[in Japanese]

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[in Japanese]

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[in Japanese]

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The time that elapses until undergoing surgery for a presumptive benign parotid tumor based on the preoperative evaluation may be prolonged at the patient’s request. Indeed, there is no clear standard for the tumor stage at which surgery is strongly recommended for a benign parotid tumor. We studied 61 patients in whom parotid tumor resection was performed in our department to determine the recommended criteria for scheduling surgery. We found that there was a high risk of postoperative facial nerve paralysis in patients in whom the tumor was situated in the upper pole of the parotid gland or the maximum tumor diameter was ≥ 25mm, so performing surgery earlier was preferable. In addition, in patients in whom a tissue type other than a Warthin’s tumor was suspected or when pain, poor mobility, or tumor growth were observed, early surgery is recommended given the possibility of malignancy.

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Epipharyngeal abrasive therapy （EAT） is effective for treating chronic epipharyngitis. White streak-like changes, which are considered a temporary whitening phenomenon （whitening）, may be observed on the epipharyngeal mucosa of patients undergoing continuous EAT. This study investigated the frequency and degree of whitening after EAT in patients with chronic epipharyngitis and examined the relationship between subjective symptoms and improvement in the severity of endoscopic findings. The relationship between the degree of redness, swelling, post-nasal drip, and crusting, which are endoscopic findings before treatment, and whitening was examined using Fisher’s exact test. In total, 102 of 154 patients （66.2％） exhibited whitening after EAT. Patients with whitening showed a significant improvement in the severity of endoscopic findings （p＝0.005）, and patients with more severe swelling showed less whitening （p＝0.002）. No significant relationship was observed between whitening and improvement in subjective symptoms. We used visible light and narrow band imaging （NBI） to observe whitening, and NBI allowed for clearer observation in determining the presence or absence of whitening in some cases. In conclusion, the severity of endoscopic findings significantly improved in cases with whitening, suggesting that whitening may be an indicator of improved endoscopic findings. These results indicate that epipharyngeal mucosal swelling involves lymphoid tissue proliferation and suggest that the presence of lymphoid tissue may be a factor that prevents whitening.

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We clinically reviewed 142 cases of oral cancer treated at Oita University, Faculty of Medicine, Department of Otolaryngology from January 2007 to December 2023. The 5-year disease-specific survival rates at our department were 83.0％ for stage Ⅰ, 72.3％ for stage Ⅱ, 60％ for stage Ⅲ, 61.6％ for stage ⅣA, and 29.2％ for stage ⅣB, which were generally comparable to those at other institutions. The survival rate of surgical treatment after induction chemotherapy （ICT） was 72.6％, followed by 72.9％ for surgical treatment alone, and 58.8％ for surgical treatment after preoperative radiation therapy, showing that the results of surgical treatment after ICT did not differ from those of cases treated with surgical treatment alone and were favorable.

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We report two cases in which a preoperative diagnosis of oncocytoma was made by fine-needle aspiration （FNA） biopsy. After parotid tumor resection, they were diagnosed as mucoepidermoid carcinoma with oncocytic lesions and acinic cell carcinoma with oncocytic lesions. The findings of oncocytic lesions and malignant tissue distribution in the excised specimens differed between the two cases, and it is possible that the diagnosis of malignancy could have been made if multiple FNA had been performed preoperatively. We reviewed 340 cases of parotid tumors that were operated at our institution, and found that oncocytic lesions were detected in 2.6％ of cases （9 cases）. When oncocytoma is diagnosed preoperatively, it is necessary to keep in mind the presence of malignancies.

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Introduction: Mediastinal emphysema is a condition characterized by the presence of air in the mediastinum, often occurring as a complication of trauma, surgery, infection, or bronchial asthma. However, there are diseases of spontaneous onset without an identifiable cause, known as spontaneous mediastinal emphysema. This rare disease affects slender young males and presents suddenly in healthy individuals, usually with a favorable prognosis. In this report, we describe a case of spontaneous mediastinal emphysema that occurred without any apparent cause.
Case Presentation: 23-Year-Old Male: The patient experienced sudden stiffness in the neck six days prior to first examination, which escalated to severe pain during swallowing and neck rotation. Initial examination revealed tenderness along the right sternocleidomastoid muscle, but no abnormalities were detected in the laryngopharyngeal region. Neck mobility was restricted in certain movements, yet there were no signs of infection, such as fever or elevated inflammatory markers in blood examination. Computed tomography was performed to exclude calcific tendinitis of the longus colli muscle; the results showed no calcification but revealed the presence of emphysema adjacent to the right cervical esophagus. Since there were no identifiable causes of the emphysema, a diagnosis of spontaneous mediastinal emphysema was established. The patient was treated conservatively with observation, and he experienced no recurrence of symptoms.
Discussion: Mediastinal emphysema often leads patients to seek medical attention for chest pain or dyspnea. However, when it occurs in the upper mediastinum, it can present as neck pain, pharyngeal pain, or swallowing difficulties, prompting visits to ENT specialists. Therefore, even in the absence of inflammatory findings, the possibility of mediastinal emphysema should be considered in cases of neck and pharyngeal pain.

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[in Japanese]

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Sialolithiasis in the sublingual gland is a rare condition, accounting for approximately 1％ of all cases of sialolithiasis. We report a case of sublingual gland sialolithiasis in a young female patient. The patient had experienced recurrent swelling in the submandibular region for over a year. Examination with a CT scan suggested the presence of a sialolith in Wharton’s duct. Surgery was performed to remove the sialolith under general anesthesia. However, no sialolith was found in Wharton’s duct during sialoendoscopy. Subsequently, a sialolith was searched for after making an incision in the floor of the mouth. Ultimately, the sialolith was identified in the sublingual gland and removed. We compared this case with past reports. In most cases, the preoperative diagnosis was sublingual gland sialoliths; however, in two cases, the diagnosis was submandibular gland sialoliths. In these two cases, the patients were unable to visit a hospital when the floor of the mouth was swollen during acute inflammation, which may have led to the incorrect diagnosis of submandibular gland sialoliths. Even in such cases, detailed examination of the relationship between the sialolith and the mandible using CT scan and/or orthopantomography is helpful for obtaining an accurate preoperative diagnosis.

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Pharyngeal foreign bodies are relatively common in otorhinolaryngological practice. Some pharyngeal foreign bodies may penetrate pharyngeal mucosa and are referred to as extrapharyngeal foreign bodies. Since extrapharyngeal foreign bodies can cause serious complications such as abscesses, early removal is required. In the present case, a 21-year-old man developed a sore throat after cooking and eating chicken meat purchased at a store. A CT scan revealed a linear foreign body, but laryngoscopy showed no findings. We decided to remove the object under general anesthesia. We first attempted to remove it by the transoral method. Initially, we observed the pharynx using a laryngoscope and searched with alligator forceps, but no foreign body was identified. Next, a cervical ultrasound was used to search for the foreign body. A high-intensity foreign body was identified near the pharyngeal constrictor muscle. We changed to a cervical approach and placed a cervical incision. We searched for the foreign body by palpation but could not identify it. By using intraoperative radioscopy （C-arm）, the foreign body became visible and was removed using alligator forceps. The foreign body was a thin, needle-shaped metal object. It is often difficult to identify foreign bodies outside the pharyngeal cavity. To avoid inadvertent damage and to prevent remaining foreign bodies, the combination of an external neck incision that allows clear visualization of the operative field and a C-arm that shows real-time localization was useful.

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The first treatment of choice for pyriform sinus fistula was traditionally cervical external incision with duct excision. However, in recent years, reports have emerged regarding oral duct excision and fistula cauterization. In the present case, we applied endoscopic laryngo-pharyngeal surgery （ELPS）, a technique used for pharyngeal superficial cancers, to close an oral fistula, and achieved primary closure of the fistula in this one case. The ELPS technique requires endoscopic manipulation and the use of curved forceps, demanding advanced skills. However, it is considered to be superior in duct identification, working space management, and maintenance of the surgical field. ELPS is expected to become one of the options for treating pyriform sinus fistula.

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