[in Japanese]

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We evaluated the relationship of sleep-disordered breathing (SDB) to surgical outcome in 104 subjects-(83 men and 21 wemen)-aged 21 to 73 years old. The conditions evaluated were obstructive sleep apnea-hypopnea syndrome (OSAHS), upper airway resistance syndrome (UARS), snoring, and excessive daytime sleepiness. Treatment involved endonasal rhinoplasty (ER) consisting of septoplasty, bilateral submucosal inferior turbinectomy with posterior nasal nerve resection and bilateral partial middle turbinectomy, and/or coblation-assisted uvulopalatopharyngoplasty (cobUPPP) using a temperature-controlled radiofrequency bipolar wand. Three months later, the postoperative effect was evaluated using polysomnography with or without electroencephalography, the Epworth sleepiness scale (ESS), snoring (VAS), and nasal allergy symptoms if any. We divided SDB upper airway levels into A, nose and epipharynx, B, nasopharynx, including soft palate and tonsils; and C, hypo-pharynx, tongue, and tonguebase.
We assumed that SDB pathophysiology involved factors (1) negatives pharyngeal pressure during sleep, (2) increased airflow volume, (3) narrow upper airway and wide posterior pillar, (4) upper airway weakness, and (5) obesity. ER reduces daytime and sleep nasal resistance which decreases negative pharyngeal pressure, and factor (1). cobUPPP directly improves factors (3) and (4). cobUPPP outcome was superior to ER in OSAHS, although these two staged operations had a better outcome than single surgeries in OSAHS, suspicious UARS, excessive daytime sleepiness, snoring, and improved respiratory events during sleep. Nonresponders in staged surgeries involved ER and cobUPPP, suggesting the influence of level C factor (3), the tongue, and/or the tongue base. These results suggest that SDB pathophysiology is attributable to upper airway multilevels together the influence of certain individual factors.

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The clinical pathway is being used increasingly as standard hospital treatment policy for major disorders in Japan. Tonsillectomy accounts for most operations per year at many ear, nose, and throat facilities. Tonsillectomies accounted for 14.8% of 155 clinical pathway cases in the last 3 years at our hospital. The percentage of otonsil operations is second after ear surgery, at 18.4%, for the same number of nasal operations.
Wuth medical interns usually conducting tonsillectomy under the direction of senior doctors, guidelines are needed to standardize hospital treatment and ensure safety against risks such as postoperative hemorrhage.
It would also help to standardize team treatment to prevent perioperative infection in cooperation with health-care providers.

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Subjects with Forestier disease, a form of diffuse idiopathic skeletal hyperostosis, suffer from dysphagia and/or dyspnea due to bone formation in front of cervical vertebrae. Surgery in severe cases is not always successful, however, because clinical symptoms are due both to physical bony lesion compression against the pharynx, esophageal, larynx, and nerves and to local inflammation, including swelling and fibrosis.
We report the results of surgery in 5 subjects. Bony lesions were removed and principal organs such as upper and lower laryngeal nerves were conserved in all cases. Cases 1 and 2, however, complained of their symptoms several months after surgery. We then, added a procedure to decrease space between vertebrae and the periosteum after bony lesion removal, suturing the periosteum closely. We found excellent results in cases 3-5. Minimizing space after eliminating bony lesions conceivably helps minimize local inflammation in Forestier disease.

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The Coblator^® II Surgery System is a surgical device introduced recently in tonsillectomy, one of the most frequently done types of surgery. Coblation tonsillectomy lessens postoperative pain compared to methods such as blunt dissection and/or bipolar coagulation. We suggest that pain is lessened due to degeneration on tonsillar fossa tissues. The changes on tonsillar fossa are caused by low thermal from coblation. Our purpose was to determine of thermal denaturation depth in tonsillar fossa tissue after coblation tonsillectomy. Directly examining such tissue is, however, difficult ethically. We hypothesize that changes in thermal injury seen in tonsil specimens are equivalent to that in remaining tonsillar fossa tissues. Histological investigation of 40 specimens removed in coblation tonsillectomy showed the depth to average 0.99mm using NADH-diaphorase staining. NADH-diaphorase staining use with the NADH reaction is one of the most important biologically and is a reliable cell viability marker. Previous studies of thermal coblation injury histopathologically examined hematoxyline-eosin (HE) stained sections, which cannot evaluate thermal tissue injury as well as NADH-diaphorase staining because HE staining cannot clarify the presence of pseudo-viable cells.

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Sialodochitis fibrinosa, first reported by Kussmaul in 1879, is a relatively rare salivary gland condition characterized by paroxysmal recurrent salivary gland swelling due to salivary duct obstruction by a fibrinous plug. Histopathologically plug examination showed the infiltration of numerous eosinophils. Hematological examination showed high levels of eosinophils and serum IgE. With disease etiology not fully understood, a number of studies have indicated the possible involvement of allergy, making antiallergic drug administration the first choice in sialodochitis fibrinosa treatment. Intractable cases call for steroid administration or salivary duct irrigation using a steroid solution.
We report three subjects with sialodochitis fibrinosa seen for recurrent parotid gland swelling. All had allergies and two had mucous discharge from Stenon's duct with eosinophil infiltration. Administrering antiallergic drugs was effective in all cases, although symptoms were not completely relieved in two of the three. Steroids should thus be considered as additional treatment.

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A 21-year-old man visited a hospital with a fever and a sore throat. Blood examination revealed liver dysfunction, and the patient was suspected of having infectious mononucleosis. He was referred to our hospital, where the initial clinical examination revealed furred palatine tonsils and the blood chemistry showed high aspartate aminotransferase/alanine aminotransferase (AST/ALT) and lactate dehydrogenase (LDH) levels. In addition, the patient had a swelling in the cervical lymph nodes and was diagnosed as having infectious mononucleosis based on positive Epstein-Barr virus (EBV) antibodies. The patient was admitted and symptomatic treatment was started. Approximately 1 week later, the sore throat and inflammatory findings improved, but general malaise was aggravated and splenomegaly and jaundice developed. This was caused by a concurrent hemophagocytic syndrome due to the initial EBV infection, because of which the platelet count decreased rapidly on the 22nd hospital day. Chemotherapy and immunosuppressive therapy were started, but the patient did not improve, resulting in an unfavorable outcome.

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The perioperative management of uvulopalatopharyngoplasty (UPPP) with obstructive sleep apnea (OSA) may present some problems because OSA and central sleep apnea may increase, respiratory depression from anesthesia, narcotic analgesic and CO₂ narcosis, and fatal heart failure may occur, and furthermore, these respiratory and heart failure conditions could require emergency tracheotomy and lead to a fatal outcome. Thus, it is important to monitor UPPP patients in the intensive-care unit and ventilate with positive airway pressure, particularly biPAP, that can control respiration in the absence of spontaneous ventilatory efforts during the perioperative period.
We have cured nasal obstruction as a priority because experiences had shown that nasal CPAP failures with night-time nasal obstructions could restart nasal CPAP following reconstructive surgery of the nasal cavity. In this currently reported case, the perioperative risk decreased because of improvement of preoperative nasal CPAP compliance.

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We retrospectively reviewed 98 cases of lateral-oropharyngeal wall squamous cell carcinoma seen from January 1999 to March 2011. The majority-75 cases-involeved advanced cancer. For these, we conducted concurrent chemoradiotherapy (CCRT) with cisplatin, docetaxel, and 5-FU from 2007. Five-year overall survival was 64.4%. In advanced cases, three-year overall survival was 77.8% in surgery, 71.2% in radiation therapy, and 84.6% in CCRT. While no statistically significant difference was seen, CCRT, appeared to provide more curative effectiveness.

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We report a case of solitary fibrous tumor (hemaingiopericytoma) of the tongue.
A 67-year-old-woman had an elastic, solid submucous tumor on the tip of the tongue, which we suspected was hypervascular. We embolized the tumor feeding vessels before resection. The tumor was histologically diagnosed as solitary fibrous tumor, or hemangiopericytoma.

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An 88-year-old woman admitted for neck swelling and dyspnea had severe dementia and feeding problems, requiring fluid diet feeding with a syringe. The floor of her mouth had been injured by the syringe about three hours before her emergency consultation. We conducted an immediate tracheostomy and antibiotic administration. Abscesses developing in the oral floor required surgical drainage through the mouth and she gradually recovered.
Oral floor trauma is rare but presents a risk for emergency airway stenosis and subsequent neck abscess. Feeding the elderly with dementia should thus be done with special attention paid to the feeding instruments used.

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Purpose: The aim of this study was to determine the expression of human epidermal growth factor-2 (HER-2), epidermal growth factor receptor (EGFR) and androgen receptor (AR) in salivary duct carcinoma (SDC) and to estimate the availability of molecular targeted therapy.
Materials and Methods: Four SDC patients diagnosed and treated at our hospital.
Theses were stained with HE, HER-2, EGFR and AR. These were judged positive, negative staining on the basis of the criteria for each staining.
Results: HER2-positive expression was observed in all of 4 SDCs. EGFR-positive expression was observed in 2 of the 4 SDCs. AR-positive expression was observed in 3 of the 4 SDCs.
Conclusion: Our report suggested the possibility of the effectiveness of HER2, EGFR and AR targeted therapy in SDC.

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In recent years, allergy contact dermatitis has become a major problem as a result of an increase in the number of chemical products and human contact with them. In the medical field, especially in dental treatment, we use several metal materials during treatment, and treatment without them is impossible. Although the metals used in clinical dentistry are recognized as appropriate for use in human patients, they can be harmful when used excessively or inappropriately.
We experienced a patient who developed a metal allergy, diagnosed with difficulty from a parotid swelling. We must take the potential for a metal allergy into consideration when we examine the patients with oral lesions.

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The deep neck abscess is one of the serious diseases in the field of otolaryngology. It generally has its onset in adulthood, and is comparatively rare in children. In the case of a neck abscess in children, the clinical symptoms are not easily perceived. Furthermore, deep neck abscesses tend to demonstrate sudden progress and could sometimes be aggravated, therefore early identification and treatment (antibiotics and drainage through incision) are essential.
In the present study, we report on ten cases of pediatric deep neck abscess treated by our department in the past ten years. The clinical data such as location of the abscess, drainage through incision, administration of antibiotics and bacterial culture were analyzed, and the connection between the timing of antibiotics administration and the length of hospital stay was investigated.
As a result, the length of stay showed a tendency to be shorter when antibiotics were given soon after the appearance of the main complaint. Swift administration of antibiotics preceded by an exact diagnosis was considered to be important in the early healing of deep neck abscesses in children.

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It is well recognized that deep neck infections and related abscess are caused by many kinds of bacterial infectious disease. Unfortunately, severe complications like central nerve palsy, mediastinitis, problems with the main vessels in the neck and airway obstruction often concur in cases where infection has not been controlled. As a solution to these problems, we have two methods to treat and get control over these infections. One is conservative method which involves the use of high dosage and many kinds of antibiotics. The other approach involves surgery, which consists of two approach techniques, namely the oral or cervical approach. The oral approach offers a comparatively easy and non-invasive procedure as positive points, but acquiring a good and wide surgical filed can be difficult, and it is classed as an invasive approach. In the case reported herein, we used the oral approach to treat an abscess in the retropharyngeal space via an endoscope, and we were able to obtain a good prognosis for the patient.
The patient was a 60-year-old man with retropharyngeal space infection and an abscess. He had some general complications such as diabetes mellitus, chronic kidney disease, hypertension, hyperuricemia, and dyslipidemia. His chief compliant was dyspnea. At first, he received conservative therapy using antibiotics such as IPM/CS, CLDM and VCM at another hospital. However, dyspnea and another symptoms were getting worse. Therefore, he underwent a tracheostomy and he was reffered to our institute. The first haematological findings of the inflammation were as follows: WBC; 12.9×10³/μl, CRP; 27.69mg/dl. A CT scan confirmed that the abscess involved the area from the nasopharynx to the hyoid bone at the level of the hypopharynx. We chose the transoral approach and performed drainage with a rigid endoscope. Postoperatively, the patient improved steadily, and he was discharged at 64 days after admission.

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This objective is to establish transolal robotic surgery (TORS) in Japan. The da Vinci^® surgical system (Intuitive) assists in laparoscopic and thoracoscopic surgery, but transoral endoscopic surgery has not yet been approved in Japan. This means that neither the, 5mm EndoWrist^® nor the FK^® laryngeal retractor can be used. Our study used 8mm EndoWrist^®, Davis^® mouth gag, and da Vinci S^®. We simulated TORS using airway mannequins and others 3-dimensional models. The instruments could be used freely in mesopharynx. These results indicate that TORS can be applied to the mesopharynx but is difficult to hypopharynx or larynx application.

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