JOURNAL OF JAPAN SOCIETY FOR HEAD AND NECK SURGERY
Online ISSN : 1884-474X
Print ISSN : 1349-581X
ISSN-L : 1349-581X
Volume 20, Issue 3
Displaying 1-18 of 18 articles from this issue
  • Hiroyuki Makino, Makito Okamoto, Meijin Nakayama, Yutomo Seino
    2011 Volume 20 Issue 3 Pages 195-200
    Published: February 28, 2011
    Released on J-STAGE: March 18, 2011
    JOURNAL FREE ACCESS
    Partial maxillectomy is one of the standard treatments for sinonasal malignant tumors. By combining this procedure with chemoradaition therapy, we have achieved a good prognosis and a better quality of life in our patient group. However, in some instances, visibility during surgery was adversely affected due to bleeding and blind spots. To improve these problems, nasal endoscopy was utilized to assist partial maxillectomy. Three patients who received partial maxillectomy assisted by nasal endoscopy were reviewed. Two patients were diagnosed with squamous cell carcinoma and one with inverted papilloma. The advantage of incorporating nasal endoscopy to the surgery include: 1) improved management of visibility in the surgical field, 2) facilitation of cooperation between primary surgeon and assistants, 3) image recording was possible for use in education, 4) overall limited invasive surgery was feasible in some patients by preserving key anatomical structures. Partial maxillectomy assisted by sinonasal endoscopy was useful in the three patients evaluated. Further analysis is needed to expand aspects of this approach.
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  • Atsuhiko Ikeda, Takahiro Shimizu, Yoshimasa Tsuchiya, Nobuyuki Katahir ...
    2011 Volume 20 Issue 3 Pages 201-206
    Published: February 28, 2011
    Released on J-STAGE: March 18, 2011
    JOURNAL FREE ACCESS
    We report a case of squamous cell carcinoma of the nasal cavity which was diagnosed as Bowen's disease (carcinoma in situ). A 21-year-old man came to hospital complaining of nasal congestion. A diagnosis of Bowen's disease was made by biopsy. A mass lesion was indentified based on his right nasal cavity and exclusion productive shade by the computed tomography image (CT), and magnetic resonance imaging (MRI). The tumor mass had reached the anterior cranial base and epipharynx.
    We need to treat the tumor as carcinoma in situ, and initial choices of surgical procedures were considered on the basis of sufficient safety margin and extirpation without residual lesion.
    An intranasal tumorectomy with external nasal dissection, anterior cranial base dissection, and forearm flap reconstruction were performed. The ultimate pathological outcome was squamous cell carcinoma. Even in light of the diagnosis of carcinoma in situ, we believe that radical consideration of the optimal procedure is preferable including extended resection for cases of images indicating suspected invasive cancer.
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  • Hirotaka Shinomiya, Shigemichi Iwae, Yuji Hirayama, Hirokazu Komatu
    2011 Volume 20 Issue 3 Pages 207-210
    Published: February 28, 2011
    Released on J-STAGE: March 18, 2011
    JOURNAL FREE ACCESS
    Gouty tophi may be located in the knees, fingers, hands, feet, or in a helix of the ear. It is unusual to find tophi in the temporomandibular joints, sternoclavicular joints, eyelids, tongue, laryngeal cartilages, vocal chords in the case of head and neck lesions, etc. We present a rare case of a gouty tophus located at the root of the nose. A 53-year-old man presented with a 2-year history of a gradually enlarging, painless, hard nodule at the root of the nose. Surgical removal of the nodule enabled identification of a gouty tophus that was histologically characterized by long, needle-shaped monosodium urate crystals. Gouty tophi can often mimic malignant or benign tumors or infection, so it is important to consider the possibility of gouty tophi in tumors in head and neck lesions.
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  • Kensuke Suzuki, Motoki Nagata, Toshiya Inoue, Hisaya Yukawa, Takuo Fuj ...
    2011 Volume 20 Issue 3 Pages 211-216
    Published: February 28, 2011
    Released on J-STAGE: March 18, 2011
    JOURNAL FREE ACCESS
    We report a case of malignant lymphoma of the upper gingiva that was considered as a methotrexate-associated lymphoproliferative disorder (MTX-LPD). A 68-year-old woman was referred to our hospital with suspected cancer of the upper gingiva. She presented with an ulcer of the upper gingiva. Two biopsies under local anesthesia did not provide a definitive pathologic diagnosis. She was subsequently hospitalized with growing ulcer and pain. We performed biopsy under general anesthesia to achieve a definitive diagnosis. Histopathological examination of the biopsy specimens revealed diffuse large B-cell lymphoma. The patient had an 11-year history of rheumatoid arthritis (RA), and had been taking MTX for 8 years. Therefore methotrexate-associated lymphoproliferative disorder (MTX-LPD) was suspected and MTX therapy was discontinued.
    The incidence of MTX-LPD may increase in otolaryngological practice because MTX therapy is the standard treatment for RA. The authors emphasize the importance of considering this disease if a patient with RA complains of a mass.
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  • Takashi Nasu, Syuji Koike, Daisuke Noda, Akihiro Ishida, Masaru Aoyagi
    2011 Volume 20 Issue 3 Pages 217-224
    Published: February 28, 2011
    Released on J-STAGE: March 18, 2011
    JOURNAL FREE ACCESS
    We evaluated postoperative complications and management in 8 patients (6 men, 2 women), who underwent laryngeal preservation surgery for hypopharyngeal cancer in the Department of Otolaryngology-Head and Neck Surgery, Yamagata University School of Medicine from 2004 through 2008. Postoperative complications occurred in all patients. Most frequent complications included recurrent laryngeal nerve palsy of the diseased side. Dysphagia and aspiration pneumonia occurred in 4 (50.0%) patients. Dysphagia in one patient required tube feeding by PEG. One patient with aspiration pneumonia presented pyothorax and drug induced nephropathy. The assessment of the extent of resection and the reconstruction indicated that dysphagia and aspiration pneumonia were most frequently associated with cases with segmental resection of the hypopharynx and free jejunum reconstruction. Leakage from insufficient closure of the tracheal stoma and gastric regurgitation due to lack of peristaltic movement caused by sedative drug, may induce the aspiration pneumonia.
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  • —Relation of cytology from tonsil—
    Akiteru Maeda, Hirohito Umeno, Shun-ichi Chitose, Hiroyuki Mihashi, Ki ...
    2011 Volume 20 Issue 3 Pages 225-229
    Published: February 28, 2011
    Released on J-STAGE: March 18, 2011
    JOURNAL FREE ACCESS
    Clinical features of 9 cases of cervical metastasis from an unknown primary carcinoma found by tonsillectomy between 1980 and 2009 were reviewed. Every case indicated a pathological finding of cancer cells in the tonsil lacuna. This pathological evidence suggested the cytological examination of two recent cases of tonsil lacuna. One case had class IV cytology. These results indicate that cytology from the tonsil lacuna is a relevant method for detecting a primary lesion of the tonsils.
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  • Kazuto Matsuura, Kengo Kato, Katsunori Katagiri, Takayuki Imai, Eiichi ...
    2011 Volume 20 Issue 3 Pages 231-237
    Published: February 28, 2011
    Released on J-STAGE: March 18, 2011
    JOURNAL FREE ACCESS
    Free tissue grafting or pediculate musculocutaneous flap reconstruction is usually required after total glosso-laryngectomy.
    We performed total glosso-laryngectomy and bilateral neck dissection for a base of tongue cancer T4aN2cM0 case. However, reconstructive surgery became impossible due to sudden perioperative cardiac arrest. Therefore sutures were performed only in left pharyngeal mucosa and a fistula was formed to thereby form the oral floor and the pharynx. Only skin was present under the suture mucosa. Postoperatively, hyperplasy of the granulation and epithelization due to the mucosa displayed deterioration, and the oral floor was formed. Ingestion of a liquid diet was shown to be possible by videofluorography performed on day 50 after an operation. The patient was discharged on day 77 after an operation without showing a recurrence by postoperative 2-month MRI/CT.
    Even if reconstruction became impossible, this experience demonstrates that troubleshooting was possible by available wound closure after total glosso-laryngectomy.
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  • Hiroyuki Ozawa, Koichiro Wasano, Ichirota Nameki, Takashi Kato, Yorihi ...
    2011 Volume 20 Issue 3 Pages 239-246
    Published: February 28, 2011
    Released on J-STAGE: March 18, 2011
    JOURNAL FREE ACCESS
    Since vascular trouble associated with free jejunum transplantation during the resection of hypopharyngeal cancer often induces severe complications, early detection and restoration of vascular disturbance is important. Various methods currently used for estimating blood flow are subjective or difficult to assess. We measured intramucosal carbon-dioxide partial pressure (PiCO2) of transferred jejunum continuously using an air tonometory method in 16 patients who underwent resection of hypopharyngeal cancer.
    PiCO2 of transferred jejunum almost paralleled arterial carbon-dioxide partial pressure (PaCO2). PiCO2 elevation and its deviation from PaCO2 were observed with blood flow disorders such as vascular anastomosis. PiCO2 evaluation is capable of quantitative and continuous assessment, and is an objective and effective method for early detection of vascular trouble of transferred jejunum.
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  • Kazuhiko Nario, Hiroshi Hosoi, Katsunari Yane, Hiroshi Miyahara
    2011 Volume 20 Issue 3 Pages 247-253
    Published: February 28, 2011
    Released on J-STAGE: March 18, 2011
    JOURNAL FREE ACCESS
    We reviewed 41 cases of tracheotomy under local anesthesia. Thirty cases demonstrated malignant disease including laryngeal cancer (12 cases) and hypopharyngeal cancer (8 cases), whereas the remainder demonstrated benign disease. Twenty-eight cases underwent tracheotomy on the first hospital day, and 8 cases on the second hospital day. Reasons for tracheotomy included: to avoid asphyxia caused by airway narrowing (32 cases); preventional tracheotomy (4 cases); bleeding in the oral cavity or pharnx (4 cases); other reasons (1 case). Postoperative complications occurred in 5 cases which were however not serious. Clinical outcomes are that 17 patients currently remain alive, 19 patients have died and the current status of 5 patients is unknown. In this series, the average survival period of patients who died was 24.4 weeks after tracheotomy. Head and neck surgeons should have thorough knowledge and surgical techniques adapted to difficult tracheotomy procedures.
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  • Yukiko Yokoyama, Kazuhiko Yokoshima, Shunta Inai, Atsuko Sakanushi, Mu ...
    2011 Volume 20 Issue 3 Pages 255-260
    Published: February 28, 2011
    Released on J-STAGE: March 18, 2011
    JOURNAL FREE ACCESS
    Lipomas are one of the most frequently encountered slow-growing benign tumors generally not associated with any symptoms or functional abnormalities due to the absence of damage to the surrounding structures. Consequently, surgery for lipomas in the neck are usually avoided.
    In this paper, we describe our experience of a patient who presented with a huge lipoma of the neck. A male patient aged 32 years with a history of right-sided neck mass for 15 years presented with complaints of dizziness, cervical pain and throat discomfort. Surgery was not recommended upon visit to another clinic. CT and MRI revealed that the neck mass was an intramuscular lipoma with a maximum diameter of 100mm. The lipoma was completely removed without any serious surgical complications. However, preservation of the surrounding vital structures was crucial. The postoperative period was uneventful and the patient was relieved of his various complaints, postoperatively.
    This case suggests that it is important to establish the criteria for surgical management of cervical lipomas. Relatively fast-growing infiltrating lipomas as in this case must be an indication for surgery.
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  • Toshikazu Shimane, Kenichiro Ikeda, Syunya Egawa, Tomoaki Mori, Tomohi ...
    2011 Volume 20 Issue 3 Pages 261-265
    Published: February 28, 2011
    Released on J-STAGE: March 18, 2011
    JOURNAL FREE ACCESS
    10 patients with cervical neurinomas who had received intercapsular resection between April 2005 and March 2010 were examined in relation to age, sex, preoperative neurological symptoms, derived nerves, tumor size, and postoperative neurological symptoms.
    The patients' ages ranged from 16-66 years with the average being 42.1 years. There were four men and six women involved in the examination. In the case of derived nerves, one case related respectively to the lingual nerve and the vagus nerve, three cases from the accessory nerve, three cases from the brachial plexus, and two cases from the cervical nerves. Although no correlation was observed between tumor size and preoperative neurological symptoms, we inferred that a larger tumor was associated with increased susceptibility to postoperative paralysis. We also ascribed postoperative neurological deficiency symptoms to surgical procedures.
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  • Toshikazu Shimane, Kenichiro Ikeda, Syunya Egawa, Tomohiro Ono, Tomoak ...
    2011 Volume 20 Issue 3 Pages 267-270
    Published: February 28, 2011
    Released on J-STAGE: March 18, 2011
    JOURNAL FREE ACCESS
    Eight patients developing complications of postoperative salivary fistulas were targeted from a group of 178 patients who had undergone parotid tumor surgeries in our hospital between April 2004 and August 2009. First, we pressed and evacuated the subcutaneously-stored saliva from the incision line on the skin formed during the surgery. Next, we rubbed the prescribed tretinoin tocoferil ointments onto regions excreting saliva. Postoperative wounds were washed and cleaned every day, and ointments were applied. The time period from surgery to development of salivary fistulas was 6 to 27 days, with the average being 12.6 days. The time period between initial treatment of the identified fistulas to cure was 14 to 31 days, with the average being 17.8 days. We believe that this treatment method will improve the QOL of patients while reducing the burdens of medical practitioners, and therefore, expect that it will become an option for the future treatment of salivary fistulas of post-surgical parotid tumors.
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  • Minoru Takaki, Takashi Goto, Yutaka Hanamure
    2011 Volume 20 Issue 3 Pages 271-278
    Published: February 28, 2011
    Released on J-STAGE: March 18, 2011
    JOURNAL FREE ACCESS
    We report a case of myoepithelial carcinoma of the parotid gland. The patient was a 60 year old male. Around July 2008, the patient noticed a left neck tumor and since it increased in size, he consulted a local doctor on October 16, 2008, and was referred to our hospital for examination. The mobility of the left neck tumor was bad and with pain, skin reddish. Swelling of the neck lymph nodes in relation to the tumor was noted. The neck tumor was identified as parotid gland carcinoma T4aN2bM0. On November 17, we performed a left salivary gland partial resection and left neck dissection under general anesthesia. The pathological examination diagnosed a myoepithelial carcinoma (pT4a, ly3, v3, pn3, margin +, pN2b). Post-operative radiation therapy of 50 Gy was performed. On February 2009, the patient lost right eye movement (palsy of the abducent nerve). CT and MRI showed metastasis of the cavernous sinus, but no metastasis of the left parotid region and left neck. This suggested a possible beneficial effect of the radiation therapy for the myoepithelial carcinoma of the parotid gland.
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  • —For postoperative facial paresis—
    Motoki Nagata, Toshiya Inoue, Hisaya Yukawa, Manabu Ogura, Masao Yagi, ...
    2011 Volume 20 Issue 3 Pages 279-286
    Published: February 28, 2011
    Released on J-STAGE: March 18, 2011
    JOURNAL FREE ACCESS
    Deep lobe parotid tumors are relatively rare. The incidence of facial nerve dysfunction following parotidectomy with these tumors is high and is associated with challenging surgical technique. We evaluated facial nerve function in 100 patients presenting between January 2006 and December 2008 with previously untreated benign parotid tumors who underwent parotidectomy (13 situated deep lobe of the parotid). The rate of postoperative facial nerve paresis of the 13 cases was 61.5% (8/13 cases), which was significantly higher than tumor cases located in the superficial lobe. In addition, all facial branches were more affected in patients with deep lobe tumors compared with patients with superficial lobe tumors. All patients who experienced postoperative facial nerve paresis showed full recovery within 3 weeks from 6 months. A mass size in excess of 40mm was associated with higher incidence of facial nerve paresis compared with the masses less than 40mm. Due to limitations on preoperative evaluation of tumor location, 4 of 13 cases with deep lobe tumors were preoperatively misdiagnosed as superficial lobe tumors.
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  • Hiroyuki Inoue, Akira Miyauchi, Mitsuyoshi Hirokawa, Chisato Tomoda, Y ...
    2011 Volume 20 Issue 3 Pages 287-290
    Published: February 28, 2011
    Released on J-STAGE: March 18, 2011
    JOURNAL FREE ACCESS
    52 patients of the 2389 patients with papillary carcinoma of the thyroid treated surgically between January 2007 and January 2009 presented the follicular variant. Ultrasonographic features of the follicular variant of papillary thyroid carcinoma (FVPC) were classified into a malignant type (70%) and an adenoma-like type (25%). 39 of 40 FVPC cases underwent pre-operative fine needle aspiration cytology examination at Kuma Hospital. Pre-operatively, 36 cases (92%) were suggestive of malignant potential. Thirty-eight cases underwent lymph node dissection. Of the 11 cases with adenoma-like-type papillary carcinoma of the thyroid, 10 had no lymph node metastasis (pN0).
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  • Takeshi Suzuki Takeshi Suzuki, Ryousuke Uchida Ryousuke Uchida, Satoya ...
    2011 Volume 20 Issue 3 Pages 291-295
    Published: February 28, 2011
    Released on J-STAGE: March 18, 2011
    JOURNAL FREE ACCESS
    It is important to identify and save normal parathyroid glands during thyroid surgery to maintain blood calcium level. But detection of normal parathyroid glands is often difficult in the thyroid surgery. Fluorescence-guided parathyroidectomy for human hyperparathyroidism has already been proved. However, there are few reports of fluorescence-guided normal human parathyroid detection. Nine patients with thyroid benign tumor were given 20 mg/kg body weight of 5-Aminolevulinic Acid (5-ALA) orally 5 hours before exposure of the parathyroid glands. After the posterior surface of the thyroid was exposed and the recurrent laryngeal nerve was identified, we illuminated the area using 405nm bluish purple light. The bluish purple light enabled identification of the normal parathyroid glands by their red fluorescence. On the other hand, surrounding structures such as thyroid, muscle, and soft tissue remained nonfluorescent. The tissue was subsequently shown by histopathological analysis to be normal parathyroid gland. 5-ALA can support detection of normal parathyroid in human neck surgery.
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  • Naritomo Miyake, Hiroya Kitano, Takahiro Fukuhara, Kazunori Fujiwara, ...
    2011 Volume 20 Issue 3 Pages 297-302
    Published: February 28, 2011
    Released on J-STAGE: March 18, 2011
    JOURNAL FREE ACCESS
    We have explored the feasibility of performing endo-robotic neck surgery in porcine models applying the techniques of endoscopic neck surgery. We performed thymus gland resections, submandibular resections, thyroidectomies and selective neck dissections using the da Vinci surgical system (Intuitive Surgical Inc.).
    We observed some distinct advantages associated with the use of the surgical robot. The electronic control system was capable of filtering out hand tremors by virtue of motion scaling, and the proportional movement of the robotic device allowed the instruments to follow directly the movement of the surgeon's hand. The articulating Endo Wrist technology permitted a large range of motion and rotation that tracks the natural range of articulation of the human wrist. Moreover, endo-robotic neck surgery proved to be a safe and efficient in experimental animal models. The innovations of three-dimensional imaging, endo-wrist articulation, and motion scaling are substantial advantages that increase surgical precision and dexterity and decrease the impact of tremor. Further investigation in cadavers, and later, clinical trials will be necessary to determine whether these advantages can be achieved in clinical practice.
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  • Kazuhiko Yokoshima, Munenaga Nakamizo, Shunta Inai, Atsuko Sakanushi, ...
    2011 Volume 20 Issue 3 Pages 303-307
    Published: February 28, 2011
    Released on J-STAGE: March 18, 2011
    JOURNAL FREE ACCESS
    Liver cirrhosis is considered as a risk factor for surgery as liver cirrhosis is a severe condition which can lead to multiple organ failure. Hence management of head and neck cancer in patients with liver cirrhosis is difficult. In the present study, the Child-Pugh classification was employed as the basis for criteria informing the choice of treatment for head and neck cancer patients presenting liver cirrhosis.
    From 1999 to 2009, 20 patients (19 male, 1 female) with liver cirrhosis with 25 sessions of treatment for head and neck cancer were treated at the Nippon Medical School Hospital. The mean and standard deviation of age was 61.6 and 9.4 yrs.
    In 2 out of 3 cases evaluated as Child-Pugh Class C cirrhosis, radiotherapy could not be accomplished. In cases with Child-Pugh Class B cirrhosis, radiotherapy could be accomplished although management of the advanced cancer was limited. Child-Pugh Class A cirrhosis cases enabled choose from various modalities of treatment. However, a high incidence of postoperative complications suggests that to achieve a superior surgical outcome, preoperative optimization for the evaluation and treatment of head and neck cancer in patients with liver cirrhosis is necessary.
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