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To determine the efficacy of endoscopic electrocauterization for pyriform sinus fistula (PSF) using a flexible Bugbee cautery electrode. From 2009 to 2016, a total of eight patients with acute suppurative thyroiditis or cervical abscess secondary to PSF were retrospectively registered in our study (three males, five females; median age 6.5 years). All patients underwent endoscopic electrocauterization as treatment for PSF. Six of eight patients had no recurrence after the initial endoscopic electrocauterization of PSF. One patient with recurrence developed symptoms 9 days after cauterization and another experienced recurrence after 2 years. Mean follow-up for the eight patients was 50 months (range 5-96 months). No post-operative complication was reported. Endoscopic electrocauterization appears to be a less-invasive, safe, and effective method for the treatment of PSF.

Primary ciliary dyskinesia (PCD) is a genetic disease inherited in an autosomal recessive manner. The prevalence of PCD is estimated to be 1 in 20,000 live births. Congenital abnormality of the primary cilia results in situs inversus in 50% of patients. Decreased function of motile cilia causes chronic rhinosinusitis, otitis media with effusion, bronchiectasis and infertility. Cases with situs inversus are considered to show "Kartagener's syndrome", and diagnosis is not difficult. However, in cases without situs inversus, the diagnosis is much more troublesome. PCD without situs inversus is thus probably underdiagnosed. Prolonged chronic cough represents an important symptom that is seen in most patients. The diagnosis of PCD requires the presence of the characteristic clinical phenotypes and either: (1) specific ciliary ultrastructural defects identified by transmission electron microscopy in biopsy samples of respiratory epithelium; or (2) identification of mutation in one of the genes known to be associated with PCD. Nasal nitric oxide concentration is extremely low in PCD, and this could be useful for screening of the disease. At present, no fundamental therapies are available for PCD. Diagnosis in the early stages is important to prevent progression of bronchiectasis and deterioration of lung function by guidance for daily life, immunization, cessation of smoking and prompt therapy at the time of respiratory tract infection. Since PCD is inherited in an autosomal-recessive manner, genetic counseling is necessary after definite diagnosis.

Pyriform sinus fistula (PSF) is an anomaly that can arise due to failure of involution of the third or fourth branchial cleft during embryogenesis. It can manifest clinically as sinuses, cysts, or abscesses in the neck and is common in childhood. Herein, we describe a neonate who presented with neck swelling and respiratory distress, which was secondary to a fourth branchial pouch sinus. Physical examination revealed swollen areas in the posterolateral pharyngeal wall and on the external left side of the neck. Computed tomography imaging showed a left-sided mass that was filled with air and fluid. Eventually, the pyriform sinus cyst and the entire fistulous tract were excised. The postoperative course was uneventful. Follow-up after 18 months showed no recurrence.

Foreign body ingestion is a commonly encountered clinical problem. In particular, sharp foreign bodies lodged in the esophagus or hypopharynx can cause complications and require urgent removal. Removal by flexible esophagogastroduodenoscopy or rigid esophagoscopy is the treatment of choice and has high success rates, but cases in which these methods are unsuccessful must be treated with an external incision. A 62-year-old man was referred for a fish bone lodged in the hypopharynx that could not be removed by flexible esophagogastroduodenoscopy. We removed the bone transorally using a specially designed rigid curved laryngoscope. Based on our experience, this method may have clear practical value due to advantages of a wide field of view and use of multiple rigid forceps. Indications may be limited, but this novel method may reduce the limitations of noninvasive removal of foreign bodies.

重度誤嚥で苦しむ2症例に対し，鹿野らにより修正された声門閉鎖術を行った。甲状軟骨ならびに輪状軟骨を鉗除した後に正中にて喉頭内腔に侵入し視野を展開した。その後，上下声帯粘膜弁ならびに胸骨舌骨筋弁を用いて声門閉鎖を行った。この術式はこの2症例に対し成功し，かつ術後経過も良好であった。結論として，成人の嚥下性肺炎の治療としては，本術式は効果的でリスクも少ないと思われた。

A retrospective clinical study was conducted involving 143 patients with laryngeal cancer treated in our department between 1998 and 2006. The subjects consisted of 138 males and 5 females, with a ratio of 28:1. The mean age was 68.1 years old. The subsite of origin comprised 78 (54.5%) in the glottis, 61 (42.7%) in the supraglottis, and 4 (2.8%) in the subglottis. The clinical stage according to the 1997 UICC TMN classification system was I in 53 cases (37.1%), II in 34 (23.8%), III in 20 (14.0%), and IV in 36 (25.2%). The 5-year overall survival rate was 71.2% in the total cases, 84.4% in stage I, 89.6% in stage II, 51.2% in stage III, and 38.9% in stage IV. The disease-specific 5-year survival rate was 88.3% in the total cases, 75.5% in the supraglottic type, 98.1% in the glottic type, and 100% in the subglottic type. The preservation rate of the larynx at 5 years was 83.3% in T1, 56.5% in T2, and 0% in T3 and T4.

甲状腺癌手術において反回神経麻痺は可及的に避けねばならない合併症であるが, 時に, 癌の浸潤のために反回神経を犠牲にせざるをえない場合がある。一側の反回神経麻痺は致命的ではないが, 患者の苦痛は深刻である。正常な声帯の可動性が再獲得できないことから, 従来から神経の再建は必要ないとされてきたが, 声帯の萎縮防止と発声時に声帯が緊張するため, 音声は良好である。今回, 反回神経の即時再建を13例に施行した。神経間移植が5例, 頸神経ワナ-反回神経吻合が8例に行われた。声帯の可動性は全例で認められなかった。MPTが9例において正常に, 呼気流量 (VC/MPT) が11例において正常範囲に復帰した。一方で, 非再建群では, MPT, VC/MPTとも正常化したものはなかった。MPT, VC/MPTによる音声機能評価では, 神経の即時再建は有用であると言える。

One hundred fifty patients have been tracheostomised in the past five years at Yamada Red Cross Hospital. Of these 150 patients, 90 were proposed for tracheostomy by other departments, and such cases are on the increase. Thirty-two patients showed indications for tracheostomy in the stenosis of the aero-tract caused by the tumors or mucosal swelling. Prophylactic tracheostomy was performed in 23 cases due to a delayed stenosis of the aero-tract. Emergent tracheostomy was performed in 31 cases, and, of these cases, an incision of the cricothyroid membrane was performed in one case. Though tracheostomies have been performed in many departments, the determination of accurate indications and safe operative techniques for different cases are best assisted when performed by head and neck surgeons.

Recurrent laryngeal nerve (RLN) paralysis is a major complication after thyroidectomy. Immediate reconstruction of the RLN is proposed in such cases.Four cases underwent concurrent recurrent laryngeal nerve reconstruction at our department between 1997 and 1998.Nerve transfer was performed in three cases and the great auricular nerve and the ansa cervicalis were chosen as nerve grafts. Direct anastomosis of the ansa cervicalis to the peripheral end of the RLN was conducted in one case. Both procedures resulted in a good post-operative status, and hoarseness and mis-swallowing in no cases were observed.The operated-side vocal cords in all cases were observed to be fixated at the paramedian portion, without atrophy. The average maximum phonation time (MPT) was 14.5 seconds, and this was longer than that in cases who had not undergone reconstruction of the recurrent laryngeal nerve (their average MPT was 8.9 seconds).We concluded that an immediate reconstruction of the RLN should be disirable for cases who need a nerve resection in a thyroid operation.

From 1990 through 1998, 143 patients with laryngeal cancer were treated in our department. Of the 143 patients, 94 had glottal, 43 had supraglottal, and 6 had subglottal cancer. The 5-year survival rate in patients with laryngeal cancer was 90.0% for stage I, 81.3% for stage II, 77.9% for stage III, and 42.6% for stage IV. The 5-year survival rate was 86.5% for glottal, 55.9% for supraglottal and 66.7% for subglottal cancer patients. The laryngeal preservation rate was 90.4% for stage I, 60.5% for stage II, 21.4% for stage III and 28.1% for stage IV.A loco-regional recurrence occurred in 24 of 143 patients (16.8%). The salvage rate for these patients was 45.8% (11/24). Six of 11 patients who died of primary disease and nodal failure (including 2 stomal recurrences) had supraglottic stage N carcinoma.In conclusion, laryngeal preservation surgery should be recommended in the early stages of cancer after radiation failure and local recurrence. It is recommended to dissect the anterior compartment including the delphian lymph node, pretracheal, and parathyroidal nodes bilaterally for patients with laryngeal tumors that have significant anterior subglottic extension, tumors arising in the subglottic region, or advanced tumors arising in any region, especially the supraglottis.

Two cases of esophageal perforations caused by endoscopy were treated at our hospital.The cause was flexible fiberscopy in one patient and rigid esophagoscopy in the other patient. Both patients were treated surgically and cured.We concluded that: (1) rigid esophagoscopy should be performed under general anesthesia; (2) a barium esophagogram indicative of an esophageal perforation should not be a contra-indication; and (3) the operation should be performed as soon as possible, and primary suture of the perforation should also be performed if possible.

Recently, we have performed microvascular anastomoses in the reconstructive surgery of the esophagus: 3 cases at the Department of Surgey of Yamada Red Cross Hospital, and 3 cases at the Department of Surgery of Saiseikai Matsusaka Hospital. In these 6 cases, a gastric pull-up technique in 3 cases, a colonic pull-up technique in 2 cases, and a pedicled jejunum technique in 1 case were performed to reconstruct the esophagus.Microvascular anastomoses were performed in the cervical region in all 6 cases; for the artery alone in 1 case, the vein alone in 1 case, and for both vessels in 4 cases.Major complications (except for the minor leakage in 1 case) were not observed, and the reconstructions by organ transfer were successful.Microvascular anastomoses in the cervical region for adjuvant circulation is safe and easy, bacause the cervical region has many adequate vessels for anastomoses and is a stable in terms of respiratory movement.For head and neck surgeons, participation in a team operation of the thoracic esophagus is important and necessary in order to be able to examine the laryngeal findings and detect double cancers in the head and neck regions.

Thirty-six patients with epistaxis requiring hospitalization evaluated over the previous five years were statistically. Twelve patients could not be controlled by the conventional packing method. Ligation of the ethmoidal arteries was perfomed in 4 cases, selective catheter embolization in 5 cases, and turbinectomy and electro-cauterization in 3 cases. In one patient treated by ligation of the ethmoidal artery, and in four patients treated by selective catheter embolization, control of epistaxis failed. All 4 patients were subsequently treated by turbinectomy and electro-cauterization. Because of its relative simplicity and effectiveness, turbinectomy from the infra turbinal posterior end is proposed as the standard method for treatment of epistaxis. Ligation of the ethmoidal arteries should be used for the treatment of epistaxis originating from the olfactory cleft, and selective catheter embolization for treatment of those cases in which the bleeding points were undetectable.

In the past 4 years, middle ear surgery has been performed on 166 ears. A total of 42 ears operated on by modified type III tympanoplasties, and 19 ears operated on by type IV tympanoplasties were reviewed. The type III tympanoplasty group included 12 ears with cholesteatoma and 20 with chronic otitis media. The type IV tympanoplasty group included 9 cases of cholesteatoma and 5 cases of chronic otitis media. Postoperative hearing results were evaluated, and success rates in hearing results were 81.6% of type III patients, and 66.7% of type IV tympanoplasty patients. Second surgeries were performed on 7 ears previously operated on at other hospitals, and success was observed in 6 ears. In 18 ears, artificial columella (hydroxyapatite) was used for reconstruction of the ossicular chain, and discharge of the columella was observed in only 1 ear. In 21 ears with cholesteatoma and reconstruction of the ossicular chain, residual recurrence of cholesteatoma was observed in 3, but true recurrence of cholesteatoma was not experienced.

Seventy-nine patients with head and neck abscesses were treated at our clinic between 1995 and 1997. Sixty-three cases had a peritonsillar abscess, seven were cases of deep neck infection and nine cases were other sorts of abscesses.Of the seven patients with deep neck infection, two were treated only with chemotherapy and steroids. Surgical drainage was performed in the remaining five patients.For the effective treatment of head and neck abscess, enhanced CT scanning is useful, in addi-tion, prompt surgical drainage of the abscess and therapy with antibiotics for anaerobic pathogens and with steroids for a short period are required.

Malignant lymphoma is a systematic disease which frequently manifests itself first in the head and neck region.Although the diagnosis of a malignant lymphoma is not difficult, the addition of infection in the affected lymphoid tissues makes the histological diagnosis complicated. A prudent evaluation and repeated biopsies are required in cases complicated by infected lymphoid tissues. On the other hand, the administration of antibiotics, drainage and debridement of the affected region are essential for the severe inflammation of the deep neck. We recently experienced a 60-year-old male patient with a malignant lymphoma and severe infection of the neck.Debridement of the infected neck region and subsequent reconstruction of the defect in the neck were performed in this case.A pectoralis major musculocutaneous flap was elevated, passing through the retro-clavicular space, and the defect in the neck was then covered by this flap without any complication.Combined chemotherapy was performed by the medical department, and achieved a complete response.This reconstructive procedure enabled the satisfactory covering of defects in the upper neck region.

Osteosarcoma arising from the maxilla is a rare tumor of the head and neck region, accounting for only 6% to 7% of all osteosarcomas. Although therapy for maxillary cancer is well established, that for sarcoma of the maxilla, especially osteosarcoma is less clearly defined. In our department, a case of osteosarcoma arising from the maxilla was treated with surgery and chemo-radiotherapy. Surgery preceded postoperative irradiation with adjuvant intra-arterial chemotherapy. In the literature, surgery is the most readily available form of therapy, whereas radiotherapy and chemotherapy are not commonly used in the treatment of osteosarcoma. The Japanese literature suggests that a combination of chemotherapy and surgery might improve the outcome in cases of osteosarcoma of the maxilla.In cases of osteosarcoma, recurrence at the primary site is common, and the prognosis in these cases is generally poor. Therefore, precise evaluation of the extent of the osteosarcoma is more essential. In our patient, 3-dimension CT was used preoperatively, and proved useful for the evaluation of the extent of disease and the determination of suitable operative procedures.

To clarify long-term outcome of benign paroxysmal positional vertigo (BPPV), 50 patients were followed up for a mean of 52 months. Overall recurrence rate by Kaplan-Meier estimation was 37% at 60 months. The patients with horizontal canal BPPV (n = 19) had a significantly higher recurrence rate (50%) at 60 months than those with posterior canal BPPV (n = 28; 26%). There was no significant association between recurrence rates and sex or age.

This study aims to identify predisposing characteristics of descending necrotizing mediastinitis (DNM) arising from deep neck infection (DNI) and to determine appropriate therapeutic intervention strategies. We retrospectively reviewed 54 patients (male, n = 34; female, n = 20; mean age, 64.5 years) who had been treated at Mie University Hospital for DNI between April 2001 and October 2011. Eight of nine patients who developed DNM confirmed by computed tomography of the neck and chest, underwent mediastinal drainage (video-assisted thoracic surgical drainage, n = 6; mediastinoscopy-assisted drainage, n = 2). A patient developed uncontrolled acute respiratory distress syndrome after aggressive surgery, resulting in a mortality rate of 12 %. High blood CRP values, and the pharynx and tonsils as origins of infection were factors involved in the development of DNM arising from DNI. In conclusion, DNM remains a destructive and fatal disease that requires aggressive treatment including mediastinal exploration.

Malignant external otitis is a severe infection of the external auditory canal, generally caused by Pseudomonas aeruginosa in elderly diabetics patients. We describe a case of malignant external otitis in a 63-year-old man with severe otalgia, purulent otorrhea and polypoid granulation of the external auditory canal. Local debridement, insulin treatment and 6-week intravenous antibiotic therapy with carbapemens were very effective and the granulation tissue disappeared completely. However, the patient readmitted for recurrent disease 3 weeks later, despite the oral and ear drop administration with new quinolone. No recurrence has been noted after 4-week additional treatment with intravenous carbapenems followed by 3-week treatment with Burow's solution as ear drops.

We describe a rare case of high-pressure grease injury of the face in a 48-year-old man with severe facial edema, soft palate swelling, and bleeding from the nose and mouth. Preoperative computed tomography (CT) revealed multiple low-density areas in nasal cavity, subcutaneous tissue of the cheek, soft palate, right maxillary sinus, and right infratemporal fossa. The patient complained of a dyspnea feeling, and immediate tracheostomy was performed. The grease was removed by the Caldwell-Luc incision approach but was partially left in the infratemporal fossa. After the operation, the patient still complained cheek and temporal pain. CT and magnetic resonance imaging were useful to diagnose the remaining grease, and the remnant of the grease was completely removed by the Weber-Fergusson incision approach.

We reported a case of thyroglossal duct cancer, which metastasized to the bilateral cervical lymph nodes. The cervical lymph node metastases were detected in the upper portion of the neck. According to the results obtained in the preoperative fine needle aspiration cytology, the lymph node metastases were classified as group V and a diagnosis of papillary carcinoma was made. The preoperative studies with 123 I revealed no concentration in the submittal tumor. In our surgical procedure, bilateral supraomohyoid neck dissection was added to excision of the tumor. Conclusion: In view of the fact that thyroglossal duct cancer metastasized bilaterally to cervical lymph nodes in the present case, we experienced an extremely rare case.

Anterior craniofacial resection is now recognized as one of the best treatment for nasal and paranasal tumors involving the cribriform plate. This approach allows for a more oncologically sound en bloc tumor removal. Here we report 6 cases of anterior skull base surgery for malignant neoplasms. The mean age was 54.0 years ranging from 30 to 70. There were 5 men and 1 woman. The pathological diagnoses were as follows: squamous cell carcinoma (4), adenocarcinoma (1), and malignant melanoma (1). Three patients required free tissue transfer and anterior skull base was reconstructed using a pericranial flap in 3 patients. Four patients are alive without disease, and two died. Major complications occurred in 1 of 6 patients and that patient developed a cerebellar hemorrhage. Infectious complications occurred in 2 patients. There were no perioperative deaths. We concluded that craniofacial resection is an effective surgical treatment for nasal and paranasal tumors.