We performed transoral videolaryngoscopic surgery (TOVS) using distending laryngoscope, videolaryngoscope and laparoscopic surgical instruments. The present status of TOVS in terms of oncological and functional outcome is described. TOVS could be used for Tis, T1, T2 and selected T3 cases. Neck dissection could be performed simultaneously if indicated. Post-treatment dysphagia occurred in 6.3% of 80 cases, but PEG placement was indicated only in one patient. In oropharyngeal cancer, 3-year disease-specific survival was 100% and that in supraglottic and hypopharyngeal cancer was 98%. Three-year laryngeal preservation rate for supraglottic and hypopharyngeal cancer was 95%. In future, further development of surgical devices is expected. Minimally invasive treatment for occult metastasis is appropriate for early-stage cancer, whereas multidisciplinary treatment including TOVS is appropriate for advanced cancer.

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The subjects were 295 patients with otorhinolaryngological disease aged 75 or older who received surgical treatment between April 2006 and August 2012. Their surgical indications and complications with preoperative examinations and postoperative courses were investigated.
The ratios of major complications in elderly patients were as follows: hypertension 63.5%, coronary vessel diseases 14%, diabetes mellitus 10.3%, central nervous system diseases 8.7%, and respiratory diseases 8.3%. Statistically, elderly patients had more preoperative complications than patients aged 60 to 64 years old.
In preoperative examinations, abnormal circulatory findings were found in almost all patients with preoperative circulatory diseases, but abnormal respiratory findings were found in many elderly patients without preoperative respiratory diseases.
Severe postoperative complications occurred in two patients. Both of them were in poor condition and underwent aggressive operations, but the complications were not caused by ageing factors. These results suggest that the issues concerning performing operations on elderly patients are influenced by the control of preoperative complications and functions, as in younger patients.

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A three-dimensional model of temporal bone was prototyped by the laser-sintering method and was used for surgical training of residents. The improvement of surgical skill and anatomical knowledge was evaluated by measuring the time needed to identify the target anatomical structures. The residents with 3-5 years of clinical experience and an otologist participated in this study. The dissection steps included the Koerner's septum, antrum, sigmoid sinus, incus, semicircular canals, etc. which were designated as the target structures. The times taken for the first dissection and the second dissection were compared. The time taken to complete the dissection by the otologist was 70 min. and that by the residents was 120-180 min. The time taken to identify the incus and posterior fossa plate tended to be longer. Structures that were easily damaged were the incus, facial nerve and semicircular canals. The time taken for the second dissection was shorter, especially among the participants with less otological experience. The model was useful to enable the residents to acquire anatomical knowledge and surgical skills.

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[in Japanese]

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[in Japanese]

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This article discusses conservative and surgical treatments of vertigo, dealing with vertiginous patients visiting the emergency room (ER), the pharmacotherapy for balance disorders, and major and minor surgical approaches for intractable Meniere's disease. Triage that does not overlook dangerous vertigo is very important in the ER, for which basic general check-ups including the character of the balance disorder, vital signs and neurological assessment are essential. The pharmacotherapy for balance disorders in Japan is not largely different from that in the US or Europe. However, there are some anti-vertigo drugs that are approved and used only in Japan, the efficacy of which may have to be re-evaluated for appropriate management of patients with balance disorders. Although it has been the focus of debate for a long time, endolymphatic sac surgery (ESS) remains the first-line surgical treatment for intractable Meniere's disease. More destructive procedures such as vestibular neurectomy may be selected when vertigo attacks fail to be cured by less destructive treatments. Less invasive minor surgeries including ventilation tube insertions or tenotomy of the middle ear muscles have been reported to reduce vertigo attacks significantly in Meniere's disease patients, although the efficacy should be confirmed by further studies.

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[in Japanese]

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[in Japanese]

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Objective: To compare the growth of secondary and primary cholesteatoma (pars tensa retraction type). Methods: This study included 22 ears with secondary cholesteatoma (secondary group) and 3 ears with pars tensa type cholesteatoma (pars tensa group) that underwent primary tympanoplasty during a period of 4 years. They were evaluated in terms of the following parameters: age at the time of tympanoplasty, otoscopic findings, hearing acuity, extent of ossicular destruction, and development of mastoid air cells. Results: The cholesteatoma matrix in the secondary group was mostly found around the malleus handle and was significantly limited to within the epitympanum, while that in the pars tensa group was rarely adjacent to the malleus handle and extended to the mastoid. Ossicular destruction of the incus and superstructure of the stapes was less frequently seen in the secondary group than in the pars tensa group. Development of mastoid air cells was significantly better in the secondary group than in the pars tensa group. Conclusions: The two groups of patients showed significantly different clinical characteristics. The cholesteatomas in the secondary group tended to ascend to the surface of the ossicle. The cause of the abnormal proliferation of epithelial migration was unknown. Long-term recurrent infection or an apparent episode (such as trauma or history of insertion of a tympanic tube) is not necessarily needed for the onset.

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Regenerative therapy for closing tympanic membrane perforation using basic fibroblast growth factor and atelocollagen/silicone bilayer in the outpatient clinic at Ehime University Hospital is described. From July 2009 to June 2011, 170 cases (62 male and 108 female; mean age 64.4 (13-96)) underwent day surgery. Complete closure was achieved in 139 cases (82.2%), a pin hole remained in 12 cases (7.1%), a small perforation remained in 18 cases (10.6%), and treatment was stopped in one case because of cerebral infarction. Among the 139 cases of complete closure, the mean number of trials was 1.4 times. The closure rate is almost the same as the outcome from simple myringoplasty with fibrin glue using fascia, so we consider that this regenerative therapy is useful for closing tympanic perforation.

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In the treatment of non-invasive fungal sinusitis, the removal of caseous matter (the lesions) is important. Endoscopic surgery has recently become the main method.
However, it is usually difficult to remove the lesions because of their fragility and the difficulty of operation on the maxillary sinus. Therefore we have been performing the operation using a foley catheter (with a balloon at the tip) in the treatment of non-invasive fungal maxillary sinusitis. We insert the catheter into the maxillary sinus from the inferior nasal meatus and inflate the balloon. Then, the lesion is extruded into the nasal cavity from the ostium of the maxillary sinus by the inflated balloon and can then be easily removed.

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The patient was a 62-year-old man who presented with a 5-year history of hoarseness; he visited us at the NTT Medical Center Tokyo in March 2011. Bilateral vocal cord paralysis and a solid anterior neck mass were found. Fine needle aspiration cytology from his neck mass showed papillary carcinoma. He was diagnosed as thyroid cancer with gross laryngeal invasion, and was hospitalized in April 2011 for surgery. Total laryngectomy, total thyroidectomy, and bilateral neck dissection were performed. Histological diagnosis was thyroid papillary carcinoma co-existing with chondrosarcoma originating from cricoid cartilage. Laryngeal chondrosarcoma is a rare entity and to our knowledge this is the first case report of laryngeal chondrosarcoma co-existing with another malignant neoplasm.

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Background: Organ preservation therapy including concurrent chemoradiotherapy is widely used to improve survival and maintain organ function for laryngeal cancer, and partial laryngectomy is usually used for the salvage operation after radiotherapy.
Objective: To evaluate the usefulness of vertical partial laryngectomy by analyzing the laryngeal preservation rate and postoperative laryngeal function.
Materials and Methods: Five patients underwent vertical partial laryngectomy for laryngeal cancer; four patients had not been treated previously, and one patient had previously received radiotherapy. All patients were male, with an average age of 57.2 years (range 48–62). Mean follow-up period was 64.6 months (range 34–87).
Results: The frontolateral resection was performed with an endoscope by cutting the anterior part of the larynx, and a sternohyoid muscle flap with hyoid bone was used for the reconstruction of cricoid cartilage. The organ preservation rate was 4/5 (80%), and locoregional control was achieved in all cases. Maximum phonation time was 14–24 seconds and pneumonia due to mis-swallowing was not seen in any of the cases, and the postoperative laryngeal function was not severely disturbed.
Conclusion: Postoperative laryngeal function in the case of vertical partial laryngectomy was not greatly diminished compared to chemoradiation therapy. Vertical partial laryngectomy may be one option in the initial treatment for cases in which the laryngeal cancer seems to be resistant to radiation therapy as well as for failure cases after radiation therapy.

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We report a case of bilateral carotid tumor treated by a two-step operation. The patient was a 30-year-old man with a painless swelling in his left neck.
He had received contrast enhanced CT and MRI, and a diagnosis of bilateral carotid body tumor, at another ENT clinic, and was referred to our hospital for operation. We judged that operation was possible because we made a definite diagnosis from carotid angiography and made sure that the balloon Matas test was negative.
First, we resected the left tumor which was suspected of Shamblin's group I. The common and internal carotid arteries on the left side were preserved. Five months later, we operated on the right tumor. The tumor was adhered to the jugular vein, carotid artery and the surrounding structures. The carotid bifurcation was involved with the tumor. The tumor was resected with carotid reconstruction using the great saphenous vein (Shamblin's group III). Preoperative angiography and embolization were performed by neurosurgery, and carotid reconstruction was done by vascular surgery. We recognized the importance of a multidisciplinary approach involving the fields of otolaryngology, neurosurgery and vascular surgery. The two-step operation and multidisciplinary approach made safe, curative treatment possible.

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Cases of Graves' disease treated surgically are not rare. However, the risk of complications after total thyroidectomy is expected to be higher than after subtotal thyroidectomy because of its higher invasiveness. Thirty-one patients underwent total thyroidectomy for Graves' disease and we examined the main postoperative complications. Permanent recurrent laryngeal nerve palsy did not occur and hypoparathyroidism occurred in 3 patients. Two of them were re-operation cases and it became clear that preservation of parathyroid function in re-operation cases is more difficult. Because Graves' disease is a benign disease, we must strive to reduce postoperative complications; discrimination by using a pigment as well as careful operation is desirable.

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Neck neurinoma is a relatively rare disease for which it is difficult to make a definitive diagnosis prior to surgery. In fact, it is not uncommon to find that tumors and their nerve origins are different from predictions only after performing comprehensive examination and treatment. We recently experienced a case of neurinoma derived from the superior laryngeal nerve, which we learned only after performing surgery with the assumption that the tumor was of vagus nerve origin. We report the case here because there are only a few reports on head and neck neurinoma originating from the superior laryngeal nerve and because it is extremely rare to successfully remove the coating without any sign of postoperative neurological deficits.

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We retrospectively reviewed 99 consecutive cases of parotid carcinoma who underwent an operation in the past 5 years. The subjects were 56 males and 43 females. Of the 99 cases, 89 were benign and 10 were malignant tumor. Pathological examination demonstrated that the most common type of benign tumor was pleomorphic tumor in 48 cases, followed by Wartin tumor in 28 cases. The most common malignant tumor was salivary duct carcinomal in 3 cases, followed by adenoid cystic carcinoma and acinic cell carcinoma in 2 cases, mucoepidermoid carcinoma, myoepithelial carcinoma and squamous cell carcinoma in 1 case, respectively. The results of preoperative fine-needle aspiration cytology were compared with postoperative pathologic findings. Sensitivity for malignancy was 50%, specificity was 100%, and accuracy was 94%. For the benign tumors, we performed parotidectomy. Total parotidectomy was carried out for the patients who had been diagnosed with malignant tumor by preoperative fine-needle aspiration cytology. For cases with a diagnosis of permanent postoperative malignant specimens had been taken of any policy of careful observation or additional treatment to consider each case. Transient facial palsy was observed as a complication in 4.4% of the patients. Salivary fistula was observed as a complication in 2.2% of the patients. None of the cases had Frey's syndrome as a postoperative complication. Postoperatively, recurrence of the malignancy was not found. The median follow-up duration for cases with malignant tumors was two years.

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We reviewed 40 cases of previously untreated malignant tumors arising in the parotid gland that had been treated at Hyogo College of Medicine Hospital between 1986 and 2008.
According to the TNM classification, 4 patients were classified as T1, 5 patients as T2, 10 patients as T3, and 21 patients as T4. Thirty cases were staged as N0, 1 case as N2a, and 9 cases as N2b. The five-year and ten-year cause-specific survival rates were 100% for stage I, 100% for stage II, 87% for stage III, and 57% and 21% for stage IV based on the Kaplan-Meier method. Survival rates were significantly lower in stage IV than in stages I-III. 14/40 patients (35%) exhibited facial nerve palsy before treatment. Total neck dissection may be necessary for N0 cases, especially for T4a or cases in which high malignancy cancer was suspected by FNAB or a frozen section obtained during surgery.

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Branchio-Oto (BO) syndrome is an autosomal dominant genetic disorder with branchial anomalies involving preauricular pits, cervical fistulas or cysts and hearing loss. We present the case of a 31-year-old female with BO syndrome who had complained of bilateral hearing loss, various ear anomalies and right cervical fistula. The cervical fistula was totally resected after staining with Pioctanin under general anesthesia. Pathological examinations showed that not only the sebaceous gland but also salivary gland tissue, which was apart from the parotid or submandibular gland, was present around the fistula. The present case was diagnosed as BO syndrome because of the presence of typical ear anomaly and functional disorder and cervical fistula without anomaly. The cervical fistula of this case was connected with ectopic salivary gland tissue and was considered to be a salivary duct fistula.

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Primary chondrosarcoma is the third most common malignancy of the bone and accounts for approximately 20% of malignant bone tumors. Chondrosarcoma arises mainly in the trunk and the limbs, and rarely in head and neck lesions. Because of their rarity, there have been few large-scale studies on the clinicopathological characteristics of these tumors. In this report, we describe three cases of head and neck chondrosarcoma and review the clinical findings, management and outcomes of the previously reported cases.
Case 1. A 67-year-old male was referred to our department with dyspnea on exertion. The tumor was located in the cricoid cartilage. Total laryngectomy was performed and post-operative diagnosis was grade III chondrosarcoma.
Case 2. The patient was a 71-year-old female with right nasal obstruction. Computed tomography and biopsy revealed the diagnosis of grade I chondrosarcoma. Transnasal endoscopic resection was performed.
Case 3. A 67-year-old male presented with preauricular swelling. Radiographic examination revealed a tumor arising from the condyle of the mandible. Cytologic examination suggested that the tumor was of cartilaginous origin. Surgical removal of the tumor was performed and subsequent histological examination revealed the diagnosis of grade II chondrosarcoma.
All patients remain free of disease at present.

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