[in Japanese]

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[in Japanese]

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[in Japanese]

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Pollen-food allergy syndrome （PFAS） is an oral allergy syndrome that develops due to cross reaction with pollen. A patient with pollinosis suffers oral symptoms after eating fruits and the like. Birch pollen is the major cause. Among them, Genus Alnus is important in the Kansai region of Japan. Sensitization to Genus Alnus and symptoms of oral allergy were examined in children with allergic disease. The rate of sensitization to Genus Alnus increased with age from infancy to over 50％ at 5 years of age. Oral allergy symptoms were observed in 17.4％ of positive patients, and Genus Alnus-specific IgE antibody titer was significantly higher in the group with oral allergy symptoms. Oral allergy symptoms were recognized from the age of 4, and were caused by apple, peach, kiwi and the like.

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A clinical study of 149 patients with taste disorder was performed between August 2003 and February 2008 in the Department of Otolaryngology, St. Marianna University School of Medicine. The patients were 65.8％ female with a mean age of 61.0 years. The causes of taste disorder were as follows: drug-induced, 34.2％; deficiency of serum zinc, 12.1％; oral and salivary gland diseases, 10.7％; idiopathic etiology, 9.4％; common colds, 8.1％; systemic disease, 6.0％; flavor disturbance, 5.4％; psychogenic, 4.7％; diseases of the central nervous system, 4.0％; peripheral nerve disorder, 2.7％; and deficiency of serum iron, 2.7％. The rate of subjective improvement in all patients was 81.2％. The rate of subjective improvement in 139 patients treated with Polaprezinc was 79.9％.
The questionnaire responses indicated that glossodynia is significantly common in patients with oral and salivary gland diseases. The responses also indicated that patients with low serum zinc significantly tended to eat processed food.
Electrogustometry and the paper filter disk method were performed for 42 patients with moderate or severe taste disorders. The causes for these 42 patients were as follows: drug-induced, 20 cases; deficiency of serum zinc, 6 cases; oral and salivary gland diseases, 6 cases; idiopathic etiology, 6 cases; common colds, 2 cases; systemic disease, 1 case; and deficiency of serum iron, 1 case. The 33 cases who showed subjective improvement had a significantly good recognition threshold for the bitter taste in the area of the glossopharyngeal nerve. No significant difference was noted in electrogustometry between the improvement and no improvement groups. These results suggest that the paper filter disk method may be predictive of the clinical course of patients with taste disorder.

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Among the four patients with pyriform sinus fistulas treated in our department, we examined the appropriate timing of a fistulectomy and the indications and procedures for chemocauterization while reviewing the course of treatment.
Acute suppurative thyroiditis recurred several times during the follow-up evaluations, and the hospital stay related to treatment was lengthy. Because no patient was cured after inflammation, it was thought that fistula removal was more beneficial for patients after the initial onset of acute suppurative thyroiditis, but before several recurrences.
At present, chemocauterization is unlikely to be the first-choice procedure because there are unresolved technical factors related to curability. However, the procedure is useful in terms of invasiveness and cosmetics, so technical improvements are desired.

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Objective: Tonsillectomy is one of the most frequent operations and is performed using various surgical methods. Coblation purportedly causes less pain than other surgical methods, however there are still a few hospitals in Japan that use coblation for tonsillectomy. The aim of the present study was to investigate the operation time, postoperative bleeding, and length of hospital stay for coblation in our hospital, and to report on the usefulness of coblation tonsillectomy.
Methods: We retrospectively analyzed 200 patients who underwent bilateral tonsillectomy in the International University of Health and Welfare Hospital from April 2012 to March 2019. We investigated disease name, operation time, intraoperative bleeding, hospital stay, primary and secondary hemorrhage, and other complications.
Results: The average operation time was 19.6 minutes. Most intraoperative bleeding was less than 5ml. The average hospital stay was 3.3 days. Primary hemorrhage was observed in 5 cases （2.5％）, and secondary hemorrhage in 29 cases （14.5％）. Five cases （2.5％） received hospital treatment for postoperative hemorrhage, but they did not require surgical treatment or blood transfusion.
Conclusion: In the present study, the rate of postoperative hemorrhage was similar to that of previous studies. Furthermore, there was no case requiring surgical treatment or blood transfusion. Coblation is considered to be a safe surgical method and enables early recovery and discharge.

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PURPOSE: We examined 25 patients who underwent aspiration prevention surgery at Yamaguchi University Hospital from May 2013 to October 2018.
METHOD: A retrospective study was conducted based on medical records.
RESULTS: The most common primary diseases were encephalopathy and cerebrovascular disease. Others were malignant tumors and neuromuscular degenerative diseases. Encephalopathy was more common in the younger age group, and cerebrovascular disease and malignant tumors were more common in the older age group.
Separation of the larynx from the trachea was performed in 6 cases, laryngeal closure in 18 cases, total laryngectomy in 2 cases, and total laryngectomy＋pectoralis major myocutaneous flap reconstruction in one case.
Regarding pre- and postoperative respiratory management, 10 of the 15 patients who did not use mechanical ventilation achieved no need of a tracheal cannula postoperatively.
The status of pre- and post-operative nutrition intake was classified according to the Food Intake Level Scale. Regarding adult cases, 10 out of 16 cases improved from alternative nutrition to oral intake. Of the 16 cases, 11 no longer needed alternative nutrition.
CONCLUSION: In cases where no ventilator was required, there was a high probability of achieving no need of a tracheal cannula postoperatively, which we assume reduces the risk of various complications from the cannula.
Although postoperative oral intake levels depended on the primary disease, many adults were able to discontinue alternative nutrition.
We consider that aspiration prevention surgery is one of the major options in patients with severe aspiration at risk of aspiration pneumonia.

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Sleep apnea in childhood is mostly cured by upper airway surgery （adenoidectomy and/or tonsillectomy）. However, sleep apnea with achondroplasia may not be cured even after upper airway surgery due to structural nasopharyngeal stenosis and central sleep apnea.
Forty-seven cases of achondroplasia were followed in our hospital, of which we examined 10 cases who underwent upper airway surgery due to suspicion of sleep apnea. Diagnosis of sleep apnea was performed by a sleep test or overnight pulse oxymetry during hospitalization. Symptoms of sleep apnea improved in 7 of the 10 cases （70.0％） including reoperation cases due to upper airway surgery and who did not relapse, but 3 of the 10 cases （30.0％） needed conservative treatment such as CPAP.
It was considered that sleep apnea with achondroplasia not only affects obstructive sleep apnea but also involves multiple factors such as central sleep apnea, lower respiratory tract disease and GH replacement therapy. In the perioperative management, it is necessary to manage patients in the PICU to secure the airway with a nasal airway or positive pressure breathing in cases where stenosis of the postoperative upper airway is temporarily exacerbated. When snoring or depressed breathing remains after surgery, CPAP therapy, continuous nasal airway and home oxygen therapy should be considered.

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Corynebacterium ulcerans （C. ulcerans） causes diphtheria and is one of the infective bacteria that can cause a zoonotic infection. In Japan, some cases with C. ulcerans infection from cats have been reported recently. Herein we report two cases of pharyngitis caused by C. ulcerans.
Case 1：A 62-year-old female patient who kept 6 cats presented to our hospital with the chief complaint of abnormal sensation of the throat. Pseudomembrane formation was observed in her pharynx. A biopsy of the membrane tested negative, and C. ulcerans was identified from her pharynx. She was treated with azithromycin and she improved.
Case 2：A 45-year-old female patient presented to our hospital with the chief complaint of sore throat. Pseudomembrane formation was observed in her pharynx. C. ulcerans was identified from her pharynx. She was treated with levofloxacin and she improved.
Diphtheria is a droplet infection caused by Corynebacterium diphtheria. Diphtheria causes pseudomembrane on the pharynx, upper respiratory inflammation, neck swelling and airway obstruction. However, the prevalence of diphtheria has decreased significantly thanks to vaccination. C. ulcerans is an indigenous bacterium of livestock, and was identified in 1926. Some cases with C. ulcerans infection have been reported since the 1980s in Europe: the patients had a history of touching animals and symptoms of diphtheria. The first case with C. ulcerans infection was reported in 2001, and 13 cases have been reported in Japan. All patients had a history of keeping pets, especially cats.
It is important to take tissue for bacterial culture and to confirm the history of pet keeping when considering C. ulcerans infection.

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[in Japanese]

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We report a case of a giant pedunculated liposarcoma that originated from the hypopharynx. A 73-year-old man visited our hospital complaining of dysphagia. No abnormal findings were detected by laryngeal fiber examination, and an upper gastrointestinal endoscopy was performed on the same day. The patient suffered cardiopulmonary arrest due to a pedunculated tumor incarcerated in the larynx, but was saved by emergency tracheostomy and resuscitation. The patient subsequently underwent surgery and the tumor was removed under general anesthesia and was diagnosed as well-differentiated liposarcoma. A slowly-increasing pedunculated hypopharyngeal tumor poses a high risk of airway obstruction. Even if the tumor is suspected to be benign, a pedunculated tumor should be resected in order to make a definite diagnosis, under airway management.

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We report a 28-year-old male with parotid carcinoma as radiation-induced cancer, who had received irradiation and chemotherapy for nasopharyngeal cancer 15 years prior. Neck dissection was performed for the remaining cervical lymph node metastasis. The following year, metastasis appeared in the thoracic spine. Therefore, radiation chemotherapy was given, and a complete remission was achieved. However, three years after the initial treatment, lung metastasis and hilar lymph node metastasis occurred, thus radiation chemotherapy was performed. Thereafter, chemotherapy was continued because hilar lymphadenopathy remained. The patient was followed up at the age of 25 when the hilar lymph nodes no longer increased. At the age of 28, computed tomography showed a low-density mass occupying the left parotid gland. Fine-needle aspiration cytology revealed malignancy. Extended parotidectomy with neck dissection was performed. The histopathological diagnosis was salivary duct carcinoma. On positron emission tomography 6 months after the surgery, local recurrence and distant metastasis were detected.
Patients treated with radiotherapy are at risk of developing a second cancer, especially children and young adults. An additional 18 patients with radiation-induced parotid carcinoma were identified in the literature. To our knowledge, no previous report has compared salivary duct carcinoma in the parotid gland as a second neoplasm following radiotherapy. It is extremely rare for parotid cancers to arise within previously irradiated areas.

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Sarcoidosis is a systemic granulomatous disease. However, the lesion may be localized. Laryngeal sarcoidosis is a rare disease. We report the clinical case of a 25-year-old woman with sarcoidosis of the pharynx and larynx. This disease presents with a swollen pharynx and larynx without inflammation, and must not be overlooked because the swelling epiglottis may cause dyspnea. Treatments include steroid and surgical resection, but in this case, lesions were present in multiple locations such as the epiglottis and tonsils, and so steroid treatment was performed. If a case presents with dyspnea or hoarseness, swelling of the larynx and no inflammation, laryngeal sarcoidosis should be suspected.

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About 70％ of salivary gland tumors are benign tumors, and among all salivary gland tumors, pleomorphic adenomas account for 60％, followed by Warthin’s tumors, which account for 10％. Myoepitheliomas represent less than 1％ of all salivary gland tumors, but the number of reports has been increasing in recent years. Approximately 50％ of salivary myoepitheliomas originate from the parotid gland, 33％ from the sublingual gland, and 13％ from the submandibular gland. We report a case of myoepithelium derived from the parotid gland, which is considered to be the most common salivary myoepithelioma. A 35-year-old man was referred for swelling of the lower ear, and a pleomorphic adenoma was suspected from the radiological findings and preoperative fine-needle aspiration cytology. He underwent partial resection of the parotid gland and was diagnosed as myoepithelioma based on the pathological and immunostaining findings. The removal was successful and there has been no recurrence. Myoepithelioma is similar to pleomorphic adenoma in radiological and pathological findings, and is difficult to diagnose preoperatively. In this case as well, a preoperative diagnosis of pleomorphic adenoma was suspected, and myoepithelioma was not diagnosed. En bloc removal by surgery is recommended. There is the same possibility of postoperative recurrence as pleomorphic adenomas, so long-term follow-up is necessary to determine whether recurrence has occurred.

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Though dolichoectasia is a relative common disease with abnormal prolongation, and meandering or expansion of the main artery system at the brain, abnormality of the extracranial-carotid artery system is rare. We encountered two cases of dolichoectasia of the extracranial-carotid artery system occurring at the back of the palatine tonsil with long-term discomfort of the throat. The first patient was a 72-year-old woman. Her chief complaint was right neck pain and discomfort of the throat. It was inferred that these symptoms were induced by a meandering and bending of the right common carotid artery and internal carotid artery toward the pharynx by visual and palpable findings or CT scan imaging. The second case was a 68-year-old woman. Her chief complaint was feeling of oppression at the throat. It was found by laryngeal endoscope and CT scan imaging that the right common artery meandered and protruded into the cavity of the oropharynx. In conclusion, there are some reports of major bleeding at the time of easy puncture of a pulsating mass of the neck or complication of adenoidectomy without understanding of this disease. For this reason, we need to recognize this pathology as vascular running abnormality in the head and neck region, although we cannot improve abnormal vascular running to the normal state completely.

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During a surgery for a parotid gland tumor, if it is determined that the case is a facial nerve schwannoma and the surgery is continued, intracapsular enucleation may be selected rather than extracapsular enucleation of the tumor to alleviate postoperative facial paralysis as much as possible. The patient is a 35-year-old woman. Initial findings revealed a hard palpable tumor with poor mobility in the anterior region of the right ear. Image findings showed a benign tumor. Although the tissue type was not revealed by cytodiagnosis, malignant findings were not observed. We determined that it was a case of facial nerve schwannoma that had developed in the main trunk. A beaver-knife was used to peel off. While aspirating and extracting the tumor capsule, the contents were peeled off from the nerve membrane little by little. As a result, while maintaining the neural capsule as much as possible, we succeeded in enucleation of most of the intracapsular contents. Although facial nerve was almost completely paralyzed immediately following surgery, this paralysis recovered to an acceptable level after 2 years. The use of a beaver knife facilitated the enucleation of the tumor and was thought to reduce the surgical damage to the facial nerve.

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Calcific retropharyngeal tendinitis （CRT） causes acute neck pain and stiffness associated with dysphagia. It is an inflammation induced by the deposition of hydroxyapatite crystals in the superior oblique tendon fibers of the longus colli muscle. We report a 51-year-old female case of CRT. A retropharyngeal abscess was initially suspected and she underwent a transoral incision on her swollen posterior pharyngeal wall. However, no drainage of pus was found. Based on this finding and enhanced CT findings, she was diagnosed as CRT. Her symptoms improved naturally without antibiotics.
It is sometimes difficult to distinguish CRT and retropharyngeal abscess, because they may have similar clinical courses and a low-density area in the retropharyngeal space on CT images. It is important to keep in mind CRT to avoid unnecessary invasive tests and treatments.

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Surgery is typically the primary treatment for parotid gland cancer; however, there is no consensus on postoperative adjuvant treatment of locally advanced disease or distant metastasis. The sensitivity of parotid gland carcinomas to chemotherapy and radiation therapy varies with the malignant subtype, which is histologically determined. Insurance covers immune checkpoint inhibitors （e.g., nivolumab） for treating head and neck cancer; however, the efficacy of these inhibitors for the subtypes of parotid gland carcinoma remains unclear. We report the use of nivolumab in a 53-year-old woman patient with locally advanced, poorly differentiated parotid gland cancer and postoperative recurrence. The patient was referred to our hospital for swelling of the lower left ear and both sides of the neck.
The parotid gland tumor revealed poorly differentiated atypical cells and was diagnosed as parotid carcinoma. The postoperative pathology following total parotid gland resection and bilateral neck dissection confirmed the diagnosis of poorly differentiated cancer. At 6 months after the completion of postoperative chemoradiotherapy, the patient experienced distant recurrence as pulmonary metastasis. Nivolumab was initiated because over 50％ PD-L1 expression was observed in pathological specimens. After the initial administration, the patient was unable to continue the immunotherapy due to interstitial pneumonia. The imaging results showed that liver metastases and bone metastases had increased mildly, but some lung lesions had decreased in size. However, the efficacy of chemotherapy for recurrent poorly differentiated carcinoma of the parotid gland is not clear; thus, more experience with chemotherapy and immunotherapy for this carcinoma is required.

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We report two cases of neck lymphadenitis due to non-tuberculous mycobacteria （NTM） in which good progress was achieved by surgical intervention. Two cases detected the swelling of the cervical lymph node of one laterality in the adult who did not merge immunodeficiency, and both cases showed resistance to antibacterial treatment. As for the acid fast bacterium culture of the puncture liquid, Mycobacterium abscessus was detected in the first case, and Mycobacterium avium complex was detected in the second case. In the first case, chemotherapy and incision drainage were performed. In the second case, chemotherapy was administered for four months, but the lymph node remained and was cured radically by enucleation. We recommend surgical intervention because the surgical approach is easier with localized cervical NTM and is expected to achieve cure earlier than treatment with chemotherapy alone.

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Granular cell tumor （GCT） is a rare benign neoplasm of neural origin that can arise in any part of the body. Although approximately 50％ of all cases are seen in the head and neck region, GCT arising from the submandibular region is quite rare.
We report the case of a 41-year-old woman in whom an elastic hard mass was found in the submandibular region. Computed tomography scan showed a spindle-shaped mass along the platysma. The tumor was surgically removed. The histopathological diagnosis was GCT. We discuss the course of treatment and surgical results, with a review of the literature.

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We report a case of nasogastric tube syndrome （NGTS） with a review of the literature. In this patient, a nasogastric tube was inserted for drug administration during artificial respiration management. At the time of extubation, vocal cord abduction dysfunction was observed, and a tracheostomy was performed. The patient was followed up for approximately 6 months after the surgery; however, the bilateral vocal cords were still fixed in the median position, and so left vocal cord lateralization was performed. Many clinical features of NGTS are still unclear, and it is necessary to screen patients for the presence of this disease during nasogastric tube insertion. Vocal cord dysfunction is believed to be caused by compression of the nasogastric tube to the posterior laryngeal muscle in the postcricoid area, which passes through the midline of the pharynx into the postcricoid area. It is important to adjust the position of the nasogastric tube by using a pharynx endoscope together in case of the midline position of the nasogastric tube. There is no established treatment for recovering impaired vocal cord mobility; future studies are warranted.

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An elongated styloid process occurs due to elongation of the styloid process, which then may produce a pain sensation due to the pressure exerted on various structures in the head and neck. In this report, we discuss one case of an elongated styloid process in which the surgical procedure was planned using a three-dimensional jaw bone model. The patient was a 38-year-old woman with a one-year history of pain in the left lower jaw and left ear tinnitus and fullness. 3D-CT images showed an overgrowth of the left styloid process of 42mm. Based on the CT data, we created a three-dimensional jaw bone model in which the temporomandibular joint could move, and confirmed whether the transoral approach was possible. We confirmed that the operative field could be sufficiently secured and that a sufficient length of left styloid process could be safely resected, and the oral method was selected. The symptoms of this patient disappeared immediately after the operation. We suggest that planning the surgical procedure using a three-dimensional jaw bone model is useful for an elongated styloid process.

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In the present case, the root of the first molar, which had accidentally invaded the maxillary sinus due to a tooth extraction operation, could be excised under clear vision by inserting a flexible endoscope with forceps from the extraction socket. The method is minimally invasive and is considered to be one of the options for the treatment of foreign bodies invading the maxillary sinus.

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