JOURNAL OF JAPAN SOCIETY FOR HEAD AND NECK SURGERY
Online ISSN : 1884-474X
Print ISSN : 1349-581X
ISSN-L : 1349-581X
Volume 26, Issue 1
Displaying 1-26 of 26 articles from this issue
  • Takenori Miyashita, Hiroshi Hoshikawa, Nozomu Mori
    2016 Volume 26 Issue 1 Pages 1-7
    Published: June 30, 2016
    Released on J-STAGE: July 15, 2016
    JOURNAL FREE ACCESS
    Multiplanar reconstruction (MPR) images of the ossicles are useful for evaluation of ossicular lesions, operation planning in ossiculoplasty, and estimation of postoperative hearing. MPR images of the ossicles allow us to evaluate ossicular lesions even in cases with soft shadows around the ossicles. Preoperative detailed information on ossicular lesions is important to ensure postoperative hearing in cases with conductive hearing loss, such as cholesteatoma, traumatic ossicular discontinuity, malformation of ossicles, and otosclerosis. MPR imaging of the stapes is very effective to detect small fenestral lesions in patients with otosclerosis. We also demonstrate the key aspects of the imaging method to obtain MPR images of ossicles as a standard tool in daily clinical practice.
    Download PDF (1163K)
  • Motohiko Suzuki
    2016 Volume 26 Issue 1 Pages 9-12
    Published: June 30, 2016
    Released on J-STAGE: July 15, 2016
    JOURNAL FREE ACCESS
    Chronic rhinosinusitis is an inflammation of the nose and sinuses. Patients with chronic rhinosinusitis that does not improve sufficiently with medical treatment undergo endoscopic sinus surgery (ESS). Although ESS is a useful technique, it sometimes causes secondary damage and complications because of massive bleeding, lack of understanding of sinus anatomy by the practitioner, malformation of sinus anatomy, and lack of surgical skill of the practitioner. Therefore, control of bleeding, understanding of the sinus anatomy in a patient undergoing surgery, and excellent surgical skills of the practitioner are necessary to prevent secondary damage.
    Download PDF (611K)
  • Toshiki Utsunomiya, Masao Yagi, Hiroshi Iwai, Tomofumi Sakagami, Kensu ...
    2016 Volume 26 Issue 1 Pages 13-17
    Published: June 30, 2016
    Released on J-STAGE: July 15, 2016
    JOURNAL FREE ACCESS
    Deep neck abscesses are often seen in ENT practice and can become a life-threatening disease if not diagnosed promptly or not treated properly. Airway management including tracheotomy is also required when the patients show ongoing tracheal stenosis. On the other hand, this surgical treatment often causes postoperative complications. The aim of this study was to analyze the indications for tracheotomy in patients with deep neck abscesses. We retrospectively analyzed the clinical characteristics of the patients with deep neck abscesses who were treated with tracheotomy in our department between 2006 and 2014. The patients comprised 14 males and 13 females ranging in age from 0 to 85 years. The results showed that edema in the trachea and a high amount of CRP of 20 mg/dl or higher were risk factors for tracheotomy. An abscess without extension located under the hyoid bone was a main factor for surgery.
    Download PDF (887K)
  • ―Regarding antimicrobial therapy
    Hisashi Kessoku, Eri Mori, Atsushi Hatano, Nobuyoshi Otori, Hiromi Koj ...
    2016 Volume 26 Issue 1 Pages 19-22
    Published: June 30, 2016
    Released on J-STAGE: July 15, 2016
    JOURNAL FREE ACCESS
    We examined the clinical presentation of 31 cases of deep neck abscess treated in our department over the past 14 years and used the Mann-Whitney test and the χ-square test to compare the course of treatment, including duration of receiving either antimicrobial monotherapy or multidrug treatment. Of the 31 cases, 19 (61.3%) were treated with multidrug combination therapy, while the remaining 12 (38.7%) received single-agent treatment. No significant differences were noted between the groups in duration of treatment (p=0.110). When treating deep neck abscess, reliably draining the abscess is important, and antibiotic treatment after drainage is considered a useful single-agent treatment regimen.
    Download PDF (755K)
  • Hiroaki Nakatani, Kei Fukushima, Yasuharu Enomoto
    2016 Volume 26 Issue 1 Pages 23-27
    Published: June 30, 2016
    Released on J-STAGE: July 15, 2016
    JOURNAL FREE ACCESS
    In the 2010 Japanese guidelines for the management of thyroid tumor, patients with papillary thyroid carcinoma excluding those in the low-risk and high-risk groups were classified into the gray-zone risk group, and the committee of the Japanese guidelines left the extent of surgery for this group to the discretion of each surgeon. In this study, we histologically examined extirpated thyroids in 20 patients with gray-zone carcinoma to determine their pathological findings. Intraglandular cancer foci in the affected side were observed in 9 patients and those in the opposite side were identified in 7 of 8 patients who received operations over subtotal thyroidectomy. Vascular invasion was observed in 15 patients in spite of all patients being M0. Lymphatic invasion and lymph node metastases were observed in 6 patients and 9 patients, respectively. These results showed that gray-zone carcinoma had a relatively high incidence of intraglandular cancer focus, vascular invasion and lymph node metastasis.
    Download PDF (777K)
  • Masakatsu Takahashi, Mikito Naiki
    2016 Volume 26 Issue 1 Pages 29-35
    Published: June 30, 2016
    Released on J-STAGE: July 15, 2016
    JOURNAL FREE ACCESS
    Adenoid cystic carcinoma (ACC) of the external auditory canal (EAC) is rare, and so protocols for its treatment and management have not yet been established. We analyzed the treatment modalities used and the outcome of 5 patients with ACC of the EAC treated between 1997 and 2014, including 1 man and 4 women. The mean age of the patients was 51.4 years (range, 27 to 67 years). Ear pain was the most common complaint, observed in 4 of 5 patients. The clinical stage according to the Pittsburgh staging system was T1 in 3 patients, T2 in 1 patient, and T4 in 1 patient. Lymph node metastasis was observed in the 1 patient with T4 stage tumor. All the patients underwent surgical treatment. The 3 patients with T1 stage tumors and the 1 patient with T2 stage tumor underwent lateral temporal bone resection. The 1 patient with T4 stage tumor underwent subtotal temporal bone resection, total parotidectomy, and neck dissection, as well as postoperative adjuvant radiotherapy owing to the advanced T and N stages. All patients were pathologically confirmed to have a tumor-free margin. None of the 5 patients developed local recurrence, but the 1 patient with T4 stage tumor developed pulmonary metastases 37 months after surgery. Thus, early diagnosis is important and the possibility of malignant neoplasms should be considered while evaluating patients with continuous ear pain. En-bloc resection with wide local margins is useful to cure ACC of the EAC. Postoperative adjuvant radiotherapy can be used for patients with advanced T-stage tumors, but may not be necessary for patients with early T-stage tumors resected with a negative margin.
    Download PDF (953K)
  • Nayuta Tsushima, Shigeru Akazawa, Shogo Kimura
    2016 Volume 26 Issue 1 Pages 37-42
    Published: June 30, 2016
    Released on J-STAGE: July 15, 2016
    JOURNAL FREE ACCESS
    Agranulocytosis is a serious side effect of antithyroid drugs. We report a case of antithyroid drug-induced agranulocytosis complicated by acute epiglottitis and deep neck abscesses. A 43-year-old woman was prescribed thiamazole for Graves' disease. She visited her regular doctor because of sore throat and high fever. She was diagnosed with agranulocytosis and was admitted to our hospital. We checked her throat because she had severe throat pain: she nearly choked due to acute epiglottitis. We intubated her using a flexible video laryngoscope. After noting a high neutrophil count, bilateral deep neck abscesses were detected. The abscesses were treated by neck incision and drainage. Intubation using an endoscope appears to be effective for a patient who should avoid surgery. The timing of abscess formation was different from usual in a patient with agranulocytosis. She suffered pulmonary embolism during the progress of treatment. A total thyroidectomy was performed for Graves' disease.
    Download PDF (932K)
  • Nobuo Ohta, Yasuhiro Abe, Yusuke Suzuki, Toshinori Kubota, Kazunori Fu ...
    2016 Volume 26 Issue 1 Pages 43-47
    Published: June 30, 2016
    Released on J-STAGE: July 15, 2016
    JOURNAL FREE ACCESS
    Cone beam computed tomography (CBCT) is an imaging modality that provides computed tomographic images using a rotational C-arm equipped with a flat panel detector. The aim of this technique is to provide additional information to conventional 2D imaging to improve the proper management of otolaryngological diseases. This article presents cases we have experienced and the usefulness of CBCT in the management of presurgical evaluation for sinonasal diseases. From our limited experience, CBCT provides accurate detection and targeting, periprocedural guidance, and post-procedural evaluation of treatment success.
    Download PDF (2174K)
  • Takeharu Ono, Hirohito Umeno, Shun-ichi Chitose, Buichiro Shin, Takeic ...
    2016 Volume 26 Issue 1 Pages 49-55
    Published: June 30, 2016
    Released on J-STAGE: July 15, 2016
    JOURNAL FREE ACCESS
    Twenty-one patients who had laryngeal squamous cell carcinoma were treated with radiotherapy and concomitant intra-arterial cisplatin (RADPLAT) between 2004 and 2010 at the Kurume University Hospital. Eleven of the 21 patients had supraglottic cancer, 7 had glottic cancer, and 3 had subglottic cancer. Six patients were at Stage II, 11 were at Stage III, and 4 were at Stage IV A. All of the patients could be treated with RADPLAT without having to stop the treatment. As a result, the 5-year laryngeal preservation rate of supraglottic cancer, glottis cancer and subglottic cancer were 82%, 100% and 100%, respectively. The 5-year overall survival rate of supraglottic cancer, glottic cancer and subglottic cancer were 91%, 100% and 100%, respectively. Side effects of Grade 4 were not observed. RADPLAT for laryngeal cancer may be a more effective treatment which allows laryngeal preservation.
    Download PDF (1348K)
  • Takahiro Kitamura
    2016 Volume 26 Issue 1 Pages 57-60
    Published: June 30, 2016
    Released on J-STAGE: July 15, 2016
    JOURNAL FREE ACCESS
    Odontogenic sinusitis is caused by dental infection. The source of the infection is usually teeth after poor root canal therapy. Although the number of cases of untreated dental caries is decreasing, we treated 14 cases by dental and rhinologic treatment and the symptoms improved. The Lund-Mackay staging system1) was used for assessing disease extent and clinical management. The average score of preoperative CT scans was 5.9 points, and that of postoperative CT scans at 6 months after the operation was 0.5 points, showing a remarkable improvement. Therefore, in this disease, it is important to perform both dental-oral and otorhinolaryngology treatment, through close coordination and a deeper understanding of this disease. This report describes dental and rhinologic treatments that produced good results. It is suggested that more minimally invasive treatment may result in healing.
    Download PDF (1041K)
  • Kyoko Saito, Norihiko Narita, Masayuki Okamoto, Takahiro Tokunaga, Tak ...
    2016 Volume 26 Issue 1 Pages 61-64
    Published: June 30, 2016
    Released on J-STAGE: July 15, 2016
    JOURNAL FREE ACCESS
    First bite syndrome (FBS), a complication associated with surgical removal of a tumor in the parapharyngeal space, is characterized by pain in the parotid area with the first bite of food, and improvement with each bite. The pain is worst with the first meal of the day, but it can develop even when thinking of eating. The literature implicates injuries of the sympathetic nerve as the cause, leading to parasympathetic nerve supersensitivity and spasms of myoepithelial cells in the parotid gland. During the two decades since April 1994, we have treated five patients who developed FBS after operations to resect the parotid tumor or parapharyngeal tumor. Herein, we report the clinical features and medications associated with each case.
    Download PDF (550K)
  • Aya Sakai, Yuko Kinoshita, Takaki Miwa
    2016 Volume 26 Issue 1 Pages 65-70
    Published: June 30, 2016
    Released on J-STAGE: July 15, 2016
    JOURNAL FREE ACCESS
    Obstructive sleep apnea (OSA) in children presents with pathological and clinical manifestations different from those of adult OSA, and adversely affects the higher brain function and development of affected children. Unless they are treated appropriately, they often exhibit delayed development, poor academic performance, attention deficit, hyperactivity, aggressive behavior, etc. The primary cause of pediatric OSA is enlarged pharyngeal tonsils (adenoids) and/or enlarged palatine tonsils; other causes include maxillofacial malformation and allergic rhinitis. Various factors, including obesity, are also involved in the development of OSA after children enter elementary school. Although no treatment has been established as the standard of care for pediatric OSA, the removal of adenoids and palatine tonsils is recommended as the first-line treatment. Between January 2007 and March 2014, we treated 71 children who visited our hospital with chief complaints of snoring, sleep apnea, etc., and performed surgical treatment in 63 of them. Among them, three children aged 3 years or less had a relapse of symptoms, and we provided additional treatment. Since OSA in childhood presents with various symptoms according to the child’s age, we need to diagnose and treat it appropriately. Here, we report upper airway findings, sleep assessments, and therapeutic approaches, with a review of the literature.
    Download PDF (864K)
  • Masami Suzuki, Kohtaro Eguchi, Shota Ida, Ryuhei Okada, Tomoyuki Kawad ...
    2016 Volume 26 Issue 1 Pages 71-78
    Published: June 30, 2016
    Released on J-STAGE: July 15, 2016
    JOURNAL FREE ACCESS
    Lingual lymph nodes present in the lateral portion of the tongue have traditionally been classified as lateral lingual lymph nodes. However, parahyoid area lymph nodes, which are not included in the traditional classification, have recently been reported and the traditional classification seems to be out of date. In this context, considering the clinical significance and the anatomical appropriateness, we propose a new classification for lingual lymph nodes. The new classification divides lingual lymph nodes into four groups: medial lingual lymph nodes (present in the space between the genioglossus muscles), anterior lateral lingual lymph nodes (present in the sublingual space), posterior lateral lingual lymph nodes (present in the submandibular space) and parahyoid lingual lymph nodes (present in the parapharyngeal space).
    In 100 cases of tongue cancers which received primary therapy at Gunma Prefectural Caner Center, there were 8 cases of lingual lymph node metastases. Three cases had anterior lateral lingual lymph node metastases, 1 case had posterior lateral lingual lymph node metastasis, and 4 cases had parahyoid lingual lymph node metastases.
    Download PDF (2535K)
  • Satoshi Koyama, Kazunori Fujiwara, Takahiro Fukuhara, Aigo Yamasaki, E ...
    2016 Volume 26 Issue 1 Pages 79-82
    Published: June 30, 2016
    Released on J-STAGE: July 15, 2016
    JOURNAL FREE ACCESS
    Introduction: Vessel punctures for blood tests or phlebitis related to chemotherapy usually cause stress to patients. To alleviate the stress, we use a peripherally inserted central venous catheter (PICC). This study aimed to clarify the safety of PICC for outpatients with head and neck cancer.
    Materials & Methods: We analyzed 9 non-hospitalized head and neck cancer patients who received chemotherapy with PICC and investigated catheter related early and late complications.
    Results: Median duration of catheter insertion was 98.6 days. Minor bleeding was the only insertion related complication which was observed in 3 patients. No catheter related blood stream infection was observed.
    Conclusion: PICC is a safe device for outpatients with head and neck cancer.
    Download PDF (315K)
  • Kenichiro Nomura, Akihiro Katayama, Miki Takahara, Toshihiro Nagato, K ...
    2016 Volume 26 Issue 1 Pages 83-89
    Published: June 30, 2016
    Released on J-STAGE: July 15, 2016
    JOURNAL FREE ACCESS
    Background: The aim of this study was to evaluate the feasibility and outcomes of video-assisted total thyroidectomy for Graves' disease.
    Methods: Between May 2009 and October 2015, a total of 192 patients with thyroid diseases underwent thyroid surgery by video-assisted neck surgery (VANS method). Among these patients, 13 underwent total thyroidectomy for Graves' disease. We had modified the VANS method mainly by using an originally-developed skin-flap retractor. In our modified method, the main incision of 2.5cm was made on the right side of the chest wall below the clavicle, then the newly-developed retractor was inserted under the subplatysmal layer to create working space. An endoscope was inserted via 5-mm ports on both sides of the neck. The intraoperative nerve monitoring system identified bilateral recurrent laryngeal nerves in all patients.
    Results: The operation was successfully completed endoscopically in all patients. The median value of preoperative estimated thyroid volume, operating time, and postoperative hospitalized period were 26ml, 180 minutes, and 3 days, respectively. As complications, two patients had transient unilateral laryngeal paralysis that recovered in a month and two patients had transient hypocalcemia.
    Conclusion: Although total thyroidectomy for Graves' disease by the modified VANS method may be contraindicated for large thyroids, it is feasible and safe with excellent cosmetic results.
    Download PDF (569K)
  • Yukiyoshi Hyo, Hisaki Fukushima, Masako Uno, Hiroaki Tadokoro, Tamotsu ...
    2016 Volume 26 Issue 1 Pages 91-96
    Published: June 30, 2016
    Released on J-STAGE: July 15, 2016
    JOURNAL FREE ACCESS
    Cheek tumor is considered to be a tumor arising from the minor salivary glands and accessory parotid glands. Tumors of the minor salivary glands and accessory parotid glands are rare. It is important to select a surgical method. Here we report two cases of cheek tumor arising from minor salivary glands and accessory parotid glands.
    Case 1:A 30-year-old man visited our hospital. A 2.5-cm surface smooth mass was palpable in the left cheek. The tumor was removed to oral approach, the pathological diagnosis was plemorphic adenoma.
    Case 2:A 36-year-old woman had become aware of a mass accompanied by tenderness in the left cheek from one month earlier. A 1-cm elastic hard mass was palpable in the left cheek. CT and MRI revealed a mass lesion in the secondary parotid gland. The tumor was surgically removed, and the pathological diagnosis was adenoid cystic carcinoma.
    Download PDF (951K)
  • Kazutomo Niwa, Yasunori Sakuma, Nobuhiko Oridate
    2016 Volume 26 Issue 1 Pages 97-101
    Published: June 30, 2016
    Released on J-STAGE: July 15, 2016
    JOURNAL FREE ACCESS
    We performed a scala vestibuli cochlear implantation for a deaf girl with ossified cochlear after meningitis. She was born uneventfully, and passed the new-born hearing screening. She suffered from bacterial meningitis at 5 months old, and 3 weeks later, was diagnosed with bilateral hearing impairment by auditory brainstem response (ABR) audiometry. Auditory steady-state response (ASSR) and conditioned orientation response (COR) audiometry confirmed profound bilateral deafness. Preoperative computed tomography (CT) and magnetic resonance imaging (MRI) suggested ossification of the scala tympani, although the scala vestibule was normal. At 23 months, she underwent right-ear cochlear implantation. The scala tympani was completely occluded, but the lumen of the scala vestibule was patent. We were able to insert all electrodes into the scala vestibuli without resistance, and then the results of the neural response telemetry (NRT) were entirely positive. There were no postoperative complications, and the hearing threshold level with the cochlear implant was good.
    Ossification of the cochlea is frequently observed after meningitis. It is important to detect the stage and the location of ossification by CT and MRI. In cases with ossification of the scala tympani, scala vestibuli cochlear implantation may be an effective treatment.
    Download PDF (1043K)
  • Tomoya Hanakita, Masashi Hamada, Tomoaki Murakami, Kosuke Saito, Masah ...
    2016 Volume 26 Issue 1 Pages 103-108
    Published: June 30, 2016
    Released on J-STAGE: July 15, 2016
    JOURNAL FREE ACCESS
    Introduction: Meningoencephalocele is a relatively rare pathology, which is a brain herniation with the surrounding arachnoid into the extracranial space. It is more likely to occur following an ear surgery or trauma within the temporal bone. We present a case of meningoencephalocele that was found due to persistent ear discharge after tympanostomy tube insertion.
    Case report: A 60-year-old female had undergone placement of tympanostomy tubes on both ears at another hospital 10 years previously. After the left tube had been removed due to persistent ear discharge, she moved away from the hospital. When she visited our hospital complaining of bilateral hearing loss, her left ear drum looked like otitis media with effusion. Accordingly, placement of a tympanostomy tube on the left ear was attempted again, but watery otorrhea appeared and continued after placement. CT scan and MRI revealed a middle fossa cranial defect and meningoencephalic herniation into the mastoid cavity. The transmastoid approach was selected to excise the meningoencephalocele and to control cerebrospinal fluid leakage by obliteration of abdominal fat into the mastoid cavity without a craniotomy. Histopathological findings were consistent with brain tissue. Neither meningoencephalic herniation nor cerebrospinal liquorrhea has recurred.
    Discussion and Conclusion: Meningoencephalic herniation into the temporal bone without a history of trauma or surgery is unusual and occurs insidiously. This pathology may be found either by episodes of meningitis or conductive hearing loss due to fluid collection in the middle ear. In the latter, care must be taken regarding insertion of the tympanostomy tube and subsequent serous discharge. As a curative treatment for meningoencephalocele within the temporal bone, a transmastoid approach, middle cranial fossa approach, or a combined approach should be selected. Of these, meningoencephalic excision followed by fat obliteration via the transmastoid approach seems to be a safer and more reliable method for otologists.
    Download PDF (614K)
  • Hiroyuki Maeda, Masatomo Touyama, Shinya Agena, Sen Matayoshi, Mikio S ...
    2016 Volume 26 Issue 1 Pages 109-113
    Published: June 30, 2016
    Released on J-STAGE: July 15, 2016
    JOURNAL FREE ACCESS
    Cavernous haemangioma commonly occurs at the mucous membrane of the nasal or oral cavity, inside the tongue and on the surface of facial skin in the head and neck region. Tumors occurring in the parapharyngeal space are very rare and we could find only three case reports worldwide. We report in detail our experience of surgical treatment for this rare tumor.
    The patient was a 66-year-old male. In April 2014, he visited his family doctor because of the symptom of globus pharyngeus. A tumor occupying the right parapharyngeal space was found by MRI imaging, so he was referred to our hospital for further tests. As initial findings, his mesopharyngeal wall was swollen and the postnasal cavity was completely obstructed. However, irregular surface of the swelling wall was not found. In the CT scan and MRI findings, spindle tumor with an obvious capsule was found in the right parapharyngeal space. In the FDG-PET findings, abnormal concentration was not found in the local neck area or any part of his body. From these results, we diagnosed the tumor as a neurogenic tumor (e.g. Schwannoma), and surgical treatment was performed. The tumor was removed clearly by a combination of the trans-cervical approach and trans-parotid approach. There was little bleeding during the operation and he was in good condition after the operation. However, the tumor was diagnosed as cavernous haemangioma from the pathological findings. Though there was no major bleeding during operation in this case, an accurate pre-operation diagnosis is important because of the high risk of major bleeding during operation.
    Download PDF (1677K)
  • Ryo Ota, Takuya Sasaki, Yasuaki Harabuchi
    2016 Volume 26 Issue 1 Pages 115-118
    Published: June 30, 2016
    Released on J-STAGE: July 15, 2016
    JOURNAL FREE ACCESS
    We report a case in which octreotide treatment was found to be beneficial to arrest chylous fluid leakage after neck surgery. A 68-year-old woman with neck bronchogenic cyst underwent surgical resection. After the second postoperative day (POD), a large quantity of chylous fluid was found in the drainage tube. We chose a method of intravenous hyperalimentation feeding and abstinence from food until the seventh POD, but the chylous fluid leakage did not decrease, so we started to administer octreotide. Three days later, the chylous leakage significantly decreased in quantity, and then ceased completely.
    Download PDF (621K)
  • Saori Yamamoto, Taeko Okuno, Yuko Hata, Nobuhiko Kurita, Kazumi Ichino ...
    2016 Volume 26 Issue 1 Pages 119-123
    Published: June 30, 2016
    Released on J-STAGE: July 15, 2016
    JOURNAL FREE ACCESS
    A 49-year-old woman visited our hospital because of conductive hearing loss in her left ear. It was found by chance during an examination for benign paroxysmal positional vertigo, but in fact, she had experienced hearing loss for the last 8 years. The CT scan showed no remarkable findings in her temporal bone and the appearance of the left tympanic membrane was normal. The pure tone audiogram showed a 2-kHz bone conduction threshold dip (Carhart’s notch), and the average level of air conduction at three frequencies (0.5 kHz, 1 kHz, 2 kHz) was 50.0 dB. The impedance audiometry showed a lower level of peak compliance (type As) and there was no response in the stapedial reflex. Preoperatively, we suspected otosclerosis and planned stapedotomy, but the main cause of hearing loss was found to be ankylosis of incus and stapes and incus fixation to the posterior wall. Just removing the incus fixation improved her hearing level from 50.0 dB to 21.6 dB.
    Download PDF (630K)
  • Yusuke Mada, Yuji Ueki, Akiyoshi Konno, Tomohiko Yamauchi, Syuji Yokoy ...
    2016 Volume 26 Issue 1 Pages 125-131
    Published: June 30, 2016
    Released on J-STAGE: July 15, 2016
    JOURNAL FREE ACCESS
    A 70-year-old woman had been suffering from left otorrhea since 2012. She was due to undergo surgery because her otitis media was refractory. In September 2014, she was referred to our hospital for double vision due to left abducent paralysis since several days earlier. MRI revealed hypertrophic pachymeningitis extending from the left cerebellum to the left temporal lobe, and high-resolution CT of the temporal bone revealed diffuse nonerosive debris throughout the middle ear cleft. The ossicular chain was entirely intact. As we suspected that the hypertrophic pachymeningitis was caused by refractory otitis media, we examined the histopathology of the middle ear by mastoidectomy. The pathologic diagnosis was nonspecific granuloma. She was treated with steroids as we suspected that the hypertrophic pachymeningitis was related to ANCA associated vasculitis. The abducent paralysis improved in three months.
    Download PDF (1639K)
  • Akio Hatanaka, Takeshi Beppu, Satoshi Shirakura, Masashi Okazaki, Nats ...
    2016 Volume 26 Issue 1 Pages 133-138
    Published: June 30, 2016
    Released on J-STAGE: July 15, 2016
    JOURNAL FREE ACCESS
    Surgical procedures of head and neck reconstructive surgeries are mature, and are generally thought to be performed safely. However, highly invasive surgery that widely extends over the cervicothoracic part, such as Grillo’s mediastinal tracheal surgery, has rather high fatal risks such as necrosis of trachea, major bleeding from great vessels, failure of anastomosis of the upper digestive tract, mediastinal infection, respiratory failure and so on. We describe the case of a 54-year-old male with double cancer of the hypopharynx and esophagus, which developed major hemorrhage from the brachiocephalic artery at 41 days after initial surgery. In this patient, ligation of the brachiocephalic artery was necessary for hemostasis. Nevertheless, the patient was able to be discharged without apparent cerebral complications. It was supposed that the arterial circle of Willis was sufficient for the supply of contralateral cerebral blood.
    Download PDF (1526K)
  • Sayuri Yamamoto, Koichiro Wasano, Taiji Kawasaki, Hideo Nameki
    2016 Volume 26 Issue 1 Pages 139-145
    Published: June 30, 2016
    Released on J-STAGE: July 15, 2016
    JOURNAL FREE ACCESS
    Adenocarcinomas are uncommon among sinonasal malignant tumors, which are usually squamous cell carcinomas. Intestinal-type adenocarcinomas (ITACs), which histologically resemble colorectal adenocarcinomas, are rare among sinonasal malignant tumors, with a frequency of 4%. There are very few case reports of ITACs in Japan. Although a search of the global literature revealed that the 5-year survival rate of patients with ITACs is approximately 40%, 5 of the 6 ITAC patients treated at our hospital have survived for more than 5 years; the sixth patient has been observed for only 10 post-operative months. We herein report the clinical background, histopathological findings, treatments, and prognoses of these patients in order to compare the differences between Japanese patients with ITACs and patients from other countries.
    Download PDF (1062K)
  • Akiko Ito, Muneo Nakaya, Ayumi Mori, Sayaka Omura, Wataru Kida, Yasuhi ...
    2016 Volume 26 Issue 1 Pages 147-151
    Published: June 30, 2016
    Released on J-STAGE: July 15, 2016
    JOURNAL FREE ACCESS
    We performed total thyroidectomy during pregnancy for two cases of pregnant patients with Basedow’s disease. Case 1 was a 30-year-old female. She had a history of side effects of propylthiouracil. She was referred to our hospital at 24 week’s gestation. As the combined therapy of thiamazole and inactive iodine could not control hyperthyroidism, we performed total thyroidectomy at 32 week’s gestation. Case 2 was a 32-year-old female who was diagnosed with Basedow’s disease at 27 week’s gestation. She started to take thiamazole but the treatment was discontinued because of the onset of agranulocytosis, and we performed total thyroidectomy at 35 week’s gestation. Both cases led to safe delivery after the operations. Indications for surgical therapy for pregnant patients with Basedow’s disease are cases with onset of severe adverse reactions with anti-thyroid drugs, and cases in whom it is difficult to control hyperthyroidism with anti-thyroid drugs. There are some risks such as urgent Cesarean section which cannot be treated just by otolaryngologists, so it is very important to closely cooperate with not only endocrine physicians but also obstetricians, anesthesiologists and pediatricians during the perioperative period.
    Download PDF (928K)
  • Wataru Okano, Takeshi Beppu, Atumori Hamahata, Satoshi Shirakura, Akio ...
    2016 Volume 26 Issue 1 Pages 153-158
    Published: June 30, 2016
    Released on J-STAGE: July 15, 2016
    JOURNAL FREE ACCESS
    In cases of thyroid cancer with tracheal invasion, laryngeal preservation and tracheal reconstruction after tracheal resection are crucial. The reliable preservation of the contralateral laryngeal recurrent nerve is important for laryngeal preservation. There have been reports of tracheal reconstruction with end-to-end anastomosis or two-stage reconstruction; however, tracheal reconstruction and resection at the same time has not been reported.
    We present a case of thyroid carcinoma with tracheal invasion in which tracheal resection and reconstruction were performed at the same time. This approach enabled safe and secure reconstruction of the trachea.
    We also reconsider the treatments for thyroid carcinoma with tracheal infiltration and report on the effectiveness of the above treatment.
    Download PDF (1496K)
feedback
Top