In our hospital, chemoradiation therapy (CRT) for oropharyngeal cancer is indicated for unresectable cases, cases in whom postoperative function is predicted to be poor, and cases who need postoperative CRT due to N3 or multiple cervical node metastasis. Among 70 cases of oropharyngeal cancer treated between 2002 and 2006, 32 cases of stage III or IV were treated by CRT. Of these, 14 cases were resectable and 18 cases were unresectable, and their 3-year cause-specific survival rates were 90% and 21% and Rouviere node metastasis rates were 0% and 72%, respectively. Thus, CRT may be a good means of radical cure for resectable cases who are unsuitable for surgery because of postoperative poor function or high possibility of relapse in cervical node metastasis. In addition, it is important to evaluate the resectability and Rouviere node metastasis for predicting the prognosis.

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As life expectancy has increased, the opportunity to treat head and neck cancer in elderly patients has increased.
This retrospective study involved 94 patients (61 males, 33 females), aged over 75 years (mean age, 81.5 years), with head and neck cancer who were treated at the International Medical Center, Saitama Medical University, between 2005 and 2008.
The primary tumor site most frequently involved the oral cavity, larynx, thyroid, and hypopharynx; 66% of the patients had advanced cancer. Some complications, mainly cardiovascular and respiratory diseases, were detected in 76% of the patients during preoperative evaluations.
Curative treatment, primarily surgery, was undertaken in 74.4% of the patients; 11 patients had reconstructive surgery without major postoperative complications. The major restriction on the treatment procedures was rejection of surgery by the patients or their families; preoperative complications were not a limiting factor.
The results suggest that the limitations to surgery are almost the same in elderly patients as in younger patients.
Informed consent is very important in elderly patients.

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Endoscopic skull base surgery which can be performed clearly and with low invasiveness is an effective approach for anterior or posterior skull base tumors. However, there are several prerequisites for using this approach, including: size of tumor, control of bleeding in operating area, treatment of CSF leakage, and close cooperation with the neurosurgeon.

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To improve the results of treatment for advanced squamous cell carcinoma of the tongue, we have performed combined modality therapy, which is a combination of preoperative intraarterial injection chemoradiation treatment with curative operation, in our hospital since 1997. We reviewed the cause-specific survival rate and recurrence rate to determine the efficacy of our therapy between 1997 and 2005. The survival rates were 86% (stage III) and 68% (stage IV) in the combined modality therapy. The cases receiving this therapy had a better survival rate than those receiving other therapies. Also, the combined modality therapy reduced loco-regional recurrence. In stage III cases, there were no loco-regional recurrences regardless of the presence of postoperative treatment. But in stage IV cases, the loco-regional recurrence rate was 30% in spite of postoperative treatment. Therefore, we should consider changing the contents of postoperative treatment.

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Perioperative oral care has been provided to patients undergoing surgery for head and neck cancer in cooperation with the general dentistry department since March 2005. We studied whether preoperative oral care reduced the incidence of postoperative complications. We reviewed 95 patients, 76 males and 19 females, who underwent free flap reconstruction surgery from June 2004 to September 2008. All reconstruction surgery was performed by the same surgeon. The procedures were performed for 34 cases of oral cancer, 24 of mesopharyngeal cancer, 23 of hypopharyngeal/cervical esophagus cancer, and 14 of other cancers. The reconstruction procedures involved 39 rectus abdominal musculo-cutaneous flaps, 19 antero-lateral thigh flaps, and 29 jejunum flaps. Postoperative complications occurred in 40.4% of 47 patients who received perioperative oral care, and in 65.0% of 48 patients who did not receive oral care. Perioperative oral care significantly reduced the incidence of postoperative infection.

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Objective: Although it is very important to choose an appropriate reconstruction in laryngeal preservation surgery for hypopharyngeal cancer, there is no guideline at present. The purpose of this study was to determine an appropriate reconstruction depending on the extent of resection.
Subjects and Method: Of hypopharyngeal cancer cases, we reviewed 23 patients who underwent laryngeal preservation surgery in our hospital from April 2004. We examined the reconstruction surgery performed and the extent of resection in each case.
Results and Discussion: If the excision was to be confined to the unilateral aryepiglottic fold and piriform fossa, a primary suture was possible. If the excision reached the posterior pharyngeal wall and/or postcricoid area across the unilateral piriform fossa, repair with jejunum patch was required. Repair with jejunum patch was also necessary in case of excision including the upper half of the arytenoid cartilage across the unilateral aryepiglottic fold. Several cases with T3/T4 advanced cancer where laryngeal preservation surgery was possible were found. Patients receiving primary suture operation could begin to eat at 2 weeks postoperatively on average, whereas patients receiving reconstruction operation could begin to eat at 3 weeks. The laryngeal function was kept in approximately 80% of cases, and disease-specific survival was approximately 90%.

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Neuroblastic tumors of the neck are rare entities, constituting only 5% of tumors in the pediatric age group. We report a case of cervical ganglioneuroblastoma in a 1-year and 9-month-old boy with Hörner syndrome. MRI revealed a mass of 4 cm in diameter in the left side of the neck growing between the common carotid artery and internal jugular vein. Biopsy specimens histopathologically indicated ganglioneuroma. Operative findings indicated that the tumor was derived from the cervical sympathetic nerve. Because histopathological findings indicated ganglioneuroblastoma surrounded by ganglioneuroma, the tumor was diagnosed as ganglioneuroblastoma. The authors emphasize the importance of considering this disease if young patients complain of the combination of a cervical mass and Hörner syndrome in the same side of the neck.

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A rare case of throat burn caused by the accidental explosion of a firework in the oral cavity is reported. A 33-year-old man complained of neck swelling and sore throat.
He was admitted to our hospital for the diagnosis of cervical subcutaneous emphysema and mediastinal emphysema.
We diagnosed throat burn injury and performed medical treatment of steroid and antibiotics. After 3 days, laryngeal fiberscopy revealed swelling and necrosis of the posterior wall of the hypopharynx, and MRI demonstrated a deep neck abscess. Therefore, we performed surgical drainage, removed the foreign body of the firework and conducted pharynx suture and mediastinal drainage through a thoracic approach with the cooperation of thoracic surgeons. After the operations, we administered broad-spectrum antibiotics and performed local irrigation for the abscess in the post pharyngeal space every day for 11 days. After these therapeutic approaches, he gradually recovered without any major complication. This patient could be saved, but required mediastinal drainage through a thoracic approach. Therefore, it is thought that some early support (cervical drainage, etc.) was needed at that time.

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We have treated 24 patients with cervical metastasis of unknown origin over the past 8 years. Primary sites became evident in 14 cases subsequently: 6 cases were mesopharynx, 2 cases were hypopharynx and submandibular gland. The pathological diagnosis was as follows: 17 cases were squamous cell carcinoma, 5 cases were adenocarcinoma, and 2 cases were unclassified neoplasm. The frequent regions of lymph node metastases were level II and III of MSKCC. Fine needle aspiration biopsy was effective for preoperative examinations. PET imaging was done in 14 cases. Four primary regions were detected by PET. In most cases, neck dissection was done with postoperative radiation therapy. The overall five-year survival rate was 50%.

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We report herein the clinical evaluation and surgical treatment of three cases of neck arteriovenous malformation (AVM). The first case underwent surgery after embolization of the artery. After 2 years and 3 months, the AVM had disappeared. The second case underwent operation after arterial embolization. Re-growth was identified after 6 years and treatment has been considered. For the third case, who had undergone an artery embolization operation 16 years earlier, re-growth was treated surgically using a cyber-knife. Three years and 6 months after treatment, the AVM has not re-grown. Care is required with operations for AVM after embolization. AVM is a benign disorder, but readily re-grows. A careful and long-term wait-and-see approach is required, and new methods of treating re-growth are needed.

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There has still been no detailed consideration of the mode of administering antimicrobial prophylaxis based on EBM when operating in the field of otorhinolaryngology. We have undertaken surgical site infection (SSI) prevention surveillance in our hospital as necessary since 2003, and report here our recent attempt to shorten the administration time. We compare the difference in SSI outbreak in 298 patients operated on in our hospital (excluding exceptional cases) whose antimicrobial agent treatment had ended. As a result, the overall SSI outbreak rate was 1.7%, and the rate was only 1.2% on the day of operation in the antimicrobial agent administration group. The SSI incidence gradually improved compared to the time at which the study began. Thus, antimicrobial prophylaxis in the field of otorhinolaryngology is considered to be effective only on the day of operation (AMP) for many patients.

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