[in Japanese]

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Endoscopic techniques have made tremendous progress in recent years. This study reviews the outcome of patients with nasal and sinonasal malignancies treated by endoscopic surgery, according the same surgical principles as the open approach. Six patients received a purely endoscopic excision of nasal and sinonasal malignant tumors in our department between 2011 and 2013. Primary tumors arose from ethmoid sinuses in four cases, septum in one and nasal cavity in one case. One, four and one patient were classified as T1, T2 and T4a, respectively. There was neither lymph node metastasis nor distant metastasis. Pathological examination included three squamous cell carcinomas, one adenocarcinoma, one malignant melanoma and one teratocarcinosarcoma. Four patients received preoperative treatment, such as chemoradiation therapy, carbon ion radiotherapy and chemotherapy in two, two and one case, respectively.
All patients were alive without evidence of the disease or significant complications after surgery. In four patients, the tumors were extirpated involving the anterior skull base, however, no cerebrospinal fluid leaks were observed postoperatively. The anterior skull base was reconstructed with fat, fascia and nasoseptal flap in a multilayer fashion.
In conclusion, endoscopic surgery seems to offer a satisfactory alternative to external procedures in carefully selected patients with nasal and sinonasal malignancies. Further studies with a larger number of cases and longer follow-up are needed to validate the reproducibility and efficacy of the technique.

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Angiosarcomas are high-grade malignant vascular tumors. They represent only 0.01-0.02% of all malignant tumors, and also only 1-4% are localized in the upper aerodigestive mucosa. Despite aggressive treatment of angiosarcomas, prognosis is poor with a median survival period of 15-24 months, and a 5-year survival rate of 10-35%. They have a high local recurrence rate and a high distant metastasis rate. The main treatment is complete resection with a wide margin. We report a case of angiosarcomas arising in the maxillary sinus, in which we were able to achieve local control by performing a complete resection.

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We report a retrospective study of 19 maxillary sinus squamous cell carcinoma patients treated in Kyoto Prefectural University of Medicine from April 2005 to March 2012. We examined the treatment results and the sites of recurrence, and evaluated the histopathological effect of intra-arterial chemo-radiotherapy, with which T3 or T4 cases were treated, and checked the relationship between the histopathological effect and the prognosis. The 5-year disease-specific survival rate was 68.4% for all cases, and 75% for T3 and T4a cases in particular. There were nine cases with recurrence of disease, and four cases suffered from recurrence of the primary tumor. The local control and the prognosis were dependent on the histopathological effect of intra-arterial chemo-radiotherapy. The treatment with combination of intra-arterial chemo-radiotherapy and surgery for maxillary sinus squamous cell carcinoma gives satisfactory results in terms of local control and survival rate.

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Malignant tumor originating in the nasal septum is rare. We experienced a case of squamous cell carcinoma of the nasal septum approached by midfacial degloving. The midfacial degloving approach offers good exposure of the mid third of the face with excellent cosmetic results. This technique is considered to be an effective procedure with low mortality and excellent cosmetic outcome.

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Plummer's disease is relatively rare in Japan, particularly among children. We encountered a pediatric case of Plummer's disease in which favorable outcomes were obtained after the surgical resection. The patient was a 14-year-old girl who was referred to the pediatric department of our hospital for detailed examination of tachycardia. Blood tests showed hyperthyroidism, palpation revealed enlargement of the left lobe of the thyroid gland, and scintigraphy showed accumulation at the same site. Based on these findings, Plummer's disease was diagnosed and the patient was referred to our department for the surgical resection. After normalizing thyroid function with an antithyroid agent, the left lobe of the thyroid gland was resected. The patient followed an uneventful postoperative course, thyroid function normalized, and the tachycardia disappeared without recurrence. Treatment methods for Plummer's disease include radioiodine therapy and percutaneous ethanol injection therapy in addition to surgical treatment. However, surgical resection is considered effective in pediatric cases, in which reliable therapeutic effects are desired at an early stage.

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We present cases of oral squamous cell carcinoma followed by neck dissection, including submandibular gland dissection. Cases with metastasis and direct invasion from the primary site and metastatic lymph nodes to the submandibular gland were reviewed. No metastasis to the submandibular gland was detected in all 42 cases (53 sides) in which neck dissection was performed. Direct invasion from the primary site to the submandibular gland was seen in one case (tongue cancer, T4a), and from the metastatic lymph node to the submandibular gland was seen in two cases (parahyoid area lymph node metastasis). Dissection of the submandibular gland is thought to impair QOL in patients undergoing neck dissection and further discussion concerning preservation of the submandibular gland is needed.

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Among the cases with oropharyngeal cancer, the ones with primary suture without repairing free flaps after excision by the trans-oral and intra-neck method (the “pull-through excision”) were examined. Among 60 cases of surgical operation, there were 30 cases done by the pull-through excision. Among them, 19 cases with primary suture after excision were selected as subjects. Regarding complications after operation, one case of fistulization was identified. It took 7-20 days (11.5 on average) until ingestion was resumed, with hospital stays of 11-30 days (19 days on average) for the 19 patients. Two cases of surgical margin positive and six cases of extracapsular extension of nodal disease were identified. For these cases, chemo-radiotherapy or radiotherapy was conducted after the operation. Although there was one case of recurrence which led to death from the primary disease, the other cases have shown good therapeutic progress with no recurrence identified. The disease-specific survival rate was 90%.

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Spinal epidural abscess (SEA) is a rare disease and has a poor prognosis if the diagnosis is delayed. Early diagnosis leads to a favorable prognosis, but the diagnosis is difficult, especially in the early stage when neurological deficits are not apparent. We report two cases of cervical SEA that had problems of differential diagnosis from retropharyngeal abscess. Case 1：A 76-year-old woman. She was receiving medication therapy for acute sphenoiditis, but developed progressive neurological deficit. MRI showed spinal cord swelling and apparent retropharyngeal abscess. However, contrast-enhanced CT revealed that the abscess was located in the prevertebral muscles of the neck, not in the retropharyngeal space. We diagnosed cervical spinal epidural abscess. Antibiotic therapy was performed, but she did not fully recover. Case 2：A 41-year-old man. He had back pain, and head MRI suggested retropharyngeal abscess. Endoscopy showed no pharyngeal swelling, and contrast-enhanced CT revealed that the abscess was located in the prevertebral space. Gadolinium contrast MRI elucidated that the infection might have spread from spondylodiscitis. Antibiotic therapy was performed successfully. For the diagnosis of cervical SEA and the differential diagnosis of retropharyngeal abscess, contrast-enhanced CT, in addition to MRI, should be performed.

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We performed adjuvant chemotherapy with S-1 for advanced head and neck squamous cell carcinoma after radical treatment. To evaluate the efficacy of our adjuvant chemotherapy with S-1, we retrospectively analyzed 91 patients in our institute between 2006 and 2009. We reviewed survival rate, recurrence rate and distant recurrence rate in the S-1 group and the non S-1 group. The 3-year survival rates were 73% in the S-1 group and 57% in the non S-1 group. The 3-year recurrence rate was 38% in the S-1 group and 49% in the non S-1 group. The 3-year distant recurrence rate was 14% in the S-1 group and 22% in the non S-1 group. These rates were not significantly different but showed a good tendency, so we consider that adjuvant chemotherapy with S-1 is an effective treatment.

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We treated 137 patients with well-differentiated thyroid carcinoma at our hospital from 2002 to 2012. This paper clarifies the high-risk group based on prognostic factors of recurrence.
The 5-year survival rate for patients with thyroid carcinoma was 94.9%. Recurrence occurred in 25 cases (18.2%). The factors of patient’s age and sex were not related to recurrence. The factors of disease, vein invasion, extracapsular spread and lymph node metastasis for D2 area made significant independent contributions.
We must determine the course of treatment of patients with prognostic factors of recurrence carefully. We also need to follow the patients carefully, such as a CT scan every six months and ultrasound every three months.

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Myxofibrosarcoma is common in the extremities, but rare in the head and neck region, and myxofibrosarcoma arising from the temporal muscle has not been reported previously. We report the first case of a patient with temporal muscle myxofibrosarcoma. The treatment was complete resection and the patient has been alive for 8 months without disease. Sarcomas in the temporal muscle are rare, but their possibility must be considered. Though a low-grade myxofibrosarcoma is a low-grade malignancy, complete resection should be performed. Greater attention should be paid to planning the treatment for neoplastic diseases.

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The choice of an appropriate surgical approach for accessory parotid gland tumors is controversial because of the rarity of this type of tumor. In this retrospective study, we analyzed and assessed our experience of surgery by a direct approach using facial incision.
From 2010 to 2013, we performed five surgeries for accessory parotid gland tumor. Three of the patients with these tumors were male patients and two were female. The mean age was 55, ranging from 40 to 66. Three were benign tumors and the other two were malignant. During these operations, the facial nerve was easily identified in all cases and preservation of the nerve was not difficult except in one case with myoepithelial carcinoma. In this case, partial excision of the masseter muscle was necessary, but this approach provided wide exposure and good flexibility. Postoperative facial scar demonstrated good cosmetic results and was satisfactory to all the patients.
These results indicate that the direct approach using facial incision is feasible and preferred from both aspects of the incidence of postoperative facial palsy and cosmetic results as compared with the trans-parotid approach by S-shaped incision.

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A retrospective review was performed on 20 patients with primary hyperparathyroidism who were initially treated at our hospital between 2007 and 2013. The 20 patients (6 men and 14 women) ranged in age from 41 to 84 years (average: 60.6). Histological examinations revealed 18 parathyroid adenoma, 1 parathyroid carcinoma and one case was not searched. Ultrasonography, CT scan and ^99mTcMIBI scintigraphy in almost cases were found to be the most useful modalities for a localized diagnosis. The serum calcium levels were normalized in 19 cases, and not normalized in one case. This case was complicated with a thyroidal nodule, and it was difficult to diagnose the localization. Even if a localized diagnosis technology is developed, it might not be possible to operate by a focused approach, and so a bilateral neck exploration should always be considered.

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Hemangioma of the thyroid gland is quite rare. We report a case of cavernous hemangioma of the thyroid gland. A 48-year-old female visited our hospital with an anterior neck mass. A massive mass was palpable in the right lobe of the thyroid. CT scanning revealed a mass measuring 7 cm with calcifications in the right lobe of the thyroid and the trachea was shifted to the left. Thyroid hormones were within the normal ranges. Although aspiration biopsy of the mass was negative, right hemithyroidectomy and D1 neck dissection were performed under a diagnosis of suspected thyroid carcinoma. Histopathological examination of the surgical specimen showed cavernous hemangioma in the thyroid gland. The patient was discharged without complications. To our knowledge, only 16 cases of hemangioma of the thyroid have ever been reported in Japan. An analysis of the previous reports showed that fine needle aspiration cytology (FNAC) was performed in 12 cases, of which 8 cases were blood only. Furthermore, they had often poor characteristic findings on ultrasound scans, computed tomography (CT) scans, and magnetic resonance imaging (MRI). Therefore, preoperative diagnosis of cavernous hemangioma of the thyroid is difficult, and in fact, a diagnosis was made before surgery in only 3 of the cases. If a large amount of fresh blood was aspirated before surgery, we should consider the possibility of hemangioma of the thyroid. There are some reports that surgery of hemangioma of the thyroid results in a large amount of blood, thus surgery should be performed with great care.

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Placing an implantable central venous port in the arm is one of safety procedures for vascular security and the use of chemotherapy for cancer patients. We introduce a procedure to place an implantable central venous port in the arm. In our experience of 30 cases from 2010 to 2012, the procedure was successful in all cases. Central venous port-related infection occurred in four cases and port-related exposure occurred in four cases, but all were resolved by removing the port, without serious complications.
There were fewer cases of port-related exposure among those in whom a subcutaneous tunnel was formed, compared with those in whom a tunnel was not formed.
Placing an implantable central venous port in the arm is a relatively easy and safe surgical procedure that head and neck surgeons can learn.

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Fine-needle aspiration (FNA) is commonly used for the preoperative assessment of salivary gland neoplasms. The aim of this study was to determine the diagnostic value of FNA for salivary gland neoplasms. We enrolled 464 patients who had undergone preoperative FNA before having operations for salivary gland neoplasms in Kurashiki Central Hospital during a 20-year period, between January 1991 and December 2010. The accuracy, sensitivity and specificity for the diagnosis of malignancy were 95.0%, 60.4% and 99.7%, respectively. The accuracy of histological typing was 74.7% (301/403) for benign neoplasms and 26.2% (16/61) for malignant neoplasms.

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