[in Japanese]

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[in Japanese]

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[in Japanese]

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Meniere’s disease is an inner ear disease, characterized by recurrent rotatory vertigo, sensorineural hearing loss and tinnitus. There are some with frequent vertigo attacks, progressive hearing loss and persistent annoying tinnitus even with continuous standard medical treatments. These cases are thought to account for 10-20％ of all cases of Meniere’s disease. In this review article, we demonstrate the standard processes for endolymphatic sac drainage surgery.

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Although the face-lift approach has been used for parotidectomy due to its esthetic benefits, its indication is still controversial. In this study, we compared several parameters of patients who underwent parotidectomy in Nagoya City University Hospital between the face-lift approach group （FL group, n＝46） and the conventional skin incision group （Co group, n＝84）. As a result, patients in the FL group were younger and there were more women in the FL group than the Co group. Tumor diameters were comparable between the two groups, whereas the number of deep lobe tumors tended to be small in the FL group. There was no significant difference in operative time or amount of bleeding between the two groups. We did not find any difference in the incidence of surgical complications among the two groups. However, salivary leakage was more common in the FL group. In conclusion, we confirmed the efficacy and safety of the face-lift approach in patients treated with parotidectomy.

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Papillary thyroid carcinoma is considered to have a good prognosis. However, there are many cases with a poor prognosis, and extracapsular tumor invasion is known as one of the poor prognosis factors. Therefore, among the 187 cases of papillary thyroid carcinoma that were initially treated at our department, we examined 29 cases that were diagnosed as Ex2. The Ex2 cases had a significantly lower disease-free survival rate than the Ex0 and Ex1 cases. In addition, among the Ex2 cases, there was no recurrent nerve alone, but infiltration of surrounding organs other than the recurrent nerve had a poor prognosis. However, papillary thyroid carcinoma is a relatively prognostic disease, and there are cases where cancer-bearing long-term survival can be obtained. Therefore, it is considered important to treat such cases appropriately while aiming for functional preservation.

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Invasive fungal sinusitis still has a poor prognosis, although removal of the lesion and infusion of antifungal drugs have been successfully applied to treat the disease in recent years. Here, we describe six cases of invasive fungal sinusitis that we experienced in the last 5 years. In case 1, MRI findings initially indicated a brain tumor spreading into the paranasal sinuses. Examination of a brain biopsy obtained by craniotomy resulted in the diagnosis of invasive fungal sinusitis, and skull base and reconstructive surgery were performed. Endoscopic sinus surgery was used to treat the other five cases. Two cases were diagnosed pathologically, resulting in a diagnosis of fungal invasion of the mucosa. In the other four cases, CT images indicated bone destruction and disease progression into the pterygopalatine fossa. Five patients survived but one patient died from underlying disease. This study demonstrates that this type of lesion can be removed by endoscopic sinus surgery and that appropriate infusion of Voriconazole is effective.

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We have created an easy light guide method performed by an otolaryngologist for endoscopic dacryocystorhinostomy （En-DCR）, namely, extraductal transillumination （EDTI）, from the medial canthus. We evaluated whether EDTI could be an alternative method instead of the conventional intraductal light guide in primary En-DCR. This paper examines its efficacy in primary En-DCR.
Eight patients （1 man, 7 women）, involving 11 eyes including 8 cases of acquired nasolacrimal duct obstruction and 3 cases of chronic dacryocystitis, were enrolled in the preliminary study of the efficacy of EDTI. We investigated whether adequate bone removal of lacrimal fossa and full exposure of lacrimal sac were achieved or not under EDTI intraoperatively. Thereafter, primary En-DCR without stenting under EDTI was performed by an otolaryngologist for 9 patients （2 men, 7 women）, involving 12 eyes including 9 cases of nasolacrimal duct obstruction, and 3 cases of chronic dacryocystitis, to validate our preliminary study.
Adequate bone removal of the frontal process of maxillary bone over the internal common punctum was achieved in all the eyes under EDTI in the preliminary study. The result of primary En-DCR without stenting under EDTI by an otolaryngologist showed an anatomical success rate of 100％ and functional success rate of 91.7％, with a mean duration of 6 months of follow-up. No adverse effects associated with EDTI were observed.
EDTI is a comparable light guide method in primary En-DCR with the intraductal light guide installed by an ophthalmologist. Primary En-DCR without stenting under EDTI which can be done by an otolaryngologist for saccal and postsaccal obstruction has high anatomical and functional success rates.

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Objective: The present study aimed to retrospectively analyze the risk factors of peritonsillar abscess （PTA） causing a severe condition with deep neck abscess （DNA）.
Methods: The study enrolled 78 patients who were diagnosed with PTA. We compared 19 PTA patients who developed DNA and 59 patients without DNA. We focused on the type of abscess, age, degree of in­fec­tion, smoking and comorbidity and analyzed the risk factors of developing DNA. As to the type of ab­scess, we classified abscesses into four types: superior oval type, superior cap type, inferior oval type and inferior cap type.
Results: Elderly patients with a high CPR level tended to develop DNA with statistical significance. Fur­ther­more, the superior cap type, inferior oval type and inferior cap type suggested a high risk of DNA. In the 19 PTA patients with DNA, the abscess tended to spread widely in the case of the inferior type. All three DNA patients in whom the abscess developed to the mediastinum were the inferior cap type.
Conclusions: The inferior type of PTA has been considered to have a high risk of severe prognosis. However, even other types such as the superior cap type should be treated as having a high risk of causing DNA and reliable surgical drainage should be performed.

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We report two cases of thyroid metastasis from renal cell carcinoma after nephrectomy. The cases were a 71-year-old female who had undergone left nephrectomy for left kidney cancer 24 years earlier and a 69-year-old female who undergone right nephrectomy with right kidney cancer three years earlier. In both cases, right anterior cervical swelling was the main complaint and fine-needle aspiration was performed because a tumor of the thyroid right lobe was observed. The result was Class Ⅴ and Class Ⅲ, respectively, and surgical operation was performed.
In both cases, the result of pathological diagnosis was clear cell type renal cell carcinoma, which was diagnosed as thyroid metastasis of renal carcinoma.
It has been reported that the survival rate of cases with distant metastasis of kidney cancer is significantly increased by surgical operation, so we should consider the possibility of metastasis and judge whether to perform surgery for cases of thyroid tumors with a history of renal cancer.

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Congenital lateral cervical fistula is a branchial anomaly that is formed by the abnormal evolution of the branchial cleft. Most lateral cervical fistulas lack an internal opening and the occurrence of complete lateral cervical fistula with an external and internal opening is rare. We report a case with a left complete lateral cervical fistula from the second cleft. A 3-year-old boy complained of mucal discharge from an opening in the left lower neck. A duct was identified by image examination （CT, MRI）, which was present along the anterior margin of the sternocleidomastoid muscle, and extended further upward from the common carotid artery bifurcation, gradually becoming thinner. The duct was completely extirpated under general anesthesia. In the surgery, two horizontal incisions were made in the neck, and 4-0 Nylon was used as a guide. An internal opening was found at the low pole of the tonsil. These findings suggested that the complete lateral cervical fistula was derived from the second branchial cleft. Three years after surgery, obvious recurrence has not been observed.

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The incidence of metastatic thyroid tumors is rare because of the high oxygen and high iodine en­vi­ron­ment in the thyroid gland. In addition, since the thyroid gland has a rich blood flow, cancer cells hardly ad­here to it. This report describes a case of thyroid tumor metastasized from renal cell carcinoma, combined with a clinical review.
A 55-year-old woman had noticed neck swelling 3 to 4 years ago which had been observed as a benign thyroid tumor. The mass lesion increased gradually in size and fine-needle aspiration findings suggested follicular tumor. The patient had a history of renal cell carcinoma 11 years ago and a recurrence in the pancreas 9 years ago. The right lobe was diffusely enlarged and the border was unclear in ul­tra­so­nog­ra­phic findings. CT and MRI examinations showed the tumor with high contrast effect. There was no ob­vi­ous lymph node metastasis or distant metastasis. Right lobectomy was performed and the bleeding volume was about 280 ml during surgery. Pathological examination after surgery confirmed metastasis of renal cell carcinoma. Lung metastasis appeared 21 months after thyroid surgery and additional treatment for lung metastasis is now under way, but there is no recurrence in the head and neck.

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Transoral videolaryngoscopic surgery （TOVS） is established as a minimally invasive transoral surgery. The neck lymph node for node-positive cases is dissected on the same day. For cases with deep invasion of the tonsil and tongue base tumor, bleeding from the dorsal lingual artery should be carefully managed. Herein, we report a case of p16 negative tongue base cancer （T1N2bM0） which was resected by TOVS and neck dissection with ligation of the lingual artery. We did not see any active bleeding during and after the opera-tion. The indication of cervical artery ligation for tonsil and tongue base cancer is discussed.

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Organ preservation therapies including （chemo）radiotherapy and laryngeal preservation surgery are currently used for the treatment of either early laryngeal or hypopharyngeal carcinomas. In particular, transoral surgery is generally recognized as a minimally invasive treatment option for preventing swal­low­ing dysfunction after the surgery. We report the case of a 79-year-old Japanese man with a medical history of chemoradiation therapy for nasopharyngeal cancer, presenting with severe swallowing impairment sub­se­quent to transoral videolaryngoscopic surgery （TOVS） for early hypopharyngeal cancer. A positive sur­gi­cal margin was diagnosed by histopathological examination. No significant improvement of swallowing function was observed after rehabilitation therapy for post-operative dysphagia for three months. He then recovered his swallowing function by receiving laryngeal suspension and cricopharyngeal myotomy in addition to further resection of the pharyngeal mucosa and the constrictor muscle followed by swallowing rehabilitation therapy. Post-operative dysfunction of swallowing by TOVS can be improved by adequate surgical management.

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Dentigerous cysts are classified as odontogenic developmental cysts among odontogenic and maxillofacial bone tumors according to the WHO classification.
Here we report our experience of a case of a dentigerous cyst removed by the endoscopic modified medial maxillectomy （EMMM） technique. A 21-year-old female presented with left nasal obstruction and swelling of her left cheek. CT examination revealed a cystic lesion containing a tooth-like structure in her left maxillary sinus. The cyst was removed by the EMMM technique with a good view of the surgical field. The patient had no postoperative complications. The nasal cavity structure was well maintained, and no recurrence was experienced for four years after the surgery. Because the nasal endoscopy technique is familiar to otolaryngologists, they should participate in the treatment of maxillary dentigerous cysts.

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Tracheal invasion of thyroid cancer is a less common complication that occasionally requires severe peri­operative airway management. Recently, extra corporeal membrane oxygenation （ECMO） has been used for inducing general anesthesia in cases of tumor resection with severe tracheal invasion. Here we report two cases of thyroid cancer highly invading the trachea, where VA-ECMO was successfully used for surgical resection.
The first case was a 68-year-old female, who presented with a persistent cough and progressive airway obstruction. CT revealed a thyroid tumor with severe tracheal invasion as well as multiple lung metastases, and cytology showed the possibility of papillary thyroid carcinoma or thyroid anaplastic cancer. Since approaches to tracheostomy or intubation were extremely difficult due to the invasive tumor, we used VA-ECMO, followed by tracheotomy and induction of general anesthesia. As intraoperative frozen sections revealed the presence of anaplastic thyroid cancer in an unresectable state, tracheoesophageal separation was performed in consideration of post-operative airway management.
The second case was a 73-year-old female, who was referred to our hospital with suspicion of thyroid cancer. She had suffered from a persistent cough for several months, and a trachea-invading thyroid tumor was radiographically identified. As in the first case, we used VA-ECMO, followed by tracheostomy and induction of general anesthesia. Total thyroidectomy and bilateral neck dissection were performed.
This report reviews airway management based on ECMO, particularly focusing on differences of VA-ECMO and VV-ECMO, and cannulation approaches. ECMO can be a safe and useful method for surgery of head and neck tumor with severe airway obstructions, where appropriate selection of the types of ECMO and cannulation approaches is important.

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Epidermal growth factor receptor （EGFR） tyrosine kinase inhibitors improve the prognosis of cancer patients and bring many treatment options. We often experience patients with secondary cancer during the treatment for primary cancer. A 76-year-old man, who taking gefitinib for lung cancer, visited our hospital complaining of hoarseness, and was diagnosed with thyroid papillary carcinoma. We planned total thyroidectomy and neck dissection. We stopped the administration of gefitinib 5 days before and after the operation because the mechanism of action of gefitinib was expected to delay wound healing. As a result, a delay in wound healing and progression of lung cancer did not occur. In the future, there will be many cases of double cancer or secondary cancer. Currently, there are many options for cancer treatment: surgery, chemotherapy, biotherapy, radiotherapy and their combinations. We must accumulate experience of therapies for multiple cancer and establish the risk and safety of combination therapy.

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Rupture of the carotid artery is one of the most serious complications in the treatment of head and neck cancer, with a mortality rate of 40％. Here, we report four cases of carotid rupture related to head and neck cancer. All patients had recurrent head and neck cancer and were successfully rescued. In case 1, the common carotid artery ruptured due to intraoperative injury. The damaged artery was successfully repaired by primary suture. In cases 2 and 3, the common carotid artery ruptured due to postoperative wound infection. The carotid artery was eventually ligated in both cases. In case 4, a recurrent tumor markedly reduced in size with nivolumab administration, and as a result, the carotid artery was exteriorized and ruptured due to infection. The patient was successfully salvaged by stent placement. These cases indicate that the risk of carotid artery rupture should be carefully considered when choosing the treatment for recurrent head and neck cancer. A resuscitation program, including a multidisciplinary team approach, should be prepared for the possible risk of carotid rupture.

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Nasal septal perforation can occur from a variety of traumatic, iatrogenic, intranasal drug abuse, or inflammatory causes. Asymptomatic nasal septal perforation does not need any treatment, but if these patients present with symptoms such as crusting, a sensation of nasal obstruction, or bleeding, treatment is needed to relieve the symptoms. If medical treatments such as nasal irrigations and ointments are unsuccessful, then surgical treatment is recommended. Although many techniques to repair nasal septal perforations have been reported, no agreement has yet been reached on the most suitable method for the best outcome. We report a patient whose septal perforation was closed using unilateral mucosal advancement flaps.
The case was an 18-year-old man. The chief complaint was recurrent epistaxis, nose pain, crusting, and a sensation of nasal obstruction. We completely closed the nasal septum perforation by unilateral mucosal advancement flaps with interposition graft, and achieved symptomatic improvement.
Septal perforation closures need a well-vascularized mucosal flap. We conclude that the unilateral mucosal advancement flap is an effective tissue for closing septal perforations because this flap is bi-pedicled and the bi-pedicled flap increases vascular supply.

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Olfactory neuroblastoma （ONB） is a rare malignant neoplasm of the midline ventral skull base. Open craniofacial resections have been the treatment of choice for many years. More recently, experience has been growing with endoscopic resection in the management of patients with ONB. It is also controversial whether ONB should be removed by en bloc resection or multilayer resection.
The present case was a 70-year-old man with ONB filling both the nasal cavity with dural invasion, which was classified as a Kadish stage C, and a Dulguerov and Calcaterra stage T4. The chief complaint was olfactory disturbance. For en bloc resection, the endoscopic endonasal resection approach was selected with the transorbital approach for ligation of the anterior and posterior ethmoid arteries.
This case study shows that ethmoid arteries of a large ONB filling the nasal cavity, which is difficult to approach endonasally, can be approached transorbitally and ligated, and ONB can be removed by en bloc resection.

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Fibrous dysplasia （FD） is a benign bone disease, and its cause is unknown. It is common on long bones and ribs, but rare in the head and neck region. FD frequently occurs in the maxilla and mandible, but rarely in temporal bone. The most common clinical manifestations of FD of temporal bone are hearing loss caused by stenosis of the external auditory canal, and ear canal cholesteatoma. Surgical treatment is the only treatment. However, restenosis of the external auditory meatus may occur after surgery, and there is no consensus on the surgical method or the timing of surgery. We report the case of an 11-year-old patient who underwent surgery and treatment because of hearing loss due to external auditory canal stenosis, and who experienced a good course.

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