We retrospectively analyzed the clinical characteristics of 54 consecutive patients with deep neck abscesses who were treated in our department between 2000 and 2011. The patients comprised 31 males and 23 females ranging from 3 to 87 years. We divided these patients into the elderly group (more than 75 years-old) and the control group (younger than 74 years-old), and we reviewed the charts and clinical records retrospectively, such as local and systemic findings, computed tomographic image findings, bacteria tests, laboratory data, treatment protocols and clinical courses. Local and systemic findings in patients in the erderly group were weaker, however, laboratory data in the elderly patients were more severe than in the control group. The re-operative morbidity rate of systemic disorders was apparently higher in the elderly patients than that in the control patients, and the incidence of complications, such as delirium, arrhythmia, respiratory dysfunction, after the surgery in the elderly patients was higher than that in the control patients according to pre-operative systemic disorders. However, the age of patients by itself was not regarded as a risk factor for the operation.

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[in Japanese]

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The authors performed a clinical study on peritonsillar abscesses (PTAs) in 34 patients using CT (computed tomography) findings. These patients were admitted to our hospital between January 2006 and March 2012. The cohort consisted of 24 men and 10 women, (age. 18 to 88 years; average age, 43.4 years). Antibiotics were administrated to 15 patients (non-surgical group). In addition to administration of antibiotics, abscess removal was performed by needle aspiration and/or drainage through incision for 19 patients (surgical group). There were no significant correlations between the WBC count, CRP level. and diameter of the PTA. The average hospitalization period was 6.88 days in the non-surgical group and 7.52 days in the surgical group. There was no significant difference in the average of hospitalization period between 2 groups. The diameter of the PTA was significantly greater in the surgical group than in the non-surgical group. The findings of the present study suggest that the diameter of the PTA serve as a clinical index.

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A tonsillectomy was performed under general anesthesia for chronic tonsillitis in a 30-year-old woman. Postoperative bleeding was noted on the 7th postoperative day, and persisted for several months despite the performance of 3 hemostatic procedures. Although the situation was unclear and proof was not available, it was possible that the hemorrhage was result of self-harming behavior. Eight months postoperatively, the hemorrhage persists, and the patient attends hospital on an outpatient basis.

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The role of otolaryngologist in sleep medicine is described based on the present condition of the Ehime University Hospital Center of Sleep Medicine. Not only a sleep-disordered breathing (SDB) patients but patients with sleep disorders also tend to consult a sleep medical center. There is a limit to sleep medical center management by an independent specialty, and combination therapy is desirable. The otolaryngologist can undertake an operation with a morphological diagnosis, and is indispensable in the diagnosis and treatment of SDB. Especially in the case of a pediatric case of SDB, a morphological diagnosis and clinical symptoms are important beyond the result of the sleep study, and the role of the otolaryngologist is also important regarding treatment. Although it is ideal that otolaryngologists take the lead and will engage themselves in sleep medicine from now on, under the present circumstances, it is desirable to build combination therapy with an otolaryngologist newly participating in the sleep medical center in the absence of an otolaryngologist.

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We describe herein two patients with esophageal perforation caused by deep neck infection.
Deep neck infection is one of otolaryngological mortal disease, which can progress to descending necrotizing mediastinitis (DNM). We describe two patients with esophageal perforation caused by DNM. One was a 76 year-old and the other was a 53 year-old male. Both of them underwent operations for a drainage procedure following intravenous antibiotic administration and saline washing through the drainage tubes. An upper gastrointestinal endoscopy or esophagography was performed to verify the closure of the esophageal perforation 47 days and 39 days after the surgery, and the patients could resume food intake.
A periesophageal abscess can often occur in the DNM procedure since most of the deep neck infection could develop through the retropharyngeal and/or lateral pharyngeal space. It is likely that esophageal perforation could occur against the background of bacterial infection and ischemia secondary to infection caused by a prolonged periesophageal abscess. Adequate treatment is necessary for an esophageal perforation to prevent deterioration of DNM. Most esophageal perforations are treated surgically. If the esophageal margins will hold sutures, esophageal closure is carried out. However, conservative management seems appropriate when the cavity should be well drained back into the esophagus. We should treat the patient suffering from severe deep neck infection and DNM bearing in mind the idea of esophageal perforation.

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Treatment modalities of tongue cancer can vary according to the stage. We report herein on a clinical study of 39 patients with stage I &II tongue carcinoma initially treated at Jichi Medical University Hospital between April 2001 and March 2011. The patientsranged in age from 31 to 85 with an average of 57yr. Twenty four were men and 15 women. Stage I patients underwent partial glossectomy in all cases. In stage II patients 11 underwent partial glossectomy and 7 had partial tongue resection with supraomohyoid neck dissection because of a deeply infiltrative lesion of more than 5mm with the help of an MRI scan. Three patients underwent subtotal glossectomy, bilateral supraomohyoid neck dissection, and reconstruction of tongue due to the contralateral extension of deep invasion. We used the CO₂ laser in 25 cases, electrocoagulationin 13 cases, and coblator^®in 1 case for partial glossectomy. The 5 year survival rate of stage I was 85.6%, and that of stage II was 72.7% calculated with theKaplan-Meier method. Recurrences were seen in 12 cases, 4 in stage I and 8 in stage II. Neck lymph node metastases were seen in 8 cases among the 12 recurrent ones, and we could perform salvage neck dissection in only 3 cases. Eleven of the 12 recurrent cases were found within one year. Stage I, II tongue cancer was likely to recur as neck lymph node metastasis within one year. With this issue in mind we should follow-up such patients carefully.

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The prognosis for patients with HPV-positive oropharyngeal carcinoma is significantly better than in those with HPV-negative carcinoma. Despite the better prognosis, there is a group of patients with HPV-positive oropharyngeal carcinoma who experience treatment failure and eventually succumb to distant metastasis. Spector et al. reported that matted nodes were associated with a poor prognosis and were a marker for distant metastasis. Matted nodes are defined as three nodes abutting one another with loss of interventing fat plane that is replaced with evidence of extracapsular spread. We performed a retrospective analysis of the association between matted nodes and the prognosis of 61 patients with oropharyngeal carcinoma at Hokkaido University Hospital, Japan, between 2002 and 2011. Of the 61 patients, 23 patients (38%) were HPV-positive. Among them, 20 patients were HPV-16 positive, two were HPV-18 positive and one was HPV-35 positive. Matted nodes were observed in 15% (9 of 61) of the population. Of the 9 patients with matted nodes, 4 patients (44%) revealed distant metastasis. On the other hand, of the 52 patients without matted nodes, 2 patients (3.8%) revealed distant metastasis. In the HPV-positive patients, there was a significant difference in the 3-year disease-specific survival between patients presenting with and without matted nodes (75.0% vs 85.7%). These results suggest that the patients with matted nodes are at risk of distant metastasis and are recommended to receive induction chemotherapy.

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A total of 89 hypopharyngeal carcinoma cases were treated at the Shiga University of Medical Science between 1995 and 2011. There were 37 multiple primary cancer (MPC) patients out of 89 hypopharyngeal cancer patients including 19 synchronous cases, 14 metachronous cases, and 4 synchronous and metachronous cases. The most common site for MPC development was the esophagus, followed by the larynx and the stomach. The prognoses of the patients with secondary primary malignancies were not significantly different from those of the patients without them. For the treatment of hypopharyngeal cancer patients with MPC, the stage and degree of MPC should be carefully considered. It is also important to inform the high-risk patients about MPC and to perform a long-term follow-up.

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A 78-years-old woman with a lump in the right side of her soft palate accompanied by oral bleeding was admitted to our hospital. CT showed an enhanced tumor shadow associated with findings suggestive of a malignant tumor. However, the histological findings failed to confirm malignancy despite repeating the biopsy three times. Subsequently, the lesion was histologically diagnosed as an actinomycosis of the soft palate. The patient was discharged from our hospital because the tumor was reduced with the administration of Penicillin G for four weeks. Two months after discharge, she underwent a biopsy from the tumor due to tumor regrowth. Finally, it was histologically diagnosed as an acinic cell carcinoma with synchronous actinomycosis. We performed a transoral lateral oropharyngectomy. She has had a good postoperative course for twelve months after surgery.

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A 33-year-old woman was admitted to our hospital with a sore throat. The lingual tonsils were enlarged significantly and believing that the infection had caused inflammatory response. We treated the patient with antibiotics. After that the inflammatory reaction was reduced, and her sore throat was relieved, but enlargement of the lingual tonsils remained. We suspected a tumor, and we biopsied the lingual tonsils. Hypertrophy of lymphoid tissue was observed, but there was no additional evidence of malignancy.
Since there was no impact on the patient's activities of daily living, we put her under observation. However, since the enlargement of the lingual tonsils failed to improve for more than 4 months, we performed surgery six months after the first visit. We pulled the tongue first, and excised as much as possible from the oral cavity lingual tonsils. The pathological diagnosis was similar to the biopsy.
We have continued to observe the postoperative course, and from 2 years postoperatively lingual tonsils apparently regrew. Since there was no impact on the patient's activities of daily living, we put her under observation. However, throat dysesthesia was observed after one year and MRI of the vocal cords showed that the enlarged lingual tonsils had occupied the pharyngeal cavity.
Because the patient was at high risk for dysphagia and respiratory problems, we carried out a second surgery 3 years and 2months after the first operation. Considering the cosmetic outcome, we transected the median tongue and totally excised the lingual tonsils from the oral cavity. The pathological diagnosis of hypertrophy of the lymphoid tissue was similar to the first operation.
At nine months postoperatively, no trend for regrowth has been seen, with no reappearance of dysphagia and respiratory failure. Because there is remnant lymphoid tissue, there is a risk of regrowth, so the patient must be followed carefully.

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We report herein on a rare case of giant pleomorphic adenoma in the oral cavity. A 69-year-old woman had been aware of an oral mass gradually increasing in size for 40 years, and presented with a 3-day history of repeated oral bleeding. When she was first seen by us on November 1, 2011, her mouth was filled with a huge mass arising from the hard palate, which hindered her from closing the jaw. Computed tomography revealed a well-defined heterogeneously-enhanced mass measuring 75mm at its greatest dimension. The mass showed low and heterogeneously high intensities in T1- and T2-weighted magnetic resonance imaging, respectively. The histopathological finding of a biopsy specimen indicated desmoma, and the patient underwent transoral resection of the tumor. The periostium of the hard palate was simultaneously removed, and the bone cortex was curetted. Because primary suturing of the surgical defect was unfeasible, the exposed bone surface was covered with a polyglycolic acid sheet and fibrin glue. The histopathological diagnosis was pleomorphic adenoma. The postoperative course was uneventful. The patient currently does not have dysarthria or difficulty in mastication/deglutition, and shows no evidence of recurrence 8 months after surgery. We should be aware that pleomorphic adenoma may grow into such a huge mass. We reviewed the clinical characteristics, diagnosis and treatment of pleomorphic adenoma in the oral cavity.

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Accessory parotid tumors are clinically rare. Neoplastic changes can be found in the accessory parotid gland as well as the major salivary glands, however, the accessory parotid tumor is extremely rare. Benign tumors of the accessory parotid gland account for approximately 50% to 74% of all accessory neoplasms. The rate of malignant tumors of accessory parotid gland is higher than that of the main parotid gland. Therefore, we should diagnose and treat the accessory parotid tumors correctly. From December 2001 to August 2012, six patients diagnosed as having accessory parotid gland tumors were identified at Tokyo Women's Medical University Hospital. All 6 patients underwent surgical intervention. In all cases, the parotid approach was performed, and no facial nerve damage was observed. Two cases were diagnosed as being malignant tumors. We present herein 6 cases of accessory parotid gland tumors and a review of the literature.

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Ectomesenchymomas are rare tumors that appears in the brain or soft tissue and are defined as tumors including ectodermal components mainly represented by neurobrasts or ganglion cells, and differentiated mesenchymal structures that are most often a rhabdomyosarcoma. They predominantly affect young children. While most ectomesenchymomas are reportedly malignant, we present a neonatal case of a pharyngeal benign ectomesenchymoma.
A one-month-old male newborn came to our division with stridor and difficulty in sucking. An endoscopic laryngeal examination was performed, and a soft mass was found, extending from the upper to middle pharynx. Based on the CT scans and MR imaging, the mass was suspected as a teratoma. Since there was a high risk of respiratory obstruction, we performed a tracheotomy and waited for the child to grow. When he was three months old, we removed the mass via transoral surgery. On pathologic examination, neuroglial tissues including diffused striated muscle cells were seen and the tumor was diagnosed as a benign ectomesenchymoma. The patient has been well with no evidence of recurrence of the tumor for nine months after the extirpation.
Considering that most of the pharyngeal tumors in newborns are teratomas, this case of a benign ectomesenchymoma is rare.

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From 2005, nasopharyngeal cancer (NPC) patients were treated with concurrent chemoradiotherapy (CCRT) as the initial treatment in our department. We evaluated the effect of CCRT at two months after completion of treatment and added cyberknife treatment for the patients with the exception of complete response cases. For the distant metastasis case, we aggressively administered local treatment such as surgery and radiofrequency wave cauterization therapy.
Nineteen nasopharyngeal cancer patients treated with CCRT in our hospital between 2005 and 2010 were analyzed retrospectively. The response rate of the initial treatment with CCRT was 94.7%, and the 3-year survival rate of all cases was 92.9%. We have sequentially accumulated cases treated with the current treatment strategy and are going to perform a repeat examination.

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Salivary duct carcinoma (SDC) is an uncommon malignant tumor which accounts for only several percent in salivary gland cancer. It is the high grade malignancy which often causes local recurrence and lymph node and distant metastasis. Since the effect of radiotherapy and chemotherapy is small, surgical resection becomes the main treatment, and surgically unresectable cases have a poor prognosis. We report here that the heavy ion radiotherapy appears to be effective in the treatment of SDC in submandibular gland which was diagnosed as surgically unresectable.
The patient was a 55-year-old man with a left submandibular mass and a complete left facial sensory paralysis. In the MRI image, the tumors extended from submandibular gland to the skull base through lingual nerve. We thought that it was difficult to resect it completely. Instead, heavy ion radiotherapy was delivered to the unresectable upper site and bilateral neck dissection for cervical lymph node metastasis was performed subsequently. The metastases of lymph nodes were full of acidophil cells with HER2 protein positive and positive GCDFP-15, and we thus diagnosed it as SDC. Necrosis of most of the tumor tissue in the submandibular gland was observed. It implies that heavy ion radiotherapy is effective on SDC. It's been two years six months since the surgery, but there is not the sign of a recurrence.

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Uvuloplatopharyngoplasty (UPPP) was previously the most well-known surgery for the treatment of obstructive sleep apnea syndrome (OSAS). It was difficult to create enough space to prevent the upper airway collapse in many patients with OSAS when performing this procedure alone. Moreover the success rate was relatively low compared with a high adherence rate to continuous positive airway pressure (CPAP) therapy, and complications have often been reportedly caused by UPPP. This procedure is becoming less frequent. We focused on the expansion sphincter pharyngoplasty (ESP), which as reported by Woodson and his colleagues is the modification of the traditional UPPP, and has achieved a higher success rate than UPPP. ESP is a simple technique that stiffens the lateral pharyngeal walls and prevents their collapse in patients with OSA. We herein introduce this procedure and demonstrate a case, together with the clinical data, in which the OSAS symptoms were remarkably improved. We also discuss what the anatomical features are, in the presence of which this procedure could be performed.

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