with advanced laryngeal cancer, the occurrence of early and late severe toxicity such as persistent dysphagia and aspiration after CCRT and complications in salvage surgery has been reported recently. A thorough discussion followed by obtaining informed consent regarding the risks and benefits of larynx-preservation therapy (CCRT or larynx-preservation surgery) has thus become crucial in the treatment of laryngeal cancer patients.

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The posterior orbit contains a number of important and vulnerable structures, including the optic nerve, the ophthalmic artery and vein, the ocular muscles and their motor nerves, which makes the surgical access to any lesions in this region quite difficult. Transfrontal, transfront-ethmoidal and transmaxillary procedures have the disadvantage of causing possible injuries to a number of normal structures, whereas the endoscopic transparanasal approach is a minimally invasive surgical procedure that proven to be effective for the orbital retrobulbar lesions. We experienced nine cases such as cavernous hemangioma, carcinoid metastasis, hematoma, and Wegener's granulomatosis. We examined the adaptation and limits of the procedure based on the experience gained from these nine cases.
Endoscopic endonasal ethmoidectomy and antrostomy clearly visualize the medial-inferior part of the orbit as well as the apex of the orbit. A slightly larger portion of the bone than the size of the lesion in the medial wall of the orbit including the ethmoid-maxillary plate should be removed.
Medial or lateral orbital subperiosteal lesions can be removed using the endoscopic endonasal transparanasal procedure with low risk of operative complications to the orbital structures. This procedure is not impossible in the treatment of upper subperiosteal liquid lesions. The endoscopic endonasal transparanasal approach is a very useful procedure for the treatment of orbital subperiosteal lesions. However, orbital tumors inside the muscle cone are accompanied serious complications. Careful consideration needs to be given to the appropriateness of adopting this procedure in such cases.

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[in Japanese]

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[in Japanese]

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[in Japanese]

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We report a very rare case of pharyngo-esophageal-gastric submucosal abscess. The patient was a 68-year-old man having a sore throat and dyspnea. CT findings revealed an abscess from the retropharyngeal space to the esophagus and gastric cardia. We performed open dissection of the neck, but no abscess was found in the retropharyngeal space, so we observed the pharynx, esophagus and stomach by esophageal scope and gastric fiberscope. The pharyngeal mucosa was swollen and spontaneous drainage was recognized. Submucosal swellings were also recognized in the esophagus and stomach, which were incised for drainage, but it was not sufficient as a surgical therapy.
After surgery, the patient suffered the complication of disseminated intravascular coagulation (DIC). Therefore, we changed the antibiotics to meropenem over time above the minimal inhibitory concentration (MIC) based on a pharmacokinetics/pharmacodynamics (PK/PD) therapy. The patient was completely cured by this surgical approach and antibiotic therapy as described.
In general, deep neck abscess progresses to the mediastinum through the retropharyngeal, carotid artery and dangerous spaces. However, the case reported here was very rare, since the abscess was recognized in the pharyngo-esophageal-gastric submucosal space.

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We encountered a rare case of arytenoid abscess secondary to acute epiglottitis. A 63-year-old man was referred to our hospital with a 3-day history of sore throat and a 4-hour history of difficulty in breathing. Flexible laryngoscopy demonstrated severe swelling of the arytenoid region with redness and swelling of the epiglottis. Computed tomography demonstrated a low density area showing a contrast effect in the arytenoid region. This case was diagnosed as having arytenoid abscess secondary to acute epiglottitis. Immediate airway intervention and surgical drainage were performed. A tracheotomy was performed following tracheal intubation by the anesthetist. Surgical drainage was performed under microscopy. Postoperatively, the patient was treated in the intensive care unit. Fortunately, all of the clinical symptoms improved postoperatively. Thirteen days postoperatively, the patient was returned to the previous hospital. When we encounter a case of epiglottitis with swelling of the arytenoids, it is important to consider the possibility of airway intervention or abscess formation requiring drainage.

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These techniques in head and neck reconstruction have been employed in our department for more than 20 years since 1987. We review the current state of free tissue transfer in head and neck reconstruction in our department.
Except for intestine transfer, tumor resections and reconstructions such as microvascular anastomosis have been done in our department by a single team consisting only of head and neck surgeons. The records of 468 consecutive free flaps performed by a single head and neck surgical team from 1987 to 2007 at the Department of Otolaryngology, Head and Neck Surgery of Kansai Medical University Hospital were reviewed. Patients were reconstructed with a variety of microvascular free flaps harvested from the radial forearm (147 cases), rectus abdominis musculocutaneous (128 cases), jejunum (173 cases), osteocutaneous scapular (10 cases), fibula (6 cases), etc. The use of rectus abdominis musculocutaneous and jejunal flaps has increased in recent years. The success rate of free tissue transfer was 94.0%. An aging society coupled with an increase in post-adjuvant recurrence may make reconstructions a growing challenge to surgeons, especially when using microvascular free flaps.
Regarding cases of failure, most of the cases were jejunum with venous thrombosis. Such cases have increased since introducing definitive chemoradiotherapy. The issue of free-flap necrosis is likely to be relevant to definitive chemoradiotherapy.

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We report three cases of salivary duct carcinoma in the parotid gland. Case 1 had a locally limited disease arising from previous pleomorphic adenoma. The case was treated with limited parotidectomy and post-operative radiotherapy without recurrence for 34 months. Case 2 underwent total parotidectomy with facial nerve preservation, modified radical neck dissection, and post-operative concomitant chemoradiation therapy with docetaxel, but the patient died of multiple lung metastasis after 23 months. Case 3 presented with facial palsy, underwent total parotidectomy with facial nerve resection and modified radical neck dissection. This case was also treated with post-operative concomitant chemoradiation therapy with docetaxel without recurrence for 23 months. Although there is little reliable clinical evidence in terms of treatments, it is considered necessary to develop and examine new therapeutic modalities for salivary duct carcinoma to utilize the biological similarity of breast cancer.

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We present a case of hemangioma in the masseter muscle, treated by surgical removal of the tumor via an extraoral approach. The patient was a 14-year-old female, who was referred to our department with a chief complaint of left buccal mass since she was 5 years old. At the first examination, a palpable left buccal mass appeared upon biting. T2-weighted MR imaging demonstrated a high intensity area accompanied by a low intensity area that appeared to be a phlebolith. Hemangioma was suspected, and surgical removal was performed. The resected tissue was pathologically rated as hemangioma. To date, the patient has shown an uneventful course both aesthetically and functionally. In such cases, it is important to completely resect the lesion via an extraoral approach.

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We report three cases of thyroid papillary carcinoma in a child and two adolescents. All cases had large or multiple thyroid tumors, multiple cervical node metastasis and multiple lung nodules. They underwent total thyroidectomy and bilateral modified radical neck dissection. A recurrent laryngeal nerve was resected and reconstructed with a nerve interposition grafting in one case because of the invasion of thyroid tumor. Radioactive iodine-131 (I¹³¹) was administered to all patients postoperatively. Lung nodules were reduced in two cases and did not enlarge in the other case. There was no enlargement of metastatic lymph node although I¹³¹ scanning after exposure revealed a subclavian node metastasis in one case. There were no major complications after treatment. Total thyroidectomy, extensive neck dissection and radioiodine therapy are effective in the management of infantile and adolescent patients suffering from advanced thyroid papillary carcinoma.

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