JOURNAL OF JAPAN SOCIETY FOR HEAD AND NECK SURGERY
Online ISSN : 1884-474X
Print ISSN : 1349-581X
ISSN-L : 1349-581X
Volume 27, Issue 2
Displaying 1-20 of 20 articles from this issue
  • Noriko Hamaguchi, Hajime Ishinaga, Satoshi Nakamura, Kazuhiko Takeuchi
    2017 Volume 27 Issue 2 Pages 173-178
    Published: October 30, 2017
    Released on J-STAGE: November 22, 2017
    JOURNAL FREE ACCESS
    Chemoradiotherapy is the main treatment modality for nasopharyngeal carcinoma because it is anatomically difficult to perform surgical therapy. In this study, we retrospectively reviewed 28 cases with nasopharyngeal carcinoma (NPC) who were treated with chemoradiotherapy (alternating chemoradiotherapy or concurrent chemoradiotherapy) in our department between 2001 and 2015.
    Therapeutic effect, outcome-survival rate, treatment completion rate, adverse effects, and prognostic factors were evaluated. The five-year overall survival rate was 62% and the cause-specific five-year survival rate was 73% for the alternating chemoradiotherapy group. No independent prognostic factors for the treatment of nasopharyngeal carcinoma were identified in our study.
    We concluded that alternating chemoradiotherapy is a useful treatment for nasopharyngeal carcinoma because of its good therapeutic effects.
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  • Takafumi Togashi, Genki Iwai, Tatsuya Yamagishi, Shigehisa Hashimoto, ...
    2017 Volume 27 Issue 2 Pages 179-185
    Published: October 30, 2017
    Released on J-STAGE: November 22, 2017
    JOURNAL FREE ACCESS
    Cervical necrotizing fasciitis is characterized by rapidly progressing necrosis of the superficial layer of the cervical fascia, the loose connective tissue in the neck. We describe a case of cervical necrotizing fasciitis in a 50-year-old man with an initial diagnosis of bilateral peritonsillar abscess and upper neck cellulitis. After treatment with antibiotics he developed Lemierre Syndrome, for which he underwent surgical treatment on the fifth day of illness. Necrotizing fasciitis was diagnosed intraoperatively, and debridement and tracheotomy were performed. A total of four operations were performed, accompanied by negative-pressure wound therapy. To restore swallowing and neck movement, rehabilitation was begun soon after the first procedure. Early diagnosis of necrotizing fasciitis requires physician awareness of the possibility of this condition and careful assessment of tissues with potential necrosis. To reduce the risks of postoperative sequelae, such as swallowing disorders and limitations in neck mobility, postoperative rehabilitation should be begun before development of scar tissue or contracture.
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  • Tomohito Fuke, Hiroyuki Yamada, Kohei Fukukita, Mamika Kaneko, Masahir ...
    2017 Volume 27 Issue 2 Pages 187-191
    Published: October 30, 2017
    Released on J-STAGE: November 22, 2017
    JOURNAL FREE ACCESS
    Immediate recurrent laryngeal nerve reconstruction can maintain vocal function in cases of papillary thyroid carcinoma with invasion of the recurrent laryngeal nerve. In our hospital, there have been 44 cases with invasion of the recurrent laryngeal nerve where the nerve was reconstructed immediately. Here we report the post-operation voice results and prognosis of immediate nerve reconstruction.
    Recurrence and metastasis occurred post-operation in 14 of 44 cases. The average and best maximum phonation time (MPT) was approximately 12.04 seconds and 25.0 seconds respectively. The group with invasion of the recurrent laryngeal nerve alone experienced fewer instances of recurrence and metastasis than the group with invasion of both the recurrent laryngeal nerve and plural organs. The group with existing nerve paresis before surgery experienced fewer instances of recurrence and metastasis than the group without existing nerve paresis.
    Papillary thyroid cancer with invasion of the recurrent laryngeal nerve is treated as stage T4a according to the UICC TNM classification. However, the prognosis of cases with invasion of the recurrent laryngeal nerve is predicted to be better than with additional invasion of other organs. Both radical treatment and preservation of vocal function are required in the treatment of papillary thyroid carcinoma with invasion of the recurrent laryngeal nerve.
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  • Noriko Hamaguchi, Hajime Ishinaga, Kazuki Chiyonobu, Satoshi Nakamura, ...
    2017 Volume 27 Issue 2 Pages 193-198
    Published: October 30, 2017
    Released on J-STAGE: November 22, 2017
    JOURNAL FREE ACCESS
    Pneumatosis intestinalis is a rare condition characterized by the presence of gas within the wall of the gastrointestinal tract, and can be life threatening in some cases. The patient was a 72-year-old male who visited our clinic with a chief complaint of left cheek pain. He was diagnosed as left maxillary carcinoma and we performed surgical therapy. On the eleventh postoperative day, he developed diarrhea, acute renal failure and a marked inflammatory response. Abdominal CT revealed pneumatosis intestinalis and hepatic portal venous gas, so conservative treatment was started. The treatment was successful and he became capable of oral ingestion 12 days after the initiation of treatment. The symptoms did not recur afterwards and he left our hospital 48 days after the operation. Although the prevalence of postoperative pneumatosis intestinalis is not high, it should be considered as a possible complication.
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  • Naoto Araki, Yutaka Suzuki, Daisuke Noda, Masashi Okazaki, Hirooki Mat ...
    2017 Volume 27 Issue 2 Pages 199-203
    Published: October 30, 2017
    Released on J-STAGE: November 22, 2017
    JOURNAL FREE ACCESS
    Spindle cell carcinoma is a highly malignant cancer that is mainly composed of sarcomatous spindle cells. It is classified as a subtype of squamous cell carcinoma. The occurrence of spindle cell carcinoma in the hypopharynx is rare.
    The patient was a 76-year-old man who visited our hospital complaining of discomfort in the throat. A pedunculated massive tumor originating in the posterior wall of the hypopharynx was observed by laryngoscopic examination. An endoscopic biopsy led to the diagnosis of angio sarcoma. A total laryngopharyngectomy, bilateral neck dissection, and reconstruction of the cervical esophagus using free jejunum transfer were performed. The pathological report for the surgical specimen was spindle cell carcinoma. The patient has had no recurrent tumor or metastases during the one year since the operation.
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  • Ken Iwanaga, Katsura Hakamada, Katsuyoshi Suzuki, Hiroyuki Arai
    2017 Volume 27 Issue 2 Pages 205-210
    Published: October 30, 2017
    Released on J-STAGE: November 22, 2017
    JOURNAL FREE ACCESS
    We report a rare case of a foreign substance in the nasal cavity, caused by an accident in which molten aluminum entered the nasal cavity and cooled to form a mass like a mold, which became difficult to remove.
    The patient was a 42 year-old man with a first episode of burn by molten aluminum. He received initial treatment for burn injury, during which we found foreign bodies in the nasal and oral cavity, and an object like a mold present in the nasal cavity by computed tomographic scan. We surgically removed the foreign bodies in the nasal cavity 20 days after the injury.
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  • Toshikazu Shimane, Kenichiro Ikeda, Yukiomi Kushihashi, Shunya Egawa, ...
    2017 Volume 27 Issue 2 Pages 211-215
    Published: October 30, 2017
    Released on J-STAGE: November 22, 2017
    JOURNAL FREE ACCESS
    Various efforts have been made to avoid post-surgical neurological deficits in the resection of cervical schwannoma. We have experienced many cases, but regarding sympathetic nerve-derived tumors, we sometimes have difficulties in identifying the nerve pathways on the epineurium even when using a nerve stimulator. This time, we investigated whether narrow band imaging (NBI) could help surgeons to identify the nerve pathways on tumors, to determine incision sites on the epineurium, and to recognize tumor capsules on the epineurium.
    As a result, NBI clearly delineated fibrous tissue, and so was effective in determining incision sites and in identifying tumor capsules on the epineurium. It was effective not only in schwannomas of the sympathetic nerve to which a nerve stimulator is not applicable, but also schwannomas to which a nerve stimulator is applicable. NBI appears to be helpful in detecting tumor capsules to determine a dissection margin for even less experienced surgeons and reducing the incidence of neurological deficits.
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  • Koji Ebisumoto, Kenji Okami, Daisuke Maki
    2017 Volume 27 Issue 2 Pages 217-221
    Published: October 30, 2017
    Released on J-STAGE: November 22, 2017
    JOURNAL FREE ACCESS
    The operation field of transoral videolaryngoscopic surgery (TOVS) is restricted. Several surgical instruments such as grasping forceps or endoscope interfere with each other, disturbing the operation; the use of new surgical devices might improve operability. Here, we describe the clinical application of new grasping forceps and malleable bipolar for TOVS.
    The new grasping forceps have satisfactory gripping force with fine tip and shaft, and so are comfortable to use. The malleable bipolar can be curved, and can reach and cauterize the blood point precisely. Both surgical instruments are useful for making the surgical environment more comfortable.
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  • Isaku Okamoto, Kiyoaki Tsukahara, Hiroki Sato, Rei Motohashi, Takahito ...
    2017 Volume 27 Issue 2 Pages 223-229
    Published: October 30, 2017
    Released on J-STAGE: November 22, 2017
    JOURNAL FREE ACCESS
    Among surgical procedures for head and neck cancer, neck dissection is one of the most important. However, there have been no clear indicators of how to conduct training on neck dissection in head and neck cancer surgery safely and efficiently and there are differences among institutions.
    At our hospital, we conduct surgical training on cadavers and in an animal laboratory for initial and late-stage interns and junior doctors who have had sufficient dry lab training.
    However, there have been no studies on animal laboratory training for head and neck surgery. In the present study, we examined self-evaluations of proficiency level by trainees themselves as well as evaluations by the supervising doctor before and after animal laboratory training conducted in the past. By doing this, we studied the effectiveness of animal laboratory training in head and neck surgery, and found that it was significantly effective in improving technique. This suggested that improvement of surgical technique was very useful from the viewpoint of ensuring medical safety.
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  • Naohiro Takeshita, Toshihito Suda, Yukio Nishiya, Hisashi Kessoku, Tak ...
    2017 Volume 27 Issue 2 Pages 231-234
    Published: October 30, 2017
    Released on J-STAGE: November 22, 2017
    JOURNAL FREE ACCESS
    Pyriform sinus fistula (PSF) is a congenital fistula which occurs mostly on the left side, and the diagnosis is made on the basis of infection, etc. We identified a fistula using an ATOM tube®-guided curved laryngoscope blade, and performed surgical removal.
    A 27-year-old female, who suffered from swelling of the left side of the neck, had undergone multiple repeated incision and drainage since childhood. She was diagnosed with PSF after a computed tomography imaging exam of the hypopharynx and esophagus with contrast material, and we surgically removed the fistula and performed partial thyroidectomy (the left lobe of the thyroid gland) under general anesthesia. A curved laryngoscope blade was placed in the epiglottis located at the base of the tongue, and a 4Fr ATOM tube® was inserted to inject gentian violet. Afterwards, an external cervical incision was made. The fistula stained with gentian violet on the back side of the upper pole of the thyroid gland was clearly identified. A fistulectomy and partial thyroidectomy were successfully performed. More than half a year has passed since the surgery, with no recurrence to date.
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  • comparison with ATA guidelines
    Hiroyuki Hanakawa, Nobuya Monden, Kaori Hashimoto, Aiko Oka
    2017 Volume 27 Issue 2 Pages 235-239
    Published: October 30, 2017
    Released on J-STAGE: November 22, 2017
    JOURNAL FREE ACCESS
    The American Thyroid Association (ATA) guidelines were revised in 2015. We compared the new ATA guidelines with the treatment of medullary thyroid carcinoma (MTC) in our hospital.
    Five cases (2 males and 3 females) of MTC between 2000 and 2016 were included in this study, and the average age was 49.0 years. MTC was suspected in 3 cases by preoperative cytology. Genetic examination was performed in 4 cases (1 pre-operation, 3 post-operation). There were 3 sporadic cases and 1 case of MEN 2 A. One case refused genetic examination.
    In the case of MTC, total thyroidectomy is recommended in the ATA guidelines. On the other hand, for sporadic cases found to be MTC after surgery, total thyroidectomy is not necessarily recommended. In our hospital, 2 patients underwent hemithyroidectomy: both were sporadic, and no additional treatment was done.
    In conclusion, genetic examination is extremely important for MTC therapy, so we will conduct genetic examinations of all MTC patients in the future. In accordance with the ATA guidelines, our hospital is planning to perform total thyroidectomy as the basic treatment. Depending on cases such as elderly sporadic cases, hemithyroidectomy is also considered.
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  • Kazuki Chiyonobu, Kazuya Otsu, Hajime Ishinaga, Kazuhiko Takeuchi
    2017 Volume 27 Issue 2 Pages 241-246
    Published: October 30, 2017
    Released on J-STAGE: November 22, 2017
    JOURNAL FREE ACCESS
    A 61-year-old male presented with a sudden onset of dyspnea and pharyngeal hemorrhage. He had been on hemodialysis for the past six years for chronic renal failure with secondary hyperparathyroidism. Since the airway was very narrow, we performed emergency tracheostomy. CT scan suggested hemorrhage from the parathyroid gland. Since conservative therapy did not resolve the hematoma in the retropharyngeal space, surgical drainage was performed as well as extirpation of the hypertrophic lower left parathyroid gland. Pathological examination revealed hyperplasia of the parathyroid gland. The patient had been receiving cinacalcet for his secondary hyperparathyroidism, which might have caused bleeding from the parathyroid gland. In the subsequent course, a metastatic lesion appeared in the left testis and lung and the primary lesion was proved to be a parathyroid cancer.
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  • Masahiro Kishikawa, Kazuchika Ohno, Yui Suematsu, Ryuhei Okada, Takahi ...
    2017 Volume 27 Issue 2 Pages 247-252
    Published: October 30, 2017
    Released on J-STAGE: November 22, 2017
    JOURNAL FREE ACCESS
    Oncocytoma is a relatively rare benign tumor composed of epithelial cells and arises in several parts of the body, for example, salivary glands, kidney, thyroid, and so on. We herein report two cases of oncocytoma arising from parotid glands which were diagnosed by postoperative histological examination
    In general, it is difficult to make a preoperative differential diagnosis between oncocytomas and other salivary gland tumors, especially Warthin tumors. We should be careful to make a correct diagnosis, as fine-needle aspiration cytology may lead to misdiagnosis. No evidence of recurrence has been observed in either case so far. However, we consider that surgical resection requires care and postoperative observation is necessary because there are some reports of cases showing recurrence and malignant transformation.
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