[in Japanese]

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Patients with unilateral vocal fold paralysis have a reduced quality of life due to difficulty in speaking and singing due to hoarseness or difficulty in swallowing. Vocal fold paralysis may recover spontaneously, however, if recovery is not achieved, it may require surgical treatment. Since there is no treatment to restore the mobility of the vocal folds, surgery to medialize the vocal folds is the only way to improve the voice. Surgical treatment for unilateral vocal fold paralysis can be broadly classified into arytenoid adduction and simple medialization. This article describes the method of evaluating postoperative results, criteria for selecting surgical procedures, and specific methods of each procedure in relation to the optimization of treatment.

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The prevalence of thyroid cancer is on the rise in Japan. Thyroid surgery is often selected as an introduction to head and neck surgery. However, when complications such as recurrent laryngeal nerve palsy and hypoparathyroidism occur, the patient’s QOL is significantly reduced. It is necessary to preserve not only the morphology of the recurrent laryngeal nerve but also its function. The reliability of intraoperative nerve monitoring has been greatly improved by establishing guidelines. In particular, intraoperative continuous nerve monitoring by vagus nerve stimulation is expected to reduce the occurrence of recurrent laryngeal nerve palsy. Preservation of the parathyroid gland is also important. In recent years, the usefulness of a method for detecting the parathyroid gland using an infrared observation camera system utilizing the autofluorescence characteristics of the parathyroid gland has been reported.

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[in Japanese]

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[in Japanese]

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We examined 365 patients who underwent surgery for thyroid lesion at our institution during the nine years from July 2012 to September 2021. There were 112 benign lesions and 253 malignant tumors. The accurate diagnosis rate of fine-needle aspiration cytology （FNAC） was 91.7％. 76.4％ of Class 3 cases that received FNAC were malignant tumors. Postoperative recurrent laryngeal nerve palsy （RLNP） was observed in 20 case, of which 16 case were transient and 4 case were permanent. We examined the postoperative complications of RLNP regarding factors of age, gender, surgical side, histological type, the presence or absence of cervical lymph node dissection, and size. The frequency of RLNP increased in cases who were 55 years old and over, bilateral side, malignant tumor and cervical lymph node dissection.

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Background: p16-positive oropharyngeal squamous cell carcinoma （OPSCC） usually responds to treatment and is known as a disease with a favorable prognosis. In this retrospective study, we sought the optimal initial treatment for Stage Ⅲ p16-positive OPSCC.
Methods: We compared the treatment outcomes and patient background factors of 23 patients who underwent curative treatment at our department between March 2006 and March 2020 by univariate analysis.
Results: Initial treatment included 13 patients treated with chemoradiotherapy （CRT）, 3 patients treated with induction chemotherapy （ICT）, 2 patients treated with surgery, and 5 patients treated with other methods. The 5-year overall survival （OS） rate was 78％ and the 5-year recurrence-free survival （RFS） rate was 69％. The 5-year OS by initial treatment （CRT/ICT/surgery/other） was 77％/67％/50％/100％ and the 5-year RFS was 69％/67％/0％/100％. Seven patients under the age of 60 years survived without recurrence. Among those who underwent CRT or ICT, all patients who smoked less than 20 pack-years survived.
Conclusion: In this study, the results of CRT and ICT for Stage Ⅲ p16-positive OPSCC were relatively favorable （70％）, but the prognosis was poor for patients who smoked more than 20 pack-years and were over 60 years old.

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We herein report 14 cases of preoperatively diagnosed anaplastic thyroid carcinoma treated at our hospital between September 2002 and September 2021 and confirmed by postoperative histopathological examination. Treatment was based on the extent of lesions; we performed total pharyngo-laryngo-cervical esophagectomy in 2 cases, total thyroidectomy in 8 cases, and lobectomy in 4 cases. As a result, 3 patients show no evidence of disease, 1 patient is alive with disease, and 10 patients have died of disease. Local control was achieved in 3 cases of disease death. The 1-year overall survival rate was 57.1％ and the local control rate was 57.1％. It is suggested that surgical treatment of anaplastic thyroid carcinoma may provide local control and contribute to improved prognosis.

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Objective: This study aimed to visualize the difference in perceptions of fundamental surgical skills for open head and neck surgery between young and expert surgeons. Sixty fundamental surgical skills were verbalized and categorized into seven categories as an expert consensus in our prior study.
Methods: An anonymous questionnaire survey of young surgeons was conducted. The young surgeons were recruited from three universities and their affiliated hospitals. Expert surgeons’ responses in our prior study were used for a comparison.
Results: Sixty-nine young surgeons who were in the tenth postgraduate year or less answered the questionnaire. Overall, the young surgeons rated the importance of the surgical skills highly compared to the expert surgeons （P＝0.027）, whereas the expert surgeons considered that the categories of “counter traction” and “flow and planning” were important. The expert surgeons evaluated the category of “counter traction” as the most difficult skill. However, the young surgeons had the third highest confidence in their own skills out of the seven categories.
Conclusion: The results of this study suggested that young surgeons paid attention to a broader range of categories than expert surgeons. The perception of “counter traction” differed between the young and expert surgeons. These differences in perception of fundamental skills could be one of the issues hindering the transfer of skills in head and neck surgery.

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Acquired hemophilia A is a bleeding disorder characterized by the development of autoantibodies to coagulation factor Ⅷ and presenting with bleeding symptoms. Herein, we report a case of acquired hemophilia A in a 65-year-old female in whom hematoma in the rectus abdominis muscle was found after surgery for a thyroid tumor. Acquired hemophilia A may have a fatal course due to bleeding, so early diagnosis and early treatment are desirable. Although unfamiliar to otolaryngologists, it is important to suspect this disease in patients with no bleeding diathesis who have normal platelet counts and PTs and only APTT prolongation.

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Oropharyngeal minor salivary gland tumors are difficult to diagnose. Polymorphous adenocarcinoma （PAC） often occurs in minor salivary glands. Herein, we report the case of a 57-year-old woman presenting with pharyngeal discomfort and manifestation of PAC as a palatine tonsil tumor. Swelling of her left palatine tonsil was found at the clinic; consequently, she was admitted to our hospital. Computed tomography showed a left palatine tonsil tumor, and the subsequent tumor biopsy was suggestive of PAC. Reconstructive surgery was performed, and histopathological examination of the postoperative tissue confirmed the diagnosis of PAC. It was suggested that the tumor occurred in the minor salivary glands surrounding the palatine tonsil, and hence was characterized as a tonsillar tumor. Thus, we conclude that it is essential to consider the presence of a salivary gland tumor in the differential diagnosis of palatine tonsil tumors.

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Metastases to the head and neck from the body’s internal organs are rare. We report a case of simultaneous metastasis of renal cell carcinoma to the thyroid gland and submandibular gland. A 69-year-old man presented to our hospital with a chief complaint of swelling in the right submandibular region. Neck ultrasonography revealed an enlarged right submandibular gland and a thyroid mass. As a result of biopsy, the thyroid mass was diagnosed as metastasis from a previous renal cell carcinoma, but the enlargement of the submandibular gland was not diagnosed. Because no other metastases were found, the patient underwent a total thyroidectomy and right submandibular dissection. Histopathological examination revealed tumor thrombosis within the facial vein, which was diagnosed as metastasis of RCC as well as the thyroid tumor. No additional treatment was performed. The patient has been recurrence-free for one year and two months since the surgery. Although renal cell carcinoma is noteworthy because of its association with hypervascularity, cases of simultaneous distant metastases in the head and neck region, as in this case, or metastatic tumors that have developed only within blood vessels are extremely rare.

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We experienced a case of tracheal adenoid cystic carcinoma that occupied approximately 90％ of the tracheal lumen. After a biopsy confirmed adenoid cystic carcinoma, tracheal ring resection and one-stage end-to-end anastomosis were performed. Laryngeal function was preserved, and the patient has not had a recurrence in the two years since the surgery. Although it depends on the conditions, tracheal ring resection and one-stage end-to-end anastomosis may be useful for simultaneously preserving laryngeal function and curing the disease.

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In Japan, tuberculosis （TB） is endemic at a medium level and there are many head and neck cancer patients with a history of TB. We report a case of suspected pulmonary TB relapse during chemotherapy for laryngeal cancer.
The case was a 61-year-old male. He had a history of pulmonary TB treatment 9 months prior to his initial visit to our hospital. He was diagnosed with laryngeal cancer and underwent induction chemotherapy, but before starting chemoradiotherapy, a sputum anti-acid test showed positive speculum. Although it was difficult to determine the activity of TB, preliminary treatment of TB in isolation was performed because of the presence of bacillary excretion. A subsequent culture test indicated no active TB and so treatment for TB was terminated. The treatment for laryngeal cancer was changed to total laryngectomy.
TB is not a rare disease, so the risk of relapse during chemotherapy should be considered.

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An ossifying fibromyxoid tumor （OFMT） is a soft tissue tumor that often occurs in the limbs, trunk, and head and neck of adolescents, but rarely occurs in the nasal and sinus regions. A case of OFMT in the nasal ala is presented.
A 54-year-old man visited our department with the complaint of a mass on the right side of his nose. A tumor in the nasal cavity was visible from the external nostril, and the right nasal ala heaved slightly because of the lesion. He did not complain of spontaneous pain or tenderness, and the tumor showed no adhesion to surrounding tissues. Computed tomography showed a high-density area, indicating calcification. An epithelial subcutaneous tumor was suspected based on the physical and imaging findings, and surgical resection was planned for the purpose of treatment and confirmation of the pathological diagnosis. The tumor was resected endoscopically via an incision on the intranasal mucosal junction. The tumor was diagnosed as an OFMT based on the histopathological findings of a tumor covered with a well-defined capsula fibrosa and a wide area of ossification inside, as well as positive immunohistochemical staining for S-100 and vimentin. OFMT usually has a clinical course that is similar to a benign lesion, though it may sometimes relapse or metastasize if it shows malignant characteristics. OFMT may be encountered in the fields of otolaryngology and head and neck surgery, but is rare. OFMT should be considered when a preoperative examination shows a mass suggesting a mixture of calcified areas.

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Epistaxis is one of the most significant symptoms impairing the quality of life in patients with hereditary hemorrhagic telangiectasia （HHT）. Nasal dermoplasty has been reported to regulate moderate to severe epistaxis with promising results. However, patients often have nasal obstruction with nasal crusting after the surgery. Here, we report two cases of HHT who were treated with nasal irrigation for nasal crusting after nasal dermoplasty. Nasal irrigation improved the nasal crusting after surgery. Also, a questionnaire survey using the Visual Analogue Scale （VAS） demonstrated that nasal obstruction worsened after surgery but improved after the initiation of nasal irrigation, and so did their QoL. Nasal irrigation may be useful for preventing nasal crusting after nasal dermoplasty.

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