Objectives: Fine-needle aspiration (FNA) and frozen section diagnosis (FSD) are commonly used as the assessment of parotid gland lesions. The aim of this study was to evaluate the diagnostic value of FNA and FSD for cystic lesions of parotid glands.
Materials and Methods: We enrolled 48 patients who had undergone operations for cystic lesions of parotid glands in Osaka Red Cross Hospital during a 10-year period between April 2004 and March 2013. The accuracy, sensitivity and specificity of FNA and FSD were studied.
Results: Of 48 lesions, 33 were benign tumors, 7 were malignant tumors, and 8 were nonneoplasms. Malignant tumors consisted of mucoepidermoid carcinomas, epithelial-myoepithelial carcinomas, acinic cell carcinoma, carcinoma ex pleomorphic adenoma and low-grade cribriform cystadenocarcinoma. In matters of FNA, the accuracy, sensitivity and specificity for the diagnosis of malignancy were 78%, 20% and 100%, respectively, whereas of FSD, the accuracy, sensitivity and specificity for the diagnosis of malignancy were 89%, 43% and 98%, respectively.
Conclusions: Cystic lesions of parotid glands decrease the sensitivity of FNA and FSD.

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We report on 29 patients with stage III/IV hypopharyngeal squamous cell carcinoma who underwent operations. 27 patients underwent total pharyngo-laryngectomy, and two patients underwent larynx-preserving partial pharingectomy. The cause-specific survival rate was 60.5% at 5 years. Fifteen patients were treated with postoperative radiotherapy, but seven patients had recurrence or metastasis. It might be reasonable to preserve elective neck dissection for N0 and N1 patients. The occult metastasis rate to the contralateral neck was 13%. Retropharyngeal node metastasis was detected in five patients before treatment, and all cases were treated with postoperative radiotherapy. However, four patients had recurrence or metastasis. These results indicate that high-risk patients are recommended to receive adjuvant concurrent chemo-radiotherapy.

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We report six cases of oral squamous cell carcinoma (OSCC) patients after hematopoietic stem cell transplantation. The median age of patients was 46.5 years (range: 37-68 years). Five patients were male, only one patient was female. All patients underwent sibling peripheral blood stem cell transplantation or not sibling bone marrow transplantation, and suffered from chronic graft-versus-host disease (GVHD). The median interval between hematopoietic stem cell transplantation and the onset of OSCC was nine years (range: 3-16 years). All cases were well differentiated squamous cell carcinoma with chronic inflammation. It is difficult to judge the excised end of the cases. The methods of surgical resection and the necessities of post-operative therapy are controversial. A clinical screening and long-term follow up for OSCC are important for patients exposed to persistent chronic GVHD.

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The management of clinical negative cervical lymph node of stage I and II squamous cell carcinoma of the tongue still remains ccntroversal. Our management of patients with clinical negative cervical lymph node is wait and watch policy. We retrospectively investigated 105 patients who had undergone brachytherapy with stage I and II squamous cell carcinoma of tongue. All these cases were treated in Hiroshima university hospital between January 2000 and December 2011. Subsequent cervical lymph node metastasis occurred in 34 patients (32.4%) 32 patients of subsequent cervical lymph node metastasis performed neck dissection and 10 patients (31.1%) had neck failure. 11 patients who finally died of disease or recurrent disease had subsequent cervical lymph node metastasis.
We examined the potential for subsequent cervical lymph node metastasis and the risk factors for neck failure. The depth of tumor invasion and the major axis of tumor were evaluated by ultrasonography with intraoral scanner. The depth of tumor invasion and the major axis of tumor had significant risk factors for the potential for subsequent cervical lymph node metastasis. The depth of tumor invasion, the major axis of tumor, extracapsular spread and age had significant risk factors for neck failure. The depth of tumor invasion, the major axis of tumor and age were significant predictor before first line treatment by brachytherapy.
These results suggest the cases that have such factors affect neck failure require additional treatment, whether to perform elective neck dissection of clinical negative cervical lymph node of stage I and II squamous cell carcinoma or not.

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Of the patients seen for cervical neurinomas at our department between April 2005 and March 2014, 31 underwent intercapsular resection. Of them, we investigated 10 in whom the condition originated in the vagus nerve. 3 patients showed postoperative neurological deficit. One patient improved within 3 months, but the others did not improve. Hoarseness, dysphagia and coughing attack may be caused in cases by a neurinoma operation in the vagus nerve, which may greatly affect a patient's occupation and quality of life. Before operation, informed consent must be obtained, and relevant surgical experience should be acquired in addition to taking any disadvantages into account.

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In recent years, a polyglycolic acid (PGA) sheet and fibrin glue have been used in surgical intervention for oral and pharyngeal cancer. We retrospectively examined the records of patients treated for oral and oropharyngeal cancer in our department and analyzed the effectiveness of this treatment. From December 2012 to July 2014, we treated 45 cases of oral and oropharyngeal cancer, including 42 cases of oral cancer and three cases of oropharyngeal cancer. The average number of days to detachment of the PGA sheet was 8.0 days postoperatively for tongue cancer and 13.3 days postoperatively for other oral and oropharyngeal cancers. The PGA sheet came unstuck earlier in the patients with tongue cancer than those with other oral and oropharyngeal cancers, although the differences were not significant (p=0.0953). Postoperative bleeding was observed in nine of the 26 tongue cancer patients (34.6%) and in one of the 19 other oral and oropharyngeal cancer patients (5.3%). Significant differences were observed in the frequency of postoperative bleeding between operation sites (p=0.0497). There was no significant correlation between the fasting period and attachment days of the PGA sheet. As a result, the fasting period after surgery was not related to the early detachment of the PGA sheet, and oral nutrition can be started in the early stages postoperatively.

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Renal clear cell carcinoma metastasizes to any part of the body, although it rarely metastasizes to the head and neck. A 76-year-old woman was referred to our hospital by her primary care physician for evaluation and treatment of a right neck mass. A CT of the neck-chest and abdomen revealed multiple tumors in the right parapharyngeal space, right lung (S10) and the body and tail of the pancreas. Right partial pneumonectomy and distal pancreatectomy were performed by thoracic surgery and abdominal surgery. A histological examination showed clear cell carcinoma. We suspected neurinoma of the parapharyngeal space, but could not rule out the possibility of metastatic clear cell carcinoma. We performed neck surgery, and a histological examination also showed clear cell carcinoma. Because we experienced the first case in 26 years of metastatic renal clear cell carcinoma of the parapharyngeal space after an operation, we will report this case and review the literature.

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Follicular dendritic cell sarcoma (FDCS) is a rare malignancy arising from the antigen-presenting cells in the lymph node and extranodal tissue. We describe a 69-year-old male patient who had a swelling of the left parapharynx. Magnetic resonance imaging (MRI) showed a 6-cm mass lesion of the left parapharyngeal space. The tumor was surgically resected. Microscopically, the tumor cells were composed of spindle cells admixed with lymphocytes. Immunohistochemically, tumor cells were positive for CD21. Based on these findings, the tumor was diagnosed as FDCS. Postoperative radiotherapy was performed. Neither local recurrence nor distant metastasis has been seen for 20 months since surgery.

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We report a case of epithelioid hemangioendothelioma (EHE) with multiple recurrences in the head and neck. The patient was a 40-year-old woman who had undergone multiple surgeries for EHE of the left skull, left mandible, left parotid gland, and left nasal septum at several hospitals during the previous 12 years. She visited our department for a follow-up examination. A mass was identified in the left nasal septum, which was diagnosed as EHE on the basis of biopsy findings, and the tumor was resected. The size and histopathologic features of the tumor indicated low-risk EHE; thus, additional treatment was not indicated. Tumor recurrence remains a concern for patients with EHE, even among those with no recurrence at 18 months after surgery. Careful follow-up is therefore essential.

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We report a case where octreotide was effectively used for a patient with chyle fistula after neck dissection. Chyle fistula after neck dissection is relatively rare, and is often difficult to treat. If conservative treatment is not successful, surgical treatment is necessary. In this case, because of the sepsis caused by surgical site infection and the patient's very bad condition due to the fistula, surgery for the chyle fistula was judged to be impossible. We began to administer octreotide on day 24 after neck dissection. On the 11th day after starting octreotide, drainage of the fistula improved. Octreotide is somatostatine analogs. Somatostatin is a peptide hormone with the effect of inhibiting gastrointestinal peristalsis and secretion of the gastrointestinal hormone. We can determine whether octerotide is effective or ineffective in a short time. Because of few side effects, octreotide is very suitable for patients in poor condition. Our experience convinces us that octreotide is an extremely effective treatment for chyle fistula.

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We reported a case of a first branchial fissure-derived branchiogenic fistula with recurrent infection.
A 2-year-old female had a recess in the right mandibular region at birth and had recurrent swelling and infection. She underwent an incomplete resection of the lesion and debridement of a fistula running towards the ear found during the intervention by plastic surgeons at another hospital.
After the surgical intervention, the recurrent infection remained and she was referred to our hospital. We performed a surgical intervention of the lesion and found that the fistula was running in parallel with the medial side of the facial nerve and the blind end of the cartilage of the external auditory meatus.
A histopathological assessment revealed that the fistula was lined by stratified squamous epithelium with a cutaneous appendage (hair follicle).
Thus, we diagnosed a first branchial fissure-derived branchiogenic fistula based on histopathological and anatomical findings, and age at onset.

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A carotid body tumor is pathologically a kind of paraganglioma. It is reported that the rate of malignancy is 5-7%. Pathologically, it is difficult to diagnose a malignant carotid body tumor. In most cases, the malignant potential is decided whether the metastasis is occured. Here, we report on a very rare case of a 25-year-old male with a malignant bilateral carotid body tumor discovered by liver metastasis. An abdominal CT revealed that the patient had a tumor of the liver. He underwent an operation to remove the tumor. Pathologically, the tumor was a metastasis of paraganglioma. He was administered FDG-PET, and pointed out the left neck high density area. The HDA was thought to be the primary tumor-a, malignant carotid body tumor. After assessment by MIBG scintigraphy and a balloon occlusion test, we operated to remove the tumor. We exfoliated the capsular adventitial plane by using irrigator bipolar and microscopy. We removed the tumor with the wall of the artery and closed it with a suture. After the operation, the patient is doing very well but we have to watch carefully in case the tumor relapses.

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Chemoradiotherapy for advanced head and neck cancer leads to good local control and organ preservation. However, there are some early complications, such as dermatitis, mucositis and myelosupression. There are also some severe late complications, such as laryngeal necrosis, bone necrosis, dysphagia and radiation-induced cancer.
When laryngeal necrosis is not controlled by conservative therapies, a total laryngectomy is necessary.
The present case developed laryngeal stenosis and necrosis after ten years of chemoradiotherapy treatment. Furthermore, cervical bone necrosis and vertebral artery rupture occurred.
A total laryngectomy and blood vessel embolization had to be performed.

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We report on a case in which thyroid cancer infiltrated the trachea, and we performed a segmental resection of the trachea and reconstructed the tracheal wall.
Case: A 25-year-old male who was diagnosed with papillary cancer in the right lobe of the thyroid gland and underwent surgery at another hospital. During surgery, the tumor was found to have spread to the trachea and the right recurrent laryngeal nerve. Complete resection was not possible, thus he was referred to our department. During the initial examination, it was confirmed that the right vocal cord was fixed at the median position. A preoperative CT scan revealed a tumor compressed on the right side of the trachea.
Surgery and post-operation: We removed the residual tumor, performed a partial resection of the trachea, and reconstructed the tracheal wall with costal cartilage as a two-stage operation. We resected about six tracheal rings, going as far as the membranous part on the right side, as far as one-third of the tracheal rings on the left, and coming above from the cricoid cartilage. We collected costal cartilage, cut one section into two vertical pieces and created a cartilage plate, with one piece forming a lateral tracheal wall, and buried the remainder under the skin at the left side of the tracheostomy to be used later to rebuild the anterior tracheal wall. Approximately six months later, we performed surgery to close the tracheostomy. We created a cutaneous flap that included the cartilage buried under the skin and closed the anterior tracheal wall. We closed the incision by extending flaps from both sides of the neck. After surgery, the shape of the trachea was good, the patient had no trouble breathing, and his phonation was good.

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A dentigerous cyst is one of the odontogenic cysts and encloses the crown of an unerupted tooth by expansion of its follicle. The treatment of dentigerous cysts is surgery, and especially if the dentigerous cyst is located in the maxillary sinus, the Caldwell-Luc procedure was usually undertaken. Recently, several authors reported novel endoscopic surgery techniques for maxillary disease. Endoscopic modified medial maxillectomy (EMMM) is a novel one. The advantage of this procedure is that elevating a mucosal flap helps to access the maxillary sinus and allows the preservation of the lateral wall of the nose involving the inferior turbinate or nasolacrimal duct.
We report two cases of maxillary dentigerous cysts, operated on with the EMMM procedure. In each case, we were able to achieve easy access to and a good operative field of the maxillary sinus. The unerupted teeth were removed and the cyst was fenestrated in case 1, and removed in case 2. The unerupted teeth were attached too firmly to be removed by usual antrostomy, without the EMMM procedure. In case 1, mucous rhinorrhea continued because of a residual lesion.
We conclude that the EMMM procedure was suitable for maxillary dentigerous cysts, but if the cyst is too large to remove with EMMM, surgeons should consider the Caldwell-Luc procedure.

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A total pharyngo-laryngectomy with pharyngeal reconstruction by free jejunum transfer was performed due to recurrence of hypopharyngeal cancer after concurrent chemoradiotherapy (CCRT) in a 77-year-old male patient. Postoperatively, a pharyngocutaneous fistula developed at the site of jejunum-esophageal anastomosis. Application of trafermin (basic fibroblast growth factor: bFGF) spray, patch-graft reconstruction using a pectoral major muscular flap and covering by absorbable polyglycolic acid (PGA) felt were sequentially performed as closure of the fistula approached, resulting in a smaller residual fistula. The fistula was totally closed by fibrin seal closure on the 140^th postoperative day.
Postoperative pharyngocutaneous fistula is a major complication of surgery for head and neck malignancies. In salvage surgery after radiotherapy or CCRT, this complication often bothers the surgeon because it usually requires a very long time to heal. Sealing the fistula by fibrin glue may be an effective procedure for prolonged postoperative pharyngocutaneous fistula.

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Once descending necrotizing mediastinitis (DNM) occurs, it progresses rapidly and a high mortality rate has been reported. We experienced two cases of dysphagia after treating DNM. Both patients had swallowing difficulty in the first swallowing test after treatment of DNM and so percutaneous endoscopic gastrostomy (PEG) was performed. After swallowing rehabilitation, both patients could eat without dysphagia. Dysphagia and DNM are discussed with a review of the literature.

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