[in Japanese]

View full abstract

We retrospectively reviewed 13 cases (8 males and 5 females) of stapes revision surgery for clinical otosclerosis. Dislocation of the prosthesis was found in 9 ears. Fracture and erosion of the incus long process were detected in 5 and 4 ears, respectively, and bony and fibrous closure of the oval window was seen in 3 and 5 ears, respectively. Although dislocation of the prosthesis from the footplate of the stapes could be detected by preoperative CT imaging, fracture or erosion of the incus could not be detected. We selected the incus bypass method in 5 of 13 ears. The success rate by the criteria of the Japanese Otological Society was 69.2% (9 of 13 ears), which was much lower than that in the primary surgery. In 3 of 4 ears in which postoperative hearing results were not improved, deterioration of preoperative bone thresholds over 10 dB at speech frequencies was seen compared to that of the opposite ears. In the literature, the incidence of postoperative sensory-neural hearing loss in revision surgery is higher than that in primary surgery. From these results, we recommend revision surgery under local anesthesia for early detection of inner ear damage during the operation. In patients with fracture or distortion of the incus long process, the incus bypass method should be selected. In patients with deterioration of preoperative bone conduction thresholds, operative indications should be considered carefully. Patients should be informed of the lower success rate and higher risk of damage to the inner ear.

View full abstract

[in Japanese]

View full abstract

[in Japanese]

View full abstract

[in Japanese]

View full abstract

[in Japanese]

View full abstract

[in Japanese]

View full abstract

Recurrent laryngeal nerve should be safely preserved for the avoidance of postoperative hoarseness. In this report, we presented the management of recurrent laryngeal nerve. Wide operative field should be prepared for the detection of recurrent laryngeal nerve, and non-invasive manipulates around the nerve are required. When the invasion to the nerve of thyroid cancer is observed macroscopically, composite resection of the nerve should not be performed. In some cases, the nerve can be preserved microscopically. In the cases who can not be preserved of the nerve microscopically, immediate reinnervation of the recurrent laryngeal nerve should be performed after the composite resection. In the cases who was performed the reinnervation, good phonation will be acquired postoperatively. In the case who can not be anastomosed extra-laryngeal area, innervation can be performed intra-laryngeal area. Intraoperative nerve monitoring is useful in the thyroid operation, and it will be popular in the near future.

View full abstract

Regarding chemoradiotherapy for head and neck cancers, evidence for the standard treatment is reported. When chemotherapy is used together, the use of single CDDP together is the standard. The JCOG head and neck cancer group was set up in recent years, and clinical trials to develop a standard regimen have begun. JCOG1008 is studying post-operative chemoradiotherapy for high-risk patients. JCOG1212 is studying super-selective intra-arterial chemoradiotherapy for maxillary sinus cancer. On the other hand, sometimes chemoradiotherapy is an unsuitable treatment due to its toxicity. It is also reported that patients cannot achieve long-term survival even if chemoradiotherapy is successful due to late toxicity. Long-term improvement of chemoradiotherapy results is expected by devising drug therapies such as using cetuximab in the future.

View full abstract

For the prevention of postoperative facial nerve paralysis in parotid tumor surgery, it is necessary to perform a thorough preoperative diagnosis, make appropriate decisions during the operation, and acquire proficient surgical skills. Classifying parotid tumors based on location as well as a qualitative diagnosis using magnetic resonance imaging and ultrasonography, it is important to explain the preoperative diagnosis to patients and families. The use of the intraoperative nerve stimulator is useful for improving the skills of the operator and can reduce the operation time, but it does not reduce postoperative facial nerve paralysis of parotid benign tumors. On the other hand, the nerve stimulator is useful for operations on recurrent parotid tumors. Based on my experience of dissection, it is most important to operate on the cause; the nerve stimulator should play the final supporting role.

View full abstract

[in Japanese]

View full abstract

Since the incidence of post-cricoid carcinoma is low among all of the hypopharyngeal carcinoma in Japan, the number of informative reports on this cancer is relatively small. We had experienced 25 cases of post-cricoid carcinoma patients who underwent initial treatment in our hospital – the National Cancer Center Hospital East – from 2007 to 2012. Five cases of superficial carcinoma patients who underwent endoscopic mucosal resection had good clinical courses. We concluded that endoscopic surgery could be appropriate for superficial post-cricoid carcinoma. The other 20 cases of locally advanced carcinoma underwent surgery or chemo/radiotherapy. Although each treatment group had similar outcomes, the larynx preservation rate of the non-operative treatment group was as low as 23%. Salvage surgery after chemo/radiotherapy for a residual or recurrent tumor could be a choice; however, we should determine the treatment strategy with consideration of tumor progression stage or general condition.

View full abstract

This retrospective study includes 30 patients with traumatic tympanic membrane perforations and 8 patients with traumatic ossicular chain dislocations in our hospital from April 2008 to December 2013. The cause, pathogenesis, hearing condition and therapeutic outcomes were examined.
In the group of tympanic membrane perforations, these were caused by either direct force in 14 cases or indirect force in 16 cases. They are mainly located in the anterior-inferior quadrant in 23 cases and involved single quadrant perforation. Although most cases healed conservatively, 6 of 30 cases required surgical operations to close the perforations. All cases improved hearing conditions after the closure of the tympanic membrane, regardless of conservative or surgical therapy.
In the group of ossicular chain dislocations, 6 of 8 cases underwent surgical repair. Malleo-incudal joint dislocations, incudo-stapedial joint dislocations, and stapedial fractures were confirmed by the operations. All 6 cases improved hearing conditions postoperatively.
On the basis of our data, we will discuss the implications of this traumatic disorder with regard to clinical issues.

View full abstract

We review 38 cases in whom intercapsular resection for neck schwannoma was carried out at our center from April 2005 to January 2015. We examined the age, sex, neurological symptoms before the operation, size of tumor, and neurological symptoms after the operation. The same surgeon conducted all of the intercapsular resections.
The results indicated that postoperative neurological deficits occurred in 8 cases (21.1%). Among these cases, paralysis which did not improve occurred in 2 cases (5.3%) and temporary paralysis in 6 cases (15.8%). However, the patients did not suffer problems for daily living. It is considered that surgery by this method is an option instead of follow-up. We must also explain the merits and demerits of follow-up and operation.

View full abstract

Thirty-nine patients (22 males, 17 females) under 40 years old with head and neck cancer were treated at Kyushu University Hospital during 2004–2013. Oral cancer was observed in 17 patients, nasopahryngeal cancer in 6 patients, salivary gland cancer in 6 patients, sinonasal cancer in 5 patients, mesopharyngeal cancer in 2 patients, and laryngeal cancer, hypopharyngeal cancer and primary unknown cancer in 1 patient each.
The three-year survival rate was 56.3% for young adult patients with oral tongue cancer, and was 71.6% for patients over 40 years old. The 3-year survival rate was 83.3% for young adult patients with nasopharyngeal cancer, and was 86.3% for patients over 40 years old. There were no significant differences between age group and survival rate. The clinical appearance, stage, treatment and survival rate are discussed.

View full abstract

Twenty-two patients (18 males, 4 females) with cancer of the base of the tongue were treated at Kyushu University Hospital during 2004–2011. They were classified by T classification as one case with T1, 8 with T2, 7 with T3, and 6 with T4a. The 3-year survival rates were 75.4% for all patients. The 3-year survival rate was 83.3% for patients treated with superselective intra-arterial chemotherapy with CDDP and DOC and irradiation, and was 71.8% for patients treated with chemotherapy with S-1 or systemic chemotherapy and irradiation.

View full abstract

The nasopalatine duct cyst is one of the nonodontogenic epithelial cysts according to the WHO classification, and it arises from the epithelial remnants of the nasopalatine duct of the fetus.
Here we report our experience of a case of a nasopalatine duct cyst removed with the assistance of a nasal endoscopy system. A 63-year-old man presented with swelling of the right nasal vestibule. Elevation of the floor of the right nasal cavity and the bone defect of a part of the hard palate were observed. The cyst was removed by the combination of the gingival approach and nasal endoscopy system. Nasal endoscopy was useful for getting a better view of the surgical field. The patient had no postoperative complications and showed no recurrence for four years after the surgery. Because the nasal endoscopy technique is familiar to otolaryngologists, we should positively treat nasopalatine duct cysts.

View full abstract

Myoepithelial carcinoma (MEC) was first treated as a separate tumor by the World Health Organization (WHO) in 1991. MEC is a rare malignant salivary gland tumor with a reported incidence of 0.2〜0.5% of all salivary gland tumors. We report a case of MEC ex pleomorphic adenoma of a parotid gland in a 75-year-old female with a review of the literature. The patient was referred to our hospital for further evaluation of her right parotid gland tumor. Surgical dissection was performed. Histopathologically, the tumor was composed of a pleomorphic adenoma; there was a rupture of the fibrous capsule and tumor cells had slightly invaded the surrounding tissues.
Immunohistochemical staining showed positive for S-100 protein, α-SMA (smooth muscle actin), and GFAP (glial fibrillary acidic protein).
The postoperative histopathologic examination confirmed the diagnosis of MEC ex pleomorphic adenoma.
For 2 years and 9 months post-operatively, there was no evidence of local recurrence or distant metastasis. We should follow-up carefully.

View full abstract

Cetuximab has received additional approval for the treatment of cancer of the head and neck and has thus become a new option for molecular-targeted therapy. To date, we have used cetuximab in nine patients with cancer of the head and neck. Here we report on two of these patients in whom comparatively favorable results were achieved. Patient 1 was a 47-year-old man who received two cycles of combination chemotherapy including cetuximab for multiple pulmonary metastases of oropharyngeal cancer. The patient was then given maintenance doses of cetuximab alone. Patient 2 was a 71-year-old man who received six cycles of combination chemotherapy including cetuximab for multiple pulmonary metastases of laryngeal cancer. The patient is currently receiving maintenance doses of cetuximab alone. The tumors were reduced in both patients, and they are currently undergoing follow-up. Cetuximab has become an established therapeutic option; however, there is still room for debate regarding the significance of use. This therapy should therefore be used with caution. Moreover, adverse reactions peculiar to this drug have been reported, suggesting the need for thorough management of preventive measures and countermeasures for these reactions.

View full abstract

Among head and neck tumors, the occurrence rate of salivary gland tumors is about 3%, of which about 10–15% are minor salivary gland tumors, so minor salivary gland tumors are relatively rare.
We report a case of pleomorphic adenoma in the buccal region. A 60-year-old man visited our hospital complaining of tumor formation in his cheek. Local findings showed an elastic firm and movable mass at his buccal mucosa.
A clinical diagnosis of benign tumor with pleomorphic adenoma was made based on magnetic resonance imaging (MRI) findings and fine-needle aspiration (FNA). We removed the mass through an intraoral approach, and the pathological diagnosis was a pleomorphic adenoma. There has been no evidence of recurrence since the operation.

View full abstract

Warthin's tumor is the second most common benign parotid gland tumor next to pleomorphic adenoma. In addition, malignant transformation of Warthin's tumor is extremely rare. We report a rare case of salivary duct carcinoma arising in Warthin's tumor of the right parotid gland in a 66-year-old male. The patient had been aware of a mass in the bottom right ear for a few years. In addition, he was also aware of right cervical lymphadenopathy, and it rapidly increased. Aspiration cytology in the right parotid gland tumor showed Papanicolaou Class V (carcinoma). We performed a total parotidectomy and neck dissection. The removed tumor was in contact with two well encapsulated nodular lesions (about 10 mm each) and histopathological findings showed Warthin's tumor and poorly differentiated salivary duct carcinoma. The patient was carefully followed up after postoperative chemoradiotherapy. 12 months later, he had a recurrence in the left cervical lymph node and distant metastasis in the stomach and died 20 months later.

View full abstract

The current study aimed to evaluate the risk factor of hypothyroidism after total laryngectomy (TL) and total pharyngolaryngectomy (TPL) combined with hemithyroidectomy. We retrospectively reviewed the clinical charts of patients treated at our institution between 2002 and 2014 and identified 98 patients treated with TL or TPL combined with hemithyroidectomy. Forty-one patients developed hypothyroidism after surgery. Radiotherapy was a significant risk factor for postoperative hypothyroidism. In conclusion, hypothyroidism is a frequent complication in patients treated with radiotherapy and TL and TPL. We should follow up laboratory data of those patients closely.

View full abstract

The case of an 82-year-old woman who developed cerebral infarction, was admitted to the ICU of Hokkaido University Hospital and subsequently underwent percutaneous tracheostomy is described. Two months after the tracheostomy, a massive tracheal hemorrhage occurred due to a tracheo-innominate artery fistula (TIF). An emergency operation was performed (primary closure of the fistula, then envelopment with an anterior cervical muscle flap). Three weeks after the surgery, enhanced CT indicated the presence of an innominate artery aneurysm. With suspected rupture, the innominate artery was resected and replaced with artificial materials and covered with a pectoral major musculo-cutaneous flap (PMMC).
However, 6 weeks after PMMC reconstruction, the patient had an episode of uncontrolled bleeding and consequently died due to severe blood loss.
TIF is considered to be one of the critical complications of tracheostomy and clinicians should keep this in mind during tracheostomy to prevent its occurrence.

View full abstract

Salivary duct carcinoma (SDC) is a rare and aggressive tumor of the salivary glands. An effective treatment for metastatic SDC has not been established. A case of metastatic SDC in which complete response was achieved with bicalutamide is presented. A 66-year-old man with an enlarged left subaural mass was diagnosed as having left parotid cancer (T4aN0M0). The patient underwent a total parotidectomy with complete facial nerve resection and upper neck dissection, and the pathological diagnosis was SDC overexpressing androgen receptor. He received localized radiotherapy of 66 Gy as a single fraction per day for 33 days after the operation. Seven months after surgery, computerized tomography (CT) showed multiple lung metastases. The lung nodules continued to increase in size, and the patient was prescribed oral bicalutamide (80 mg once daily). After 2 months of bicalutamide treatment, the lung nodules decreased in size. After 8 months, almost all lung metastases decreased more than 30% in size, and the patient was judged to have a partial response (PR). After 14 months, practically all lung metastases disappeared, and the patient was judged to have a complete response (CR). Five months after the commencement of treatment, the patient complained of grade 2 gynecomastia (Common Terminology Criteria for Adverse Events, version 4.0). Three years since the development of metastases to the lung, the patient is now doing well without recurrence of the disease. Bicalutamide monotherapy is safe and should be considered for patients with androgen receptor-positive salivary duct carcinoma.

View full abstract

Thyroglossal duct cysts are thought to originate from the epithelial remnants of the thyroglossal tract. The cysts may occur in the lingual or submental areas, but rarely occur in the lateral of the neck.
We report two cases of papillary carcinoma arising in a side chain of a thyroglossal duct cyst. Most cases of cysts arising in the lateral of the neck are lateral cervical cysts, but there is a possibility of thyroglossal duct cyst carcinoma. We should examine these cases sufficiently with neck CT, MRI, echo and FNA before the operation.

View full abstract