Introduction: The importance of transoral resection for hypopharyngeal carcinoma is increasing, but indications have not yet been established. This study was intended to help establish standard indications for transoral resection and additional therapy in patients with early hypopharyngeal carcinoma. Methods: A total of 52 lesions of Tis, T1 and T2 (any N, M0) hypopharyngeal carcinoma underwent surgery at the Cancer Institute Hospital between 2005 and 2011. We measured tumor thickness and checked lymph node metastasis (LNM), lymphatic invasion, venous invasion, and noted whether death was a result of the original cancer. We additionally examined correlations between each of these items. Results: A tumor thickness ≥2mm was associated with higher incidences of LNM. A tumor thickness ≥5mm was associated with higher incidences of death due to the original cancer. Disease-specific survival was significantly lower for tumors ≥5mm thick than for tumors <5mm thick. Conclusions: In early hypopharyngeal carcinoma, careful observation is necessary for tumors ≥2mm thick because of the higher risk of nodal metastasis. Patients with a tumor ≥5mm thick should consider elective neck dissection, because of the higher risk of death due to the original cancer. If there is a risk of penetrating pharyngeal and cervical wounds, partial pharyngectomy using an open method must be considered instead of transoral resection.
Educational Lecture Anatomy of deep neck spaces and deep neck infection
A-13-year-old female who underwent tonsillectomy and adenotomy at the age of eight came to our hospital because of snoring and sleep apnea. She underwent a lingual tonsillectomy using coblation. After the surgery, her complaints disappeared. Lingual tonsillectomy is rarely performed because of the risk of bleeding. Coblation has been reported to be both safe and minimally invasive for adenotonsillectomy both overseas and in Japan. We were able to conduct the current surgery using coblation without severe bleeding and think that coblation is a useful surgical technology for lingual tonsillectomies.
We retrospectively reviewed 26 cases of oropharyngeal cancer from 2003 to 2012. Advanced cases (Stage III and IV) accounted for 81%. Case in which TPF alternation chemoradiotherapy was indicated accounted for 16 of the 26 and the three-year overall survival rate was 75% and 68% in Stage III and IV, respectively. The disease free survival of TPF alternation chemoradiotherapy was 66.7%, and it is acceptable as one of the oropharyngeal cancer treatment methods.
A carcinosarcoma of the head and neck area having both carcinomatous and sarcomatous element is extremely rare. We report herein on the case of a 40-year-old woman with a carcinosarcoma of the right parotid gland. She had noticed enlargement of her right parotid gland from 20 years previously, but was not admitted to any hospital. After rapid enlargement of the tumor for a few months, she presented at our hospital. Enhanced computer tomography showed a 30 mm tumor containing caltification, and uptake of FDG-PET (SUVmax was 11.5). Fine-needle aspiration biopsy showed a class V tumor. We conducted a total right parotidectomy and radical right neck dissection for a malignant tumor. Histological examination showed carcinosarcoma, which contained ductal carcinoma as a cartinomatous component and osteosarcoma as a sarcomatous component. This tumor also contained an area like a pleomorphic adenoma, so it was thought to have arisen from the pleomorphic adenoma. Because this tumor is very malignant and has a high frequency of recurrence and metastasis, the patient underwent postoperative radiation therapy (60Gy). Despite achieving a negative surgical margin, metastasis was seen at the sacral spine at one year and 6 month after resection, so she underwent radiation theraphy of the spine (45Gy). She underwent chemotherapy at another hospital, but showed new metastasis. In the literature in Japan, carcinosarcoma of the head and neck area has been reported in 20 other cases. We discuss this tumor with a review of the literature.
The patient was a 32-years-old man who had been diagnosed as having with type 2 von Willebrand disease at 8 years of age. He was referred to our hospital with an unusual persistent sensation of pharyngeal and bilateral tonsillar swelling. We successfully performed a tonsillectomy using a coblation system, with little bleeding and minimal use of blood preparations. In this paper, we describe the use of blood preparations and the precautionary steps to be taken in cases of tonsillectomy for patients with hematopathy, which is likely to pose difficulty with hemostasis; we also include a description of the characteristics of coblation, a new surgical procedure that has recently been disseminated in Japan.
Oral ranula is a pseudocyst caused by the leakage of saliva from a sublingual gland. Various medical treatments are available including marsupialization, removal of the cyst and scleratization. If surgical treatment does not stop the saliva leakage, oral ranula will recur. If scar formation causes a change in the route of saliva leakage then ranula may recur in the form of a “plunging” ranula. I have experienced 139 ranula patients from 1993 to 2015. The types observed were 65 oral ranula, 61 plunging ranula and 13 combined oral/plunging ranula. Analysis of the history of these plunging and combined ranula patients shows that 15 cases (20.5%) had developed from oral ranula subsequent to surgery (mainly marsupialization).