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Objective The aim of the present study was to evaluate the psychological condition of patients with non-cured facial nerve palsy and to investigate whether their psychological condition is correlated with the degree of facial nerve palsy, synkinesis or quality of life. Methods Thirty patients with non-cured facial nerve palsy were enrolled in this study. Psychological conditions were evaluated by questionnaires including State-Trait Anxiety Inventory and Self-rating Depression Scale. Results Of the thirty patients with non-cured facial nerve palsy, 17 (56.7%) and 15 patients (50.0%) felt anxiety and depression, respectively. Although there were no significant correlations between their psychological condition and the degree of facial nerve palsy or that of sequelae, significant correlations were observed between psychological condition and the degree of QOL, especially in terms of social function. Conclusions and significance Disabilities associated with facial nerve palsy may be overlooked when evaluation is performed by physician-graded instruments alone. To resolve this problem, patients with non-cured facial nerve palsy should be evaluated by not only physician-graded tools but also patient-based assessment tools.

Objectives The aim of the present study was to investigate the characteristics and prognosis of facial palsy in patients with otitis media with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (OMAAV). Study design Retrospective case review. Setting Tertiary referral center. Patients Thirty-seven patients with OMAAV. Main outcome measures The patients were divided into the facial palsy group and non-palsy group. The severity of and prognosis for facial palsy were evaluated using the House-Brackmann facial grading system (HB). Characteristics were compared between the facial palsy group and non-palsy group. Results Facial palsy was observed in eight patients. The last HB grade for all patients was either grade I or II after treatment with a combination of corticosteroids and immunosuppressant therapy. There were no cases in which palsy relapsed. Facial palsy in OMAAV was significantly more common in female patients, and patients with facial palsy demonstrated significantly higher rates of hypertrophic pachymeningitis than did those without facial palsy. Conclusions Facial palsy in patients with OMAAV was detected in 21.6% and a good prognosis was obtained by use of the appropriate treatment. Facial palsy is one of the most important symptoms by which to diagnose OMAAV. When encountering the patients with intractable otitis media complicated with facial palsy, appropriate examination including ANCA titer should be performed.

This study aimed to investigate the demographic, clinical, and epidemiological statistics of Japanese patients attending a designated outpatient clinic for COVID‐19 in Sapporo, Japan, and contrast the clinical and epidemiological features between those with and without mild COVID‐19. A total of 27 (8.6%) of 315 patients were diagnosed with COVID‐19. They had higher proportions of myalgia, direct contact with a confirmed COVID‐19 patient, and attendance of social gatherings in close confines. We believe that our study makes a significant contribution to the literature because it provides a clinical picture of mild COVID‐19 in the Japanese population, which has not been studied extensively. It can also assist in optimizing the local preventive measures to reduce the transmission of COVID‐19.

Objectives The aim of the present study was to evaluate semicircular canal function by video Head Impulse Test (vHIT) in patients with facial nerve schwannoma (FNS). Study design Retrospective case review. Setting Tertiary referral center. Patients Seven patients with FNS underwent vHIT examination. Main outcome measures The gain in vestibulo-ocular reflex and the presence of catch-up saccade were examined for the semicircular canals including the vertical canals. Results Dysfunction of the semicircular canals was detected by vHIT in three of seven cases. Nystagmus beating toward the non-affected side was observed in all three cases with semicircular canal dysfunction. Dysfunction was observed in a case with no direct compression of the vestibular nerve or semicircular canals by FNS. Conclusions Semicircular canal function in patients with FNS could be evaluated by vHIT. vHIT has two advantages for the evaluation of vestibular function in patients with FNS. First, vHIT could be used for the patients in whom a tumor exists in the external auditory canal or middle ear, unlike caloric testing. Second, as vHIT could evaluate all three canals, impaired vestibular nerves could be speculated from vHIT results when a tumor exists in internal auditory canal. vHIT should be performed in patients with FNS, especially before surgery, to evaluate vestibular function.

Objectives: To investigate the effectiveness of make-up therapy for patients with facial nerve palsy. Methods: Seven female patients with facial nerve palsy who received specialist make-up therapy were enrolled. The objective of the make-up therapy was to obtain a symmetrical facial appearance. Results: Overall score for the Facial Clinimetric Evaluation (FaCE) scale was significantly improved after make-up therapy. There was a tendency for symptoms of depression to be improved among patients after make-up therapy. Conclusion: Make-up therapy to improve the symmetry of facial appearance could afford a noninvasive and low-cost treatment for patients with facial nerve palsy, especially in terms of patient quality of life and psychological condition.

Objective To investigate the effect of the timing of tracheostomy in patients who required prolonged mechanical ventilation using two methods: analysis of early versus late tracheostomy and landmark analysis. Study Design Retrospective cohort study. Methods Patients who were emergently intubated and admitted into the intensive care unit or high dependency unit between January 2011 and August 2016, with or without tracheostomy, were included. In the early and late tracheostomy analysis, all patients were divided into early (≤10 days, n = 88) and late (>10 days, n = 132) groups. In the landmark analysis, 198 patients requiring ventilation for more than 10 days were divided into early tracheostomy (≤10 days, n = 57) and nonearly tracheostomy (>10 days, n = 141) groups. We compared 60-day ventilation withdrawal rate and 60-day mortality. Results Early tracheostomy was a significant factor for early ventilation withdrawal, as shown by log-rank test results (early and late tracheostomy: P = .001, landmark: P = .021). Multivariable analysis showed that the early group was also associated with a higher chance of ventilation withdrawal in each analysis (early and late tracheostomy: adjusted hazard ratio [aHR] = 1.69, 95% confidence interval [CI] = 1.20-2.39, P = .003; landmark: aHR = 1.61, 95% CI = 1.06-2.38, P = .027). Early tracheostomy, however, was not associated with improved 60-day mortality (early and late tracheostomy: aHR = 0.88, 95% CI = 0.46-1.69, P = .71; landmark: aHR = 1.46; 95% CI = 0.58-3.66; P = .42). Conclusion For patients requiring ventilation, performing tracheostomy within 10 days of admission was independently associated with shortened duration of mechanical ventilation; 60-day mortality was not associated with the timing of tracheostomy. Level of Evidence 2b.

In 2009, we introduced percutaneous dilational tracheotomy (PDT) in otolaryngology residency training. PDT was performed in 21 cases and five residents had an opportunity to learn PDT. No major complications occurred. Decannulation was achieved in 17 of the 18 cases, excluding 3 mortalities. All residents felt that their knowledge of PDT had advanced. Introduction of PDT has great significance in otolaryngology residency training.

This chapter describes the knowledge of Bell's palsy in general and its diagnosis and its treatment. The pathology associated with Bell's palsy is still unknown, but ischemia and viral infection of the facial nerve have been proposed. The reactivation of herpes simplex virus (HSV) type 1 has been reported most frequently and this is one of the most likely causes. The facial nerve consists of two roots: the motor division, and the nervus intermedius containing parasympathetic and sensory fibers. The two roots enter the caudolateral aspect of the pons in the cerebellopontine angle. Virus isolation in cell culture is the gold standard for the diagnosis of viral infections. Attempts have been made in several studies to isolate HSV from patients with Bell's palsy. HSV frequently reactivates without causing herpetic lesions, and can be cultured from the saliva and tears of healthy people. Such viral shedding without mucocutaneous disease has been documented in patients with Bell's palsy.

Objective To investigate factors affecting the effect of physical rehabilitation therapy for synkinesis as a sequela to facial nerve palsy. Methods A total of 37 patients with peripheral facial nerve palsy in Teine-Keijinkai Hospital were enrolled in this study. All patients showed synkinesis at 6 months after the onset of facial nerve palsy and were instructed in physical rehabilitation by expert staff from their first visit. The degree of synkinesis was evaluated at 6, 9 and 12 months after the onset of facial nerve palsy based on Sunnybrook facial grading system score and asymmetry in eye opening width. The patients were divided into two groups by age, gender, cause of palsy, electroneurography (ENoG) value, onset of synkinesis, initial treatment and timing of the start of physical rehabilitation. Results Female patients and younger patients did not show any deterioration in synkinesis. Patients in the lower ENoG group and the later onset of synkinesis group showed significant deterioration in synkinesis after the 6th month from onset of facial palsy. Conclusion Physical rehabilitation was shown to prevent significant deterioration in synkinesis in female and younger patients with facial nerve palsy. Careful follow-up with regard to synkinesis is required in cases in which the facial nerve damage is thought to be severe.

Objectives: To investigate the biological factors related to the onset of Bell's palsy, we sought to identify differentially expressed genes in peripheral blood mononuclear cells (PBMCs) and plasma of patients with Bell's palsy and Ramsay Hunt syndrome (RHS). Methods: We carried out DNA microarray analyses using PBMCs taken from patients with Bell's palsy at their initial visit and 2 to 4 weeks later. To validate these analyses, we measured the relative messenger RNA levels of α-defensin in paired PBMCs by reverse transcription–polymerase chain reaction. The plasma concentrations of α-defensin in patients and healthy volunteers were quantified by enzyme-linked immunosorbent assay. Results: The DNA microarray analysis identified α-defensin as a candidate gene related to the onset of Bell's palsy. Reverse transcription–polymerase chain reaction analysis showed that the relative α-defensin messenger RNA levels in PBMCs from the later visit were increased at least twofold in 9 of 13 patients (69%) with Bell's palsy and in 4 of 6 patients (67%) with RHS. The plasma α-defensin concentrations in the patients with RHS were significantly higher than those in healthy volunteers (p = 0.0013) and in the patients with Bell's palsy (p = 0.0306). Elevations of plasma α-defensin were observed in 5 of the 9 patients with Bell's palsy who demonstrated α-defensin overexpression in PBMCs. Conclusions: α-Defensin may be one of the biological factors related to the onset of Bell's palsy and RHS.

Objectives/Hypothesis: Sinonasal inverted papilloma is a rare but locally aggressive benign tumor. Inverted papilloma tends to recur after surgical resection and is occasionally associated with squamous cell carcinoma. Radical en bloc resection by lateral rhinotomy and medial maxillectomy has been recommended for initial management; however, endoscopic sinus surgery is effective in selected cases. To determine adequate surgical approaches, a staging system for inverted papilloma based on extent and location of the tumor has been advocated. The study investigated whether preoperative assessment by magnetic resonance imaging (MRI) accurately predicts the extent of inverted papilloma. Study Design: Magnetic resonance imaging was retrospectively reviewed in 21 cases of inverted papilloma without knowledge of the surgical and pathological findings. Methods: Patients were categorized into stages based on MRI findings, according to the staging system proposed by Krouse. The involvement of inverted papilloma in each sinus was also assessed. Results: Stages graded by MRI were coincident with postoperative staging verified by surgical and pathological findings in 18 of the 21 cases (86%), which included 1 case of stage T1, 3 cases of stage T2, and 14 cases of stage T3. Two cases of stage T2 were judged as T3, and one case of T3 was judged as T2 by MRI. Positive predictive value of MRI diagnosis for tumor involvement was 68% to 89% in each sinus, and negative predictive value was more than 93%. Conclusion: In most cases, MRI assessment of inverted papilloma can accurately predict the extent of tumor involvement. Preoperative staging of inverted papilloma by MRI may be useful for planning an appropriate surgical approach.

Background The current study aimed to evaluate the significance of an immunohistochemical assessment of tumor suppressor p53 as a prognostic marker in head and neck squamous cell carcinoma (HNSCC) patients treated with docetaxel and radiotherapy. Methods The expression of tumor suppressor p53 and its phosphorylated form at the Ser392 residue was retrospectively evaluated by immunohistochemistry in 51 Stage T1-3N0-2M0 (except T1N0 glottis) HNSCC patients who were treated with 10 mg/m 2 /week docetaxel four to six times and received concurrent chemoradiotherapy. Results Kaplan–Meier univariate analysis revealed that no difference in rates for overall and disease-free survival (DFS) between patients with p53-positive and -negative tumors ( p = 0.786 and p = 0.924, respectively). The prognostic significance of phosphorylated p53 at the Ser392 residue was neither observed. Conclusions An immunohistochemical assessment of the expression of p53 and its phosphorylated form might not be of clinical use in defining subgroups of patients with poor prognosis.

コロラドマイクロディセクションニードル®はチップ先端が5ミクロンと極めて鋭利なモノポーラ針である。最長で有効長17.8 cmのプローブもあり，直達喉頭鏡下手術においても使用できる。通常のモノポーラーと同様，止血能に優れ，さらに先端が極めて鋭利であるので周囲組織障害を起こしにくい。また安価であり，汎用されている一般のメスホルダーに接続可能であるため，レーザーに比べ導入は容易である。当科においては直達喉頭鏡下の喉頭蓋嚢胞造袋術，喉頭蓋血管腫切除術，喉頭腫瘍切除術で切開，凝固，止血に使用してきた。コロラドマイクロディセクションニードル®を使用した喉頭微細手術の手技と工夫について述べる。

ヒト乳頭腫ウイルス（human papillomavirus：HPV）は子宮頸癌の発生に関与することが知られているが，近年の分子疫学的検索から頭頸部扁平上皮癌，とくに扁桃原発中咽頭癌へのHPVの関与が明らかになりつつある。HPV感染の有無は扁桃原発の中咽頭癌においては診断としても有用であるばかりでなく，ワクチンの開発，普及が進めば予防，さらには発症数の減少につながる可能性があり，今後の発展が望まれる分野である。本稿ではこれまでに報告されているHPVによる頭頸部癌の発癌メカニズムおよびHPV検出法について概説するとともに当科における中，下咽頭癌症例でのHPV検出についても述べる。

耳下腺癌切除後の顔面神経再建は，患者のQOLの向上を図る上で重要な課題である。本論文では，耳下腺癌切除後の顔面神経再建の現状について述べた。耳下腺癌切除後の顔面神経再建についての全国アンケート調査によれば，大部分の施設では腫瘍切除時に即時再建を行うことを基本方針としており，また60%の施設においては形成外科医が再建を担っていた。耳下腺癌切除後の顔面神経再建において，二期的形成術を含め形成外科医の果たす役割が大きいことが示唆された。また，顔面神経再建術後の評価法について考察し，Sunnybrook評価法の応用について示した。頭頸部外科医・形成外科医が術後の評価について共通の評価法を用いることを提案した。

Surgical complication rates of total laryngectomy vary according to the preoperative treatments performed and patient factors. Wound complications after salvage laryngectomy following concurrent chemoradiotherapy (CCRT) were analyzed.Eighty-six patients who had undergone total laryngectomy for laryngeal cancer at Hokkaido University Hospital, Japan, between 1990 and 2006 were divided into three groups according to preoperative treatments received: group I (n = 35) without radiotherapy (RT) or CCRT, group II (n = 17) RT alone, and group III (n = 34) low-dose CCRT. Salvage total laryngectomy was performed as a consequence of residual or recurrent disease after completion of the treatments. Wound complications such as pharyngocutaneous fistulas, bleeding, infections, and skin necrosis were retrospectively analyzed in each group.A considerable (not statistically significant) difference in the incidence of major wound complications was observed between groups I and III (11.4% vs 29.4%, P = 0.078), but not between groups II and III. In stage III/IV patients, a significant increase in the incidence of wound complications was observed in group III compared to group I. Pharyngocutaneous fistulas were the most common complication, occurring in 8/34 (23.5%) of the group III patients. Additional pharyngeal reconstruction surgery was performed in 5 of the 8 (62.5%) group III patients with pha ryngocutaneous fistulas, while no such patients (0/3) in group I required reconstruction surgery.There was an increased risk of wound complications in patients undergoing salvage laryngectomy following CCRT. Patients who developed pharyngocutaneous fistulas after CCRT tended to require surgical reintervention for repair. These findings should be taken into account before the initiation of CCRT and salvage surgery.

Detecting the risk factors for late neck metastasis (LNM) in early tongue and oral floor cancer is important for establishing an accurate prognosis, as well as for increasing survival rates. Patients with either stage I or II tongue and oral floor cancer underwent either a resection of the primary tumor or interstitial radiotherapy without neck dissection. We measured the short- and long-axis diameters of lymph nodes on initial CT images. Of the 38 patients, 20 had LNM and 18 did not. CT images showed a total of 161 lymph nodes. Twenty-five ""occult lymph nodes"" developed into LNM, whereas the remaining 136 ""reactive lymph nodes"" did not. Comparison between ""occult"" and ""reactive"" lymph nodes revealed significant differences in the short-axis diameters (p = 0.01). The measure of short-axis diameters of neck lymph nodes on initial, CT images is a useful predictor of LNM in patients with early tongue and oral floor cancer. (c) 2007 Elsevier Ltd. All rights reserved.

The purpose of the study was to evaluate upper abdominal symptoms in laryngopharyngeal reflux (LPR) patients and changes in both upper abdominal and LPR symptoms before and after acid-suppression therapy.In 100 patients with LPR symptoms, upper abdominal and LPR symptoms were evaluated by using the Frequency Scale for the Symptoms of Gastroesophageal Reflux Disease (FSSG) and the LPR symptom scoring system, respectively. In the 52 assessable patients, changes in these symptoms before and after acid-suppression therapy were evaluated.Upper abdominal symptoms were reported by 96/100 LPR patients: 89 responded positively to at least one of the questions about acid reflux-related symptoms and 89 to at least one of those about dysmotility-like symptoms. There was poor correlation between positive rates to FSSG upper abdominal symptom questions and the frequency of reported laryngopharyngeal symptoms. There were significant reductions in the frequency of acid reflux-related symptoms, dysmotility-like symptoms, and laryngopharyngeal symptoms after acidsuppression therapy. The LPR symptom score decreased to less than half the pretreatment score in 25 subjects (therapeutic response group). The pretreatment frequency of dysmotility-like symptoms seemed to be higher in the nonresponse group than in the response group, although the difference was not significant. There was no significant difference between the two groups in the pretreatment frequency of acid reflux-related symptoms.The majority of these Japanese LPR patients experienced some form of upper abdominal symptoms. The frequency of dysmotility-like symptoms was similar to that of acid reflux-related symptoms. The pretreatment frequency of dysmotility-like symptoms, but not of acid reflux-related symptoms, might be a predictor of patient response to acid-suppression therapy.

Carotid body tumors are uncommon neoplasms that arise at the bifurcation of the common carotid artery. Surgical resection is generally recommended, but entails an inherent risk of cranial nerves injury and excessive blood loss. Preoperative embolization has been reported to decrease blood loss and shorten resection time. In this study, we analyzed the benefits of preoperative embolization and the postoperative complications when preoperative embolization was performed. Six patients with seven tumors were treated between 1990 and 2005. Each patient's preoperative evaluation included CT, MRI, US, and angiography, and preoperative embolization was performed in four patients with five tumors. Blood loss, in the patients who underwent preoperative embolization, ranged from 20 ml to 900 ml (mean: 291ml), and operation time ranged from 4 hours 34 minutes to 6 hours 40 minutes (mean: 4 hours 55 minutes). In the group that did not undergo preoperative embolization, blood loss ranged from 642 ml to 1390 ml (mean: 1016 ml), and operation time ranged from 9 hours 48 minutes to 10 hours 45 minutes (mean: 10 hours 17 minutes). Five patients had postoperative cranial nerve dysfunction, and it involved cranial nerve IX in one patient (14.3%), cranial nerve X in two patients (28.5%), and cranial nerve XII in five patients (71.4%). Resection of bilateral carotid body tumors in one patient resulted in baroreflex failure syndrome. In conclusion, preoperative embolization tends to decrease blood loss and shorten operation time, resulting in lower postoperative neurologic morbidity.

Heerfordt’s syndrome is a rare manifestation of sarcoidosis characterized by the presence of facial nerve palsy, parotid gland enlargement, anterior uveitis, and low grade fever. Two cases of Heerfordt’s syndrome and a literature review are presented.Case 1. A 53-year-old man presented with swelling of his right eyelid, right facial nerve palsy, and swelling of his right parotid gland. A biopsy specimen from the swollen eyelid indicated sarcoidosis and he was diagnosed with incomplete Heerfordt’s syndrome based on the absence of uveitis. His symptoms were improved by corticosteroid therapy.Case 2. A 55-year-old woman presented with left facial nerve palsy, bilateral hearing loss, and swelling of her bilateral parotid glands. She had been previously diagnosed with uveitis and bilateral hilar lymphadenopathy. Although no histological confirmation was performed, she was diagnosed with complete Heerfordt’s syndrome on the basis of her clinical symptoms. Swelling of the bilateral parotid glands and left facial nerve palsy were improved immediately by corticosteroid therapy. Sarcoidosis is a relatively uncommon disease for the otolaryngologist. However, the otolaryngologist may encounter Heerfordt’s syndrome as this syndrome presents with facial nerve palsy and swelling of the parotid gland. Therefore, we otolaryngologists should diagnose and treat Heerfordt’s syndrome appropriately in cooperation with pneumologists and ophthalmologists.

Background. The current study aimed to evaluate the significance of the cell-cycle-control proteins cyclin D1 and p16 as prognostic markers in head and neck squamous cell carcinoma (HNSCC) patients treated with docetaxel and radio- therapy. Methods. Cyclin D1 and/or p16 protein expression was retrospectively evaluated by immunohistochemistry in 53 patients with stage T1-3N0-2M0 (except T1N0 glottis) HNSCC who were treated with 10 mg/m 2 /week docetaxel 4 to 6 times and received concurrent chemoradiotherapy. Results. Kaplan-Meier univariate analysis revealed that patients with cyclin D1-positive tumors or p16-negative tumors had a worse prognosis compared with those with cyclin D1-neg- ative tumors or p16-positive tumors (p ¼ .0004 and p ¼ .025, respectively). The prognostic significance of cyclin D1 expres- sion, not p16 expression, was confirmed using a proportional hazard regression model. Conclusions. An assessment of cyclin D1 and p16 levels might be of clinical use in defining subgroups of patients with poor prognosis. V

Objectives: We analyzed the clinical characteristics, pathological findings, and treatment outcomes of patients with recurrent sinonasal inverted papilloma (IP). Methods: This retrospective study consisted of 13 patients with recurrent IP. Patient data were collected on prior treatment, sites of recurrence, surgical procedures, pathological findings, and postoperative time to recurrence. Results: Eleven of the 13 patients (85%) had recurrence in the ethmoid sinus, particularly at the lamina papyracea (n = 8; 62%). Inverted papilloma with severe dysplasia (SD) was observed in 4 patients, 3 of whom showed malignant transformation of the recurrent tumor. Craniofacial resection was performed in 2 of the 4 patients, resulting in no further recurrence. However, the tumor was not managed in the remaining 2 patients. In the 9 patients without SD, lateral rhinotomy was performed in 6 patients and endoscopic sinus surgery was selected in 3 patients who had a small tumor without scar formation. No further recurrence was observed in the 9 patients. Conclusions: Careful management of IP around the lamina papyracea is essential during initial surgery. Recurrent IP without SD can be successfully managed by lateral rhinotomy in most cases, and by endoscopic sinus surgery in selected cases. However, more aggressive treatment, including craniofacial resection, should be considered in IP with SD, which is associated with a high rate of recurrence and malignant transformation.

【背景】喉頭癌に対する治療法は単独あるいは化学療法併用での放射線,喉頭微細手術，喉頭部分切除，喉頭亜全摘術，喉頭全摘術など多様化しており，それぞれ治療成績が報告されているが，音声に関するQOLを同一の基準で比較検討した報告は少ない。【目的】各治療法による音声に関するQOLを検証すること。【対象と方法】対象は喉頭癌に対する根治治療を受け，北海道大学病院にて外来経過観察中であり，かつ無病生存が確認された患者137例である。外来経過観察受診時にVOICE-RELATED QUALITY OF LIFE（V-RQOL），VOICE HANDICAP INDEX-10（VHI-10）による質問表調査を施行，音声障害を認める例については，GRBASによる聴覚印象評価をあわせて行い，その結果を治療法別に検討した。【結果】対象患者の治療法別V-RQOLスコアの平均値は放射線治療92.6（n=63），化学放射線治療92.9（n=29），レーザー手術85.5（n=14），喉頭全摘術68.4（n=27）であり，既報の結果と矛盾しないと考えられた。V-RQOLはVHI-10と強い相関を示し，聴覚印象Gスコアと中程度の相関を示した。【結論】音声QOL質問表は喉頭癌治療後の音声QOLの評価に有用であると考えられた。

目的：原発巣に対して超選択的動注＋照射の同時併用療法（以下RADPLAT）を行った症例のうちリンパ節転移（以下LN）陽性で頸部を1年以上観察できた23例についてLNの治療結果・成績について検討した。対象：症例は鼻副鼻腔4例，中咽頭5例，下咽頭13例，耳下腺1例，N分類はN1：2例，N2b：10例，N2c：8例，N3：3例であった。方法：動注はSeldinger法によりシスプラチン100～120mg/m2を主に原発巣に投与するが，LNの栄養血管が容易に同定された場合にはLNへも動注を行った。治療後LNの残存があった場合には頸部郭清を行うという方針で経過観察を行った。結果：LNは17例（73.9％）がRADPLATで制御されている。残存・再発した6例のうち3例は頸部郭清にて制御された。結語：LNに対してもRADPLATは有効であると考えられたが，N2-3でも29％は残存・再発したため，積極的に頸部郭清を行うのか，その場合の郭清範囲をどうするか，あるいは“watch-and-see”で慎重に見極めるようにするのが良いのかを今後明らかにしていく必要がある。

喉頭摘出を含む一次治療終了後にvoice prosthesisを二期的に挿入する場合，食道直達鏡を用いた挿入術に難渋することがある。われわれが行っている気管内挿管チューブの側孔を利用したvoice prosthesis挿入方法を紹介する。全身麻酔下に気管内挿管チューブと内視鏡を食道内に挿入し，モニターで観察しながら挿入用インサーターが気管チューブの先端にある側孔を通るように穿刺する。従来の方法で穿刺する時は，抵抗が大きく容易に穿刺できず，また食道後壁を損傷する危険性もあるが，本法では挿入用インサーターの先端が確実に気管チューブ内に誘導されるので，かなり力を入れても安全に穿刺することができる。

Objectives: Although an inverse relationship has been reported between the rates of reflux esophagitis and Helicobacter pylori infection in Japan, infection rates among patients complaining of laryngopharyngeal reflux symptoms, such as abnormal laryngopharyngeal sensation, chronic coughing, and hoarseness, have not previously been investigated. The effects of H. pylori infection on outcomes of acid suppression therapy have not been studied. Study Design: Retrospective cohort study. Methods: We investigated the relationships between H. pylori antibody positivity, laryngopharyngeal reflux symptoms, objective laryngopharyngeal findings, and rate of response to acid-suppression therapy in 42 subjects who were diagnosed with gastroesophageal reflux disease, using upper gastrointestinal endoscopy, and were assayed for the serum H. pylori antibody. Results: The incidence of H. pylori antibody positivity in the targeted patient group was 59.5%. Kaplan-Meier analysis showed that the laryngopharyngeal symptom-improvement rate, measured using the symptom score, was significantly lower for H. pylori antibody-negative cases than for H. pylori antibody-positive cases (30.0 vs. 84.6%; P = .002) 60 days after the start of acid-suppression therapy. No significant differences in the esophageal symptom-improvement rate were noted between the two groups (76.2 vs. 89.5%; P = .576) Conclusions: By focusing on the involvement of H. pylori infection in laryngopharyngeal reflux, we determined the relationships between H. pylori antibody positivity and response to acid-suppression therapy among patients. The laryngopharyngeal, not esophageal, symptom relief by acid-suppression therapy was significantly lower among H. pylori antibody-negative cases than among antibody-positive cases.

Objectives: The mechanism by which varicella-zoster virus (VZV) reactivation causes cochleovestibular symptoms (CVSs) in patients with Ramsay Hunt syndrome (RHS) remains to be elucidated. The present study analyzed the relationship between VZV load and the onset of CVSs in RHS. Methods: The subjects consisted of 56 patients with RHS; 29 exhibited CVSs and facial paralysis (FP; group 1), and 27 exhibited FP without CVSs (group 2). The VZV DNA copy number in the saliva was measured with a quantitative polymerase chain reaction. Anti-VZV antibodies were assayed by an enzyme-linked immunosorbent assay with paired sera. Results: There was no significant difference in maximum viral copy number between the Two groups. In group 1, CVSs occurred at various times between the early phase and the regression phase of VZV reactivation. In some patients, CVSs occurred in the early phase of VZV reactivation, before the onset of zoster lesions and FP. Conclusions: There are various different patterns in the development of eighth cranial nerve dysfunction, which is caused by progression of neuritis or labyrinthitis following VZV reactivation. Our data suggest that CVSs in RHS may also be caused by reactivation of VZV in the spiral and/or vestibular ganglia.

Olfactory neuroblastoma is such a rare malignancy that no consensus has been reached on its management. We analyzed 17 patients with olfactory neuroblastoma treated between April 1980 and March 2004--9 men and 8 women, aged 16 to 76 years old(mean: 50.4 years). Follow-up of current survivors was 1 year 8 months to 16 years 6 months (average: 7 years 9 months). Initially, 2 were treated with surgery alone, 5 with surgery and radiotherapy, and 2 with a combination of these and chemotherapy. Without surgery, radiotherapy alone was conducted in 3 and combined of radiation and chemotherapy in 5. Three of the 5 patients treated with surgery and radiotherapy survive without locoregional recurrence as do 2 with chemotherapy added. All 5 initially treated with craniofacial resection survived more than 5 years. Combined radiotherapy and chemotherapy without surgery was effective in 2. 5- and 10-year overall survival for all patients were 75.5% and 64.7%. Overall 5-year survival of 8 patients with low-grade tumors was 87.5% and of 6 with high-grade tumors 33.3%. In conclusion, combined craniofacial resection plus radiotherapy and chemotherapy seemed to improve survival. Histopathological grading is a prognostic factors.

本邦では逆流性食道炎罹患率とHericobactor pylori感染率について逆相関を示唆する報告が多いが，咽喉頭異常感，慢性咳嗽，嗄声などの咽喉頭酸逆流症状を訴える患者におけるH. pylori感染率についての報告はまだない。われわれは咽喉頭酸逆流症状にて北海道大学病院耳鼻咽喉科を受診した患者のうち血清H. pylori抗体を測定し得た67例を対象としてH. pylori抗体陽性率，咽喉頭酸逆流症状，酸抑制治療への反応性との関連を検討した。対象患者群の血清抗H. pylori抗体の陽性率は61.2%であり，H. pylori抗体陽性群と陰性群の間には，患者背景，治療前の自覚症状の各項目において有意差を認めなかった。Kaplan-Meyer解析により咽喉頭症状改善率についてはH. pylori抗体陽性群は陰性群に比べ酸抑制治療に対する反応が良好であるが，食道症状については両群間に有意差を認めないことが示された。

結膜原発の悪性黒色腫は, 統計上, 本邦では年間発生数が5例前後と推察される稀な腫瘍である。2002年のUICCが発表した結膜悪性黒色腫のTNM分類には病期分類と治療指針は組み入れられていないため, 病期ごとに確立された治療指針が無いのが現状である。近年, 症例数の蓄積により, 進行期の症例では侵襲の大きい治療を行っても有意な生命予後の延長につながらないため, 全体として縮小手術に向かう傾向にある。今回, 我々は, 結膜悪性黒色腫に対して, 拡大切除とセンチネルリンパ節生検を施行した。治療法ならびに, 眼部におけるセンチネルリンパ節生検の意義とその実際の手技について, 文献学的考察も加えて報告する。

PURPOSE Ethmoidal malignant tumors, for which intensity-modulated radiotherapy is expected to improve outcome, consist of heterogeneous pathological types. Reports about their outcome are influenced by the inclusion of favorable histology, such as adenocarcinoma and adenoid cystic carcinoma. We investigated the long-term treatment outcome of squamous cell carcinoma and undifferentiated carcinoma of the ethmoid sinus. MATERIALS AND METHODS Between August 1976 and April 2002, 25 patients (20 squamous cell carcinomas and five undifferentiated carcinomas) received radical radiotherapy or preoperative radiotherapy in our institution. One (4%) had stage T2 disease, seven (28%) had stage T3, three (12%) had stage T4a, and 14 (56%) had stage T4b. Surgery was performed in 13 patients. Radiation dose varied from 50.4 Gy in 16 fractions (50.4 Gy/16 Fr) to 65 Gy in 26 fractions with or without stereotactic boost irradiation. Eleven patients received chemotherapy consisting mainly of platinum-based compounds. RESULTS The 3- and 5-year overall survival rates for all 25 patients were 34% (95% confidence interval [CI]: 14%-54%) and 24% (CI: 6%-42%), respectively. The 3- or 5-year local progression-free rates for all patients were 48.9% and 36.7%, respectively. Visual acuity of a single eye was impaired in three patients and was lost in five patients as a result of tumor progression, but no patient had visual impairment or loss due to radiotherapy. CONCLUSION Ethmoid squamous cell carcinoma or undifferentiated carcinoma was diagnosed at advanced T stages and was treated with radiotherapy; these patients had a poorer outcome than patients with adenocarcinoma or adenoid cystic carcinoma. Prospective trials using advanced technology should be carefully compared with historical controls because pathological types can considerably influence the treatment results.

Infraglottic edema extending from the anterior commissure to the posterior larynx, called the laryngeal pseudosulcus, may have some value in the diagnosing of laryngopharyngeal reflux (LPR). The purpose of this study is to evaluate the prevalence, sensitivity and specificity of this finding among Japanese patients with LPR-related symptoms. Forty-three patients diagnosed as LPR based on their symptoms and 42 control patients without LPR were enrolled. The presence of pseudosulcus was determined with transnasal fiberoptic laryngoscopy. Thirty-seven of the 43 patients with LPR and 13 of the 42 control patients had evidence of laryngeal pseudosulcus (p0.001). The sensitivity and specificity of pseudosulcus in the symptom-based diagnosis of LPR are 86 and 69%, respectively. This study shows that laryngeal pseudosulcus is highly correlated with LPR-related symptoms. The presence of this finding is suggestive of LPR.

Purpose This randomized, phase II study aimed to compare concomitant chemoradiotherapy using weekly carboplatin or daily low-dose cisplatin as a treatment for squamous cell carcinoma of the head and neck. Patients and methods One hundred nineteen patients with moderate- to advanced-stage disease were eligible for the study. Fifty-three patients had stage II disease, 28 had stage III, and the remaining 38 had stage IV disease. Primary tumor sites included the larynx (N = 63), oropharynx (N = 30), hypopharynx (N = 23), and oral cavity (N = 3). Each patient received either a weekly carboplatin dose (100 mg/m(2)) in one arm or daily cisplatin (4 mg/m(2)) in the other arm for the initial 4 weeks of radiotherapy. The radiotherapy dose of 65 Gy was given in 26 fractions over 45 days, dependent on a good tumor response at 40 Gy. For ty-nine (81.7%) of 60 patients treated with carboplatin and 41 (69.5%) of 59 patients treated with cisplatin received the full dose of radiotherapy. Surgical-resection was optionally used for the remaining patients. Results The median follow-up time was 63 months. The local control rate at 5 years was 56.2% for the carboplatin-treated arm and 35.5% for the cisplatin-treated arm, respectively. The 5-year overall survival rate did not significantly differ between treatments: 71.4% for carboplatin and 66.0% for cisplatin. Hematologic toxicity was more frequent in the carboplatin-treated arm. No difference was observed in surgical complications or in radiation-related adverse effects. Discussion These findings suggest that weekly carboplatin treatment is preferable to daily low-dose cisplatin. This could be because the total dose of cisplatin was too low to be effective.

The frequency of either CD4(-)8(-) (double negative; DN) or CD4(+) V alpha 24(+)V beta 11(+) NKT cells, the expression of CD1d and the binding of CD1d-tetramer loaded with alpha-galactosylceramide (alpha-GalCer) to NKT cells were analysed in peripheral blood mononuclear cells (PBMCs) of patients with Wegener's granulomatosis (WG), relapsing polychondritis (RP) and healthy subjects (HS). DN and CD4(+) V alpha 24(+)V beta 11(+) NKT cells as well as CD1d-alpha-GalCer tetramer-positive NKT cells, were significantly decreased in number in both WG and RP patients compared to those from HS. When cytokine profiles were analysed in these PBMCs upon stimulation with phorbol ester and calcium ionophore, CD4(+) T cells from patients with WG and RP exhibited a Th1 bias, whereas CD4(+) NKT cells from WG patients in remission showed a Th2 bias. These findings suggest that NKT cells (especially CD4(+) NKT cells) play a regulatory role in Th1 autoimmunity in patients with WG and RP. The reduction in NKT cell counts appears to be associated with the low responsiveness to alpha-GalCer. The dysfunction of NKT cells to recognize ligands such as alpha-GalCer may also contribute to the defects observed in NKT cells from WG and RP patients.

The aim of this study was to assess the potential role of macrophage migration inhibitory factor (MIF) in the pathogenesis of allergic rhinitis (AR). Serum MIF concentrations were measured by a specific enzyme-linked immunosorbent assay. In order to elucidate the cellular source of MIF, we performed double immunostaining of biopsy specimens of the nasal mucous membrane with markers for MIF and for inflammatory cells. The mean MIF level in sera from patients with AR was significantly higher than that in sera from healthy controls. Moreover, the levels were significantly correlated with the severity of the clinical symptoms. The majority of the MIF-positive cells at the site of allergic inflammation were eosinophils. These data suggest that MIF plays a role in the initiation and maintenance of AR. Eosinophils formed the largest population of MIF-producing cells; this finding suggests that they may be a major source of MIF at inflammatory sites in atopic disease.

頭頸部癌の場合では治療方針の決定, 治療中, 治療後と一連の治療過程の中で看護師は大きな役割を果たしており, チームとして医師と看護師が連携し有機的に機能することが治療を行っていく上で非常に大切である。治療過程を治療方針の決定まで, 治療中, 治療後の3つに分けて北海道大学の実際を紹介した。医師・看護師が連携しあって患者・家族の希望や病気に対する理解を把握して, 患者・家族に十分な説明を行い治療方針を最終的に決定していくように心がけている。合同カンファレンスを行い, お互いに患者に対する理解を深めたり, 我々が看護師に対して耳鼻咽喉科・頭頸部外科についての勉強会を行うなどの努力をしている。また, “チーム医療”を成功させるためには, スタッフ間の信頼関係が必要であり, そのためには意思の疎通が大切である。医師と看護師が連携し同じ方向に向かって努力していくことにより, より良い医療を提供できるようになるものと考える。

フッ化ピリミジン系抗悪性腫瘍剤TS-1を用いて頭頸部癌再発23症例に対して外来経口投与を行い以下の結果を得た。1) CR1例を含め、奏効率は30.4%であった。2) 同一症例にて血小板, 呼吸器に Grade 4の有害事象が認められた。腎機能障害を有する症例で治療として血小板輸血, ステロイド投与しその後, 有害事象は回復し可逆的である事が確認された。この症例以外は, 特に重篤な有害事象は, 認めなかった。3) 頭頸部癌再発症例においても他剤と同等の効果をもち外来で安全に投与できた。4) 肺転移症例においては, TS-1投与群で median survival time 585日, TS-1非投与で入院化学療法中心群では120日であった。5) 外来通院可能なTS-1投与群のほうが治療後のPSの悪化を認めず, QOLは良好であった。これらのことより, TS-1投与により肺転移症例においてQOLの維持の可能性が外来通院化学療法にて示唆された。

We report a case of mucocele of the frontal sinus treated with reconstruction of the skull base. The patient showed swelling of the left side of the medial ocular angle and was diagnosed as mucocele of the frontal sinus. At first, endoscopic sinus surgery was carried out and the mucocele was unfolded into the nasal ' cavity. However, acute frontal sinusitis with MRSA emerged and this inflammation spread to dura mater. Debridement of the frontal sinus granulation and reconstruction of the anterior skull base by a galeo-pericranial flap were performed with craniotomy. It is an effective method to shield the cranial cavity from the nasal cavity by utilizing a galeo-pericranial flap to prevent infection from the frontal sinus from spreading to the cranial cavity.

Background. Few published large series have described a surgical approach to maxillary skeletal reconstruc- tion on the basis of the extent of maxillectomy. Methods. We have reviewed a 10-year experience with 38 consecutive maxillary reconstructions with respect to maxillec- tomy defects, reconstructive procedures, reconstructed but- tresses, and functional and aesthetic outcomes. Results. Maxillectomy defects were classified into three categories on the basis of the buttress concept. Buttress reconstruction was most frequently performed in category III maxillary defects (56%), followed by category I (50%) and categoryII(20%).Thevascularizedcompositeautograftincluded the rectus abdominis myocutaneous free flap combined with costal cartilage, and the latissimus dorsi myocutaneous free flap combined with the V-shaped scapula is an effective method for reliable reconstruction of both skeletal and soft tissues. Conclusions. A critical assessment for skeletal defects and associated soft tissue defects is essential for an adequate approach to solve complex problems in maxillary reconstruction. On the basis of retrospective analysis of this series, a recon- structive algorithm for surgical management of maxillectomy

Purpose. The purpose of this study was to evaluate the efficacy of rapid superselective high-dose cisplatin infusion with concomitant radiotherapy for previously untreated patients with advanced head and neck cancer. Methods. Forty-three patients for whom surgery was contraindicated or who rejected radical surgery were given superselective intra-arterial infusions of cisplatin (100–120 mg/m2/week) with simultaneous intravenous infusion of thiosulfate to neutralize cisplatin toxicity and conventional extra-beam radiotherapy (65 Gy/26 f/6.5 weeks). Results. Thirty-nine patients had stage IV disease, and the remaining four had stage III disease. During the median follow-up period of 21 months, the 3-year locoregional progression-free rates of all patients (n = 43) and patients with unresectable disease (n = 24) were 68.9% and 56.4%, respectively. In addition, the 3-year overall survival of all patients and patients with unresectable disease was 54.0% and 39.6%, respectively. Thirty-five patients (81.4%) experienced nonhematologic grade III to IV toxicity, including mucositis (n = 16), nausea/vomiting (n = 8), and neurologic signs (n = 2). No patient died as a result of treatment toxicity. There are 29 surviving patients without evidence of disease, all of whom are able to have oral intake without feeding-tube support. Conclusions. We confirmed the efficacy of superselective arterial infusion and concomitant radiotherapy, which can concentrate the attack of supradose cisplatin on locoregional disease. Even patients with unresectable disease can be cured. Further studies are needed to establish the indications, long-term outcome, and possible late side effects of this treatment. © 2004 Wiley Periodicals, Inc. Head Neck27: 65–71, 2005

The mechanism by which reactivation of varicella-zoster virus (VZV) causes facial paralysis in Ramsay Hunt syndrome remains unclear. The relationship between VZV load and the onset of facial paralysis was analyzed in 42 patients with Ramsay Hunt syndrome. The patients were divided into three groups according to the times of appearance of zoster and of facial paralysis; group I (zoster preceding, n = 13), group II (simultaneous, n = 22), group III (paralysis preceding, n = 7). A real-time quantitative PCR assay was used to measure VZV DNA copy number in saliva, and paired sera were assayed for anti-VZV IgG and IgM antibodies. In group I, the VZV DNA-positive rate was low and virus load decreased gradually after the initial hospital visit around the time of onset of paralysis. The level of anti-VZV antibodies had in most cases already increased at that time. In group III, viral load tended to increase after the onset of paralysis and peaked around the time of appearance of zoster. The level of anti-VZV antibodies was low at the onset of paralysis but showed a significant increase when paired sera were tested. In group II, virus load and changes in level of anti-VZV antibodies either resembled group I or group III behavior. These results indicate that facial paralysis in Ramsay Hunt syndrome can occur at various times between the early and the regression phase of VZV reactivation, suggesting that there are variable patterns of development of facial nerve dysfunction caused by VZV reactivation and the progression of neuritis.