[in Japanese]

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[in Japanese]

View full abstract

[in Japanese]

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[in Japanese]

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[in Japanese]

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A clinical study was performed on 13 patients with olfactory neuroblastoma who were treated between 1984 and 2011 at the Department of Otolaryngology-Head and Neck Surgery, Kurume University School of Medicine. The patients consisted of 8 men and 5 women, with ages ranging from 19 to 82 years old. Initial symptoms were mainly nasal obstruction and nasal bleeding. Nine patients were treated with surgery with postoperative radiotherapy and the other four patients were treated with chemoradiotherapy. Five-year overall survival rate for all patients was 51%.
Seven patients survived, but four patients died of primary lesion, 2 patients died of distant metastasis. Operation combined with radiotherapy seemed to improve survival. Neck metastasis, intracranial infiltration and histopathological grading were prognostic factors.

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For treating maxillary sinus cancer, combined therapy of surgery, chemotherapy, and radiation is a primary modality. While chemotherapy administered through the superficial temporal artery is conventionally used, we have worked since 2003 to assess the effi cacy of combined therapy after superselective arterial docetaxel (DOC) infusion for treating maxillary sinus cancer. The treatment consisted of preoperative radiation of 40Gy.
The 5-year survival rate of all cases was 66%, and the disease-specifi c survival rate was 75% for five years. The eyeball retention rate was 100%. It is necessary to consider the occurrence of late complications though radiation osteomyelitis is admitted in two examples as a late complication, and contributes to radical cure and organ preservation.

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Remarkable progress in the technology of three-dimensional computed tomography (3DCT) has made it possible to create accurate and high-resolution 3D images from conventional 2DCT images in quite a short time. For skull-based surgery, which is highly complex anatomically, we benefit from 3DCT images, which are reconstructed preoperatively, focusing on “what we want to see”. In this manuscript, we describe how to create 3DCT images and also discuss the usefulness of 3DCT images in preoperative diagnosis and virtual simulation before surgery through two representative cases of anterior and middle skull-based tumors.

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We investigated head and neck cancer cases treated in our hospital from April of 2006 to March of 2011, from the perspective of equalization in the quality of head and neck cancer management. Most of the oropharyngeal, hypopharyngeal and laryngeal cancer patients were treated with chemo-radiation therapy. The outcome of the patient group, including disease-specific survival rate and laryngeal preservation rate, were calculated. In addition, we tallied the numbers of oral, pharyngeal and laryngeal cancer cases from each hospital using the annual report of domestic cancer registry of Japan 2008.
We found that of the total number of 139 cases treated with the intention of curing the disease, 36 were advanced oropharyngeal, hypopharyngeal and laryngeal cancer patients (Stage III and IV), and their disease-specific, 3-year survival rate was 70%, while the laryngeal preservation (excluding oropharyngeal cancer) rate was 58%.
Among the 218 hospitals with registered oral, pharyngeal and laryngeal cancer cases, 121 hospitals registered less than 40 cases. This fact indicates there are many rural hospitals, which treat a relatively small number of patients, and equalization of the quality of head and neck cancer management is considered an urgent task.

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We report on a case of aberrant common carotid artery. The patient was an 88-year-old-woman with a foreign-body sensation, which got worse when she swallowed. Pharyngeal tumor was pointed out by a doctor of internal medicine after gastrofiberscopy was performed, and the patient then visited our department. A CT scan demonstrated an aberrant course of the common carotid artery. An MR image was useful in distinguishing this anomaly from other diseases. Here we discuss the clinical presentation of this patient, review pertinent recent literature and discuss the findings.

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Chondrosarcoma accounts for about 10% to 20% of malignant primary bone tumors, which is the most frequent type after osteosarcoma. It has high incidence in the pelvis, long bone (hemur, etc.), and ribs, but is rarely encountered in the head and neck lesion, particularly the mandible. Radiosensitivity is ineffective, and there is no effective chemotherapy, therefore a complete resection of the tumor is necessary for curative treatment. Since the rate of local recurrence is high, it is necessary to secure a sufficient safety margin, but we have to take into account postoperative morphological, functional preservation, such as facial appearance, eating and swallowing in the head and neck lesion. Here we report on a rare case of mandible chondrosarcoma. The patient was a 39-year-old man. Chief complaint was swelling of the left oropharyngeal lateral wall that developed a year ago, and had increased in the recent 1-2 weeks. Through imaging findings, the tumor was suspected to be derived from the left mandibular ramus. We underwent fine-needle aspiration cytology, which did not lead to the diagnosis. Transoral biopsy of the left retromortar submucosal tumor diagnosed chondrosarcoma in the intraoperative frozen section diagnosis. We could perform compatible treatment through curative wide resection of the mandible and hard reconstruction in a term. There is no local recurrence and no distant metastasis 1 year after surgery; functional preservation was obtained using both local control and postoperative.

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To compare the efficacy of transoral glossectomy and brachytherapy, we reviewed 64 patients suffering from stage I/II squamous cell carcinoma of the oral tongue who underwent either of the treatments from 1998 to 2009. The three-year disease-specific survival rate, loco-regional control rate, and incidence of cervical lymph node metastasis were examined. Among these 64 patients, 30 patients had undergone surgery and 34 had undergone brachytherapy. The three-years disease-specific survival and local control rates of the patients who had undergone surgery were 90.0% and 90.0% in stage I (n = 20), and 80.0% and 100.0% in stage II (n = 10), respectively. On the other hand, those rates of patients who had undergone brachytherapy were 90.0% and 63.0% in stage I (n = 10), and 81.2% and 80.6% in stage II (n = 24) respectively. A statistically significant difference was not observed. The incidence of secondary cervical lymph node metastasis was observed to be 33.5% (surgery) and 30.3% (brachytherapy) with no statistically significant difference between these therapies. The overall control rate of this cervical lymph node metastasis was 63.6%. The three-year disease-specific survival rate, local control rate, and incidence of cervical lymph node metastases were also assessed and no statistically significant difference was observed.

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Recently, free tissue transfer techniques using microvascular anastomosis have become generally accepted tools in reconstruction of the head and neck. However, such radical techniques cannot always be applied in cases of high-risk patients due to the possibility of serious complications. We describe here a case of buccal mucosa squamous cell carcinoma infiltrating the corner of the lip. The patient was a 74-year-old woman who had severe heart disease. Therefore, we performed an oral cavity reconstruction with platysma myocutaneous flap and chalinoplasty to avoid severe complications. The patient was discharged on the 14^th postoperative day and no complications had occurred after a 9-month period. The platysma myocutaneous flap can be one alternative to free tissue transfer, especially in high-risk cases of buccal mucosa carcinoma.

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The purpose of this article is to report on our study of 64 cases of submandibular gland (SMG) tumors that were operated on as first treatment at our establishment during the 24 years from September 1983 to December 2007.
We evaluated this study around patient background, diagnosis and treatment results. There were 44 benign tumors and 20 malignancies, with a mean age of 47.8 years old. In total, women were much more affected than men, but malignancies would affect men significantly compared to women. Three patients with spontaneous pain were all malignancies. The accuracy of fine needle aspiration cytology (FNAC) was 90%, while the concordance rate of histological type between FNAC and the final diagnosis was 81.8%. Three-year and 5-year survival rates were 85.1% and 48.6%, respectively.
On the other hand, we compared the present study with the “clinical review of cases with parotid tumors” which our department reported on previously. Data on tumors of SMG exceeded that of parotid tumors when regarding pre-operative diagnostic capabilities, but there were many more rates of malignant tumors and cervical lymph node metastasis shown in SMG than in the parotid gland.

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A rare case of a cervical bronchogenic cyst is reported. The patient, a 68-year-old female, showed cervical mass through CT findings. The mass was surgically resected. Histologically, the cyst consisted of ciliated columnar epithelium, smooth muscle, and cartilage, yielding a definitive diagnosis of bronchogenic cyst. In conclusion, congenital bronchogenic cysts may occur in the necks of adults, and should be considered in the differential diagnosis of cervical masses.

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We examined the parathyroid function preservation of 13 hypopharyngeal carcinoma patients who underwent bilateral neck dissection and hemithyroidectomy. At the time of neck dissection, ligature of the common facial vein, the area where the superior thyroid vein flows into the jugular vein, middle thyroid vein and inferior thyroid veins, was performed. We kept surgical capsule of the thyroid gland and connective tissue existing between carotid sheath, and surgical capsule of the thyroid gland in the area to be surrounded with common carotid artery, superior thyroid artery, upper pole of thyroid gland, inferior thyroid artery (non-touch preservation) and kept the thyroid gland attached to the trachea in 12 of 13 cases, the calcium level was within normal range by the third day. In one case with long-term fistula, temporary hypoparathyroidism occurred. We were able to finally keep parathyroid function in all 13 cases.

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Deep neck abscess is a serious, life-threatening disease. In spite of the development of antibiotics, this condition sometimes shows a poor prognosis.
11 patients with deep neck abscesses were treated in our hospital between April 2006 and August 2010. Of the 11 patients, 8 were men and 3 were women, aged 31 to 84 (average age: 59years).
All patients resulted in good recovery with surgical drainage.
Surgical drainage was performed proactively in our hospital and rapid recovery was realized.

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Submental island flap (SIF), first reported by Dr. Martin in 1990, is an axial-patterned flap located on the submental artery, which is a well defined and consistent branch of the facial artery. SIF has been utilized for small or intermediate defects of the oral cavity, pharyngeal, laryngeal and facial or neck skin. Reconstruction was performed on 19 patients with SIF at the Aichi Cancer Center Hospital between December 2008 and December 2009. Concerning the primary tumor site, 13 cases were in the oral cavity, 1 in the oropharynx, 1 in the larynx, and 2 neck skin defects. While partial necrosis and anastomotic leakage was seen in 1 case and abscess was seen in 2 cases, others did not show any complications or recurrences. Therefore, we consider SIF as an alternative option for free transfer vascularized flaps. Additionally, we think that patients who meet the following characteristics are considered good indications of SIF: 1) no Level 1 neck metastasis, 2) small or intermediate defect from soft palate to hypopharynx, 3) advanced age 4) exhibition of comorbidities (ex, hypertension, diabetes etc).

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A case of acromegaly with mediastinal thyroid tumors in a 48-year-old male is reported. A mediastinal tumor was suspected through health diagnosis. A large mediastinal tumor was discovered in the patient through a chest CT and he was introduced to our department. Growth hormone was a marked high. In the thyroid TSH the value was low, Free-T3, Free-T4 was at a normal value. We performed surgery with collar incision and sternotomy. The pathological examination showed adenomatous goiter with microscopic papillary carcinoma. We determined, because of the goiter merger and about 80% acromegaly, thyroid cancer patients, showing a high rate of prevalence in the general population, when actively reported, should have surgery.

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We report on a case of perioperative cardiac arrest during reconstructive surgery for cT4aN2cM0 oral floor carcinoma. The patient was a 74-year-old man without any complications. Preoperative laboratory test data, chest radiographs, and electrocardiogram showed no remarkable findings. We performed pull-through dissection with mandibular segmental resection and bilateral neck dissection. We planned the reconstruction at the fibula flap and the pectoralis major myocutaneous flap until the patient developed cardiac arrest during the surgery. With cooperation from other hospital departments, we were able to recover his heartbeat and maintain circulation by using percutaneous cardiopulmonary support (PCPS) and intra-aortic balloon pump (IABP). We modified our plan to reconstruct at only the pectoralis major myocutaneous flap. He did not develop cardiac arrest again and recovered without any sequela such as brain dysfunction. After postoperative rehabilitation, he was able to receive semisolid food orally.

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In recent years, the importance of chemoradiotherapy (CRT) for the purpose of organ preservation in the treatment of laryngopharyngeal cancer has increased. In conducting a prospective study about post CRT neck dissection, it is difficult to plan a study on a detailed treatment regimen because of the variability of CRT regimen performed in each institution. Therefore, we conducted a study on imaging criteria used when determining the necessity of neck dissection after CRT. A prospective study was conducted on “examination about neck dissection after chemoradiotherapy” to confirm the accuracy of imaging as a feasibility study.
Oropharyngeal, hypopharyngeal and supraglottic laryngeal cancer patients administered with platinum-based chemoradiotherapy were eligible. An imaging examination by CT (and/or MRI, if possible US) was performed 4-6 weeks after completion of CRT (first evaluation), while a PET-CT was performed 8-12 weeks after completion (second evaluation). The necessity of neck dissection was evaluated by the imaging.
Accuracy of the imaging (CT/MRI) at the first evaluation was 60%, while the negative predictive value was 77%. At the same time, accuracy of the general diagnosis by physicians was 83%, while the negative predictive value was 92%. The accuracy rate of the second evaluation by PET-CT was 93%, while the negative predictive value was 92%.
The protocol of diagnostic imaging for this examination was permitted by hypothesis testing, but further improvement is necessary. Addition of US diagnosis may lead to improved accuracy at first judgment. It should thus be further examined.

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We report on a 5-year-old female with midline cervical cleft. Midline cervical cleft is a rare congenital anomaly of the ventral neck, characterized by a submental tissue protrusion, red scar-like depression running longitudinally from the protrusion, a caudal fistula, and a subcutaneous cord-like structure. These findings were observed in this patient at birth. The cause of midline cervical cleft is unclear, and the only treatment method is complete surgical resection. In this patient, complete resection of the midline cervical cleft was performed, followed by reconstruction using Z-plasty. The surgical wound state was favorable without any aesthetic problems. There were no functional abnormalities, such as impairment of neck flexion or extension.

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Mohs'chemosurgery, originally developed to treat skin cancer, uses zinc chloride in Mohs'ointment to fix tissues, and is applicable in different clinical settings.
In advanced cancer, not only in the head and neck, Mohs'chemosurgery relieves major skin-infiltration symptoms such as bleeding, exudation, odor, and severe pain. Mohs'chemosurgery, conducted in 15 cases of cancer involving different primary lesions and histological types, yielded an acceptable result free of bleeding and pain. Most patients were relived from massive exudation and offensive odor. For those with insufficient relief from odor, Metronidazole paste was applied.
Steps in palliative care are repeated until the tumor surface is completely fixed. Mohs'chemosurgery provides acceptable relief without technical complications. Although not a topical chemotherapeutic agent, it fixes lesions well. Mohs'chemosurgery improves the quality of life for advanced cancer patients with local advanced, unresectable skin lesions.

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