[in Japanese]

View full abstract

[in Japanese]

View full abstract

The objective of this study was to evaluate the outcomes of thyroid tumor treatments conducted at our hospital. From April 2014 to March 2024, our department conducted 768 thyroidectomies: 502 benign and 266 malignant. Since introducing video-assisted neck surgery （VANS） in August 2021, we have performed 88 thyroidectomies using this method to March 2024. Hemithyroidectomy for benign tumors averages 101 minutes using the conventional open method and 150 minutes with the VANS method. The rate of postoperative bleeding was 2.4％ for conventional open thyroidectomy and 1.1％ for the VANS method. Postoperative transient recurrent laryngeal nerve paralysis was observed in approximately 4.8％ of cases following conventional open thyroidectomy and 6.5％ of cases using the VANS method. Permanent recurrent laryngeal nerve paralysis occurred in 2.2％ of cases with conventional open thyroidectomy and 1.1％ of cases with the VANS method. The VANS method took longer compared to conventional open thyroidectomy, but it had similar complication rates and demonstrated safety. For malignant tumors, the rates of complications and recurrence were consistent with previous studies. These results confirm the safety and efficacy of thyroid tumor treatment at our hospital.

View full abstract

HPV-related oropharyngeal cancer is considered to have a better prognosis and higher efficacy of chemoradiotherapy （CRT） than HPV-unrelated oropharyngeal cancer. On the other hand, in recent years, transoral robotic surgery （TORS） has been covered by health insurance in Japan and is considered a good indication for T1/T2 oropharyngeal cancer without extranodal extension. Since HPV-related oropharyngeal cancer often occurs in young people, it is believed that radiotherapy should be avoided or conserved as much as possible. However, although the usefulness of transoral resection for patients with early-stage oropharyngeal cancer has been reported, there are not enough data in Japan comparing it with radiotherapy or chemoradiotherapy. Therefore, it is difficult to decide on a treatment plan for patients with early-stage HPV-related local oropharyngeal cancer, and whether to choose transoral surgery or CRT. In our department, we have developed and performed transoral videolaryngoscopic surgery （TOVS）, a non-robotic transoral surgery, as a minimally invasive surgery for early-stage local laryngopharyngeal cancer. Therefore, we conducted a retrospective chart review of cases of early-stage HPV-related oropharyngeal cancer treated with TOVS or CRT at our institution.
This study retrospectively analyzed 29 patients who underwent either TOVS or CRT as initial treatment （18 in the TOVS group and 11 in the CRT group）, evaluating treatment outcomes, complications, post-treatment laryngeal function, and positive surgical margins in the TOVS group.
At the 3-year mark, both groups demonstrated 100％ overall survival, disease-specific survival and local control. No patients experienced major complications or disabling dysphagia. While positive surgical margins were observed in 3 TOVS cases （16.7％）, all were in the anterior wall.
TOVS was associated with good outcomes and 72％ of patients in this study were able to preserve radiotherapy. In cases of anterior wall, it is possible to avoid or preserve radiation therapy by setting an adequate resection range.

View full abstract

This study reviewed the surgical approaches and safety outcomes in six cases of sternotomy performed at the Department of Otolaryngology and Head and Neck Surgery, University of Tokyo Hospital, over a three-year period from January 2021 to December 2023. The histopathological diagnoses included papillary thyroid carcinoma in five cases and squamous cell carcinoma in one case. Four lesions were in contact with the superior surface of the brachiocephalic vein, one was positioned dorsal to the brachiocephalic vein, and one case exhibited invasion into the venous angle. An L-shaped sternal incision was made at the first intercostal space after dissecting the sternothyroid muscle from the posterior surface of the sternum. A transmanubrial approach （TMA） was added in one case involving lesions extending around the venous angle. No postoperative complications, including sternotomy-related infections or functional impairments, were observed. This study suggests that a comprehensive understanding of sternal anatomy enables sternotomy to be performed safely by head and neck surgeons.

View full abstract

Relapsing polychondritis is a chronic and recurrent inflammatory disease that is specific to cartilage tissues throughout the body. We report a case of relapsing polychondritis localized in the airway. A 72-year-old woman presented to the emergency department with persistent pharyngeal pain, hoarseness, and dyspnea for the past month, and started receiving treatment for acute laryngitis. The patient’s condition was once relieved, but repeatedly worsened and went into remission. Therefore, a tracheotomy and biopsy of the larynx and tracheal cartilage were performed, and a diagnosis of recurrent polychondritis was made based on histopathological examination. The patient was treated with corticosteroids and immunosuppressive drugs at the department of immunology. 22 months have passed since the onset of the disease, and the patient has been doing well without any recurrence.

View full abstract

Warthin tumor, along with pleomorphic adenoma, is a typical benign parotid tumor. During operation, it is essential to preserve the facial nerve. In the present case, the facial nerve was found to be significantly adhered to the tumor, leading to suspicion of malignancy based on intraoperative findings. The patient was a 40-year-old woman who had been aware of a parotid mass for the past 8 years. She had not experienced any swelling or pain from the time the mass was first noticed until the initial visit. There were no clinical symptoms or imaging findings suggesting malignancy. Fine-needle aspiration cytology revealed a diagnosis of pleomorphic adenoma. Surgery was planned for treatment. Intraoperative findings showed that the mandibular branch of the facial nerve was involved in the tumor, making preservation difficult. For this reason, it was necessary to resect the tumor along with the affected branch of the facial nerve. Final pathology revealed a diagnosis of Warthin tumor. Differentiation from mucoepidermoid carcinoma with tumor-associated lymphoid proliferation was necessary; however, the evaluation results were negative for mucoepidermoid carcinoma. The tumor was surrounded by inflammatory scar tissue, and the nerve ran within the scar. It is known that Warthin tumor is more frequently associated with inflammation than other histological types. Warthin tumor with inflammation can be challenging to differentiate from malignancy. Therefore, it is important to keep in mind that nerve preservation may be difficult in such cases. It should be explained preoperatively that preservation of the facial nerve may be difficult in rare cases, even with benign parotid tumors.

View full abstract

A 65-year-old man was referred to our hospital as an emergency case due to severe posterior neck pain and dysphagia which appeared 6 months after a diagnosis of right acute dacryocystitis. The patient was diagnosed with prevertebral abscess, posterior cervical abscess, and spinal epidural abscess due to the spread of sinusitis triggered by a tumor in the right nasal cavity. In addition to antibiotic therapy, a posterior pharyngeal wall incision was performed to drain the prevertebral abscess, and CT-guided drainage was performed for the posterior cervical and spinal epidural abscesses, and finally the abscesses were cured. The nasal cavity tumor was diagnosed as cT4bN0M0, Stage ⅣB nasal neuroendocrine carcinoma by biopsy and image examination, and the patient was treated with proton beam therapy with cisplatin and is now under follow-up observation without recurrence. Neuroendocrine carcinoma is treated similarly to small cell carcinoma of the lung. There have been no reports of spinal epidural abscesses derived from sinonasal diseases. We report here a rare case of neuroendocrine carcinomas accompanied with deep neck abscesses, with a review of the literature.

View full abstract

Eyelid sebaceous carcinoma is a rare tumor that originates from the sebaceous glands of the eyelids and is more likely to occur in the elderly. It is known that metastases to regional lymph nodes such as parotid lymph nodes and/or cervical lymph nodes are relatively common.
We retrospectively reviewed 10 patients with eyelid sebaceous carcinoma with delayed metastases to the parotid and/or cervical lymph nodes who underwent surgery at our department. Site distribution of lymph node metastasis was 8 cases with parotid lymph node metastasis only, and 2 cases with both parotid and cervical lymph node metastases. Regarding treatment, both parotid surgery and neck dissection should be considered. In this study, total parotidectomy and neck dissection （Level Ⅰ-Ⅴ） was performed in a majority of the cases （6 cases）. The 1-year disease-free survival rate was 48％, and the 5-year overall survival rate was 83％. Superficial cervical lymph node dissection should also be considered. Postoperative irradiation was performed in only one case. Postoperative pathological examination revealed no Level Ⅲ-Ⅴ lymph node metastasis, suggesting that level Ⅳ and Ⅴ lymph node dissection may be omitted in cases of parotid lymph node metastasis only.

View full abstract

We report a case of radiation-induced myxofibrosarcoma arising after chemoradiotherapy for maxillary sinus carcinoma. The patient was a 55-year-old man. In 20XX, he underwent maxillary sinus opening and chemoradiotherapy for squamous cell carcinoma T3N0M0 of the left maxillary sinus. In 20XX＋14, he returned to our hospital because of symptoms of left buccal discomfort, swelling around the left zygomatic region, and left nasal bleeding. Preoperative biopsy revealed spindle-shaped to stellate atypical cell proliferation with abundant capillaries on the background of myxomatous matrix. Based on these findings, the pathological diagnosis was myxofibrosarcoma, FNCLCC score 4 points, Grade 2. As a curative treatment, he underwent an extended maxillectomy with craniotomy and reconstruction with a free rectus abdominis muscle flap. Currently, more than 5 years have passed since surgery, and there has been no recurrence of the disease.

View full abstract

Malignant melanoma is a tumor originating from melanocytes found in the skin and mucosa, and it is relatively rare in the head and neck region. In particular, cases arising in the parotid gland are extremely rare worldwide. We report a case of amelanotic malignant melanoma arising in the parotid gland.
A 72-year-old woman presented with a history of swelling in the preauricular region for six months. A 4-cm fixed mass was palpated in the left cheek, but facial nerve palsy was absent. Fine-needle aspiration cytology suggested a Class 5 adenocarcinoma, and the patient was referred to our hospital for surgical treatment. Contrast-enhanced CT and contrast-enhanced MRI revealed a 35-mm partially ill-defined mass with enhancement in the superficial lobe of the left parotid gland. The patient was diagnosed with stage IV parotid gland carcinoma （cT3N2bM0） and underwent extended total parotidectomy （middle cranial fossa resection）, left radical neck dissection, free rectus abdominis musculocutaneous flap reconstruction, and peroneal nerve reconstruction. Pathological examination confirmed the diagnosis of amelanotic malignant melanoma. To exclude the possibility of parotid gland metastasis from a primary melanoma in another organ, a comprehensive examination was performed, including the ear, nose, and throat region, head and neck skin, fundus and eyeball, and panendoscopy, but no primary site was found. Adjuvant therapy with dabrafenib and trametinib combination therapy was administered for one year, and there has been no evidence of recurrence. Given the favorable outcome after treatment, we report this case with a brief literature review.

View full abstract

Preoperative localization evaluation is important in surgery for parathyroid tumors; however, accurate evaluation can sometimes be challenging. We report here a case in which pde-neo® was useful in localizing a parathyroid tumor in the thyroid gland. The patient was a woman in her 70s who presented with hypercalcemia and suspected primary hyperparathyroidism. Blood tests showed serum intact parathyroid hormone （PTH） of 183.5pg/mL and calcium of 11.3mg/dL. Ultrasonography and computed tomography scan detected a 7mm-sized mass on the lateral side of the right lobe of the thyroid gland. ^99m Tc-MIBI scintigraphy showed residual accumulation on the right side of the neck in the late phase. From these test results, we concluded that the patient had primary hyperparathyroidism caused by the right parathyroid tumor, and subsequently the tumor was resected. Frozen section diagnosis revealed that the mass was suspected to be a schwannoma instead of a parathyroid tumor. Parathyroid tumor could not be detected around the perithyroid area. According to the findings of ^99m Tc-MIBI scintigraphy, the right lobe of the thyroid gland was resected in consideration of the possibility of its intra-thyroidal location. Grossly, no parathyroid tumor could be identified in the right lobe of the thyroid gland; however, a luminescent area was observed on the back surface of the thyroid gland by pde-neo®. Permanent histopathological examination confirmed a parathyroid adenoma consistent with the luminescent area. Postoperatively, the level of serum intact PTH and calcium was improved. In this case, preoperative localization evaluation was incorrectly assessed because the parathyroid adenoma was located in the thyroid gland and also coexisted with a schwannoma. However, pde-neo® enabled detection of the location of the parathyroid adenoma intraoperatively.

View full abstract

A 43-year-old male patient presented with erythema and swelling in the right posterior neck, accompanied by purulent discharge and bleeding from a hair follicle, raising suspicion of necrotizing soft tissue infection （NSTI）. Extensive necrosis was observed from the epidermis to the muscle layer, and thorough debridement was performed, successfully controlling the local infection. To address the resultant skin defect in the posterior neck, reconstructive surgery was conducted using a rotational flap and split-thickness skin graft postoperatively. The patient was discharged without any subjective functional impairment. NSTI involving the posterior neck is rare, and we report this unusual case. Since the lesion was localized to the posterior neck and occipital region, aggressive debridement could be performed during the initial surgery, which was considered crucial for the patient’s survival.

View full abstract