[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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Malignant tumors of the parotid gland are classified into various histological types, and their prognosis is significantly affected by the histological grade of malignancy, but preoperative evaluation of their grade is generally difficult. To improve the accuracy of preoperative pathological diagnosis, we have used core needle biopsy in cases in which there was suspicion suspected of a malignant tumor based on the clinical manifestations and imaging findings, including by dynamic MRI and ultrasonography. Extended total parotidectomy that included the sacrifice of the facial nerve followed by immediate nerve grafting was chosen in cases diagnosed as high-grade tumors. During the l0-year period from January 1996 to December in 2005, 49 cases of parotid gland cancer were treated at Chiba University Hospital. The accuracy of core needle biopsy and survival rates were assessed according to grade of histological malignancy and clinical stage. The accuracy of core needle biopsy (21 cases) was 95% (20/21) for malignancy, 76% (16/21) for histological malignancy grade, and 67% (14/21) for pathological diagnosis. According to clinical stage, the 5-years survival rate was 100% for stage I, 66.7% for stage II, and 54.5% for stage IV. According to histological grade, the 5-year survival rate was 100% for low/intermediate grade lesions and 61.5% for high grade lesions. Accurate preoperative diagnosis and consideration of histological grade are very important to the management of parotid gland cancer.
We also describe our unique procedure for extended total parotidectomy.

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Generally, cystic disease around the parotid gland is relatively rare in the salivary gland. We have found almost no report on cystic disease developed primarily in the parotid duct. In this report, we describe the case of a patient who visited us complaining of tumor formation in the anterior ear, and was diagnosed with branchiogenic cyst as the result of an operation.

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Renal metastasis originating from metachronous development of hypopharyngeal and esophageal cancer is reported. A 60-year-old man had received pharyngolaryngectomy for hypopharyngeal cancer in 2003. He had stomachache in 2005 and a right renal tumor was found with CT and MRI. Percutaneous needle biopsy was performed and histological results showed squamous cell carcinoma. At the same time, squamous cell carcinoma was detected in the esophagus. He had chemotherapy but it was ineffective. This case was thought to be a rare case of metastatic renal cancer arising from multiple primary cancers.

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There have been 14 case reports of calcific tendinitis of the longus colli tendon in Japan. All were conservatively treated, and on cases of surgical treatment have been reported. We report a case of calcific tendinitis of the longus colli tendon in which the calcified lesion was surgically removed. A 63-year-old female was referred to our department because of odynophagia. The results of the physical examination, plain radiography of the neck, CT, and blood examination suggested calcific tendinitis of the longus colli tendon. Her odynophagia persisted during a 3-month observation period, and the calcified lesion was surgically removed at her request. The composition of the surgical specimen was 84% calcium carbonate and 16% calcium phosphate. The postoperative course was uneventful, and the odynophagia completely resolved.

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The incidence of postoperative bleeding after tonsillectomy is relatively high on the day of operation and at about one week postoperatively. In some critical pathways, patients are discharged within one week following their operation. However, the appropriateness of such postoperative management may be questionable, even if patients are provided a thorough explanation and written instructions on the possible bleeding that can occur after discharge. Immediate treatment cannot be administered if postoperative bleeding occurs in a non-hospitalized setting, and in the case of an unfortunate event, the state of bleeding, measures taken by the patient and his or her family, and the course of illness are difficult to later demonstrate. For these reasons, early discharge cannot be said to benefit the patient. Against this backdrop, we report on some post-tonsillectomy cases at our hospital.

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We investigated the treatment of adults with sleep-disordered breathing (SDB). Literally, SDB means sleep disorder and breathing disorder. For diagnosis of sleep disorder, polysomnography (PSG) is indispensable and formal examination is necessary to the diagnosis of breathing disorder. The main points of formal examination are (1) low level soft palate (2) falling of lingual back (3) tonsiller hypertrophy, and (4) small jaw and retreat of mandibular position. The choice of treatments for breathing disorder are decided by results of PSG, formal examination, patient's age, and previous disease. Add treatment of sleep disorder, and the treatment of SDB is completed. This method is useful for the improvement of the results of SDB treatment, in our hospital, and includies continuous positive airway pressure (CPAP), oral appliance, and pharyngeal surgery. In SDB treatment, the role of the otorhinolaryngologist, who can make a formal examination easily and correctly, is very important.

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The treatment areas covered within the specialty of dentistry and oral surgery are generally defined as “places affecting the lips, buccal mucosa, superior and inferior alveoli, hard palate, anterior 2/3 of tongue, floor of mouth, soft palate, jaw bone (including mandibular joint), and salivary glands (excluding parotid gland).”
However, the regulations for these dentistry and oral surgery treatment areas have no legally binding authority, and so the fact is that today dentistry and oral surgery departments and clinics overtly conduct medical practice in the neck and head regions.
We conducted a questionnaire survey of 120 fifth-year students in the Aichi Gakuin University School of Dentistry on medical practices in the oral and pharyngeal regions.
The questionnaire was focused on the following four items:
1. The area of medical care covered by the specialty of dentistry and oral surgery
2. Is the palatine tonsil an area to be treated in dentistry and oral surgery?
3. The treatment of dysphagia (aspiration)
4. The treatment of obstructive sleep apnea syndrome (OSAS)
The following results were obtained:
1. The currently defined range of medical care in the specialty of dentistry and oral surgery was considered to be “an appropriate range” by 69.2% of respondents, and “too narrow” by 23.3% of students.
2. With regard to the palatine tonsil, 50.0% were of the opinion that “it should be treated in some cases, ” and 25.8% that it is “subject to treatment” in the field.
3. With regard to the treatment of dysphagia, 57.5% thought that “involvement should be focused on oral care, ” and 37.5% that “involvement should be by the team leader.”
4. In the treatment of OSAS, 82.5% thought that “they should be involved in mild cases in which oral appliances are effective.”
These results are reported with some consideration of the literature.

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Periodic limb movements in sleep (PLMS) and obstructive sleep apnea syndrome (OSAS) are common sleep disorders. PLMS is frequently associated with restless legs syndrome (RLS). Ninety-three consecutive patients with suspected OSAS who underwent polysomnography (PSG) from November 2006 until May 2007 at the department of Otorhinolaryngology at Juntendo University School of Medicine were analyzed. Among them, 4 patients (4.3%) had PLMS associated with electroencephalographic arousal and needed medical therapy (clonazepam). Two of the PLMS patients had already used continuous positive airway pressure (CPAP) for moderate to severe OSAS but their CPAP usage of>4 hours per night was 42.9% associated with PLMS. The Epworth Sleepiness Scale (ESS) and CPAP usage were compared before and after medical treatment. All PLMS patients also had RLS, and clonazepam was effective in reducing ESS and symptoms of RLS and in improving sleep quality and subjective sleepiness. CPAP usage showed significant augmentation to 76.4% in 2 CPAP-treated patients. PLMS is a common finding in OSAS and it may become evident or increase in CPAP therapy. The association of OSAS and PLMS has been reported in the literature for many years within sleep medicine. This report reminds us of the importance of all PSG indices.

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Introduction-In Japan, continuous positive airway pressure (CPAP) treatment is indicated for the patients with moderate to severe obstructive sleep apnea-hypopnea syndrome (OSAHS) after having the polysomnography (PSG) done, in cases of the apnea-hypopnea index (AHI) indicating 20 and more. However, even the patients with mild OSAHS (AHI<15) occasionally feel excessive daytime sleepiness (EDS) and may need CPAP. In the present study we investigated the difference in the sleep parameters and symptoms between patients with AHI>20 and patients with AHI<20.
Methods-Twenty-nine patients with mild to moderate OSAHS took part in this study. Fifteen of 29 patients had AHI 10-20 (relatively mild; RM) and 14 had AHI 20-30 (relatively severe; RS). The Epworth sleepiness scale (ESS) as a subjective symptom and arousal index (ARI) and sleep architecture (SA) as objective parameters were cpmpared statistically between the RM and RS groups.
Results-The mean ESS scores were 6.3+/-3.3 in the RM group and 7.2+/-3.1 in the RS group. The mean ARI was 24.6+/-13.6 in RM and 22.7+/-12.0 in RS. The mean percentage of the sleep stage 3, 4, and REM were 23.2+/-17.0% and 18.4+/-9.6%, respectively. There was no statistical difference observed between two groups in any of ESS, ARI or SA (Student t test or Welch test).
Conclusion-It seems difficult to categorize the patients with mild to moderate OSAHS by its severity based on AHI.

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To evaluate positive rates for gonorrheal infection and chlamydial infection of the pharynx, two pharyngeal specimens, throat washing and throat swab, were obtained from 555 cases visiting an otolaryngology department or a sexually transmitted disease (STD) clinic for 6 months from November, 2005. A nucleic acid amplification test (NAAT), Becton Dickinson strand displacement amplification (SDA), and gonococcal culture were performed for detection of Neisseria gonorrhoeae, and SDA and Roche PCR were performed for detection of Chlamydia trachomatis in the pharyngeal specimens.
The number of cases, who got tested for N. gonorrhoeae and C. trachomatis at the otolaryngology department and at STD clinic, were 12 and 543 during the period. All 555 cases consisted of 283 females ranging in age from 17 to 55 years old (mean, 27.9 years) and 272 males ranging in age from 18 to 69 years old (mean, 36.7 years). The number (percentage) of cases in females to males of with gonorrheal infection and chlamydial infection of the pharynx were 36 (13%) to 35 (13%), and 25 (9%) to 7 (3%), respectively. All the positive individuals were patients at the STD clinic. The results of the study suggested the high degree of detection of cases with a positive result for N. gonorrhoeae and C. trachomatis at the STD clinic, while the number of subjects at the otolaryngology department was considerably less than at the STD clinic.

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Favorable function and morphology were achieved by treating a defect created by wide-range lower lip excision by reconstructing the lip with a forearm flap and lifting the lip and labial angle with fascia from the thigh. A 30×20 mm tumor was observed in the right lower labial mucosa of a 78-year-old woman, and biopsy confirmed squamous cell carcinoma. A safety margin of 20 mm was maintained during excision of the facial skin from the labial angle to the lower lip, the tumor and the adjacent mandible, buccal mucosa, oral cavity floor and lower gingiva. The resulting defect was treated by using a free forearm flap to cover the oral cavity and the face, and fascia from the thigh to lift the lip and labial angle. Postoperatively, the patient had no difficulty opening or completely closing her mouth, and an esthetically favorable outcome was achieved. This technique can be used to treat relatively broad defects, and it is one option for labial angle and lower lip reconstruction.

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Hemophilia A is an X-linked hereditary bleeding disorder caused by coagulation factor VIII deficiency, and although males are usually affected, there have been a few reports of excessive bleeding in female carriers. Here we report a case of a hemophilia A carrier diagnosed after postadenotonsillectomy hemorrhage.
A 4-year-old girl with sleep apnea was referred to one of the authors. Adenotonsillar hypertrophy was detected, and her parents requested surgical treatment. Preoperative blood tests showed an elevated activated partial thromboplastin time (APTT) of 41.5s (normal range: 25.8-37.7s, normal control: 27.0s), but other routine laboratory data yielded no abnormal fundings. Adenotonsillectomy was carried out uneventfully under general anesthesia with little intraoperative blood loss. However, there was significant wound hemorrhage within several hours after the operation, and reoperation was performed, but oozing from the wound persisted. A second reoperation with blood transfusion was performed on postoperative day 5, and detailed questioning about the family history revealed that her mother's brother had mild hemophilia. The patient was tested for clotting function, and was diagnosed as a hemophilia A carrier. Coagulation factor VIII activity was 68%, the lower limit of the normal range, but the vWF (von Wiilebrand factor) level was 152% and within the normal range. Infusion of factor VIII concentrate was started and there was immediate and complete resolution of the oozing. The patient was discharged 17 days after the adenotonsillectomy.
We wish to emphasize that whenever the APTT of female patients as well as male patients is prolonged 10 seconds or more above normal control in a preoperative blood test, clotting factor tests should be performed in addition to careful questioning about the family history. Preoperative diagnosis and adequate correction of factor VIII activity, if necessary, allow surgery, such as tonsillectomy to be performed safely in hemophilia patients and hemophilia carriers.

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Although pharyngeal foreign bodies are very frequently seen in daily practice, there have few systematic analyses of a large case population.
We analyzed 737 cases seen at our clinic during the 21 years from January 1986 to December 2006. During the same period there were 94, 175 new patients, and the cases of pharyngeal foreign bodies accounted for 0.78% of the total.
There were 197 cases (26.7%) seen during routine outpatient clinic hours, and 540 cases (73.3%) were seen in the emergency room.
These were 354 males (48.0%) and 383 females (52.0%).
The oropharynx was involved in 704 cases (95.5%) and the hypopharynx in 25 cases (3.4%).
The monthly distribution showed an average of 61.4 cases a month with peaks in May, July and August.
The age distribution showed an average age of 26.6 years and a range of 9 months to 91 years. The peak incidence by age was in the under 9 years group.
The most common foreign body in the pharynx was a fish bone (93.6%). The majority of the fish bones was from horse mackerel followed by eel bones and salmon bones.

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