[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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Although an increasing number of congenital cholesteatoma cases have been reported recently, bilateral congenital cholesteatoma is still rare, with only 15 cases reported in the international literature. We encountered a case of bilateral congenital cholesteatoma. A 6-year-old boy was referred to our hospital by a local otolaryngologist because of a white mass of the left tympanic membrane. The right tympanic membrane seemed to be normal, but computed tomography revealed a soft-tissue dense mass in the right middle ear cavity with extension medial to the body of the incus. A type w.o. modified tympanoplasty was performed on the left ear and six months later, a type III-c modified tympanoplasty was performed on the right ear.

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The oropharynx is an anatomically and physiologically complicated organ, and challenging problems regarding postoperative functions of speech and swallowing remain in reconstructive surgery after wide resection of the lateral and superior wall of the oropharynx. We evaluated the speech and swallowing functions after surgical treatment of oropharyngeal cancer. Between 2000 and 2009, 17 patients underwent wide resection and reconstruction of the oropharyngeal cancer at Tokai University Hospital. In 13 patients, the surgical defect was reconstructed by Gehanno's method. The functional outcome of speech and swallowing was assessed by a subjective scale and videoendoscopic examination of swallowing for all 13 patients. The speech and swallowing functions were satisfactory. These results suggest that Gehanno's method is valuable for surgical treatment of oropharyngeal cancer.

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More than 95% of cases of cancer of the oropharynx including the tongue base are squamous cell carcinomas; adenoid cystic carcinoma of the tongue base is rarely observed. Resection of the tongue base can cause dysphagia or articulation disorder after surgery. We report a patient with adenoid cystic carcinoma of the tongue base treated by resection with reconstruction using a set-back tongue flap.
A 72-year-old female complaining of an unusual sensation of the tongue underwent a close examination. Pathological examination showed pleomorphic adenoma of the left tongue base, but diagnostic imaging could not exclude the possibility of a malignant tumor. We therefore performed surgery, and when the tumor was found to be malignant, we considered using a set-back tongue flap for reconstruction. Intraoperative pathological diagnosis demonstrated adenoid cystic carcinoma. After additional resection, reconstruction was performed using a set-back tongue flap. Postoperative dysphagia and articulation disorder were mild, and this technique was useful for maintaining the QOL in this case.

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During the period from 2002 to 2008, 31 patients who had undergone a resection of upper gingival carcinoma were reviewed. We divided the surgical approach for the initial treatment of upper gingival carcinoma into the following four types: 1. membrane resection, 2. alveolar bone resection, 3. partial maxillectomy, and 4. total maxillectomy. Two patients underwent a membrane resection, 4 patients underwent alveolar bone resection, 19 patients underwent partial maxillectomy, and 6 patients underwent total maxillectomy. Regarding the histological differentiation of the 31 cases, 19 (61.3%) cases were diagnosed as having either verrucous carcinoma or well-differentiated squamous carcinoma. Of these 31 cases, 12 cases demonstrated a disease relapse and the relapse-free 5-year survival rate was 56.2%. Of those 12 recurrent cases, 8 cases survived after salvage treatment, and the final overall 5-year survival rate was 83.9%. In 5 cases which had recurrence in only the cervical lymph nodes, 4 cases survived after salvage surgery. On the other hand, of the 6 cases who demonstrated local recurrence, only half of the cases survived after salvage treatment. It is suggested that a proper margin from the tumor during the initial surgery plays a very important role in the control of disease.

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We report a case of cervical thymic carcinoma extended to the superior mediastinum which was preoperatively diagnosed as thyroid carcinoma. A 61-year-old man presented with an anterior neck mass which he had suffered for 6 years. Magnetic resonance imaging revealed that the mass extended from the thyroid gland to the superior mediastinum. Cytological diagnosis suggested the mass was possibly a papillary carcinoma. Based on the preoperative diagnosis, total thyroidectomy was performed. The histological assessment was carcinoma showing thymus-like differentiation (CASTLE) or thymic carcinoma. Because the tumor was clearly separated from the thyroid gland, we finally made a diagnosis of thymic carcinoma. Radiotherapy was not administered because the mass was completely resected. Fifteen months after the surgery, there was no evidence of recurrence.

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The rarity of malignant tumors in the periorbital area makes it difficult to assess metastasis to the parotid gland and cervical lymph nodes, and to determine the optimal treatment. We retrospectively reviewed the medical records of 5 patients with metastasis to the parotid gland and cervical lymph nodes from malignant tumors in the periorbital area except for malignant lymphoma and malignant melanoma. The primary sites of malignant tumors were ocular adnexa in 3 cases and eyelid in 2 cases. At the time of diagnosis, parotid metastasis was found in 1 case, both parotid and cervical lymph node metastasis in 2 cases, and cervical lymph node metastasis in 2 cases. As the initial treatment for the primary tumors, wide surgical excision was performed in 4 cases, and carbon ion radiotherapy was adopted in 1 case. To treat the metastatic lesions, total parotidectomy and neck dissection was performed in 2 cases, superficial parotidectomy and neck dissection in 1 case, and neck dissection in 2 cases. Postoperative radiotherapy for metastatic lesions was performed in 4 cases. One of the 5 cases died from metastatic disease, while the other 4 remain alive without disease.
Surgical treatment for metastasis to the parotid gland and cervical lymph nodes from malignant tumors in the periorbital area remains controversial. The extent of parotidectomy and neck dissection, and the efficacy of postoperative radiotherapy, will need to be discussed.

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Total parotidectomy is a treatment option for radical surgery for patients with advanced parotid cancer. We have selected and used extended total parotidectomy with mastoidectomy followed by proximal resection of the facial nerve to obtain a sufficient safety margin for advanced cases. Here, we report the clinical features of 12 cases who have undergone this surgical procedure so far. There were 9 males and 3 females. Their tumors appeared at the right parotid in 6 cases and at the left parotid in 6 cases. The tumor originated from the parotid gland in all but one case, who had skin cancer in the parotid region. There were 3 salivary duct carcinomas, 2 mucoepidermoid carcinomas, 2 myoepithelial carcinomas, 2 carcinosarcomas, 1 acinic cell carcinoma, 1 adenoid cystic carcinoma and 1 squamous cell carcinoma. Five patients showed facial nerve palsy preoperatively. Two patients underwent lateral temporal resection with resection of the condylar process. Four patients underwent free flap reconstruction because of the defect of the skin. Seven patients underwent facial nerve reconstruction by nerve grafting and also 3 patients underwent static reconstruction of the facial nerve. One patient with carcinosarcoma died of disease due to lung and brain metastases, and another patient died due to lung metastasis. They showed no local recurrence and ten patients remain alive now. We think this surgical procedure is an effective radical treatment for advanced parotid cancers.

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We performed formalin application therapy under the concept of Tenju-gann or “natural-end cancer” for the treatment of a very old patient with parotid gland cancer who had given up complete curative treatment such as operations for chronic pulmonary insufficiency. The formalin application therapy controlled exudation and hemorrhaging of the skin surface, and it alleviated unpleasant symptoms. The concept of “natural-end cancer” and an explanation of the term facilitated informed consent. We conclude that the concept of natural-end cancer and non-aggressive treatment for maintaining quality of life is acceptable for some patients with head and neck cancer.

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Papillary thyroid carcinoma (PTC) usually progresses slowly and the survival rate is very high. The standard treatment for PTC is curative resection. We performed combined resection of the right carotid artery and bilateral internal jugular vein and vascular reconstruction for an advanced PTC case.
A 69-year-old woman was found to have bilateral vocal cord palsy because of thyroid malignancy at a previous clinic, and was referred to our hospital. We diagnosed PTC cT4bN1bM1 stage IVC. The primary lesion involved the right common carotid artery and right internal jugular vein. Left lymph node metastasis adhered to the left internal jugular vein. Total thyroidectomy combined with total laryngectomy bilateral neck dissection, right common carotid artery and bilateral internal jugular vein resection, and vascular reconstruction were performed. No central nervous system complications were observed.

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To perform a statistical analysis of both clinical and pathological factors of prognostic significance for course-specific survival, we retrospectively reviewed the files of 42 patients with primary major salivary gland carcinoma treated mainly by surgery at our institution from 1999 to 2008. The primary tumor was in the parotid gland in 31 and in the submandibular gland in the other 11. The 5-year cause-specific survival rate of all 42 patients was 74.5%, and those of the parotid gland and submandibular gland were 76.3% and 70.1%, respectively. Eleven patients had histologically low grade malignancy (7: mucoepidermoid carcinoma, 3: acinic cell carcinoma, 1: basal cell carcinoma), 7 patients had intermediate grade (6: adenoid cystic carcinoma, 1: sebaceous carcinoma), 24 patients had high grade (2: adenoid cystic carcinoma, 5: adenocarcinoma, 7: salivary duct carcinoma, 2: squamous cell carcinoma, 6: carcinoma ex pleomorphic adenoma, 1: myoepithelial carcinoma, 1: lymphoepithelial carcinoma). Univariate analyses indicated that clinical T-stage, presence of lymph node metastasis, pathological grade, margin condition, presence of facial nerve dysfunction, lymphovascular invasion, and stage of disease were prognostic factors for cause-specific survival.
Multivariate analysis confirmed that only lymphovascular invasion was a prognostic factor for cause-specific survival. Therefore, lymphovascular invasion is suggested to be the most significant prognostic factor for major salivary gland carcinomas in this study.

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Organ-preserving chemoradiotherapy (CRT) for head and neck cancer is widely practiced, and as a result, salvage surgery for patients with recurrent tumor after chemoradiotherapy has attracted much attention recently. Salvage surgery following chemoradiotherapy is technically difficult as the tissues become firm and fibromatic, and so surgical complications are a serious concern. Therefore, the design of surgical incisions is important to avoid surgical complications.
Our approach to surgical incisions for salvage surgery is as follows: to stretch the skin of the chest superiorly and use it to close wounds, to make the line of skin incision lie on the tissue to be transferred, and not to avoid a 3-point incision if the skin flap has sufficient blood flow.

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