I have made recommendations regarding the problems currently faced by the Japan Society of Stomato-Pharyngology and how to solve them. The society deals with a large number of fields in addition to inflammatory and neoplastic diseases, and some of the fields overlap with those of dentistry and oral surgery, which are borderline fields. The number of otorhinolaryngologists is about 1/10 of dentists. This has resulted in a chronic shortage of members. I’ll propose coexistence with other departments and methods of holding academic conferences.
The next social problem is the super-aging society. The population is already in decline, and the COVID-19 pandemic is accelerating the decline in the number of births. The time may no longer be ripe for relying on traditional outpatient and inpatient forms of medical care. Fortunately, online medical services are expanding, and I’ll propose the active use of online medical services.

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[in Japanese]

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Objective: Head and neck squamous cell carcinoma is often detected in a locally advanced state, and surgery, radiotherapy, and chemoradiotherapy are generally performed for local control. However, even when local control is achieved, some cases die due to distant metastasis （DM）. This study aimed to investigate the predictive factors for DM after total pharyngolaryngectomy （TPL） in head and neck cancer.
Material and Methods: Forty-three patients with head and neck squamous cell carcinomas underwent TPL in Nara Medical University Hospital from January 2010 to December 2019. The primary tumor sites were the oropharynx （n＝4）, hypopharynx （n＝34）, and larynx （n＝5）. The DM-free survival （DMFS） was evaluated according to factors including pathological T classification （T2 vs T3-4 and T3 vs T4）, pathological N classification （bilateral lymph node metastasis vs ipsilateral and no lymph node metastasis）, extra nodal extension （positive vs negative）, degree of differentiation （well differentiated vs moderately and poorly differentiated） and smoking （Brinkman Index （BI） ≥ 450 vs BI＜450）. Moreover, total treatment package time was evaluated in patients who underwent adjuvant chemoradiotherapy or radiotherapy after TPL.
Results: DM developed in 11 patients of the 43. Ten of 11 patients with DM underwent TPL as the initial treatment and one received salvage treatment. DMFS was statistically shorter in the group of bilateral lymph node metastasis and extra node extension positive. There was no significant difference in other factors.
Conclusions: Bilateral lymph node metastasis and extra node extension positive were predictive factors for shorter DMFS.

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[in Japanese]

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Herpes simplex virus （HSV） infections involve many organs such as the oral cavity, lips, pharynx, larynx, genitals, cornea, brain and spinal cord. Serological tests are common for the diagnosis of HSV infection, but clinicians must know that serum HSV antibodies are undetectable until 7 days after onset. Accordingly, we re-examined serum HSV antibodies in cases in which serum HSV antibodies were negative in the early phase. We diagnosed 24 patients （9 males, 15 females; age, 4 to 41 years, mean 23.58 years） as primary herpetic gingivostomatitis and pharyngo-laryngitis. Most patients had vesicular and ulcerative eruptions on the oral cavity, pharynx and larynx, and their cervical lymph nodes were swollen. They complained of high fever, severe sore throat and difficulty in oral intake. We treated the patients with anti-viral drugs （acyclovir or valaciclovir）, antibiotics and steroids and all patients recovered completely without any sequelae.

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The severity of obstructive sleep apnea （OSA） is not necessarily linked to worsening quality of life （QOL）, and improvement in OSA with treatment does not necessarily mean improvement in QOL. In addition, QOL may differ by age group. The subjects of this study were 34 patients （29 males and 5 females） who underwent bilateral tonsillectomy and soft palate plasty for OSA, and 71 patients （59 males and 12 females） who were treated with nasal continuous positive airway pressure ventilators （nCPAP）. Three months after treatment, changes in quality of life in each treatment group by age group were investigated using the Medical Outcome Study 36-Item Short Form Health Survey （SF-36） version 2 questionnaire. As a result, among patients in their 30s and 40s, the improvement in physical QOL was remarkable in the group treated with surgery, but among those in their 50s, the QOL was better in the CPAP treatment group both physically and mentally. The results indicated that CPAP is not always suitable as a treatment method from the viewpoint of QOL improvement. It is necessary to select a treatment method that takes into account the age group and QOL, and it is also important to evaluate not only whether OSA improves, but also whether QOL improves.

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This study examined the indications for oral appliance therapy based on evaluations using endoscopy and the efficacy of oral appliance therapy assessed by polysomnography.
The postoperative apnea hypopnea index significantly improved by oral appliance therapy. Oral appliance therapy was indicated for patients whose cross section of the airway at the tongue base level widened when the mandible protruded. However, oral appliance therapy was not very effective for some patients whose cross section of the entire circumference of the airway at the soft palate level was occluded when snoring.
Endoscopic evaluation of the upper airway at the level of the oropharynx and assessment of the therapeutic efficacy by polysomnography should be performed when using oral appliance therapy for obstructive sleep apnea syndrome.

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Spindle cell carcinoma is a malignant tumor with both a squamous cell carcinoma component and sarcomatoid growth of spindle-shaped cells, and is classified as a subtype of squamous cell carcinoma. Spindle cell carcinoma accounts for 0.4% to 4% of all squamous cell carcinomas of the head and neck, and frequently involved sites include the oral cavity and larynx. In this study, we describe six cases of spindle cell carcinoma in the head and neck, with a review of the literature. The ages of the patients ranged from 59 to 86 years; three were male and three were female. The primary site was tongue in 3 cases, maxilla in 1 case, and mandible in 2 cases. Surgery was performed in all 6 patients, and 2 of them died due to early local recurrence.
Compared to squamous cell carcinoma, spindle cell carcinoma of the oral cavity is generally associated with a poorer prognosis, and early diagnosis and surgical resection are important.

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Although there are various reports on the clinical manifestations and frequency of olfactory and taste disorders after COVID-19, the olfactory and taste functions of patients had not been assessed, nor do the authors of most reports follow the long-term course of the disease. In this study, we aimed to evaluate symptoms, virus strains expected from the time of infection, duration of illness, results of olfactory and gustatory tests, association between olfactory and gustatory sensation, and outcome 6 months after the initial visit. Seventy-seven patients （32 men and 45 women, aged 6-65 years） who complained of smell and taste disorders after COVID-19 and who visited our clinic from January 2021 to October 2022 were included in the study. The subjective olfactory and taste changes were assessed using the visual analog scale （VAS）. A standard olfactometry （T＆T olfactometer） and intravenous olfaction test were used to assess olfactory function, and a filter paper disk and an electrogustometer were used to assess taste function.
The most common complaint was both olfactory and gustatory impairment （49％）. The highest number of patients （48％） was seen during the Delta variant epidemic. The median duration of illness was 4 months. In 38 patients who complained of both olfactory and gustatory impairment, there was a correlation between olfactory and gustatory symptoms in terms of type, severity, and test results. Of 63％ patients, the results of taste examination were assessed as normal, indicating the cause was olfactory dysfunction. In total, 79％ of the patients were finally diagnosed as having olfactory dysfunction. After 6 months of follow-up, 68％ of the patients with taste impairment and 61％ of those with olfactory impairment showed improvement.
It is important to evaluate olfactory and gustatory function by not only symptoms but also examinations in order to understand the status of COVID-19 patients.

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Tongue pressure is a useful parameter of oral function generated by the tongue and palate, and is a component used to assess the deterioration of oral function. Tongue pressure is also a prognostic factor for systemic frailty and a parameter of swallowing function. On the other hand, in some cases of obstructive sleep apnea （OSA）, the pathogenesis of OSA is derived from tongue narrowing and base of tongue level. However, there have been few studies on the relationship between tongue pressure and OSA. Therefore, we measured the tongue pressure of OSA patients requiring continuous positive airway pressure （CPAP） and compared the results with those of a control group. Tongue pressure was reduced in OSA patients who were elderly or not obese. Oral functional failure, including low tongue pressure, may contribute to the pathogenesis or progression of OSA.

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We investigated the association between clinical and pathological factors and prognosis in patients with squamous cell carcinoma of the oral cavity and pharynx who received nivolumab at our department from September 2017 to July 2019. Eight patients had oral cavity cancer and 20 had pharyngeal cancer, and the median survival was 10 months. Patients with an ECOG PS of ≥2, a neutrophil to lymphocyte ratio （NLR） of ≥5, and a serum CRP level of ≥0.87mg/dl had a significantly worse prognosis （p＝0.0004, 0.01, 0.03）. PD-L1 expression and tumor-infiltrating lymphocyte （CD4, CD8, FoxP3） expression in initial pathology specimens were not associated with prognosis, but those with high expression of tumor-associated macrophages （CD163） showed a tendency toward poor prognosis. Further development of prognostic factors is desirable.

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During sleep, not only adults but also children repeatedly change positions from supine, lateral, and prone, but the relationship between position changes and apnea hypopnea index （AHI） has not been investigated. In addition, parents at outpatient clinics often say that their children frequently change positions during sleep and have poor sleeping habits, but there has been no actual examination and evaluation. In this study, we investigated the relationship between postural changes during sleep and AHI in adults and children, and the status of postural changes during sleep and postural changes by asking questions in only children. The subjects were 396 patients aged from 0 to 86 who visited the otolaryngology department of Fujita Medical University Bantane hospital between November 2018 and December 2019, had suspected sleep-disordered breathing, and underwent the first all-night polysomnography. As the children grew older, the high correlation between postural changes and AHI gradually disappeared, and no correlation was found between 9 and 14 years of age. Since the questioning revealed no significant correlation between the child’s postural changes and the status of postural changes, it is important to perform PSG in addition to questioning alone. There is a positive correlation between the postural change index and AHI in younger children. We hypothesize that children may change their position to avoid apnea.

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Tonsillectomy is one of the most common surgical procedures, and postoperative hemorrhage occurs at a certain rate. We investigated the possible risk factors for postoperative bleeding in 243 patients who underwent tonsillectomy, in terms of age, gender, indications for surgery, preoperative APTT, surgeon’s experience of otolaryngology, operative time, and intraoperative blood loss. Postoperative hemorrhage was observed in 54 patients （22.2%）, and hemostasis under general anesthesia was required in 7 patients （2.9%）. Logistic regression analysis showed that male, chronic and recurrent tonsillitis, and prolonged APTT were independent risk factors for postoperative hemorrhage. Although APTT is widely used as a preoperative screening, it is rarely examined closely even when abnormalities are found. Patients with a prolonged APTT are at risk of postoperative hemorrhage, therefore a medical interview regarding family history and further testing are necessary to diagnose coagulopathy in these patients.

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[in Japanese]

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An 18-year male with fever, sore throat and poor oral intake was admitted to our hospital. Based on the pharyngeal findings and laboratory data including leukocytosis with lymphocytes predominance and atypical lymphocytes, and liver dysfunction, infectious mononucleosis （IM） was diagnosed. This was established based on elevated EBV titer VCA-IgM two days later. However, the detailed pharyngeal examination at admission suggested pharyngeal edema which was atypical in IM. CT with contrast enhancement revealed bilateral peritonsillar abscess （PTA）. The patient recovered well after conservative treatment including intravenous injection of antibiotics and needle aspiration of the bilateral abscesses. The association of PTA, especially bilateral ones, with IM is rare. Therefore, even if one is diagnosed, differentiation of association with others should be considered.

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We report a case of schwannoma that developed in the masseter muscle. The patient was a 33-year-old woman who was referred to our hospital due to swelling of the right cheek. An elastic movable mass 40mm in diameter was found in the masseter muscle. Contrast-enhanced computed tomography （CT） showed poor enhancement. Malignant atypical cells were not detected using fine-needle aspiration. The lesion was diagnosed as schwannoma and resected under general anesthesia. We made an S-shaped incision from the anterior part of the ear. During the operation, a nerve stimulator was used to identify the nerve originating from the masseter muscle nerve, and the tumor was removed by intercapsular resection. Postoperative pathological examination confirmed the diagnosis of schwannoma. No postoperative neurological deficits and no recurrence of the tumor were observed, and the clinical course was uneventful.

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Introduction: Granulomatous tonsillitis is a very rare disease in which granulomas form in tonsil tissue. Various diseases such as tuberculosis, sarcoidosis, and Crohn’s disease have been implicated as causes, but in many cases the cause is unknown. Crohn’s disease is an inflammatory bowel disease and requires early diagnosis and treatment. We report a case of granulomatous tonsillitis that was diagnosed as Crohn’s disease after tonsillectomy.
Case: The patient was a 28-year-old woman who underwent tonsillectomy for habitual tonsillitis. Histopathological examination of the palatine tonsils revealed the formation of a non-caseating epithelioid cell granuloma. A thorough systemic examination was performed, but did not lead to a diagnosis of the causative disease. On postoperative day 45, the patient began to have fever, gastrointestinal symptoms, and stomatitis. A lower gastrointestinal endoscopy was performed on postoperative day 73. The ileal mucosa showed easily hemorrhagic mucositis with longitudinal ulceration. A mucosal biopsy resulted in a diagnosis of Crohn’s disease. Treatment was initiated promptly, and the patient has remained in remission to this day.
Conclusion: The granulomatous tonsillitis in this case was considered to be an oral lesion preceding Crohn’s disease. In cases of granulomatous tonsillitis with epithelioid cell granuloma, the possibility that Crohn’s disease is the cause should be fully considered.

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Transoral videolaryngoscopic surgery （TOVS） requires surgical manipulation in a limited surgical field under endoscopy. For successful resection, it is essential to devise ways to secure the field of view and operability. Recently, we have been working on TOVS using a rigid three-dimensional endoscope, called 3D TOVS.
While it is easier to obtain a clear 3D view than with a 2D endoscope, the 3D endoscope requires a wide aperture due to the larger diameter of the endoscope and cannot be applied to some lesions due to poor development of the operative field.
For cases in which the hypopharynx is difficult to expand, a rigid curved pharyngo-laryngoscope with a mouth prop can be used to expand the hypopharynx and secure a wide aperture, allowing 3D TOVS to be performed.

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