[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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The purposes of rehabilitation after neck dissection are to maintain the range of motion of the shoulder and prevent muscular pain and arthralgia in it. It is important that shoulder exercise to improve the range of motion is initiated soon after neck dissection and it is initially performed in a supine position to reduce the weight of the arm. It is also important not to produce muscular pain and arthralgia due to overexercise. Even in functional neck dissection, which has often been performed recently, this rehabilitation is necessary because of the high incidence of surgical damage to the accessory nerve. In neck dissection in which the accessory nerve has been removed surgically, a good range of motion of the shoulder without associated difficulties in daily life can be achieved by rehabilitation.

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We retrospectively analyzed 17 patients with primary major salivary gland carcinoma who underwent initial surgical treatment at our institution from 2006 to 2015. The study group comprised 11 males and 6 females with a median age of 51 years (range, 19-88y). There were 12 cases in the parotid gland, 4 in the submandibular gland and 1 in the sublingual gland. According to the TNM classification of UICC 2005, three patients were classified as Stage I, 6 as II, 4 as III, and 4 as IV. Median follow-up was 28 months (range, 11-114m). The 5-year disease-specific survival rate was 85.1%, and the 5-year disease-free survival was 77.4% in all patients. Three patients relapsed. The site of relapse was distant metastatic site alone in 2 and primary site with distant metastatic site in 1. Univariate analysis indicated that clinical T status, presence of lymph node metastasis and clinical stage had a significant impact on disease-free survival.
We conclude that patients with poor prognostic factors should receive adequate resection and adjuvant therapy to improve therapeutic outcomes.

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Patients with systemic diseases who need thyroid operations are often introduced to general hospitals because thyroid-specific private hospitals in Japan do not provide medical treatment for complicated systemic diseases. We retrospectively investigated the perioperative care, postoperative complications and prognosis of patients introduced to our institute for thyroid operation from these thyroid-specific private hospitals.
From 2006 to 2015, we performed 34 thyroid operations on patients introduced from thyroid-specific private hospitals because of complicated systemic diseases. The patients were aged 35-86 (median: 72 years old), consisting of 9 males and 25 females with 25 papillary carcinomas, 3 poorly differentiated carcinomas, 1 medullary carcinoma and 3 adenomatous goiters. The most frequent systemic disease was cardiovascular (11 cases), followed by diabetes mellitus (6 cases), cerebrovascular (5 cases), renal failure needing hemodialysis (4 cases), bronchopulmonary (3 cases) and others. Anesthesiologists categorized 12 patients (35%) with ASA-PS (The American Society of Anesthesiologists – Physical Status) 3, 22 patients with ASA-PS 2 and one with ASA-PS 1. Four out of 5 patients treated with anticoagulants needed preoperative heparinization. Three out of 8 patients treated with antiplatelet agents preoperatively received the operation under antiplatelet administration. Twenty-one patients (62%) were discharged within 9 postoperative days as scheduled while 3 patients stayed at hospital for more than 30 days because of postoperative comorbidities. A patient with Parkinson’s disease, cognitive problems and diabetes mellitus died in hospital without discharge at postoperative day 93 because of aspiration pneumonia.
The overall 5-year survival rate of the patients was 73% and the disease-specific survival rate was 88%.
We concluded that the operation should be planned according to the patient’s systemic status because we experienced some patients who suffered from delayed wound healing or severe comorbidities caused by their systemic status.

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We reviewed 103 cases of laryngeal cancer in Japanese Red Cross Ashikaga Hospital from 2005 to 2015. Ninety-six cases were male and 7 were female. Two of the females (28.6%) had a history of smoking and the other 5 were nonsmokers, although 3 of them were exposed to second-hand smoking at home. As a result, 5 people (71.4%) had a risk of smoking and second-hand smoking in case they had both of them. In Japan, there have been few reports of the association between second-hand smoking and laryngeal cancer. Based on our finding, second-hand smoking is a potential risk factor for laryngeal cancer.

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Transoral surgery assisted by endoscope for locally superficial and early-stage cancers of the head and neck area has been performed. Endoscopic Laryngo-pharyngeal Surgery (ELPS) and Transoral Videolaryngoscopic Surgery (TOVS) have been reported to be safe and useful. We developed a new method called End-flexible-rigidscopic Transoral Surgery (E-TOS) at the Department of Otolaryngology, Head and Neck Surgery, Kyoto Medical Center, and have reported its benefits. The key characteristic is that this surgical procedure uses a flexible-tip rigid endoscope, so we can get a wide working space and choose various types of laryngoscope depending on the tumor location. The author started working at the Department of Otolaryngology, Head and Neck Surgery, Osaka Red Cross Hospital. We report the results of our treatment of 48 oropharyngeal, hypopharyngeal and supraglottic laryngeal cases who underwent E-TOS at our department from July 2013 to March 2016.

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We report two cases of carotid blowout syndrome. The first case, a 38-year-old man, suffered from common carotid artery rupture due to postoperative infection after thyroid surgery, and visited our emergency room. The site of rupture was identified under angiography, and was occluded with a balloon catheter. Then, carotid ligation was performed and the surgical site was covered with a deltopectoral skin flap. The second case, a 55-year-old woman, had undergone neck dissection and Co⁶⁰ irradiation for oral tongue cancer 30 years before. Subsequently, she developed a cervical fistula, and suffered a hemorrhage from the fistula. Pseudoaneurysm of the external carotid artery was found by CT, so we tried to perform coil embolization, but could not control the bleeding. Thereafter, we confirmed necrosis around the carotid bifurcation, ligated the common carotid artery, and covered the surgical site with a pectoralis major myocutaneous flap. The triggers of both ruptures were inflammation, and, fortunately, ligating the carotid artery enabled both cases to survive without cerebrovascular disorder.

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Twenty-seven patients who underwent surgery for well-differentiated thyroid carcinoma with laryngotracheal invasion from January 2000 to May 2015 were included in this study. The 10-year overall survival rate and disease-specific survival rate were 70% and 83%, respectively. Trachea, thyroid cartilage and cricoid cartilage were resected in 25, 5 and 7 patients, respectively. Eleven patients had recurrence: no patients had local recurrence, 5 patients had regional recurrence, and 6 patients had distant recurrence. Eleven of 22 patients without post-operative radioactive iodine had recurrence, whereas none of 4 patients with post-operative radioactive iodine had recurrence.
In the treatment of well-differentiated thyroid cancer with laryngotracheal invasion, appropriate selection of surgical procedure and post-operative treatment are important to improve prognosis.

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The aim of this study was retrospectively to evaluate oncologic rates and risk factors for local recurrence in patients undergoing vertical partial laryngectomy for squamous cell carcinoma of the larynx. In total, 21 patients, who underwent vertical partial laryngectomy at Hyogo Cancer Center from 2005 to 2014, were included. Three patients presented local recurrence. The 3-year overall survival rate and local control rate were 68% and 83%, respectively. Subglottic extension (p=0.0087) was a significant risk factor for local recurrence. Salvage treatment (p=0.12), subsite (p=0.31), paraglottic invasion (p=0.026) and previous radiotherapy for the neck (p=0.48) were not significant. Subglottic extension was significantly related to local recurrence in patients undergoing vertical partial laryngectomy.

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A retrospective study was conducted to evaluate the clinical outcomes of 17 patients with T3 glottic squamous cell carcinoma in our hospital between January 2000 and December 2011. The 3- and 5-year overall survival rates were 76% and 63%. The 3- and 5-year cause-specific survival rates were 87% and 78%. Larynx preservation rates were both 29%. None of the larynx preservation cases had invasion of thyroid cartilage at the time of pre-treatment. It may be possible to preserve the larynx in cases without invasion of thyroid cartilage.

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Functional preservation of the marginal mandibular branch of the facial nerve is crucial in head and neck surgeries. It is important not only for the postoperative QOL of the operated patients, but also for improving the surgical skills of the surgeons. Appropriate evaluation of postoperative facial paralysis is necessary for utilizing feedback information. In this study, we retrospectively analyzed the postoperative status of marginal mandibular branch function.
Patients with non-malignant disease who underwent parotidectomy were selected. One hundred consecutive patients who were operated from 2013 were included. None had preoperative facial paralysis. Mean and standard deviation of age were 54.8 and 16.4. Fifty males and 50 females were included. Postoperative mobility of the lip was evaluated in depressing and everting the lip. In addition, the function of the mentalis muscle was scored by inspection and palpation; no paralysis as score 0, complete paralysis as score 2, and incomplete paralysis as score 1. This was assessed at day 2, 1 month, 2 months and 3 months after surgery.
Asymmetric depressing of the lip occurred in 36 of the 100 patients. In these, the number of patients with each score (0 to 2) of the mentalis muscle paralysis was 22, 9, and 5, respectively. Residual rates of asymmetric depressing in patients with score 0 were 31.8% in 1 month, 22.7% in 2 months, 4.5% in 3 months after surgery. Those incidences were 77.7%, 55.5%, 55.5% in patients with score 1. There were no patients with score 2 whose asymmetric depressing of the lip was cured within 3 months after surgery.
Prognosis of asymmetrical depressing of the lip could be predicted by assessing contraction of the mentalis muscle in protrusion of the lip after surgery, which might indicate the postoperative condition of the marginal mandibular branch of the facial nerve.

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A retrospective review was performed on 123 patients with parotid tumor who underwent surgery at our hospital between 2010 and 2014. The age range of the subjects (75 men and 48 women) was 18–82 years (average: 54.3). Of the 123 cases, 105 were benign and 18 were malignant. The results of preoperative computed tomography (CT), magnetic resonance imaging (MRI), fine-needle aspiration cytology (FNA), and intraoperative frozen-section (FS) were compared with the final histopathologic diagnosis. The sensitivity and specificity for detecting malignant tumors were 53.8% (10/17) and 92.4% (61/66) on CT, 58.8% (10/17) and 94.9% (94/99) on MRI, 30.8% (4/13) and 100% (81/81) on FNA, and 75.0% (12/16) and 96.9% (95/98) on FS, respectively. Our analysis showed a superiority of FS over other examinations; however, there were 4 false negative and 3 false positive cases. In those cases, we needed to determine the extent of surgery after considering preoperative surveys and intraoperative findings of the tumor.

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Sinonasal inverted papilloma (IP) is a rare benign tumor of the nasal cavity and paranasal sinuses. An IP can be destructive: bone-remodeling tends to recur after surgical resection and it has a significant malignant potential. IP is also associated with squamous cell carcinoma (SCC). However, it is difficult to diagnose an associated malignancy before treatment as the pathological findings are different depending on the sampling site. We retrospectively reviewed 3 patients with SCC arising from IP to analyze predictors of associated malignancy. The chief complaints of two cases included diplopia, headache, trismus and facial nerve palsy. Although these symptoms are suspected for a malignant process, the main complaint of the third case was lateral nasal obstruction alone. Thus, clinical symptoms cannot rule out coexisting malignancy in IP. All three cases had bone destruction on CT. Malignant tumors were diagnosed by biopsy from the bone destruction sites. The characteristic finding on CT, namely bone destruction, which was classified as T4 on the Krouse staging system, was useful to detect the associated malignancy. A convoluted cerebriform pattern (CCP) on MRI is regularly seen in IP. IP with SCC has been reported to show areas of focal loss of a CCP (partial CCP). All of our cases lacked such CCP findings on MRI. Partial CCP or loss of CCP could indicate an associated malignancy in IP. These characteristic findings on CT and MRI can be useful to predict an associated malignancy in IP, and to decide the treatment plan before intervention.

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Tracheoesophageal speech is the most fluent voice rehabilitation with long maximum phonation time for laryngectomized patients. Some patients, however, cannot achieve optimal outcomes. We report one case who was diagnosed with hypertonicity of the cricopharyngeal muscle preventing the development of tracheoesophageal speech and who was treated by surgical methods. Head and neck surgeons have an important role to play in enabling alaryngeal persons to regain optimal oral communications.

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Chondrosarcoma of the larynx is a relatively rare disease, accounting for less than 1％ of laryngeal malignant tumors. Among this malignancy, low-grade chondrosarcoma is the most common and grows slowly. The standard treatment for chondrosarcoma is surgical resection. Here, we report a case of chondrosarcoma arising from the cricoid cartilage and review the literature.
A 77-year-old man consulted our department with hoarseness. CT and MRI scans showed a well-circumscribed tumor arising from the left side of the cricoid cartilage without lymph node metastasis. Open biopsy revealed low-grade chondrosarcoma. We resected the tumor with laryngeal preservation via the lateral side of the thyroid cartilage. One year after the surgery, no evidence of recurrence or aspiration has been observed.

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We present a patient with a malignant lesion diagnosed as carcinoma ex pleomorphic adenoma of the parotid gland detected by advanced MRI techniques such as diffusion-weighted MR imaging （DWI） and apparent diffusion coefficient （ADC）. A 64-year-old male was referred to our hospital due to a gradual growing left parotid tumor originally discovered 20 years earlier. MRI imaging detected a left parotid tumor 4 cm in the longer axis and 3 cm in the shorter axis. On two occasions, fine needle aspiration cytology and an echo-guided core needle biopsy indicated the possibility of a carcinoma. Total parotidectomy with facial nerve reconstruction was performed. Histological findings confirmed the presence of a carcinoma as well as hyaline degeneration. The tumor was finally diagnosed as a carcinoma ex pleomorphic adenoma by histological examination and gradual growth of the tumor. Advanced MRI techniques revealed low ADC and high DWI only in the regions of the carcinoma.

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Multiple symmetric lipomatosis （MSL） is a benign nontumorigenic disease characterized by multiple and symmetrical unencapsulated adipose tissue deposits on the neck, shoulders, and upper extremities. It is comparatively common in the Mediterranean region, but is very rare in Japan. We report a case of MSL in a 63-year-old Japanese male who was referred to our hospital because of bilateral swelling of the upper cervical region. The swelling gradually increased for 4 years until he was unable to fasten his shirt. For cosmetic reasons, adipose tissues from the submental to submandibular regions were excised using the neck dissection technique. Subcutaneous fat lying superficial to the platysma muscle was also reduced using scissors. Six months later, the patient showed good cosmetic results, with no recurrence of cervical lipomatosis on magnetic resonance imaging scans.

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Removal of foreign bodies in the parapharyngeal space from penetrating oral trauma in infants is troublesome due to the difficulty of diagnosis. We herein report the case of a foreign body, namely the tip of a chopstick, which was removed by endoscopic surgery using the navigation system in an infant patient. A 2-year-old boy suspected of foreign body ingestion, namely the tip of a chopstick, was brought to our hospital. There were superficial lacerations to the palate and the right posterior wall of the epipharynx. Enhanced computer tomography （CT） showed a small air shadow in the right parapharyngeal space close to the cervical vertebra. We tried to remove the foreign body endoscopically under general anesthesia, but could not find it after six hours of searching. Subsequent CT revealed an increase in Hounsfield units （HU） of a small region in the parapharyngeal space 24 days after the first operation. We again tried to remove the tip endoscopically, this time using the navigation system. The tip, measuring 13mm, was removed successfully in 32 minutes without bleeding or any subsequent complications. A change of HU in CT findings tipped us off as to the location of the wooden foreign body. Endoscopic surgery using the navigation system is a useful tool to detect and remove small parapharyngeal foreign bodies in pediatric patients.

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We report a case of lymph node swelling caused by dental filler used for root canal treatment. The patient was a 44-year-old woman, who presented with the chief complaint of repeated swelling of the mandibular lymph nodes. On cytological examination, the lymph nodes were identified as class 3, and the possibility of a malignant lymphoma could not be definitively eliminated. She had undergone root canal therapy twice in the right lower front molar teeth, the most recent of which had been performed 4 years before her visit to our hospital. Because panoramic tomographic radiography revealed periapical cyst formation at the teeth, we considered that the lymph node swelling was because of inflammation. After extraction of the teeth, the size of the lymph node slightly decreased but repeated aggravation and relief continued. We performed submandibular glandectomy and lymph node biopsy for diagnosis. Pathological analysis of the samples showed normal submandibular glands and macrophage phagocytosis of a black particle suspected as being root canal filler. To our knowledge, this report is the first to show lymph node swelling caused by root canal filler, which is considered safe for use in humans.

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Angiosarcomas are malignant tumors originating from the vascular endothelial cells. Comprising only 2％ of soft tissue sarcomas, primary angiosarcomas of the oral cavity are extremely rare.
A 68-year-old woman presented with massive bleeding from necrotizing tumor of the left maxillary gingiva and was brought by ambulance due to hemorrhagic shock to our hospital. Upon arrival, we tried to stop the bleeding from the tumor with local hemostatics after tracheostomy. However, as it was not enough, we ligated the external carotid artery and could stop the bleeding. A week later, she had bleeding from the tumor again. As it was difficult to control, we performed an emergency infrastructure maxillectomy. The resected tumor was diagnosed as angiosarcoma of maxillary gingiva and adjuvant radiation therapy was performed. One year has passed since the initial treatment and she survives with no recurrence.

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Intestinal-type adenocarcinoma is a rare malignant tumor of the nasal cavity and paranasal sinus. We describe a case of intestinal-type adenocarcinoma of the ethmoid sinus in a 58-year-old man. He had no history of wood dust inhalation. CT and MRI demonstrated a mass that extended from the ethmoid sinus to the anterior skull base. First, we performed induction chemotherapy using cisplatin （CDDP）, 5-FU and leucovorin （LV）. After that, we performed anterior craniofacial resection of the tumor, and postoperative radiotherapy.
The patient survives without recurrence 6 months after the operation.

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We herein report a case of laryngocele with laryngeal edema caused by cystic infection. A 69-year-old female complained of a sore throat, spitting, and swelling of the left side of the neck. Endoscopy revealed airway narrowing due to swelling and edema of the larynx. A diagnosis of laryngocele with infection was made, because CT examination showed a cystic lesion with liquid surface in the neck from the larynx. The infection of laryngocele was relieved by treatment with antibiotics as well as puncture and drainage of the cyst from the cervical outside. We removed it surgically by an external neck approach approximately two months after initial treatment. The laryngeal edema was observed temporarily postoperatively, but it was cured by conservative treatment. Tracheotomy was not required throughout the course of treatment.

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When a head and neck tumor invades the upper lateral mediastinum, partial sternotomy （e.g., L shape） is not sufficient to gain a good surgical view, while removal of part of the bony thorax causes cosmetic and functional problems. The Grunenwald approach, in which bones around the sternoclavicle joint are temporary mobilized and replaced back to the physiological position following required surgery, appears to be an excellent method that can address these issues. However, there are only a few reports about the application of this approach to head and neck tumor. We recently used this technique to remove two head and neck tumors, which required handling of the venus angle and the subclavian and innominate veins, and favorable results were obtained. We here describe the advantages of this method mainly focusing on the comparison of the surgical views obtained by sternotomy or removal of the bony thorax.

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