JOURNAL OF JAPAN SOCIETY FOR HEAD AND NECK SURGERY
Online ISSN : 1884-474X
Print ISSN : 1349-581X
ISSN-L : 1349-581X
Volume 29, Issue 3
Displaying 1-20 of 20 articles from this issue
  • Ryo Kawata, Tetsuya Terada, Masaaki Higashino, Shuji Nishikawa, Tsuyos ...
    2020 Volume 29 Issue 3 Pages 251-257
    Published: 2020
    Released on J-STAGE: March 31, 2020
    JOURNAL FREE ACCESS
    There is no consensus about the indications and range of neck dissection for parotid cancer. In particular, elective neck dissection (END) for clinically N0 cases is still controversial. Fifty-one among 194 patients had lymph node metastasis, including 6.9%, 12.0%, 35.7%, and 53.7% of patients with T1, T2, T3, and T4 disease, respectively. As to histological grade, 6.4% of patients with low/intermediate-grade versus 52.4% of patients with high-grade had lymph node metastasis. We have performed END for clinically N0 patients, and occult metastasis was found in 9 out of 79. The most common site of metastasis was level Ⅱ, followed by the periparotid nodes and levelⅢ. The disease-specific 5-year survival rate for the N classification was 88.1%, 75.0%, and 32.9% in patients with N0, N1, and N2 disease, respectively. END may be most appropriate for high-grade parotid carcinoma with an advanced T classification. Because preoperative grade evaluation has limited reliability, it is important to decide the indications and range of neck dissection from the results of frozen section biopsy.
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  • Naoki Otsuki, Hikari Shimoda, Tatsuya Furukaw, Hirotaka Shinomiya, Mas ...
    2020 Volume 29 Issue 3 Pages 259-265
    Published: 2020
    Released on J-STAGE: March 31, 2020
    JOURNAL FREE ACCESS
     Postoperative hypoparathyroidism (HPT) is one of the most common complications following total thyroidectomy. Parathyroid glands (PTGs) are at risk of being damaged during total thyroidectomy with or without central neck dissection (CND) mainly due to inadvertent removal, interruption of the blood supply or hematoma formation. Careful preservation of the PTGs in situ is recommended, but not always possible in practice, and the functional results have been unpredictable.  We retrospectively evaluated the efficacy of our surgical procedure to preserve parathyroid function and clarified the risk factors of HPT after total thyroidectomy for thyroid cancer. One hundred five patients undergoing total thyroidectomy with CND for thyroid cancer were retrospectively assessed. Postoperative transient HPT and permanent HPT were observed in 46 (44%) patients and in 19 (18%) patients, respectively. Among 60 patients in whom PTGs were preserved in situ, transient HPT and permanent HPT were observed in 20 (33%) patients and in 5 (8%) patients, respectively. Among 45 patients in whom PTGs were not preserved in situ, postoperative permanent HPT was observed in 6 patients without PTG autotransplantation, and 8 (35%) out of the 23 patients who had one PTG autotransplantation. On the other hand, none of the 12 patients who had two or more PTG autotransplantations at the time of thyroidectomy developed permanent HPT (p=0.01). The patients with large tumor (>40mm) and/or gross extra glandular invasion, upper mediastinal dissection had a significantly higher risk of permanent postoperative HPT compared with the patients without these pathological features (p<0.01). Two or more PTGs should be autotransplanted in cases where PTG is not preserved in situ to prevent postoperative HPT after total thyroidectomy with CND, especially in cases of large tumor and/or gross extrathyroidal extension.
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  • Masaki Kawabata, Keiichi Miyashita, Yuichi Kurono
    2020 Volume 29 Issue 3 Pages 267-272
    Published: 2020
    Released on J-STAGE: March 31, 2020
    JOURNAL FREE ACCESS
     We treated 20 patients with acute sinusitis or paranasal cysts accompanied by orbital complications between January 2007 and September 2017. This retrospective study of these patients analyzed age, sex, location of sinus lesions, visual disturbance, and the relationship between the outcome and the interval between the onset of the visual disorder and the surgical procedure. Visual outcomes were poor for patients with sinusitis when the interval between the onset of the visual disturbance and surgery was>48 hours. On the other hand, visual disturbances resulting from paranasal cysts were potentially reversible. However, visual outcomes were poor for patients with rapid deterioration of visual acuity. Many complications due to cysts required more time to diagnose. Therefore, cysts in the posterior ethmoid sinus should be suspected when patients with visual impairment have a history of transantral sinus surgery.
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  • Ryuji Yasumatsu, Ryutaro Uchi, Takahiro Wakasaki, Masahiko Taura, Miok ...
    2020 Volume 29 Issue 3 Pages 273-278
    Published: 2020
    Released on J-STAGE: March 31, 2020
    JOURNAL FREE ACCESS
     The TNM classification was revised to the 8th edition in 2016. In the revision for oral cancer, the depth of invasion(DOI)in classification T and the extranodal extension(ENE)in classification N were newly introduced. Between 2007 and 2016, 93 patients with tongue cancer were treated in our hospital and evaluated for TNM classification according to the 7th and 8th editions. The 3-year disease-specific survival rate based on the 8th edition was 72.3%; stageⅠ(25 cases): 89.9%, stageⅡ(17 cases): 80%, stageⅢ(15 cases): 70%, stageⅣA(31 cases): 64.2%, and stageⅣB(5 cases): 20%. Twenty-nine cases developed recurrences and the total salvage rate of recurrence was 36%(10 cases). The 8th TNM classification reflected the prognosis more clearly than the 7th edition.
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  • Taimu Yamaguchi, Ikuko Takeda, Atsushi Matsubara
    2020 Volume 29 Issue 3 Pages 279-283
    Published: 2020
    Released on J-STAGE: March 31, 2020
    JOURNAL FREE ACCESS
     We examined the types of foreign bodies and extraction methods for 100 cases of hypopharyngeal and esophagus foreign bodies removed under general anesthesia in our department over the past 20 years. Regarding the type of foreign body, fish bones were the most common at 66 cases, dentures at 9 cases, PTP preparations at 8 cases, and food lumps at 7 cases. Examination by age group showed a large number of cases under 10 years old and in their 60s with bimodality. There were many foreign bodies of coins and toys in children, while the proportion of fish bones and PTP denture foreign bodies was high after the 20s. In a comparative study of cases every 10 years, there was an increase in the number of cases in each age group in the last 10 years, and the number of cases aged 65 years and older was significantly increased, which is considered to be associated with the aging society. With regard to PTP foreign bodies, there were cases of accidental ingestion at medical facilities, which is considered to be a subject requiring further study.
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  • Kazuhira Endo, Takayoshi Ueno, Kazuya Ishikawa, Yosuke Nakanishi, Sato ...
    2020 Volume 29 Issue 3 Pages 285-289
    Published: 2020
    Released on J-STAGE: March 31, 2020
    JOURNAL FREE ACCESS
     Pedicled flaps still play an important role in reconstruction because of their dependability and ease of preparation. The nasolabial flap is a reliable pedicled flap along the nasofacial groove. We report the case of a 71-year-old male patient with squamous cell carcinoma of the buccal mucosa(T2N0M0). The major blood supply of the nasolabial flap is derived from the facial artery. The flap was raised in the supero-inferior fashion and in the plane of the superficial musculoaponeurotic system. The nasolabial flap was used for reconstruction of the buccal defect after tumor resection. After surgery, the flap was successfully applied and the donor site was primarily closed. The patient experienced no complications and recovered without oral pain. Herein, we describe the clinical course, technique and critical points of the reconstruction.
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  • Mizuki Korematsu, Tadashi Yoshii, Shinji Otozai, Motoyuki Suzuki, Hiro ...
    2020 Volume 29 Issue 3 Pages 291-297
    Published: 2020
    Released on J-STAGE: March 31, 2020
    JOURNAL FREE ACCESS
    Introduction: In the resection of tongue cancer and subsequent reconstruction, preservation of postoperative function of the upper aero-digestive tract has been considered to affect quality of life. In the present study, we attempted to assess the degrees of conversation and swallowing function after radical surgery and reconstruction in patients with tongue cancer.
    Patients and methods: Fifty-eight patients with tongue cancer were enrolled (median age: 59, range: 16-88). Conversation function was evaluated according to the Conversation Score (CS) of the Clinical Practice Guideline for Head and Neck Cancer of the Japan Society for Head and Neck Cancer. Swallowing function was evaluated using the Method of intake, Time of intake, and Food Score (MTFS), and Functional Outcome Swallowing Scale (FOSS).
    Results: The median of CS, MTFS and FOSS was 9, 12, and 1, respectively. Only one case (2%) showed CS of 4 reflecting poor social language activity. Patients in whom more than 50% of the tongue was resected showed a significant decrease in CS compared with those in whom no more than 50% was resected (p=0.004). With regard to MTFS and FOSS, in the younger group (‹65 years of age, 40 patients), 78% were scored as MTFS of no less than 12 and 68% showed FOSS of 1 or less. In the older group (≥65 years of age, 18 patients), 33% showed MTFS of no less than 12 and 33% exhibited FOSS of 1 or less. A comparison between the two groups showed significant differences (MTFS: p=0.001, FOSS: p=0.042). Patients in whom more than 50% of the base of the tongue was resected showed a significant decrease of FOSS compared with those in whom no more than 50% was resected (p=0.045). However, the performance of postoperative radiation therapy affected none of the scores.
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  • Kenta Ishii, Itsuo Nakajima, Yurie Takise, Kanta Imai, Takahiro Nakaji ...
    2020 Volume 29 Issue 3 Pages 299-304
    Published: 2020
    Released on J-STAGE: March 31, 2020
    JOURNAL FREE ACCESS
     We report a case of nasopharyngeal carcinoma with hypoglossal nerve paralysis as lower cranial nerve paralysis as an initial symptom. A 52-year-old man was admitted to our hospital’s neurology department with the chief complaint of tongue movement disorder. At first, a central disease such as cerebral infarction was suspected due to the sudden onset of lingual movement disorder. A brain MRI was performed, but no intracranial abnormality was detected. Next, the patient was referred to our department for right hypoglossal nerve palsy. Nasopharyngeal endoscopy was performed and a protruding lesion on the right lateral wall to the posterior superior wall of the nasopharynx was detected. Squamous cell carcinoma was diagnosed from the protruding lesion by biopsy. In addition, right cervical lymph node metastasis was recognized by CT scan, so chemoradiotherapy was performed. Cases of nasopharyngeal carcinoma with the chief complaint of hypoglossal nerve paralysis are rare, and few cases have been reported in Japan. We consider the pattern of extension of the tumor and lower cranial nerve paralysis of this case.
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  • Shinsaku Matsuda, Taisuke Mori, Toshihito Sahara, Emi Matsuda, Yoshiko ...
    2020 Volume 29 Issue 3 Pages 305-309
    Published: 2020
    Released on J-STAGE: March 31, 2020
    JOURNAL FREE ACCESS
     Many cases of papillomas on the tongue have been reported. Clinically, resection is often recommended because of the possibility of canceration. However, the pathology of the canceration process and the mechanism of cancer development have not been clarified. For sinonasal papillomas, a consensus regarding the grading of dysplasia in inverted papillomas does not yet exist, and the diagnosis of malignant transformation can be challenging. The patient was a 48-year-old woman. A tumor on her tongue was detected, and fiberscopic examination using narrow-band imaging showed a papillary structure and relatively organized new blood vessels. A biopsy revealed an inverted papilloma, and surgery was planned because of the possibility of canceration. A partial glossectomy was performed. Microscopic evaluation of the surgical specimen showed hyperplasia and multiple invasions of the surface epithelium into the underlying stroma, composed of squamous cells. Immunohistochemical staining showed the focal expression of p53, and p16 was negative. In addition, BerEP4 and EGFR were partial positive. By evaluating p53 staining images at the same site as HE staining, in this papilloma it was possible to confirm the site showing canceration and the site not so. Consequently, a pathological diagnosis of squamous cell carcinoma arising from an inverted papilloma on the tongue was made.
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  • Shunsuke Miyamoto, Yutomo Seino, Takashi Matsuki, Koichi Kano, Shohei ...
    2020 Volume 29 Issue 3 Pages 311-320
    Published: 2020
    Released on J-STAGE: March 31, 2020
    JOURNAL FREE ACCESS
    Invasive surgery for geriatric patients with cancer increases the risk of severe complications even if it is indispensable for definitive therapy. The submental flap is a pedicled flap which is easy to harvest only in the cervical region, and does not require microvascular anastomosis and strict postoperative bed rest. We report two geriatric cases with advanced supraglottic cancer in whom this less-invasive flap was used for pharyngeal reconstruction after tumor resection.  The first case was an 89-year-old male with rT4aN0 cancer recurrence in epiglottic vallecula diagnosed 52 months after radiotherapy for cT2N0 epiglottic cancer. The second case was an 84-year-old male with cT3N2c primary epiglottic cancer. The histological type was squamous cell carcinoma in both cases. Extended total laryngectomy was applied to both cases due to tumor invasion of the tongue base and unilateral pyriform sinus. The pharyngeal defects in the first and second cases were successfully reconstructed with submental flaps measuring 8cm by 4cm and 11cm by 3.5cm, respectively. There was no significant postoperative morbidity other than a minor leak in the first case, and both cases were discharged 33 days after surgery. The first case died of local recurrence and cervical lymph node metastases 22 months after surgery, and he was able to consume a normal diet and utilize an electrolarynx until one month before death. The second case has been followed for 17 months after surgery with no disease.  These cases indicate that definitive surgery with reconstruction using the submental flap in the laryngopharyngeal region is practicable even in geriatric patients. Therefore, this less-invasive local flap would be a reasonable alternative to a free flap for pharyngeal reconstruction especially in vulnerable patients of advanced age with comorbidities.
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  • Takahiko Nagaki, Ryuichi Hayashi, Takeshi Shinozaki, Toshifumi Tomioka ...
    2020 Volume 29 Issue 3 Pages 321-326
    Published: 2020
    Released on J-STAGE: March 31, 2020
    JOURNAL FREE ACCESS
     We report a case of recurrent thyroid cancer with thyroid cartilage invasion that was treated with partial resection of the larynx with preservation of laryngeal function. The patient was a 47-year-old man who had previously undergone total thyroidectomy and neck dissection for papillary thyroid carcinoma at another hospital. A recurrent lesion infiltrating the thyroid cartilage was detected 6 years later and so he was referred to our department. Computed tomography revealed a tumor with a maximum diameter of 39mm infiltrating the right plate of the thyroid cartilage. However, the infiltration into the larynx was limited to the paraglottic space, and so larynx preservation was deemed possible. Surgery was performed by removing the right plate of the thyroid cartilage en bloc with the tumor. The mucosa of the pyriform sinus was preserved. Currently, as of 1 year after the surgery, there has been no recurrence. Functional preservation of the larynx in cases of invasive differentiated thyroid carcinoma is a plausible consideration when the tumor has not infiltrated the laryngeal lumen and the framework of the thyroid cartilage(especially anterior-posterior diameter)remains considerably intact.
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  • Atsumu Teramura, Nobuo Kitahara, Hitoshi Iwamura, Yasuhiro Ebihara, To ...
    2020 Volume 29 Issue 3 Pages 327-331
    Published: 2020
    Released on J-STAGE: March 31, 2020
    JOURNAL FREE ACCESS
     We report the case of a well-differentiated liposarcoma of the pharynx. The patient was a 62-year-old man who presented with dysphagia. The tumor was totally resected and histological examination of the operative specimen confirmed lipoma. Seven years after the first surgery, the tumor recurred and we performed tumor resection with lateral pharyngotomy. The histological diagnosis was lipoma. Ten years after the first surgery, the tumor recurred again and we performed lateral pharyngotomy. The histological examination did not prove malignancy, but the clinical history was compatible with well-differentiated liposarcoma. Eighteen years after the first surgery, the tumor recurred and we performed total pharyngolaryngectomy and reconstruction of the cervical esophagus with a jejunal free flap. Well-differentiated liposarcoma was diagnosed from histological findings of the operative specimen. The surgical margin of the caudal side was positive. Two years after the last surgery, he remains under observation without recurrence.
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  • Yutaro Oi, Hirohiko Tachino, Hiromasa Takakura, Hideo Shojaku
    2020 Volume 29 Issue 3 Pages 333-336
    Published: 2020
    Released on J-STAGE: March 31, 2020
    JOURNAL FREE ACCESS
     In recent years, the number of cases of sinusitis caused by the foreign body of a dental implant has increased. However, the foreign body of a dental implant in the ethmoid sinus is extremely rare. We experienced the case of a 66-year-old man who was diagnosed with chronic sinusitis by MRI and medical treatment was done at the department of internal medicine in a nearby general hospital. However, there was no improvement, so he was referred to our department a few months later. CT scan indicated a foreign body made of metal in the ethmoid sinus, so we removed it by endoscopic sinus surgery. The foreign body was a dental implant that had been placed almost 10 years earlier.
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  • Shota Ida, Yutaro Yajima, Takaharu Yasuzuka, Masato Shino, Osamu Nikku ...
    2020 Volume 29 Issue 3 Pages 337-342
    Published: 2020
    Released on J-STAGE: March 31, 2020
    JOURNAL FREE ACCESS
     Carcinosarcoma is known as a malignant tumor consisting of a mixture of carcinoma and sarcoma; such tumors of the head and neck region are rare. Here, we report a case of carcinosarcoma arising in the hypopharynx. The patient was a 76-year-old man who had complained of dyspnea and was referred to our hospital. As a large mass with near total obstruction at the supraglottic level was observed by endoscopic examination, the patient underwent emergency tracheostomy, and then an endoscopic biopsy was performed. Histopathologic examination revealed poorly differentiated carcinoma, but did not lead to a definitive diagnosis. The patient underwent total laryngopharyngoesophagectomy, bilateral neck dissection, and reconstruction with free jejunum for radical treatment. The final histopathological examination showed carcinosarcoma which consisted of adenocarcinoma originating from the hypopharynx. Three months after surgery, follow-up CT identified multiple lung metastasis. In the treatment of hypopharyngeal carcinosarcoma, careful attention should be paid to airway management, and if possible, surgical resection should be considered as a first line therapy.
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  • Muneyuki Masuda, Kazuo Nishiyama, Fumihide Rikimaru, Satoshi Toh, Yuic ...
    2020 Volume 29 Issue 3 Pages 343-347
    Published: 2020
    Released on J-STAGE: March 31, 2020
    JOURNAL FREE ACCESS
     There have been few reports about laryngeal-preserving resection of the base of the tongue and epiglottis, in particular, for recurrent cases after chemoradiation or for cases which require wide resection of the base of the tongue. In contrast, we have reported that it is feasible to restore the swallowing function after laryngeal-preserving surgery for recurrent or residual tumors. In the present study, we experienced a case for which favorable postoperative function was obtained after resection of 4/5 of the base of the tongue and epiglottis. To obtain successful results, it is essential to resect the tumor while paying full attention to the postoperative function and to conduct morphological and functional reconstruction of the epiglottis. We present the key points of these procedures.
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  • Masayoshi Mukai, Kohtaro Eguchi, Satoshi Shirakura, Taro Sugimoto
    2020 Volume 29 Issue 3 Pages 349-354
    Published: 2020
    Released on J-STAGE: March 31, 2020
    JOURNAL FREE ACCESS
    Transoral surgery and radiotherapy are the standard treatments for superficial head and neck cancer. The treatment modality should be carefully chosen based on the patient’s age, past history, tumor site, and tumor invasion depth. Here, we present the case of a 75-year-old man with a history of endoscopic treatment for superficial esophageal cancer. Multiple superficial hypopharyngeal cancers were identified in the bilateral piriform sinus and posterior wall. Instead of radiotherapy, transoral surgery was planned, due to concerns over second primary lesions and locoregional recurrences in the future. Since a wide resection was planned, the risk of dysphagia, caused by postoperative stricture, was a concern. In an effort to prevent this complication, staged resection and local intralesional triamcinolone acetonide (TA) injection was performed. The patient followed a favorable postoperative course with no adverse events. This case illustrates that staged resection and TA injection may be useful in preventing postoperative dysphagia, and thus lead to a more aggressive indication of transoral surgery.
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  • Yutaro Yajima, Masato Shino, Takaharu Yasuzuka, Shota Ida, Osamu Nikku ...
    2020 Volume 29 Issue 3 Pages 355-359
    Published: 2020
    Released on J-STAGE: March 31, 2020
    JOURNAL FREE ACCESS
    Pharyngeal foreign bodies, mostly fish bones, are a common occurrence. These bones are usually located at the tonsils or the base of the tongue and are easily removed. However, foreign bodies are sometimes embedded in the submucosa and cannot be identified by fiberscope, making them difficult to remove.  Here we report a case of an extra-pharyngeal foreign body that we could safely remove utilizing intraoperative X-ray radioscopy.  The case was a 74-year-old man who had a sore throat and pharyngeal discomfort just after eating a dried fish two weeks before admission to our hospital. The foreign body was suspected to be embedded in the submucosa of the pharynx, because we could not find it in the pharynx with a fiberscope or even CT scan; X-ray examination of the neck clearly showed the foreign body in the pharynx and no sign of deep neck abscess. The CT scan was performed again on the 6th day after admission as the patient felt movement of the location of discomfort. The foreign body still remained and its position and shape were changed upward and curved. After taking aspirin for 7 days, we aimed to remove the submucosal embedded foreign body. The pharyngeal lumen was widely broadened by inserting a Sato-type curved laryngoscope transorally and X-ray radioscopy was used to detect the precise location of the embedded foreign body. The foreign body was extracted safely without bleeding, and was a thin wire that had likely strayed into the dried fish during the production process. We showed that intraoperative X-ray radioscopy was very useful for safely removing the submucosal embedded foreign body that could be detected by X-ray.
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  • Ryoto Munekawa, Daichi Mori, Jyunichi Mitsuda, Gaku Omura, Hitosuke Ta ...
    2020 Volume 29 Issue 3 Pages 361-365
    Published: 2020
    Released on J-STAGE: March 31, 2020
    JOURNAL FREE ACCESS
    Branchial cysts are caused by abnormal development of the branchial cleft, most of which originate from the second branchial cleft. They may arise from any part of the second branchial tract from the tonsillar fossa to the hyoid bone, and most frequently occur in the upper laterocervical region. We report a case of a six-month-old male child who was diagnosed with a nasopharyngeal cyst. The main complaint was snoring. He started snoring at 2 months after birth, and a cyst from the epipharynx to the right side of the oropharynx was found at 6 months of age. Development was normal, and elective surgery was planned. At 1 year and 7 months of age, we performed oral cyst fenestration under general anesthesia. No recurrence has been noted to date, 6 months after surgery.
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  • Shintaro Nakamura, Yasuo Satou, Noboru Habu, Mitsuru Kitamura, Takeshi ...
    2020 Volume 29 Issue 3 Pages 367-371
    Published: 2020
    Released on J-STAGE: March 31, 2020
    JOURNAL FREE ACCESS
     As a treatment for early-stage glottic cancer, we have performed laser surgery with Satou's curved laryngo-pharyngo scope, a flexible endoscope for otolaryngology, and a fiber-delivered laser. The advantages of this surgery are: 1) We can observe in detail the laryngeal ventricle and the subglottis by using the flexible endoscope and the narrow band imaging system (NBI), and 2) This surgery can also be performed for patients with poor condition of cervical vertebrae and teeth, in whom conventional microscope surgery cannot be performed. This surgery has local a control rate and laryngeal preservation rate comparable to those by conventional treatments.
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