[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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In this study, we investigated 74 patients who received selective radiotherapy and concomitant intra-arterial low-dose cisplatin infusion （modified RADPLAT） for treatment of locally advanced laryngeal cancer. The 5-year local control and laryngo-esophageal dysfunction-free survival （LEDFS） rates were 100％ and 85％ in patients with stage T2, 89％ and 76％ in those with stage T3, and 75％ and 75％ in those with stage T4a, respectively. Toxicities categorized as ≥ Grade 3 were observed as follows: leukopenia in 11 （15％）, neutropenia in 11 （15％）, and pharyngolaryngeal mucositis in 5 patients （7％）. Among 23 patients with fixed vocal folds, normal movement was restored in 19 patients （83％）, and impaired movement persisted in 1 patient, 3 months after completion of modified RADPLAT. We observed persistent fixed vocal folds in 3 patients. The 5-year LEDFS rates were 75％ and 77％, respectively in patients with or without fixed vocal folds. This study highlights that modified RADPLAT is useful for laryngeal preservation, is associated with few serious toxicities and shows favorable survival outcomes.

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[in Japanese]

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[in Japanese]

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[in Japanese]

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Objective: We studied lymphatic （chylous） leakage after neck dissection in thyroid cancer and clarified the risk factors in the perioperative period.
Methods: We retrospectively reviewed 50 patients who underwent lateral neck dissection with thyroidectomy for cervical lymphatic metastasis in papillary thyroid cancer between January 2015 and March 2021 at Sapporo City General Hospital.
Results: Neck dissections were performed on the right side in 18 cases, on the left side in 24 cases, and on both sides of the neck in 8 cases. Drainage duration was significantly longer in the case of neck dissection on the left side than on the right side. Severe PONV cases significantly increased drainage duration in the case of neck dissection on the left side.
Conclusion: The drainage duration was significantly prolonged on the left side, which has a venous angle into which the thoracic duct flows. Therefore, it is considered necessary to reconfirm the surgical method. There was a correlation between PONV and drainage duration, suggesting that measures against PONV may reduce lymphatic leakage.

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Recently, it has been reported that high-intensity local treatment improves the prognosis of head and neck cancer with distant metastasis. In this study, we report five cases of recurrent or metastatic head and neck cancer treated with PD-1 inhibitors in which salvage surgery was performed for locoregional lesions that were difficult to control. Four patients with CR except for the resected lesion have progressed without recurrence, and so salvage surgery for difficult-to-control locoregional lesions can be considered as a treatment if distant metastases can be controlled with PD-1 inhibitors. On the other hand, one patient with residual distant metastases in addition to the resected lesions died 9 months after surgery due to tumor growth and the appearance of new distant metastases. Thus, the indication for salvage surgery after PD-1 inhibitor administration should be carefully considered.

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ENT patients may have difficulty with oral intake and require enteral nutrition. Those with long-term inability of oral intake and low nutritional status are at risk of nutritional complications such as refeeding syndrome. It is necessary to take measures in consideration of such complications when starting enteral nutrition. We introduced an enteral nutrition protocol tailored to the condition of each patient in general wards, and conducted a questionnaire survey of physicians and nurses. Introduction of the protocol led to nutritional therapies that more adequately fulfilled the needs of undernourished patients and decelerated the rate of nutrient administration when intolerance symptoms appeared.

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Objective: Being proficient in neck dissection （ND） is a gateway to success for head and neck surgeons. However, it is not easy to master the procedure since the neck has essential structures, such as nerves and vessels, which exist in three-dimensional （3D） form. In this study, we aimed to develop digital educational material for ND to meet learners’ demands.
Methods: Content analysis of a questionnaire survey of 27 otolaryngologists revealed that existing conventional educational materials do not have enough information on 3D anatomy and actual surgical flow. Based on the results, we developed a new educational material for ND including 3D models of the neck and 3D virtual reality movies.
Results: Twenty otolaryngologists participated in the questionnaire survey to evaluate the developed educational material. According to the results of the co-occurrence network of words in their descriptions, the following three categories were found to be advantageous compared to traditional materials: （1） 3D images of the anatomy, （2） videos to understand the surgical process, and （3） step-by-step explanations of the procedure.
Conclusion: This material is considered valuable as a new educational tool for young otolaryngologists learning neck dissection.

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We report the first case of pediatric parotid gland secretory carcinoma harboring the ETV6::RET fusion gene in Japan. A 10-year-old boy presented with gradual enlargement of a parotid mass that had been present since infancy. A painless, mobile mass was palpable in the right parotid gland, without facial paralysis. A contrast-enhanced CT showed a cystic mass with an enhanced margin in the right parotid gland. Fine-needle aspiration cytology showed no malignant findings, and partial superficial parotidectomy was performed for the purpose of diagnosis and treatment. Pathological diagnosis detected the ETV6::RET fusion gene, leading to the diagnosis of parotid secretory carcinoma. Surgical margins were negative, and no apparent recurrence was observed 1 year after the operation. It has been reported that salivary gland secretory carcinomas are mainly associated with the ETV6::NTRK3 fusion gene. Because pediatric cases with the ETV6::RETE gene are very rare and the characteristics of the disease are uncertain, careful follow-up is important.

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RS3PE （Remitting Seronegative Symmetrical Synovitis with Pitting Edema） syndrome has been reported as an irAE （immune-related adverse event） of immune checkpoint inhibitor （ICI）. RS3PE syndrome induced by ICI of head and neck cancer has not been reported, and so we report it as an irAE that should be noted. A 62-year-old male patient with pulmonary metastasis that developed after curative chemoradiotherapy for oropharyngeal cancer （p16-positive cT3N1M0 Stage Ⅱ） was second-line treated by pembrolizumab. Edema and pain of both hands and feet were observed after the third cycle of pembrolizumab infusion. Antinuclear antibody, RF, and anti-CCP antibody were negative. RS3PE syndrome was diagnosed definitively. Steroid treatment improved the symptoms, which made it possible to continue pembrolizumab therapy, and the pulmonary metastasis was well controlled.

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We report a case who underwent robot-assisted surgery simultaneously for oropharyngeal and colorectal cancer using a da Vinci surgical robot. A 78-year-old man with lesions of the right soft palate was radiologically and pathologically diagnosed with cT2N1M0 p16-negative oropharyngeal cancer. Transoral robotic surgery （TORS） was scheduled two weeks after neck dissection and facial artery ligation. Since a preoperative PET-CT indicated abnormal uptake from the sigmoid colon to the rectum, a lower endoscopy was scheduled after neck dissection surgery. However, because advanced colorectal cancer caused obstructive ileus after the neck dissection, emergency lower endoscopy was performed and a stent was inserted. There was an urgent need to treat the colorectal cancer as well, so robot-assisted low anterior resection （Rob-LAR） followed by TORS was performed simultaneously under general anesthesia. There have been no reports of simultaneous operations for oropharyngeal and colorectal cancers by robot-assisted surgery. We report the merits and demerits of performing simultaneous operations by robot-assisted surgery.

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We report two cases of nasopharyngeal carcinoma resected by endoscopic nasopharyngectomy （ENPG）. The first case was a 62-year-old man with rT1 squamous cell carcinoma after radiotherapy. Transpalatal ENPG was selected because the tumors were confined to the median position of the postero-superior wall in the nasopharynx. No local recurrence was observed, though wound healing was delayed. The second case was a 92-year-old woman with T1 adenocarcinoma. Transnasal ENPG was selected because the tumors were confined to the superficial position of the lateral wall in the nasopharynx. The wound was covered with a free mucosal flap, resulting in good wound healing. No recurrence has been observed to date. ENPG for nasopharyngeal carcinoma with radioresistant histology and local recurrence after radiotherapy is considered to be a useful option that enables minimally invasive resection with a good visual field.

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We present three cases of recurrent metastasis in the mesenteric lymph node of free jejunal grafts after total hypopharyngolaryngectomy and free jejunum reconstruction （TPL） for hypopharyngeal cancer. Case 1 and Case 2 displayed recurrence at the resection margin after TPL and resection were performed. Several years later, since the metastatic lymph node was located in the mesentery, we carried out resection of the mesenteric lymph node. Case 3 was treated with chemoradiotherapy for mesenteric lymph node metastasis after TPL. Eight months later, the patient developed recurrent lymph node metastasis and underwent lymphadenectomy. Mesenteric lymph node metastasis of the reconstructed jejunum is rare, but interruption of blood flow to the reconstructed jejunum can result in ischemia and scar narrowing. Therefore, it was necessary to resect the mesenteric lymph node without damaging nutrient vessels.

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Nivolumab-related tracheobronchial chondritis is an extremely rare immune-related adverse event. The patient was a 66-year-old male who had received radiotherapy for hypopharyngeal carcinoma two years ago, and then undergone surgery for local recurrence. Thereafter, due to recurrence of multiple lymph nodes, Nivolumab was administered every 2 weeks 19 times, every 4 weeks two times, and twice after one month of rest due to pneumonia. When he complained of fever, cough, sputum and fatigue, examinations revealed an increase of CRP value, swelling of the tracheobronchial wall, and intratracheal stenosis. An immuno-related adverse event was diagnosed and methylprednisolone was administered, which immediately improved the symptoms, swelling of the trachea and increased CRP value. However, during tapering of prednisolone, chondritis flared up. Second tapered treatment of prednisolone combined with methotrexate was carried out, but was insufficient. Tocilizumab was administered during the third tapered treatment of prednisolone. Matrix metalloproteinase-3 increased although the CRP value remained normal, therefore, colchicine was added. As a result, prednisolone was successfully tapered.

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Chondrosarcoma of the larynx is a rare disease, accounting for less than 1％ of all malignant tumors of the larynx. We report a case of chondrosarcoma of the larynx that originated in the cricoid cartilage, for which a total laryngectomy was performed. The patient was a 74-year-old male who came to our hospital with a chief complaint of dyspnea on exertion. Endoscopic examination of the larynx revealed a prominent lesion below the glottis. Furthermore, CT and MRI indicated a laryngeal chondrosarcoma with a primary origin in the cricoid cartilage. For diagnostic purposes, a direct laryngoscopic tumor reduction procedure was performed, however, it was difficult to distinguish chondrosarcoma from chondroma. The tumor grew slowly, and a total laryngectomy was eventually performed, with the final histopathological result leading to a diagnosis of chondrosarcoma Grade Ⅱ. In the treatment of laryngeal chondrosarcoma, not only cure but also function preservation must be considered. Additionally, the choice of surgical technique must be carefully considered.

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We report a case of primary squamous cell carcinoma （SCC） of the thyroid that was extremely difficult to diagnose and treat.
A 76-year-old woman with hoarseness and discomfort when swallowing was referred to our hospital for a close examination for a suspected thyroid tumor. Laryngeal endoscopy revealed paramedian fixation of the right vocal cord, indicating right recurrent laryngeal nerve palsy. Computed tomography （CT） showed a nodular lesion in the right lobe of the thyroid contiguous to a hypodense lesion extending from the dorsal side of the right lobe to the upper mediastinum, which compressed the right common carotid artery. Fine needle aspiration cytology from the right lobe nodule showed class Ⅴ, whereas that from the hypodense lesion was class Ⅲ with atypical keratinized cells, suggesting a possibility of SCC. Positron emission tomography-CT （PET-CT）, gastrointestinal endoscopy, and bronchoscopy showed no possible primary lesion in other organs. Although we planned a complete resection of the tumor, rapid growth of the tumor during the work-up led to circumferential involvement of the right common carotid artery along with lung metastasis, which forced us to abandon the plan and only perform an excisional biopsy. Pathological evaluation with a series of immunohistochemical examinations determined the histological diagnosis of the tumor as SCC of the thyroid. In consideration of the unresectable status along with the high expression of PD-L1, combined pharmacotherapy consisting of CDDP and 5FU plus pembrolizumab was administered. Temporary suppression of the tumor growth and relief of the symptoms were observed, however, she eventually passed away about 8 months after the initial visit.
SCC is an extremely rare histological type of thyroid-origin malignancy with a poor prognosis. In clinical practice of thyroid diseases, it is essential to keep in mind that there is another type of carcinoma that progresses remarkably fast besides undifferentiated carcinoma.

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Neurofibromatosis type 1 （NF-1） is an autosomal dominant inherited disease, in which approximately 3-5％ of patients develop malignant peripheral nerve sheath tumor （MPNST）. In this report, we present a case of MPNST associated with NF-1. The patient was a 26-year-old man presenting with a lump on his right neck. Based on his café-au-lait spots and family history, neurofibroma associated with NF-1 was suspected. The tumor showed rapid growth and pain, and so the patient underwent surgical resection. The final histopathological diagnosis was MPNST. The surgical margin was close, and postoperative radiation therapy was administered. MPNST is a disease with a poor prognosis due to frequent local recurrence and distant metastasis. Although surgical resection for MPNST carries the risk of neurological deficit, early diagnosis and treatment including surgery are important.

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Enlargement of the cochlear aqueduct is considered a predictor of stapes gusher. We report a case of stapes gusher that was thought to be caused by an enlarged medial orifice of the cochlear aqueduct. We also examined the diameter and area of the medial orifice of the cochlear aqueduct in a patient who had undergone stapes gusher surgery in our department and compared them with those of the present case.
A 43-year-old female patient presented to our hospital because of right-sided sensorineural hearing loss, which she had been aware of since the age of 32. Considered to be otosclerosis, right stapes surgery was performed. Ten years after the right surgery, left stapes surgery was performed due to progressive left hearing loss. Intraoperatively, a gusher appeared, and the piston implantation was abandoned. The diameter and area of the medial opening （axial section） of the cochlear aqueduct measured by CT were 6.1 mm/21.7mm² on the gusher side （left） and 3.8mm/5.3mm² on the non-gusher side （right）. The maximum diameter and area of the medial orifice （axial section） in 23 ears of 19 patients who underwent stapes surgery and did not have a gusher were 5.0mm and 10.6mm², respectively, and the diameter and area on the gusher side were larger than the maximum values in non-gusher cases. These results suggest that enlargement of the medial orifice of the cochlear aqueduct may be one of the causes of gusher.

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Thyroid-like low-grade nasopharyngeal papillary adenocarcinoma （TL-LGNPPA） is a rare low-grade tumor that predominantly occurs in the nasopharynx. The tumor shows papillary thyroid carcinoma-like histopathology, positive for thyroid transcription factor-1 （TTF-1）, but negative for thyroglobulin. We report a case of TL-LGNPPA at the posterior end of the nasal septum. A 30-year-old woman was found by chance to have a tumor at the posterior end of the nasal septum. We preoperatively diagnosed the tumor as an exophytic papilloma and endoscopically resected the tumor. The tumor was diagnosed by postoperative histopathology as TL-LGNPPA. More than one year after surgery, there is no evidence of recurrence or metastasis.

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[in Japanese]

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