一般的に喉頭・下咽頭の CO₂ レーザー手術は, 経口的に直達喉頭鏡を挿入し, 顕微鏡下に手術操作を行う Transoral CO₂ Laser Microsurgery (TLM) という手法で施行される場合が多い。 当科における喉頭乳頭腫症例の検討では, 単発型乳頭腫症例の術後再発率より多発型乳頭腫症例の再発率が有意に高かった。 最近の手術手技は, 腫瘍のレーザー蒸散よりも上皮を含めたレーザー切除術を推奨している。 その根拠として, 早期声門癌に対する TLM では腫瘍の蒸散術から腫瘍切除術へと手術手技を変えることで有意な局所制御率の改善が得られた事実がある。 早期下咽頭癌についても TLM による粘膜切除術または粘膜切除術後に (化学) 放射線療法を追加することで良好な治療成績が得られている。 さらに, 本稿では TLM による両側声帯麻痺に対する披裂軟骨 CO₂ レーザー切除術のポイント, TLM による輪状咽頭筋切除術の術式のポイント, 喉頭部分切除または喉頭亜全摘出術時のマーキングとしての CO₂ レーザーの応用について解説した。

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　静脈性嗅覚検査 (アリナミンテスト) は嗅覚障害の予後判定として有効な検査法といわれており, アリナミンテストに反応のない例は嗅覚障害が高度で予後不良なことが多いとされている。 しかし, アリナミンテストに反応のない例でも治療により嗅覚が改善する例もしばしば経験する。 そこで今回, アリナミンテストに反応しない嗅覚障害例を, 治療により改善した群と改善しなかった群に分類して統計学的解析を行った。 その結果, 障害早期に受診し基準嗅力検査の検知域値と日常のにおいアンケートの合計点が良ければ, 予後良好な例があることがわかった。 また, アリナミンテストのみで評価を行っている施設においても早期受診した場合, 特に感冒後は改善する場合があり, 諦めずに治療を施行する意義があると考えた。

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　外リンパ瘻は, 明らかな原因や誘因がない症例では診断に苦慮することがある。 治療までの期間が短いほど聴力改善度が高いことが知られており, 早期診断は予後を左右する。 しかし, 診断に有用な検査の一つである瘻孔症状は全例が陽性となるわけではなく, 外リンパ液に特異的な蛋白である CTP (cochlin tomoprotein) の検出は非常に有用だが検査時間の問題がある。 今回我々は, 厚生中央病院耳鼻咽喉科で2010年1月から2012年10月までの間に, 試験的鼓室開放術を行い外リンパ瘻と診断した9症例を誘因の有無で比較し診断方法について検討した。
　誘因が明らかな例は5例, 誘因が明らかでない例は4例であった。 誘因は鼻かみ2例, 潜水1例, 耳かき1例, 力み1例であった。 術後は全症例で聴力は改善した。 術前は7例で患側向き眼振があった。 術後, 眼振は全例で1ヵ月以内に消失し, めまい感は消失した。
　外リンパ瘻は外リンパ液漏出の程度やタイミングによって症状, 検査所見が変化することがあり, 診断に難渋する場合がある。 そのため, 積極的な問診や詳細な診察を繰り返し行うことが非常に重要である。 今回の検討では, 患側耳向き眼振の持続が外リンパ瘻の眼振所見の特徴と考えられた。

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　We are now able to record non-microscopic surgical views inexpensively and easily by using full high-definition video (FHDV) recording equipment for family use. On the other hand, FHDV recording of microscopic surgical views is not easy, when compared with the non-microscopic surgical views recording, because it is necessary to record a microscopic surgical view through a camera which is connected to a microscope and there is little information about how to connect a camera and a microscope. Additionally, there are many standards of FHDV and those connections. Herein we report on our experience in trying to introduce FHDV recording systems for two surgical microscopes.

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　The use of high-definition (HD) cameras and monitors during surgery can provide the surgeon and operating team with more than twice the resolution of standard definition (SD) systems. Although this improvement in visualization offers numerous advantages, the adoption of HD cameras in the operating room can be challenging because new recording equipment must be purchased, and several new technologies are required to edit video. We reported our recording and editing HD video system during surgery in various regions of otolaryngology.

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　Diffusion-weighted imaging (DWI) provides surgeons with a superior imaging tool to more accurately diagnosis cholesteatoma which are to be treated using transcanal endoscopic ear surgery (TEES). Two different DWI techniques are currently in use: non-echo planar (non-EPI) and echo planar (EPI) DWI. In the comparison of preoperative evaluation for cholesteatoma and intraoperative findings by non-EPI DWI and EPI DWI, both positive predictive value (PPV) and negative predictive value (NPV) of non-EPI DWI were high. PPV of EPI DWI was high, however NPV of EPI DWI was low. Therefore, non-EPI DWI is more reliable in identifying cholesteatomas than EPI DWI. Non-EPI DWI can be even further enhanced by the incorporation of MR cisternography (MRC). We combined a 1-mm thin slice non-EPI DWI with MRC and performed color mapping to enhance the visualization of the cholesteatoma by this color mapped fusion imaging (CMFI). Both PPV and NPV were high in the comparison of the preoperative evaluation for cholesteatomas and intraoperative findings. We found that CMFI is a reliable tool for preoperative evaluation of the anatomical location of a cholesteatoma and to determine whether a patient is indicated for TEES to treat cholesteatomas.

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　Introduction: Transoral robotic surgery (TORS) for head and neck cancer treatment is not approved in Japan. We have stared TORS as a clinical trial from August 2011. We presented the result of simulation surgery previously. But larynx and hypopharynx couldn't be exposed adequately because of instrument limitation. In June 2013, a new FKWO retractor become available.
　Aim: We attempted whether larynx and hypopharynx could be exposed and whether 8mm EndoWrist could be handled smoothly in these areas.
　Results: We were able to clearly expose these areas. However the movement of EndoWrist was limited at lateral side of hypopharynx and ventral side of larynx.
　Conclusion: The exposure of TORS was improved but cases of larynxand hypopharynx should carefully be selected.

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　Computer programing for the navigation image analysis was made. We can get the information about that when we use the navigation system during the operation to check the image outputted from navigation system. But this method took a lot of time. So we tried to make such a computer program to analyze the navigation usage timing during the operation. We think that it is useful also as a tool of an operation educational program for the way person of an initial level operator.

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　Brainlab introduces the latest technology with 3 new devices. Brainlab is specialized in surgical navigation system however aiming to provide total medical imaging services using various devices including iPad/iPhone etc. BUZZ provides network hub function for medical imaging in the hospital. QUENTRY CLOUD SOLUSTION provides information sharing among multiple group over the hospital or department. KICK provides improved performance as compact navigation platform.

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　Nasolacrimal duct obstruction used to be treated with extranasal dacryocystorhinostomy before, but nasal endoscopic dacryocystorhinostomy has recently become more common due to the development of nasal endoscopy. We report a 41-year-old man of nasolacrimal duct obstruction secondary to sarcoidosis. Epiphora in both eyes developed and endoscopic-dacryocystorhinostomy was performed to both sides. His nasal cavity was deformed and the mucous membrane was hypertrophic. We used the navigation system and 25G light guide to establish orientation. A 2.5mm diamond bur was used for dacryocystorhinostomy. A Nunchaku-type silicon tube was inserted successfully in the left side, but was inserted only half way in the right side. The left and right tubes were removed a month and 3 months after surgery. The symptom of the left eye disappeared after one and a half year but the symptom of the right eye remained.

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　We used the Sonopet^® ultrasonic bone aspirator for endoscopic sinonasal surgery, including septoplasty (one case), dacryocystorhinostomy (five cases) and surgery for maxillary sinus mucocele (one case). The insertion and maneuverability of the tip of the Sonopet^® in the sinonasal cavities were satisfactory. Bone fragmentation was smooth, gradual and limited on the contact area of the thin tip. Mechanical damage of mucosa and nearby structures was not observed. The Sonopet^® is expected to use as the substitute of the standard surgical drills for sinonasal bone drilling applications.

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