[in Japanese]

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[in Japanese]

View full abstract

[in Japanese]

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[in Japanese]

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Fine-needle aspiration （FNA） of thyroid nodules is useful for distinguishing between malignant and benign nodules. However, this examination has problems with the rate of insufficient materials and the risk of complications. Previously, it was reported that a new device for FNA consisting of a vibrating linear resonant actuator improved the inadequacy rate while reducing the risk of complications. We have been using the new device since October 2022, and retrospectively examined the background of the cases, the inadequacy rate and the complications by comparing the results with those of our hospital’s conventional method.
We performed FNA on 227 nodules by this new method and 196 nodules by the conventional method from August 2021 to November 2023. The inadequacy rate of the new method was 10.6％ and that of the conventional method was 19.9％. The rate was improved, and the background of the cases between the new method and the conventional method had no difference. In addition, no significant complications were observed, demonstrating the usefulness of the new FNA device.

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Lacrimal gland cancer and lacrimal sac cancer are said to be relatively rare diseases. Of the 7 cases of lacrimal gland cancer and lacrimal sac cancer treated at our department over the 7 years from 2015 to 2022, chronic inflammation was suspected in all cases by a local ophthalmologist at the time of initial examination. Symptoms of early lacrimal gland cancer and lacrimal sac cancer are difficult to differentiate from chronic inflammation, and collaboration with other departments was considered necessary. In addition, metastasis to the same-side parotid gland lymph node was observed in 3 of the 7 patients. It is necessary to consider the possibility of metastasis to parotid gland lymph nodes when planning the surgery.

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We investigated 16 patients with p16-positive oropharyngeal squamous cell carcinomas in the lateral wall who received induction chemotherapy with docetaxel, cisplatin, and fluorouracil （TPF-ICT）, followed by simultaneous transoral resection combined with neck dissection. The following post-operative complications were observed in one patient each: bleeding, chylothorax, pneumonia, and velopharyngeal insufficiency. The 3-year loco-regional control, overall survival, and disease-free survival rates were 100％, 100％, and 92.9％, respectively. Post-operative pathological examinations revealed a positive surgical margin and extranodal extension in two patients and one patient, respectively. Of these three patients, two received chemoradiation and one radiation therapy. The remaining patients needed no post-operative （chemo） radiation therapy. These findings indicate that TPF-ICT, followed by transoral resection combined with neck dissection, can be performed safely. However, it is important to archive negative surgical margin tissue from the primary site and predict the pre-existing extranodal extension before treatment to avoid post-operative （chemo） radiation therapy.

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We conducted a retrospective analysis of 16 cases of malignant tumors originating from the submandibular gland, which were diagnosed and surgically managed at our department between April 2007 and July 2022. Among these cases, adenoid cystic carcinoma was the most common subtype with 7 cases, followed by carcinoma ex pleomorphic adenoma with 4 cases, and mucoepidermoid carcinoma with 2 cases. Eight cases were suspected or diagnosed as malignant by fine-needle aspiration cytology, 5 cases were classified as atypia of undetermined significance or uncertain malignant potential, and 3 cases were diagnosed as benign. Disease staging revealed 7 cases at stage Ⅰ, 3 cases at stage Ⅱ, 2 cases at stage Ⅲ, and 4 cases at stage Ⅳ. The 5-year overall survival rate was 87.1％, with clinical stage Ⅳ, primary stage T4, and cervical lymph node metastasis identified as poor prognostic factors. Recurrence in all cases was associated with a poor prognosis.

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The oropharynx plays an important role in swallowing and articulation. The tissue deficit that remains after the excision of a soft palate tumor has a high possibility of causing disorders of swallowing and articulation, necessitating reconstruction in most cases. Several reconstruction techniques are available, including local mucosal flaps, pedicled fat flaps, and free flaps; the optimal technique depends on the area of the deficit. Local mucosal flaps are the most noninvasive and desirable for patients of advanced age in whom surgical tolerance is of concern. We herein report three cases of local flap reconstruction for soft palate deficits using a buccinator myomucosal flap, a buccinator myomucosal flap with the Gehanno method, and a palatal flap. None of the patients experienced any problems after the operations. Our findings in these cases indicate the utility of the buccinator myomucosal flap and palatal flap as optimal choices for reconstruction of the soft palate.

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Solitary fibrous tumors （SFT） are rare soft tissue tumors that can occur throughout the body but are most commonly found in the chest cavity. SFTs are usually, but not always, benign. We report herein on a 76-year-old female who was diagnosed with a submucosal transglottic SFT. The patient presented with a complaint of hoarseness at a local hospital. An endoscopic examination of the throat revealed a submucosal transglottic tumor on the left side. A CT scan further revealed a 25-mm contrast-enhanced mass. The initial diagnosis was a paraganglioma tumor and the patient was subsequently referred to our department for further examination and surgery. The surgery was scheduled in February 20XX for June 20XX, however, over the course of the next two months, the tumor grew rapidly with breathing becoming difficult. Thus, surgery was performed in April 20XX. The procedure began with preoperative embolization of the feeding vessels with the upper end of the thyroid cartilage resected to provide a field of view. The tumor was removed in one piece and without complications. Postoperative pathology revealed diffuse proliferation of spindle-shaped tumor cells with the tumor positive for both CD34 and STAT6. These factors are all indicative of an SFT. Metastasis of an SFT is evaluated based on Demicco’s risk classification and this SFT was graded as 2, which is low risk. No recurrence has been found as of 8 months follow-up. Thus, despite the rarity of a mass in the submucosal transglottic area being an SFT, the possibility should be considered due to the need for early diagnosis and immediate surgery to prevent serious and potentially life-threatening complications.

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We experienced a congenital laryngeal web with 22q11.2 deletion, which caused dysphonia immediately after birth and required surgical intervention to open the airway. Laryngeal videoscope findings revealed that the anterior commissure and vocal cord cartilage were covered with a membrane, and the patient was barely breathing through the posterior commissure. We considered that it would be difficult to secure an emergency airway when breathing was difficult, so we decided to perform surgery. We resected the laryngeal web under general anesthesia and with videoscope assistance. An intubation tube was left in place for 3 days to prevent airway restenosis. Following extubation, the patient’s respiratory status remained good, with no restenosis. This surgery was a palliative procedure to secure the airway, and we considered that long-term follow-up was required because the residual web could narrow the airway or cause a speech impediment.

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We report a very rare case of primary clear cell carcinoma of the sphenoid sinus. When a 61-year-old male visited our department because of sleep apnea syndrome, he was discovered by chance to have a sphenoid sinus tumor. The tumor was diagnosed to be benign based on clinical findings, and endoscopic surgery was performed. We found no malignant findings by the rapid intraoperative pathological examination, but postoperative pathological examination including immunological staining showed extensive and highly expressed AE1 / AE3, EMA, and CAM5.2, but no myoepithelial or nerve traits. Since no expression of endocrine traits was observed, the patient was diagnosed with clear cell carcinoma. Since it was a malignant tumor, additional resection was performed, but no residual tumor was found. A CT scan confirmed that there was no renal tumor, and the patient was diagnosed with primary clear cell carcinoma. Three years have passed since the operation without recurrence. There are few reports about primary clear cell carcinoma of the paranasal sinus. This is the second case report of primary clear cell carcinoma of the sphenoid sinus.

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A 60-year-old woman, a housebound patient for COVID-19, visited her previous doctor because of a worsening sore throat. A simple CT showed swelling around the left tonsil with gas shadows, and so she was transferred to our hospital during the night for a close examination and treatment for a suspected left peritonsillar abscess. At admission, a video endoscopy of the larynx showed blood accumulation in the hypopharynx and swelling from the left tonsil to the lateral pharynx. Antibiotic therapy was started, but active bleeding was observed in the oral cavity the next day. Contrast-enhanced CT showed a pseudoaneurysm at a branch of the external carotid artery running into the abscess cavity, which was thought to be involved in the bleeding. We planned to perform an emergency tracheostomy and interventional radiology. However, airway obstruction occurred prior to surgery, and patient was secured through an immediate cricothyrotomy. After that, emergency IVR was performed, and bleeding from a pseudoaneurysm of the tonsillar branch of the left facial artery was suspected. Embolization was performed and the bleeding was controlled and recovered. In cases of active bleeding from the pharynx, we should suspect the presence of a pseudoaneurysm and immediately secure the airway.

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Verruca vulgaris are keratotic lesions and are caused by human papillomavirus infection.
The present case was a man in his 50s. We found a tumor on his left vocal cord. We biopsied the tumor under general anesthesia, and considered it was likely to be verrucous carcinoma. We decided to surgically resect it under general anesthesia again. We removed it surgically using a direct laryngoscope and finally diagnosed it as a verruca vulgaris.
Laryngeal papilloma and oropharyngeal squamous cell carcinoma are well known as head and neck tumors associated with HPV infection. Verruca vulgaris usually arise from the skin and very rarely from mucous membranes.
In this case, no tumor recurrence was observed after surgical resection, but there has been one case of repeated recurrence and a final laryngectomy. Since verruca vulgaris are benign, we do not consider that wide excision is necessary. However, it is necessary to carefully determine the extent of resection so that no tumor remains.

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Deep neck abscess is a severe disease that requires intensive treatment immediately. The abscess is often caused by dental or tonsil infection, and rarely occurs due to infection of hematoma caused by blunt trauma. Recently, a few cases have been reported in otorhinolaryngology and head and neck surgery. We present a case of deep neck abscess that occurred after infection of hematoma caused by blunt trauma due to javelin-throwing. A 15-year-old male student with a history of swelling and pain in the right neck presented to the Department of Orthopedic Surgery of our hospital. His friend had thrown a practice javelin at the patient from behind, which injured his right rear neck. He was treated for contusion, but was referred to the Department of Otorhinolaryngology - Head and Neck Surgery due to persistent neck swelling. Echo and contrast-enhanced CT revealed findings suggestive of hematoma deep below the right common carotid artery and internal jugular vein. Medication treatment with steroids and antibiotics was performed, and temporary improvement was observed. However, the swelling and pain in the neck worsened again. Blood examination revealed elevated neutrophils and CRP, and contrast-enhanced CT showed that a mass with ring enhancement in the right neck had become larger. Because of these results, we diagnosed deep neck abscess from hematoma. Under general anesthesia, surgery and drainage were performed. After surgical treatment, he subsequently recovered without recurrence. There are few reports of deep neck abscess caused by post-blunt trauma hematoma. If the treatment is delayed, the patient’s condition may become more serious. It is necessary to consider the possibility of abscess formation when treating persistent neck swelling and pain after blunt trauma.

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Surgical indications for nasopharyngeal carcinoma are limited, and dealing with recurrent cases is often challenging. We experienced a case of nasopharyngeal cancer recurrence in the nasal sinuses after chemoradiotherapy, in which the lesion was completely removed by two transnasal endoscopic procedures. The patient was a 50-year-old man. He was diagnosed with T2N2M0 nasopharyngeal carcinoma on the left posteriosuperior wall and was treated by chemoradiotherapy with CDDP. Nine months after the treatment, a grossly recurrent lesion was found in the left nasal cavity. Since no intracranial or intraorbital extension was observed, the lesion was considered resectable and a transnasal endoscopic surgery was performed. Four months after the surgery, a small recurrent lesion was found, and an additional endoscopic resection was performed. Surgical margins of the specimen from the additional resection were negative, and no recurrence was observed for 18 months after the second surgery. Neither cranial or orbital complication was experienced, and minimally invasive treatments were achieved.

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Marine-Lenhart syndrome consists of coexisting Basedow’s and Plummer’s diseases. Here, we report a case of Marine-Lenhart syndrome, in which hyperthyroidism was detected during the follow-up of a thyroid tumor, and the diagnosis was made based on scintigraphy findings.
A 69-year-old woman had been diagnosed with a left thyroid tumor more than 20 years ago. Because cytological examination suggested a benign tumor, surgical removal was not performed. She was diagnosed with hyperthyroidism by a local family doctor, and was referred to our department for further examination. TRAb was positive, and CT and echography showed a substantial mass with a maximum diameter of 32 mm in the left lobe of the thyroid gland. I¹²³ scintigraphy showed an accumulation in the left lobe tumor, and weak but diffuse accumulation in other lesions of the thyroid glands. Based on these findings, she was diagnosed with Marine-Lenhart syndrome. The patient was treated with total thyroidectomy, and no malignant findings were observed.

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Medication-related osteonecrosis of the jaw （MRONJ） is a known severe complication of using bone-modifying agents. This report describes two cases of MRONJ-induced severe otorhinolaryngological infection. Case 1: MRONJ-induced neck abscess and descending necrotizing mediastinitis. Drainage was performed through the cervical and thoracoscopic approaches; subsequently, the patient recovered and was able to resume oral food intake. Case 2: MRONJ-induced skull base osteomyelitis and inflammation attenuated by long-term antibiotic use. Treatment strategies for MRONJ-induced severe otorhinolaryngological infections vary considerably depending on the areas affected; therefore, appropriate medical and dental consultation is critical for selecting the treatment most appropriate for individual patients and their general condition.

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Chimeric antigen receptor （CAR） T cell therapy is an innovative treatment for hematologic malignancies. Major adverse events associated with CAR-T cell therapy include cytokine release syndrome （CRS） and central nervous system toxicity. Common symptoms of CRS encompass fever, hypotension, disseminated intravascular coagulation syndrome, hemophagocytic syndrome, and acute respiratory distress syndrome. While there have been limited reports of laryngeal edema resulting from CRS, it is crucial to note that laryngeal edema can pose a risk of choking for patients. In this context, we present two cases of laryngeal edema following CAR-T cell therapy.

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We describe a case of anaplastic thyroid carcinoma （ATC） who had a tracheoesophageal fistula and post-gastrostomy wound problem during lenvatinib treatment. A 48-year-old male presented to us with the chief complaint of dyspnea and dysphagia. CT revealed a bulky thyroid tumor invading the trachea, left wall of the cricoid cartilage, and anterior wall of the esophagus. An emergency tracheostomy following tissue biopsy was performed, resulting in a pathological diagnosis of ATC. Because of prominent tumor invasion, the surgical removal seemed to have a risk of severe complications, so lenvatinib therapy was started after building the gastrostoma tube. Lenvatinib administration rapidly decreased the tumor volume, causing a tissue defect at the tracheal wall and the esophageal wall, finally resulting in a tracheoesophageal fistula. Additionally, leakage from the side of the gastrostomy tube occurred because of wound healing disorder of the gastrostomy site. To treat these complications, drug suspension and dose reduction were decided. Severe aspiration pneumonitis happened about five months after commencing lenvatinib administration, resulting in patient death. Lenvatinib has specific complications, especially in the wound healing process, attributable to the anti-VEGF function. When using lenvatinib, care is required regarding the appearance of complications.

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Tracheal end-to-end anastomosis is a reconstruction procedure after tracheal resection due to injury, stenosis, or malignant tumor. There is a risk of complications such as recurrent nerve palsy in addition to anastomotic stenosis and suture failure.
Nerve integrity monitoring is useful for intraoperative recurrent nerve monitoring, but signal errors can occur due to misalignment of the electrodes. In such cases, a method of directly sensing the movement of the posterior cricothyroid muscle by inserting a finger into the dorsal surface of the hypopharynx （laryngeal twitch method） has been used to confirm the function of the recurrent nerve.
We performed tracheal end-to-end anastomosis for tracheal stenosis after tracheostomy. We report the effectiveness of the laryngeal twitch method in preserving the function of the recurrent nerve.

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