[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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Chronic epipharyngitis is difficult to diagnose because it is often asymptomatic and presents no abnormal gross appearance. The epipharynx is rich in lymphocytes with phenotypic analysis showing highly activated T and B lymphocytes. Ciliated epithelial epipharynx cells express class II antigen and act as antigen-presenting cells. Chronic epipharyngitis thus may act as a focal infection, similar to chronic tonsillitis, in developing various types of autoimmune disease such as glomerulonephritis and chronic skin conditions.

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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The clinical outcomes in inpatients with infectious mononucleosis treated with antibiotics and those who did not receive antibiotic therapy were compared to explore the necessity of antibiotic therapy in these patients. The mean duration to subsidence of fever to normal was 4.6 days in the antibiotic-treated group and 3.1 days in the non-antibiotic-treated group; thus, the interval was rather longer in the antibiotic-treated group. During the hospital course, worsening of liver function impairment was noted in 42% of cases in the antibiotic-treated group and 0% of cases in The non-antibiotic-treated group. Exacerbation or development of rash occurred in 17% of cases in the antibiotic-treated group and 0% of cases in the non-antibiotic-treated group. Liver dysfunction and development or exacerbation of rash were noted as adverse events in 58% of cases in the antibiotic-treated group and improved following discontinuation of the antibiotic. It is thus considered advisable that patients with infectious mononucleosis be carefully observed after hospitalization for rest, if feasible, and that the use of antibiotics may only be considered in the presence of a complication requiring antimicrobial chemotherapy,e,g., peritonsillar abscess.

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Maintaining function after complete tumor resection and improved prognosis are important in patients with head and neck cancer. We assessed articulation and swallowing after radical surgery and reconstruction in 25 patients with advanced tongue cancer. Articulation was assessed based on General Rules for Clinical Studies on Head and Neck Cancer of the Japan Society for Head and Neck Cancer. Swallowing was assessed based on Method of intake, Time of intake, and Food (MTF) scores proposed by Fujimoto et al. Results showed articulation to be significantly impaired in those whose lingual apex was removed. Swallowing became worse in those with greater lingual root removal. Specifically, those with less than 50% of the lingual root resected consumed soft or normal foods easily. Two of the eight subjects with more than 50% of lingual root resected together with subtotal glossectomy or hemiglossectomy could not take any foods due to swallowing difficulty. Their swallowing was evaluated using videoendscopy (VE) and videofluorography (VF), based on which, cricopharyngeal myotomy and laryngeal suspension were conducted, enabling them to consume soft foods. Results thus confirmed the importance of evaluating swallowing difficulty postoperatively using VE and VF, and of the role of revised surgery in recovering swallowing function. Our clinical experience suggests that cricopharyngeal myotomy and laryngeal suspension should be done simultaneously with 50% lingual root resection.

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The Plummer-Vinson syndrome is characterized by three main manifestations: iron deficiency anemia, glossitis and dysphagia. This syndrome has become relatively rare in recent years in Japan, because of the generally improved nutritional status of the subjects. The symptoms include difficulty in swallowing solid foods due to mucosal atrophy and web formation in the postcricoid region and cervical esophagus, and glossitis and angular stomatitis due to atrophy of the tongue and oral mucosa, in addition to symptoms of anemia, such as palpitation, shortness of breath and generalized fatigue. In addition, the syndrome is well known to be a high risk factor for postcricoid and cervical esophagus cancers, and a relationship with oral cancer has also been suggested. In the present report, we describe our experience of a case of Plummer-Vinson syndrome associated with tongue cancer.

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We evaluated the postoperative effect on 30 sleep-disordered breathing subjects including 21 with obstructive sleep apnea-hypopnea syndrome (OSAHS), 3 months after they underwent coblation-assisted uvulopalatopharyngoplasty (cobUPPP). We used polisomnography without electroencephalography, the Epworth sleepiness scale (ESS), and the SF36v2 questionnaire for QOL in the evaluation. Apnea-hypopnea, apnea, hypopnea, and O₂ desatsuration indexies all improved significantly, as did the lowest SpO₂ and SpO₂ less than 90%, ESS and QOL improved significantly, as did snoring on the visual analog scale. Postoperative spontaneous pain was mild, and moderate on swallowing but did not impair performance. Based on the screening for OSAHS using PSG without electroencephalography, ESS score, and QOL score was used. Excellent improvement was seen in 2/10 in severe OSAHS and effective in 6/10, and excellent improvement was seen in 3/6 in moderate OSAHS, effective was seen in 3/6, and effective was 4/5 in mild OSAHS.

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To analyze factors in parotid gland carcinoma influencing disease-specific survival, we retrospectively reviewed 33 cases treated by surgery from 1998 to 2008. According to UICC/2002 TNM Classification, 1 subject was stage I, 11 stage II, 3 stage III, and 18 stage IV. We analyzed the influence of selected factors on the 3-year disease-specific survival using the Kaplan-Meier actuarial method and the log-rank test. They included 12 with low-grade malignancy carcinoma and 21 with high-grade malignancy carcinoma based on 2005 WHO classification. Of the 33, 12 patients had mucoepidermoid carcinoma, 4 adenocarcinoma NOS, 3 squamous cell carcinoma, 5 carcinoma ex pleomorphic adenocarcinoma, 4 salivary duct carcinoma, and 5 patients other pathology. In other results, 13 had recurrences, 7 local or neck recurrence, and 9 metastasis. Stage (p=0.048), pathological grade (p=0.038), + lymph nodes (p=0.0048) and preoperative facial nerve palsy (p=0.043) affected prognosis negatively. The 3-year disease-specific survival was 100% for low-grade malignancy and 79% for high-grade malignancy. Preoperative rates of >45 years old, male, preoperative facial palsy and lymph node metastasis in those with high-grade malignancy were significantly higher than low-grade malignancy (p<0.05). Our results suggest that the pathological grade is the most important prognostic factor and that above preoperative clinical findings may be helpful for estimating the grade of malignancy.

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Working with other departments hospitals, the otolaryngology department organized a conference on swallowing to evaluate dysphagia by sharing records and experience and standardizing of treatment. Understanding complex dental surgery leading to occlusal disharmony, a form of dysphagia enabled otolaryngologists to evaluate neurological causes of dysphagia. The conference let to a consensus for different specialties in dealing with dysphagia and developed standardized rehabilitation applicable to subjects transferrd to hospital in belonging to this group hospital.

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We report a case of internal jugular vein thrombosis (IJVT) associated with pharyngitis and a neck abscess. A 54-year- old man with a 2-week fever and sore throat treated with oral antibiotics was admitted elsewhere and diagnosed with sepsis. Blood culture identified Porphyromonas asaccharolytica, an anaerobic Gram-negative rod bacilli, treated with cefpirome sulfate and nafamostat mesilate administered intravenously. On postadmission day 4, the left side of the man's neck developed swelling. The man was then transferred to our hospital for evaluation and management.
Contrast-enhanced computed tomography (CT) showed a mass with a contrast-enhanced margin and a nonenhanced low-density center on the left side of the neck. The diagnosis was IJVT with neck abscess. Intravenous antibiotics were given and the abscess drained. The man became afebrile and neck swelling markedly decreased. Three days after drainage, anticoagulant therapy was started to reduce the risk of pulmonary embolism.
Before antibiotics became widely disseminated, IJVT was a life-threatening complication associated with deep neck infection secondary to pharyngitis or tonsillitis. The most serious IJVT complication is now pulmonary embolism. Radiological examinations, including those of enhanced CT, are essential to diagnosing IJVT. Anticoagulation is recommended to prevent serious complications such as pulmonary embolism.
Although IJVT is relatively rare, otolaryngologists should familiarize themselves with its management.

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