Language：English   Publishing type：Research paper (scientific journal)  

Regulatory T cells (Tregs) play an important role in creating an immunosuppressive microenvironment in cancer tissues. However, the mechanisms by which Tregs are activated and suppress cancer immunity remain unclear. To elucidate these mechanisms, we performed a T cell receptor (TCR) repertoire analysis of Tregs and conventional T cells in peripheral blood, draining lymph nodes (DLNs), and cancer tissues of patients with head and neck squamous cell cancer (HNSCC). We found that the TCR repertoire was skewed in cancer tissue and metastatic DLNs (M-DLNs) compared with non-metastatic DLNs, and TCR repertoire similarities in Tregs and CD8+ T cells between M-DLNs and cancer tissue were high compared with those at other sites. These results suggest that Tregs and CD8+ T cells are activated in M-DLNs and cancer tissues by cancer antigens, such as neoantigens, and shared antigens and Tregs suppress CD8+ T cell function in a cancer antigen-specific manner in M-DLNs and cancer tissue. Moreover, M-DLNs might be a source of Tregs and CD8+ T cells recruited into the cancer tissue. Therefore, targeting Tregs in M-DLNs in an antigen-specific manner is expected to be a novel immunotherapeutic strategy for HNSCCs.

DOI： 10.1111/pin.13430

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Language：Japanese   Publisher：(一社)日本頭頸部癌学会  

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2024&ichushi_jid=J04195&link_issn=&doc_id=20240523380005&doc_link_id=1390863097401548544&url=https%3A%2F%2Fcir.nii.ac.jp%2Fcrid%2F1390863097401548544&type=CiNii&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00003_2.gif

Language：Japanese   Publisher：耳鼻と臨床会  

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OBJECTIVES/HYPOTHESIS: Some people who practice singing on a daily basis may be able to produce a voice higher than the upper limit of the normal range (extra high voice), but there is much regarding the movement of the larynx that remains unknown. We have been conducting dynamic analysis of the larynx using multi-row detection computed tomography (MD-CT) at our university and report herein an analysis of the extra high voice. STUDY DESIGN: Observational. METHODS: Images of a normal male participant capable of extremely high-frequency speech (the highest speech range is C7 [2093 Hz] and the singing application range is up to B5 [988 Hz]) during speech were captured by MD-CT. The acquisition time was 2 seconds, and the rise of the voice from low to high and then to very high tones was recorded. Ten frames per second were analyzed as three-dimensional images. RESULTS: In the fundamental frequency range from A3 to D5 (220-587 Hz), laryngeal elevation movements were observed as the voice rose in pitch. However, posterior upward displacement of the laryngeal cartilage was observed as the frequency range increased from E5 to B5 (659-988 Hz). CONCLUSIONS: In the E5-B5 range, laryngeal movements were different from those observed in the previous range. MD-CT analysis is useful in the study of this range because it allows visualization of laryngeal movements that are unclear using endoscopy or external examination.

DOI： 10.1016/j.jvoice.2023.07.025

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Language：English   Publisher：(一社)日本癌学会  

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Language：English   Publisher：(一社)日本癌学会  

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In the treatment of head and neck cancer, cisplatin is often used as a therapeutic agent; however, its efficacy is limited and it can cause renal dysfunction as an adverse effect. For this reason, the use of cisplatin is limited in elderly patients with reduced renal function. Recently, artemisinin, which was developed as an antimalarial drug, was found to have antitumor effects and is effective in combination with other anticancer drugs. In the present study, the antitumor effects of artemisinin and its derivatives as well as their combination with cisplatin and iron on head and neck squamous cell carcinoma cell lines, were investigated. Cell viability was determined by a cell viability assay, the cell cycle was analyzed by flow cytometry, cell death was assessed with annexin V and propidium iodide staining, and western blotting was used to analyze retinoblastoma protein (Rb), phosphorylated (p‑)Rb, and other cell cycle‑associated molecules. A total of four artemisinin compounds were examined and it was found that artesunate and dihydroartemisinin had a significant inhibitory effect on growth. It was also identified that the combination of artesunate, cisplatin, and iron inhibited cell proliferation and caused S/G2‑M cell cycle arrest. In addition, western blotting of Rb, a molecule involved in the cell cycle, showed that artesunate induced the loss of not only Rb but also p‑Rb. These results suggested that artesunate is a useful drug in combination with cisplatin.

DOI： 10.3892/or.2023.8591

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Neck dissection for cervical lymph node metastasis is an established procedure for head and neck cancer (HNC). However, with the advent of immunotherapy, head and neck surgical oncologists need to rethink removing all lymph nodes, including those with immune function. We investigated the anti-cancer immune response of the cervical lymph nodes in four patients with human papillomavirus type 16 (HPV16)-positive head and neck squamous cell carcinoma. Using lymphocytes extracted from local, metastatic, and non-metastatic lymph nodes and peripheral blood from these patients, we performed an intracellular flow cytometric cytokine assay using anti-IFNγ and anti-TNF-α monoclonal antibodies to detect HPV16 E6- and E7-specific T cells. HPV status and p16 immunostaining were determined by in situ detection using the HPV RNAscope method and immunohistochemistry. In one case, E6-specific and E7-specific CD8+ T cells were detected in proximal metastatic nodes and distal non-metastatic nodes. This finding suggests that non-metastatic nodes should be preserved for their immune function during neck dissection and that the immune function of non-metastatic lymph nodes is important when administering immunotherapy. In this context, head and neck surgical oncologists treating HNC should consider the place of immunotherapy and neck dissection in the treatment of HNC.

DOI： 10.3390/jpm13071174

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Radical temporal bone resection (TBR) for lateral skull base malignancies is technically challenging because of the vital anatomical structures located at the medial part of the temporal bone and their limited exposure. A possible solution is to adopt an additional endoscopic approach for medial osteotomy to reduce blind spots. The authors aimed to describe a combined exoscopic and endoscopic approach (CEEA) for cranial dissection in radical TBR and to determine the usefulness of the endoscopic approach to the medial aspect of the temporal bone. Having utilized the CEEA in for cranial dissection in radical TBR since 2021, the authors included 5 consecutive patients who underwent the procedure between 2021 and 2022. All surgeries were successful and resulted in no significant complications. The additional use of an endoscope improved visualization of the middle ear in 4 patients and that of the inner ear and carotid canal in 1 patient, enabling precise and safe cranial dissection. Furthermore, surgeons experienced reduced intraoperative postural stress with CEEA than with a microscopic approach. The main advantage of CEEA in radical TBR was the extension of the viewing angles of the endoscope, which allowed observation of the medial aspect of the temporal bone and limited tumor exposure and injury to vital structures. Given the other benefits of exoscopes and endoscopes, including compact size, ergonomics, and surgical field accessibility, CEEA proved to be an efficient treatment option for cranial dissection in radical TBR.

DOI： 10.1097/SCS.0000000000009522

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Language：Japanese   Publisher：耳鼻咽喉科臨床学会  

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Language：English   Publisher：(一社)日本内分泌学会  

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Language：Japanese   Publisher：(一社)日本頭頸部癌学会  

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Language：Japanese   Publisher：(一社)日本頭頸部癌学会  

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Language：Japanese   Publisher：(一社)日本頭頸部癌学会  

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Language：Japanese   Publisher：(一社)日本内分泌学会  

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In 15-20% of cases, Graves' disease (GD) shifts to Hashimoto's thyroiditis (HT), while the shift from HT to GD is rare. We present a case of a patient in whom HT shifted to GD, along with a literature review. A 50-year-old woman with myxedema was diagnosed with Hashimoto's disease due to hypothyroidism and the presence of antibodies against thyroid peroxidase (TPOAb) and thyroglobulin (TgAb); she also had thyroid stimulating antibodies (TSAb) without any signs of GD. Although thyroid hormone replacement therapy improved her thyroid function, 2 months later, hyperthyroidism appeared and did not improve after discontinuation of the replacement therapy. The patient was diagnosed with GD, which improved with antithyroid agent administration. To date, only 50 cases regarding conversion from HT to GD have been reported. The median age is 44 years (range, 23-82 years), and the median time of conversion is 7 years (range, 0.1-27 years). The male-to-female ratio of HT conversion to GD is 1:9, closer to that of regular GD (1:10) than that of general HT (1:18). All patients received thyroid hormone replacement therapy for hypothyroidism due to HT. Continuous evaluation of TSAb levels is recommended in HT, particularly in cases of TSAb-positive and those under replacement, since it may help predict conversion to GD. Evaluating the clinical characteristics of patients with HT preceding GD is crucial to ensure appropriate treatment and reduce the risk of adverse events.

DOI： 10.3390/medicina59040757

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Language：Japanese   Publisher：(一社)日本耳鼻咽喉科頭頸部外科学会  

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Language：Japanese   Publisher：(一社)日本耳鼻咽喉科頭頸部外科学会  

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Primary and metastatic malignancies arising in the sinuses are rare and histologically diverse. The role of fine-needle aspiration cytology (FNAC) and the cytomorphologic characteristics of these tumors have not been specifically addressed. We described two cases of suspected malignant maxillary sinus tumors in 85- and 90-year-old patients with comorbid conditions, both of whom underwent tissue biopsies that failed to yield a definitive diagnosis. We performed FNAC after imaging confirmed that the malignant tumors were outside the maxillary sinus. The 85- and 90-year-old patients were diagnosed with squamous cell carcinoma (SCC) and adenocarcinoma, respectively. In the latter, the cell block method was used to prepare the specimen, rendering individual cells identifiable. Atypia of the histological structure was confirmed without the influence of cell duplication, a known weakness of FNAC. Thus, the diagnosis was made quickly. We believe that FNAC would be utilized more frequently for the definitive diagnosis of sinonasal tumors as the technique and diagnostic technology improve further.

DOI： 10.7759/cureus.36506

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Patients with advanced/recurrent mucoepidermoid carcinoma (MEC) have a poor prognosis. This study aimed to establish and characterize human mucoepidermoid carcinoma cell lines from the initial surgical specimen and biopsy specimen upon recurrence from the same patient to provide a resource for MEC research. MEC specimens from the initial surgical procedure and biopsy upon recurrence were used to establish cell lines. The established cell lines were cytogenetically characterized using multi-color fluorescence in situ hybridization and detection, and the sequence of the CRTC1-MAML2 chimeric gene was determined. Furthermore, the susceptibility of head and neck mucoepidermoid carcinoma to standard treatment drugs such as cisplatin, 5-fluorouracil, and cetuximab was investigated. We successfully established unique MEC cell lines, AMU-MEC1, from an initial surgical specimen and AMU-MEC1-R1 and AMU-MEC1-R2 from the recurrent biopsy specimen in the same patient. These cell lines exhibited epithelial morphology and developed in vitro-like cobblestones. They shared eight chromosomal abnormalities, including der(19)ins(19;11)(p13;?), which resulted in a chimeric CRTC1-MAML2 gene, indicating the same origin of the cell lines. The susceptibility of all cell lines to cisplatin and 5-fluorouracil was low. Interestingly, EGFR dependency for cell growth decreased in AMU-MEC-R1 and AMU-MEC-R2 but was retained in AMU-MEC1. These cytogenetic and biochemical findings suggest that the established cell lines can be used to investigate the disease progression mechanisms and develop novel therapeutics for MEC.

DOI： 10.3390/ijms24021722

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Regulatory T-cells (Tregs) play a major role in suppressing anti-tumor immune responses. Mogamulizumab, an anti-CC chemokine receptor type 4 (CCR4) monoclonal antibody, depletes effector Tregs (eTregs). However, the clinical efficacy of mogamulizumab was limited in phase Ia/Ib studies for solid tumors (NCT01929486); the finding suggests that mogamulizumab may also deplete beneficial CCR4+CD8+ T-cells in patients. Therefore, we focused on CTLs and aimed to identify a way to protect CCR4+ CTLs. Here, we evaluated the association of CCR4 expression in cytotoxic T-lymphocytes (CTLs) with antigen and cytokine stimulations and kinase inhibition using cytomegalovirus antigen instead of tumor antigen. CCR4 expression in CTLs was induced by antigen stimulation (mean 3.14-29.0%), enhanced by transforming growth factor-β1 (TGF-β1) (mean 29.0-51.2%), and downregulated by trametinib with (mean 51.2-11.4%) or without TGF-β1 treatment (mean 29.0-6.98%). Phosphorylation of ERK in CD8+ T-cells was suppressed by trametinib. Regarding the effect on immunological function of CTL, trametinib reduced cytokine production but not affected cytotoxicity. Importantly, trametinib alleviated CTL reduction by anti-CCR4 antibody without affecting eTreg depletion because CCR4 expression in eTregs was not downregulated. In conclusion, combination therapy with trametinib may improve the clinical efficacy of mogamulizumab.

DOI： 10.1038/s41598-022-22773-1

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Language：Japanese   Publisher：日本耳鼻咽喉科免疫アレルギー感染症学会  

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2022&ichushi_jid=J07545&link_issn=&doc_id=20230116470012&doc_link_id=%2Ffm9areka%2F2022%2F000204%2F012%2F0191-0196%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Ffm9areka%2F2022%2F000204%2F012%2F0191-0196%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

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For decades, no clear consensus existed on the standard treatment option for malignant tumors of the external auditory canal, an extremely rare disease. Here we report the case of a 55-year-old female patient with secretory carcinoma that originated from the left external auditory canal. Magnetic resonance imaging (MRI) at baseline showed that the tumor had extended to the medulla oblongata despite surgical and radiation treatments for more than 20 years from the initial diagnosis. Based on the results of a next-generation sequencing test of a formalin-fixed paraffin-embedded surgical specimen indicating that the tumor harbored ETV6-NTRK3 fusion, the patient was enrolled in a global basket study of larotrectinib, an oral selective tropomyosin receptor kinase (TRK) inhibitor. Three weeks after the start of larotrectinib treatment, MRI showed only small remnants of the tumor in the medulla oblongata and the patient's headache before the treatment had disappeared. Subsequent MRI after 12 weeks of treatment confirmed the complete disappearance of the tumor. The patient repeated grade 2 flu-like symptoms related to treatment, but did not experience any other grade 2 or worse treatment-related adverse events. TRK inhibitors, such as larotrectinib, exert potent antitumor activity against neurotrophic tyrosine receptor kinase (NTRK) fusion-positive tumors in a tumor-agnostic manner. To the best of our knowledge, this is the first report on NTRK fusion-positive secretory carcinoma of the external auditory canal, and this report provides a valuable insight into the management of the extremely rare but now treatable malignancy.

DOI： 10.1007/s13691-022-00559-6

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Language：Japanese   Publisher：(一社)日本鼻科学会  

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BACKGROUND/AIM: The immunotherapy approach using anti-programmed cell death 1 (PD-1) antibody has been demonstrated in oral cancer treatment. However, serious immune-related adverse events (irAE) have been reported. If local administration of small doses of anti-PD-1 antibody via intraarterial chemoradiotherapy could have the same antitumor effect of systemic administration, this can reduce irAE and medical expenses. In this study, we investigate the antitumor effects of local and systemic administration of a small amount of anti-PD-1 antibody, the overall survival (OS), and the immune environment around cancer. MATERIALS AND METHODS: A mouse buccal mucosal oral squamous cell carcinoma cell line (Sq-1979) was used, and anti-mouse PD-1 was used as the drug. The cell line was transplanted to mouse, and the drug was locally (30 mg/body) and systemically (300 mg/body) administered in a dose. The tumor shrinkage rate and antitumor effect were examined 21 and 29 days after the start of administration. The OS was also compared in each of the groups. Furthermore, the subcutaneous growth of the tumors was inhibited, and the expressions of PD-L1, CD8T cells, perforin, and granzyme B were examined. RESULTS: We found that the local low-dose and systemic groups had the same antitumor effect, OS also showed a significant prolongation. In addition, indicated that the expression of granzyme B was higher in the local low-dose group. CONCLUSION: Local low-dose administration of anti-PD-1 antibody showed the same antitumor effect and OS as systemic normal-dose administration. Therefore, local low-dose administration in oral cancer can be useful.

DOI： 10.21873/anticanres.15929

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PURPOSE: To compare the decompressive effect around the optic nerve canal among 3 different decompression procedures (medial, balanced, and inferomedial) using 3D printed models. METHODS: In this experimental study, based on data obtained from 9 patients (18 sides) with dysthyroid optic neuropathy, a preoperative control model and 3 plaster decompression models were created using a 3D printer (total, 72 sides of 36 models). A pressure sensor was placed at the optic foramen, and the orbital space was filled with silicone. The surface of the silicone was pushed down directly, and changes in pressure were recorded at 2-mm increments of pushing. RESULTS: At 10 mm of pushing, there was significantly lower pressure in the medial (19,782.2 ± 4319.9 Pa, P = 0.001), balanced (19,448.3 ± 3767.4 Pa, P = 0.003), and inferomedial (15,855.8 ± 4000.7 Pa, P < 0.001) decompression models than in the control model (25,217.8 ± 6087.5 Pa). Overall, the statistical results for each 2-mm push were similar among the models up to 10 mm of pushing (P < 0.050). At each push, inferomedial decompression caused the greatest reduction in pressure (P < 0.050), whereas there was no significant difference in pressure between the medial and balanced decompression models (P > 0.050). CONCLUSION: All 3 commonly performed decompression procedures significantly reduced retrobulbar pressure. Because inferomedial decompression models obtained the greatest reduction in pressure on the optic nerve canal, inferomedial decompression should be considered the most reliable procedure for rescuing vision in dysthyroid optic neuropathy.

DOI： 10.1007/s00417-022-05645-2

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Language：English   Publisher：(一社)日本癌学会  

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Language：Japanese   Publisher：耳鼻咽喉科臨床学会  

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Language：Japanese   Publisher：(一社)日本頭頸部癌学会  

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Language：Japanese   Publisher：(一社)日本頭頸部癌学会  

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Language：Japanese   Publisher：(一社)日本頭頸部癌学会  

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Language：English   Publishing type：Research paper (scientific journal)  

The expression of programmed death ligand-1 (PD-L1) is controlled by complex mechanisms. The elucidation of the molecular mechanisms of PD-L1 expression is important for the exploration of new insights into PD-1 blockade therapy. Detailed mechanisms of the in situ expression of PD-L1 in tissues of oral squamous cell carcinomas (OSCCs) have not yet been clarified. We examined the mechanisms of PD-L1 expression focusing on the phosphorylation of downstream molecules of epidermal growth factor (EGF) and interferon gamma (IFN-γ) signaling in vitro and in vivo by immunoblotting and multi-fluorescence immunohistochemistry (MF-IHC), respectively. The in vitro experiments demonstrated that PD-L1 expression in OSCC cell lines is upregulated by EGF via the EGF receptor (EGFR)/PI3K/AKT pathway, the EGFR/STAT1 pathway, and the EGFR/MEK/ERK pathway, and by IFN-γ via the JAK2/STAT1 pathway. MF-IHC demonstrated that STAT1 and EGFR phosphorylation was frequently shown in PD-L1-positive cases and STAT1 phosphorylation was correlated with lymphocyte infiltration and EGFR phosphorylation. Moreover, the phosphorylation pattern of the related molecules in PD-L1-positive cells differed among the cases investigated. These findings indicate that PD-L1 expression mechanisms differ depending on the tissue environment and suggest that the examination of the tissue environment and molecular alterations of cancer cells affecting PD-L1 expression make it necessary for each patient to choose the appropriate combination drugs for PD-1 blockade cancer treatment.

DOI： 10.3390/ijms23084077

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This article aims to describe the two cases in which chemotherapy and chemoradiotherapy were effective for advanced HPV-related lacrimal sac squamous cell carcinoma and avoided the need for radical surgery. This was an interventional study of two patients with advanced lacrimal sac squamous cell carcinoma. Two patients with advanced lacrimal sac squamous cell carcinoma were treated at our University Hospital between January 2020 and February 2021. Diagnosis of HPV-related lacrimal sac carcinoma was done by p16 immunostaining and RNA in situ hybridization. Received neoadjuvant chemotherapy and chemoradiotherapy, also minimally invasive surgery to remove any residual tumor if the final response, were unfavorable. HPV-related carcinoma was decided by checking p16 and RNA status. Response was assessed by computed tomography, magnetic resonance imaging, positron emission tomography-computed tomography, and endoscopic images. Both patients had positive p16 staining also HPV RNA in situ hybridization. Received definitive chemoradiotherapy instead of radical surgery after showing a partial response to neoadjuvant chemotherapy. A complete response was achieved in one patient and the other had a partial response, leaving a small residual tumor in the nose that was successfully removed by endonasal endoscopic surgery. Cure was achieved in two patients with HPV-related lacrimal sac squamous cell carcinoma by neoadjuvant chemotherapy followed by definitive chemoradiotherapy, with only one requiring minimally invasive surgery. This is a new direction in the treatment of p16-positive lacrimal sac carcinoma, especially for advanced cases, whereby molecular biological indicators can be used to avoid highly invasive surgery and preserve quality of life without compromising prognosis.

DOI： 10.1080/08820538.2021.1963458

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Language：Japanese   Publisher：(一社)日本耳鼻咽喉科頭頸部外科学会  

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Language：Japanese   Publisher：(一社)日本耳鼻咽喉科頭頸部外科学会  

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Language：English   Publishing type：Research paper (scientific journal)  

We determined the feasibility of the combined exoscopic-endoscopic technique (CEE) as an alternative to the microscope in craniofacial resection (CFR). This retrospective study was conducted at a single institution and included eight consecutive patients with head and neck tumors who underwent CFR between September 2019 and July 2021. During the transcranial approach, microsurgery was performed using an exoscope in the same manner as in traditional microscopic surgery, and an endoscope was used at the blind spot of the exoscope. The exoscope provided images of sufficient quality to perform microsurgery, while the sphenoid sinus lumen was the blind spot of the exoscope during anterior (n = 3) and anterolateral CFR (n = 2), and the medial aspect of the temporal bone was the blind spot of the exoscope during temporal bone resection (n = 2). These blind spots were visualized by the endoscope to facilitate accurate transection of the skull base. The advantages of the exoscope and endoscope include compact size, ergonomics, surgical field accessibility, and equal visual experience for neurosurgeons and head and neck surgeons, which enabled simultaneous transcranial and transfacial surgical procedures. All the surgeries were successful without any relevant complications. CEE is effective in transcranial skull base surgery, especially CFR involving simultaneous surgical procedures.

DOI： 10.3390/curroncol28050336

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Language：English   Publisher：(一社)日本癌学会  

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Language：English   Publisher：(一社)日本癌学会  

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Publishing type：Research paper (scientific journal)   Publisher：Wiley  

DOI： 10.1111/cas.15081

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Other Link： https://onlinelibrary.wiley.com/doi/full-xml/10.1111/cas.15081

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Objective  Craniofacial resection (CFR) and temporal bone resection (TBR) on malignant head and neck tumors (MHNTs) invading skull base require accurate and precise determination of the tumor invasion. We investigated tumor skull base invasion patterns and surgical results in CFR and TBR cases. Methods  We performed either CFR or TBR for 75 selected patients with the possibility of en bloc resection over the period between 2011 and 2018. The medical charts of the selected patients were reviewed. Results  Primary tumor onset site (TOS) groups were: (1) nasal cavity/ethmoid sinus, 20 cases; (2) orbit, 10 cases; (3) maxillary sinus, 28 cases; and (4) external ear/temporomandibular joint, 17 cases. Grades for tumor invasion depth (TID) included: (I) extracranial invasion and skull base bone invasion; (II) extradural invasion; or (III) intradural invasion. Patients in groups 1 and 2 had a significantly higher frequency of grade II and III invasions than patients in groups 3 and 4. The main invasion site was nasal cavity superior wall and ethmoid sinus superior wall for group 1 tumors, orbit superior wall, and lateral skull base sphenoid bone for group 2 and 3 tumors, and lateral skull base temporal bone for group 4 tumors. Positive resection margins represented a significant negative prognostic factor. TID and TOS did not affect skull base margin status. Conclusion  Skull base invasion of MHNTs exhibits certain fixed patterns in sites susceptible to invasion based on the TOS. The frequencies of extradural and intradural invasions differed, indicating the importance for accurate preoperative tumor evaluation.

DOI： 10.1055/s-0039-3402034

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Language：Japanese   Publisher：(一社)日本頭頸部癌学会  

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Language：Japanese   Publisher：(一社)日本頭頸部癌学会  

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Language：Japanese   Publisher：(一社)日本耳鼻咽喉科頭頸部外科学会  

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Language：Japanese   Publisher：(一社)日本耳鼻咽喉科頭頸部外科学会  

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Language：Japanese   Publisher：(一社)日本耳鼻咽喉科頭頸部外科学会  

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OBJECTIVE: Cholesteatoma is a clinically heterogeneous disease, with some patients showing spontaneous regression, while others experiencing an aggressive, lethal disease. Cholesteatoma in children can be divided into two types: congenital and acquired. Identifying good prognostic markers is needed to help select patients who will require immediate surgical intervention. Matrix metalloproteinase-2 (MMP2) was previously reported to play an important role in cholesteatoma progression, by promoting bone destruction and keratinocyte infiltration. Herein, we analyzed MMP2 mRNA expression level in cholesteatoma using RNA-in situ hybridization in formalin-fixed, paraffin-embedded (FFPE) tissue samples. METHODS: Sixty patients with cholesteatoma under 15 years old, who underwent their primary surgery at Aichi Medical University's Otolaryngology Department, were analyzed for MMP2 expression level, using RNA-in situ hybridization. RESULTS: There were no significant differences in MMP2 mRNA expression level between congenital cholesteatoma and acquired cholesteatomas. In congenital cholesteatoma, higher MMP2 signals were observed in the open type than in the closed type (p < 0.001). In acquired cholesteatoma, higher MMP2 signals were observed in the pars tensa than in the pars flaccida (p < 0.001). MMP2 mRNA expression level was almost exclusively found in the fibroblasts or in the inflammatory cells in the stroma, but not in the epithelium. CONCLUSION: Our study reveals that MMP2 mRNA expression level is strongly associated with the subtypes of cholesteatoma. The findings suggest that the level of expression of MMP2 mRNA may be related to the pathogenesis and aggressive features of cholesteatoma.

DOI： 10.1155/2021/6644897

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Society of Practical Otolaryngology  

DOI： 10.5631/jibirin.114.581

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Head and neck surgery sometimes causes small defects, and salvage surgery after chemoradiotherapy poses some risk because of damage to the surgical site from the previous treatment. We have developed a novel thyroid gland flap for head and neck surgical reconstruction and here we describe elevating the flap, including arc rotation, size, and suture technique, and our outcomes to date. Methods: Thyroid gland flap reconstruction was performed in 13 cases (11 patients) between July 2009 and May 2020. The clinical importance and adverse effects of the procedure were examined. Thyroid function and blood flow of the flap were assessed, and the status of the flap and irradiated recipient tissue was examined histopathologically. Results: Median age at surgery was 64.6 years (range 49-77 years). Two of the patients underwent reconstruction with a thyroid gland flap twice. There were 4 cases of primary head and neck cancer resection with neck dissection in which the flap was harvested from the thyroid gland as reinforcement. In 1 case, surgery was performed for cervical esophageal diverticulum. In all cases, the arc was limited to 6 cm and suturing was basic. There were no complications of the surgical procedure, and the postoperative course was uneventful. Contrast-enhanced computed tomography revealed adequate enhancement of the flap. Postoperative thyroid function was normal. The thyroid gland flap was firmly adapted and fused with the irradiated recipient tissue. Conclusion: The thyroid gland flap could be an effective tissue flap fed by the superior thyroid arteriovenous pedicle for head and neck reconstruction.

DOI： 10.1097/GOX.0000000000003297

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Language：Japanese   Publisher：耳鼻咽喉科臨床学会  

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BACKGROUND: A Killian-Jamieson diverticulum is a rare pharyngoesophageal diverticulum that is radically treated by diverticulectomy. However, there is no consensus on whether cricopharyngeal myotomy is necessary, and the optimal surgical methods that prevent postoperative complications such as leakage are undetermined. CASE PRESENTATION: A 49-year-old man was referred to our hospital with oropharyngeal dysphagia while eating. The patient was preoperatively diagnosed with a Killian-Jamieson diverticulum based on radiographic and clinical findings and underwent a transcervical diverticulectomy. The recurrent laryngeal nerves were preserved using an intraoperative nerve monitoring system, and the diverticulum was identified without difficulty. A partial cricopharyngeal myotomy was performed to expose the base of the diverticulum. The diverticulum was transected transversally using a linear stapler under the guidance of intraoperative upper intestinal endoscopy. A thyroid gland flap supplied by the superior thyroid artery was harvested and placed overlapping the area of the partial cricopharyngeal myotomy. Due to the proximity of the recurrent laryngeal nerve course to the diverticulum stump, the staple line was not buried with sutures. The thyroid gland flap with its rich vascular supply was fixed to completely cover the staple line on the cut surface of the thyroid gland. The postoperative course was uneventful, without vocal cord paralysis. The patient was discharged on postoperative day 8. He developed no clinical signs suggesting leakage, recurrence, or adverse events. CONCLUSION: Killian-Jamieson diverticulectomy using a thyroid gland flap and partial cricopharyngeal myotomy is a valid treatment option that may prevent complications and recurrence. Precise evaluation of the diverticulum using an intraoperative nerve monitoring system is crucial for the repair.

DOI： 10.1186/s40792-020-01060-z

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Language：English   Publisher：(一社)日本癌学会  

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Language：English   Publisher：(一社)日本癌学会  

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Language：English   Publisher：(一社)日本癌治療学会  

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Language：English   Publisher：(一社)日本癌学会  

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Language：English  

Human papillomavirus (HPV)-related, p16-positive oropharyngeal carcinoma is considered to be sensitive to anticancer drugs, and the standard treatment is therefore chemoradiotherapy, rather than surgery, especially for aggressive disease. However, with this higher sensitivity, chemotherapy alone may achieve a pathological complete response (CR), making radiation therapy unnecessary. A 46-year-old man with p16-positive squamous cell carcinoma (SCC) of the lateral oropharynx (palatine tonsil) underwent neoadjuvant chemotherapy. This achieved clinically significant tumor shrinkage and therefore surgery was performed for subsequent definitive treatment. Clinical and CT findings indicated a good effect of neoadjuvant chemotherapy on the tumor. A biopsy prior to chemotherapy revealed SCC, which demonstrated p16 immunoreactivity and positive signals for high-risk HPV by RNA in situ hybridization. The post-chemotherapy surgical specimen showed pathological CR and no p16 positive cells nor positive signals for high-risk HPV those were detected in the pre-chemotherapy specimen. There are some reports of chemotherapy alone achieving pathological CR in cases of p16-positive oropharyngeal carcinoma, but none have included high-risk HPV RNA findings. This is the first report of the disappearance of cancer cells as well as p16 staining and a positive signal for high-risk HPV. Achieving pathological CR confirmed by immunohistochemistry and high-risk HPV RNA in situ hybridization in a solid tumor with chemotherapy alone suggests that chemotherapy may have both an antitumor effect and an antiviral effect. Forgoing subsequent radiotherapy and undergoing surgery might be unnecessary and follow-up instead might be sufficient in such cases. Into the future, in an optimal tailored treatment approach, the option of neoadjuvant chemotherapy should be considered for management of p16-positive oropharyngeal carcinoma. Other options such as tumor immunotherapy are also expected to be effective.

DOI： 10.3390/microorganisms8101497

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Language：Japanese   Publisher：(一社)日本耳鼻咽喉科学会  

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Language：English   Publishing type：Research paper (scientific journal)  

Cisplatin is an important drug for the treatment of head and neck squamous cell carcinoma (HNSCC). Determining chemoresistant factors prior to treatment will lead to great benefits for clinicians and patients. Here, we evaluated chemoresistant factors by integrating proteomic and transcriptomic data using HNSCC cell lines to identify a more precise chemoresistant factor in HNSCC. We used four HNSCC cell lines: cisplatin-sensitive, acquired cisplatin resistance, naturally cisplatin-resistant, and acquired 5-FU resistance. Proteomic analysis was performed using iTRAQ, tandem mass spectrometry, and liquid chromatography-electrospray ionization-tandem mass spectrometry. Transcriptomic analysis was performed using microarrays. By integrating these independent data, common factors were addressed and functional analysis was performed using small interfering RNAs (siRNAs) to change the chemosensitivity. Using iTRAQ analysis, 7 proteins were identified as specific for cisplatin chemoresistance factors. Transcriptomic analysis revealed hundreds of potential candidate factors. By combining and integrating these data, S100A2 was identified as a potential cisplatin-specific chemoresistance factor. Functional analysis with siRNA revealed that the expression of S100A2 was reduced and cisplatin sensitivity recovered in the acquired and naturally cisplatin-resistant cell lines, but not in the cisplatin-sensitive cell lines. S100A2 was identified as a cisplatin-specific chemoresistance factor by integrating the transcriptomic and proteomic results obtained using HNSCC cell lines. This is a novel technique that allows for a precise identification, also known as a comprehensive analysis. Our findings indicate that these proteins could be used as biomarkers of HNSCC treatments, providing physicians with new treatment strategies for patients with HNSCC, showing chemoresistance.

DOI： 10.18999/nagjms.82.3.519

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Wound infection is a major complication after supracricoid partial laryngectomy with cricohyoidoepiglottopexy (CHEP) for radiation therapy failure. A 60-year-old man received chemoradiotherapy for a glottic carcinoma. CHEP, reusing the thyroid gland flap (TF), was performed because the cancer recurred after a salvage vertical partial laryngectomy following radiation therapy failure. The TF was sutured to the supraglottis and cricoid cartilage mucosa to minimize mucosal defects before the hyoid bone and cricoid cartilage were sutured. Wound healing after CHEP was good without infection. After decannulation, oral food intake was possible without aspiration, and speech function was comparable to that of other patients who had supracricoid partial laryngectomies. Histopathological examination revealed a close connection between the TF and its surrounding tissues without fibrous scarring. TF may improve wound healing after CHEP for radiation failure by minimizing mucosal defects.

DOI： 10.1016/j.anl.2019.06.009

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This case report describes resection without facial incision for aggressive Kadish stage C olfactory neuroblastoma (ONB). We performed resection via transcaruncular approach with combined endonasal and skull base surgery. This multidisciplinary team surgical approach is expected to lead to a new strategy for this type of tumor in the future.

DOI： 10.1002/ccr3.2906

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Language：Japanese   Publisher：(一社)日本頭頸部癌学会  

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Summary: Dupilumab an inhibitor of the interleukin (IL)-4R-alpha subunit is used for the treatment of allergic diseases. The patient was a 49-year-old man who received dupilumab for the treatment of severe atopic dermatitis. He presented hyperthyroidism with elevated thyroglobulin and anti-thyroid antibody negativity at 4 months after the initiation of therapy. On scintigraphy, the thyroid radioiodine uptake was low. Ultrasonography showed a diffuse hypoechoic area in the thyroid gland. A pathological study revealed lymphocytic infiltration. The administration of dupilumab was continued because of his atopic dermatitis that showed an excellent response. The patient`s hyperthyroidism changed to hypothyroidism 3 weeks later. Six months later his thyroid function normalized without any treatment. We herein describe the case of a patient with atopic dermatitis who developed painless thyroiditis under treatment with dupilumab. To the best of our knowledge, this is the first report of this event in the literature. Learning points: Dupilumab, a fully human monoclonal antibody that blocks interleukin-4 and interleukin-13, has been shown to be effective in the treatment atopic dermatitis and asthma with eosinophilia. Painless thyroiditis is characterized by transient hyperthyroidism and hypothyroidism and recovery without anti-thyroid treatment. This is the first report of painless thyroiditis as an adverse effect of dupilumab, although conjunctivitis and nasopharyngitis are the main adverse effects of dupilumab.

DOI： 10.1530/EDM-20-0030

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OBJECTIVE: The availability of an audiological evaluation for the differential diagnosis of clinical otosclerosis (OS) was examined. METHODS: Included were 98 patients (107 ears) with OS and 19 patients (20 ears) with incudostapedial disconnection (ISD) diagnosed by surgery between 2009 and 2017 at Aichi University Hospital. Results of preoperative pure-tone audiometry and impedance audiometry were analyzed. The most reliable index for distinguishing the two diseases was evaluated, and the cut-off value, sensitivity, and specificity were calculated. RESULTS: In the univariate analysis, age, static compliance, reversed ipsilateral acoustic reflex (reversed IAR) at 0.5 kHz and 2 kHz, negative contralateral acoustic reflex (negative CAR), difference between the air-bone gap at 0.25 and 2 kHz (0.25-2 kHzABG) and that at 0.25 and 4 kHz (0.25-4 kHzABG) showed statistical significance between the two diseases, whereas the Carhart notch did not. Multivariate logistic regression analysis by the variable selection method showed that reversed IAR (0.5 kHz), negative CAR, and 0.25-4 kHzABG were statistically significantly better factors for the differential diagnosis of the two diseases. The receiver operating characteristic curve for diagnosing OS using the difference between air-bone gap at 0.25 kHz and 4 kHz showed moderate accuracy. If the cut-off value of 0.25-4 kHzABG was 10 dB, then the sensitivity and specificity were 81.1% and 55.0%, respectively. In other words, if the cut-off value of 0.25-4 kHzABG was less than 10 dB, then the possibility of diagnosing ISD becomes higher, and if greater than 10 dB, then the possibility of diagnosing OS becomes higher. CONCLUSION: The differences in the air-bone gap at low and high frequency in pure-tone audiometry, static compliance, and acoustic reflex in impedance audiometry are useful for distinguishing OS from ISD. However, combinations of several examinations including computed tomography imaging are needed for the differential diagnosis of other ear diseases and specific preoperative planning.

DOI： 10.1016/j.anl.2020.03.009

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Language：English   Publishing type：Research paper (scientific journal)  

Immune-checkpoint inhibitors improve the survival of head and neck squamous cell carcinoma (HNSCC) patients. Although recent studies have demonstrated that the tumor immune microenvironment (TIME) has critical roles in immunotherapy, the precise mechanisms involved are unclear. Therefore, further investigations of TIME are required for the improvement of immunotherapy. The frequency of effector regulatory T-cells (eTregs) and the expression of immune-checkpoint molecules (ICM) on eTregs and conventional T-cells (Tconvs) both in peripheral blood lymphocytes (PBL) and tumor-infiltrating lymphocytes (TIL) from HNSCC patients were analyzed by flow cytometry and their distributions were evaluated by multi-color immunofluorescence microscopy. High frequency eTreg infiltration into HNSCC tissues was observed and high expressions of CD25, FOXP3, stimulatory-ICM (4-1BB, ICOS, OX40 and GITR) and inhibitory-ICM (programmed cell death-1 [PD-1] and cytotoxic T-lymphocyte-associated protein-4 [CTLA-4]) were found on invasive eTregs. In contrast, the expression of stimulatory-ICM on Tconvs was low and the expression of inhibitory-ICM was high. In addition, ICM-ligands (programmed cell death-1 [PD-L1], galectin-9 and CEACAM-1) were frequently expressed on cancer cells. PD-L1 and galectin-9 were also expressed on macrophages. PD-1+ T-cells interacted with PD-L1+ cancer cells or PD-L1+ macrophages. This suggested that in TIL, eTregs are highly activated, but Tconvs are exhausted or inactivated by eTregs and immune-checkpoint systems, and ICM and eTregs are strongly involved in the creation of an immunosuppressive environment in HNSCC tissues. These suggested eTreg targeting drugs are expected to be a combination partner with immune-checkpoint inhibitors that will improve immunotherapy of HNSCC.

DOI： 10.1111/cas.14422

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Background: Descending necrotizing mediastinitis (DNM) resulting from oropharyngeal and cervical abscess is a life-threatening condition. This study attempted to improve our recognition of the extension and distribution of the abscess for ideal thoracic drainage. Methods: We performed a retrospective clinical analysis of seven patients who underwent thoracic drainage for DNM with available clinical data. For mapping and classification of the distribution of the abscess, computed tomography and intraoperative findings were utilized. Results: To cure patients, cervical drainage and thoracic drainage were performed 14 and 11 times, respectively. The operation time for thoracic drainage and intraoperative blood loss were 141±77 min and 103±103 g, respectively. The mean hospital stay was 66±41 days. All patients are alive without recurrence. We divided the abscess distribution into nine categories including the anterior thoracic wall, according to the computed tomography and intraoperative findings. The rate of abscess descended gradually toward the lower mediastinum. Abscesses were not necessarily continuous, and skipped lesions were occasionally noted. Conclusions: We were able to cure all seven patients with DNM. It might be helpful to recognize the exact distribution of the abscess and distribution-specific drainage using a new map and classification of thoracic abscess.

DOI： 10.21037/jtd.2020.03.82

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OBJECTIVE: To compare postoperative changes in visual acuity between the transnasal endoscopic approach and the transcaruncular approach when comparison of preoperative values used for medial orbital wall decompression in patients with dysthyroid optic neuropathy. METHODS: We included 14 patients (23 sides) and divided them into a transnasal group (11 sides, 8 patients) and a transcaruncular group (12 sides, 6 patients). Visual acuity was examined preoperatively, on postoperative days 1, 3, and 7, and at a final follow-up visit. The differences in postoperative improvement of the logarithm of the minimum angle of resolution (logMAR) visual acuity and critical flicker frequency (CFF) between the two surgical groups at each time point were analyzed using the Mann-Whitney U test. RESULTS: Postoperative improvement in logMAR visual acuity on postoperative days 1 and 3 and that in CFF on postoperative day 1 were greater in the endonasal group than in the transcaruncular group (P < 0.050). Vision was improved or maintained in all patients in the transnasal group at the final follow-up. One patient in the transcaruncular group had loss of vision on one side and decreased vision on the other side after surgery. CONCLUSION: Medial orbital decompression appears to provide better postoperative vision when performed by the transnasal approach than by the transcaruncular approach in patients with dysthyroid optic neuropathy.

DOI： 10.1016/j.anl.2019.03.010

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This case report describes larynx-preserving pharyngectomy after chemoradiotherapy using a thyroid gland flap. A thyroid gland flap has good blood supply and reconstruction can be done in the same surgical field. The thyroid gland flap has potential as a novel appropriate flap for use in head and neck surgery.

DOI： 10.1002/ccr3.2477

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Language：English   Publisher：(一社)日本癌治療学会  

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Language：English   Publisher：(一社)日本癌治療学会  

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Language：Japanese   Publisher：耳鼻と臨床会  

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Language：English   Publisher：(一社)日本癌学会  

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Language：English   Publisher：(一社)日本癌学会  

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Language：Japanese   Publisher：耳鼻咽喉科臨床学会  

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Language：Japanese   Publisher：(一社)日本頭頸部癌学会  

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Language：Japanese   Publisher：(一社)日本頭頸部癌学会  

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Language：Japanese   Publisher：(一社)日本耳鼻咽喉科学会  

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Publishing type：Research paper (scientific journal)   Publisher：Fortune Journals  

DOI： 10.26502/acmcr.96550152

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OBJECTIVEAlthough sphenoidotomy is more commonly performed via the transnasal approach than via the transcranial approach, transcranial sphenoidotomy (TCS) remains indispensable for en bloc resection of locally advanced sinonasal malignant tumors (SNMTs) extending to the skull base. TCS also enables transsphenoidal transposition of the temporoparietal galeal flap (TPGF) to compensate for the lack of vascularized reconstructive tissue after endoscopic transnasal skull base surgery. The objective of this study was to review the authors' surgical experience using TCS with an emphasis on the surgical anatomy of the sphenoid sinus and on the purpose of TCS. Relevant anatomy is further illustrated through cadaveric dissection and photo documentation.METHODSThe authors reviewed the records of 50 patients who underwent TCS at the Nagoya University Hospital, Fukushima Medical University Hospital, or Aichi Medical University Hospital over the course of 7 years (between January 2011 and November 2017). The authors also performed cadaveric dissection in 2 adult cadaveric skull base specimens.RESULTSOf the 50 patients included in this study, 44 underwent craniofacial resection (CFR) for en bloc resection of SNMTs involving the anterior and/or lateral skull base, and 6 underwent transsphenoidal transposition of the TPGF flap. The authors categorized the TCS procedures according to the portion of the sphenoid sinus wall involved (i.e., superior, lateral, and superolateral). Superior sphenoidotomy was used in patients requiring anterior CFR. Lateral sphenoidotomy was further divided into 2 subtypes, with type 1 procedures performed for the transsphenoidal transpositioning of the TPGF, and type 2 procedures used in patients requiring lateral CFR. Superolateral sphenoidotomy was used in anterolateral CFR.CONCLUSIONSTCS still represents a useful tool in the armamentarium of neurosurgeons treating central skull base lesions. The newly proposed surgical classification facilitates a profound understanding of TCS and how to incorporate this technique into clinical practice.

DOI： 10.3171/2018.6.JNS181013

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Language：English   Publisher：(一社)日本癌学会  

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Language：Japanese   Publisher：耳鼻咽喉科臨床学会  

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Language：Japanese   Publisher：耳鼻咽喉科臨床学会  

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Language：Japanese   Publisher：(一社)日本頭頸部癌学会  

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Publishing type：Research paper (scientific journal)  

DOI： 10.5631/jibirinsuppl.152.2

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BACKGROUND: Invasive fungal sinusitis is usually associated with poor prognosis, but no clear guidelines have been established for surgical treatment. Here, we report the development and application of the endoscopic orbit-sinus combined approach (EOSCA), a novel surgical technique to approach the nasal cavity and orbit concurrently, in patients with invasive fungal sinusitis with orbital infiltration. MATERIAL AND METHODS: Two patients with invasive fungal sinusitis infiltrating the orbit underwent EOSCA. Transnasal endoscopy was performed for maximum debulking of tissues infiltrated by fungi in the nasal cavity and orbit, before making an incision into the palpebral conjunctiva. An endoscope was then inserted into the orbit through the incision in the palpebral conjunctiva to remove adipose tissue and muscles that had been infiltrated by fungi from the orbital regions where the transnasal approach was difficult or impossible. Another surgeon assisted the procedure by operating an endoscope concurrently via the nasal cavity (four-hands technique). RESULTS: We were able to remove lesions safely and with precision, preserving visual acuity and a functional eyeball in both cases. Currently, the patients are alive, with no postoperative complications, recurrence, or disfigurement. CONCLUSIONS: This novel method shows promise as a safe and reliable surgical procedure for patients with invasive fungal sinusitis infiltrating into the orbit, with no postoperative complications, recurrence, or disfigurement.

DOI： 10.1080/13645706.2017.1305971

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Language：English   Publisher：(一社)日本癌学会  

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Language：Japanese   Publisher：(株)東京医学社  

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Language：Japanese   Publisher：(一社)日本耳鼻咽喉科学会  

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Language：Japanese   Publisher：(一社)日本耳鼻咽喉科学会  

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Language：English  

BACKGROUND: Cholesterol granuloma of the middle ear is extremely rare in comparison to cholesterol granuloma of the petrous apex but sometimes shows an aggressive course. CASE REPORT: We report herein a case involving a large, aggressive cholesterol granuloma of the middle ear that eroded the middle cranial fossa. A 64-year-old woman presented with pain in the left ear and hearing loss. Cholesterol granuloma was finally diagnosed from diffusion-weighted imaging, and cortical mastoidectomy was performed with canal wall down tympanoplasty type III. Recovery was uneventful recovery and the patient well at the 3-year follow-up. CONCLUSION: This case demonstrates the rare but clinically important pathology of aggressive cholesterol granuloma of the middle ear.

DOI： 10.1155/2017/4793786

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The aim of this study was to investigate the potential polysomnographic predictors of CPAP adherence using polysomnographic parameters at the time of obstructive sleep apnea diagnosis that distinguished between REM and NREM sleep. This was a retrospective cross-sectional study of 173 patients. Patients who used CPAP for more than 4 hours per night for at least 70% of nights over a 6-month period were considered to have good adherence. The poor adherence group included those who had used CPAP for 6 months from initiation, but did not fulfill the definition of good adherence or gave up the treatment within 6 months of treatment initiation. Of the 173 participants, 44 patients had good CPAP adherence and 129 patients had poor adherence. Univariate analysis showed that patients with good adherence had significantly higher apnea-hypopnea index during NREM sleep (p = 0.043), oxygen desaturation index during NREM sleep (p = 0.011), and cumulative percentage of time spent at saturations below 90% (CT90) during NREM sleep (p < .001). In multiple logistic regression analysis including all variables, CT90 during NREM sleep was the only factor independently associated with CPAP adherence (odds ratio, 0.693; 95% confidence interval, 0.582-0.824; p <.0001). The area under the receiver-operating characteristic curve of CT90 during NREM sleep was 0.823 (95% confidence interval, 0.745-0.901).Evaluating NREM sleep is important in reliably predicting CPAP adherence using polysomnographic parameters. CT90 during NREM sleep was the best predictor of CPAP adherence.

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Language：English   Publishing type：Research paper (scientific journal)  

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Language：English   Publishing type：Research paper (scientific journal)  

AIM: Recurrence rates of oral cancer following primary treatment have been reported in the range of 25-48%. However, salvage therapy remains a critical challenge to improving outcomes. Here, we investigated prognostic factors and outcomes for salvage surgery in patients with recurrent oral tongue squamous cell carcinoma (OTSCC). METHODS: We retrospectively reviewed patients who were referred to Aichi Cancer Center, Japan, for the treatment of recurrent OTSCC. All patients included in the present study had undergone salvage surgery. Data to identify the predictive value of prognostic factors were available from 69 patients. Prognostic factors were assessed using Cox's proportional hazards regression analysis. Differences in overall survival between groups of patients were assessed by the log-rank test. RESULTS: In all, 36 patients (52%) developed second recurrence or died, of which 21 (58%) occurred within 12 months of salvage surgery. Univariate analysis indicated that survival was significantly worse in patients with recurrent stage III or IV tumors, two or more positive cervical lymph nodes, levels IV or V positive cervical lymph nodes, extracapsular spread (ECS) of positive cervical lymph nodes and a disease-free interval from initial treatment of less than 12 months. On multivariate analysis, ECS was an independent prognostic factor for overall survival after salvage surgery. CONCLUSION: Neck status at the time of salvage surgery, particularly ECS is a significant prognostic factor for surgical salvage. Survival was also influenced by the stage of the recurrent tumor and disease-free interval, suggesting that the biological features of recurrent tumors might impact on prognosis.

DOI： 10.1111/ajco.12087

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AIM: To examine the effects of patient age, canalicular obstruction, mode of anesthesia, and duration of nasolacrimal intubation on the outcomes of endoscopic endonasal dacryocystorhinostomy (DCR). METHODS: Totally 56 eyes of 46 patients with prolonged epiphora underwent minimally invasive endoscopic endonasal DCR. A successful surgical outcome was defined as a significant improvement in symptoms, adequate water passage from the puncta to the nasal cavity, and patency of the DCR ostium. All outcomes were assessed at least 6mo after extubation. Fisher's exact test was used to discuss the factors, and then the logistic regression analysis was made by SAS 9.4 software. RESULTS: The overall success rate was 75.0%, and complete resolution was observed in 27 eyes. The success rate was higher for patients with ≥6mo intubation than for those with <6mo intubation. However, there were no significant differences in outcomes between groups stratified by age (<65 or ≥65y), presence or absence of canalicular obstruction, mode of anesthesia (local or general), and use or nonuse of a radiowave unit. One patient developed subcutaneous emphysema around the eye and nose and one developed subcutaneous hemorrhage after surgery. CONCLUSION: Endoscopic endonasal DCR can be considered safe and minimally invasive with reasonable success rates, particularly when the duration of nasolacrimal intubation is ≥6mo.

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Language：Japanese   Publisher：耳鼻咽喉科臨床学会  

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Language：Japanese   Publisher：(一社)日本耳鼻咽喉科学会  

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Language：English   Publishing type：Research paper (scientific journal)   Publisher：Society of Practical Otolaryngology  

DOI： 10.5631/jibirinsuppl.141.54

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BACKGROUND: To preserve laryngeal function in early-stage laryngeal cancer, chemotherapy and radiotherapy are performed more often than surgery as initial treatment. However, in recurrent cases, complex salvage surgery is often required as patients who received aggressive chemoradiotherapy are susceptible to postoperative complications. We report here salvage therapy that preserved laryngeal function in a recurrent case. METHODS: A 52-year-old man with recurrent laryngeal cancer (rT2N0M0) after chemoradiotherapy and followed by induction chemotherapy underwent partial vertical laryngectomy and right vocal cord reconstruction with a thyroid flap. RESULTS: Laryngeal functions were successfully preserved and the patient was discharged 2 months after surgery. CONCLUSION: The number of salvage surgeries performed after high-dose chemotherapy and radiation is expected to increase in the future. A thyroid gland flap promises to be an effective treatment option for vocal cord reconstruction especially for patients at high risk of postchemoradiotherapy complications.

DOI： 10.1002/hed.23525

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Language：Japanese   Publisher：(株)東京医学社  

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Authorship：Corresponding author   Publishing type：Research paper (scientific journal)   Publisher：Springer Science and Business Media LLC  

DOI： 10.1038/bjc.2014.395

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Other Link： http://www.nature.com/articles/bjc2014395

Language：Japanese   Publisher：(株)メディカルレビュー社  

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2014&ichushi_jid=J06217&link_issn=&doc_id=20140811250012&doc_link_id=%2Fai1tokec%2F2014%2F000201%2F012%2F0055-0057%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fai1tokec%2F2014%2F000201%2F012%2F0055-0057%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: Acquired chemoresistance to 5-fluorouracil (5-FU) remains one of the obstacles for the success of 5-FU-based cancer chemotherapy, and some molecular mechanisms of acquired 5-FU resistance are still unknown. The main action of 5-FU is the suppression of DNA replication by inhibiting Thymidylate Synthase (TS). MATERIALS AND METHODS: We analyzed 5-FU resistance mechanisms using the head and neck squamous cell carcinoma cell lines, UM-SCC-23, and two different resistant cell lines, UM-SCC-23/WR and UM-SCC-23/MR, which were procured from UM-SCC-23 cells. To acquire resistance, the two cells underwent repeated treatment of 5-FU with different durations and frequency. We determined differences in the cell-cycle distribution and the expression of TS proteins in the three cell lines. Moreover, cell-cycle distribution in cells which acquired resistance after 5-FU treatment, was compared to that of parental cells, using flow cytometric analysis. RESULTS: There was a remarkable increase in TS protein expression levels in UM-SCC-23/WR following 5-FU treatment. S-phase cells of UM-SCC-23 and UM-SCC-23/WR cells were immediately increased after treatment with 5-FU, whereas UM-SCC-23/MR were accumulated to the S-phase slightly later. CONCLUSION: The cell-cycle perturbation or elevation of TS protein expression may be involved in acquired 5-FU resistance and identifies 5-FU resistance mechanisms in the two different 5-FU treatment regimens.

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Language：Japanese   Publishing type：Research paper (scientific journal)  

Acute epiglottitis may trigger death because of serious airway obstruction. It is necessary to perform emergency and accurate airway intervention. In this retrospective study we present 216 cases of acute epiglottitis in adults. Airway management was done in 39 cases (18.1%), but most cases were treated conservatively. The mean patient age was 53 years and the male-to-female ratio was 1.9 to 1.0. The most frequent symptoms were sore throat (88%). The mean duration from symptom onset to consultation to our hospital was 1.9 days in the airway management group and 2.9 days in the conservatively treated group, which was statistically significant (p<0.05). Focusing on epiglottal swelling seen under the flexible laryngoscope, the percentage of airway management was 52.6% for swelling of the unilateral false vocal cords and 12.9% for swelling of the aryepiglottic fold. A statistically significant difference was also seen in complaints of respiratory difficulties (p<0.01), the rise of WBC (p<0.01), the rise of CRP (p<0.01), and diabetes mellitus (p<0.01).

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BACKGROUND: It is known that benign tumors have the potential for malignant transformation. Malignant transformation of vagus nerve schwannoma to angiosarcoma is very rare. METHODS: We report a case of malignant transformation in which the initial diagnosis was subsequently altered to angiosarcoma originating from the vagus nerve. We compared the findings of MRI and fine-needle aspiration (FNA) at initial diagnosis with those after malignant transformation. RESULTS: MRI revealed that the mass property had been changed from the initial tumor; also the FNA findings were significantly different from those in the previous ones. The patient had significant clinical progression with multiple cranial neuropathies and died. CONCLUSION: Schwannomas sometimes undergo malignant transformation; therefore, surgery should be recommended. If follow-up observation is chosen, MRI and FNA should be regular and patients should sign a statement acknowledging awareness of the potential for malignant transformation.

DOI： 10.1002/hed.23390

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Society of Practical Otolaryngology  

DOI： 10.5631/jibirin.107.735

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Head and neck squamous cell carcinoma (HNSCC) may be curable with surgery, radiation and chemotherapy in its early stages. However, recurrence and metastasis often prevail following primary treatment in advanced stage cases and are associated with significant morbidity and mortality. In this study we investigated the combination therapy of gemcitabine and cetuximab for HNSCC. The UM-SCC-6 and UM-SCC-23 HNSCC cell lines were analyzed following treatment with gemcitabine and cetuximab. To determine the mechanism of action of this combination treatment, the cell cycle distributions following gemcitabine and/or cetuximab treatment were analyzed by flow cytometry and apoptosis assay. Gemcitabine and cetuximab combination treatment exerted an enhanced cytotoxic effect. The cell cycle analysis demonstrated that cells accumulated in the S phase following gemcitabine treatment and G1 arrest occurred following cetuximab treatment. An increase in sub-G1 phase cells was also observed following treatment with the two drugs. In an apoptosis assay, caspase 3/7 activity was found to be higher when administering a combination of gemcitabine and cetuximab compared to each agent administered alone. Gemcitabine and cetuximab are individually effective against HNSCC and an enhanced growth inhibitory effect may be expected when these agents are used in combination.

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Language：Japanese   Publisher：(一社)日本鼻科学会  

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Language：Japanese   Publisher：JAPAN SOCIETY FOR HEAD AND NECK SURGERY  

We report a case of squamous cell carcinoma of the nasal cavity which was diagnosed as Bowen's disease (carcinoma in situ). A 21-year-old man came to hospital complaining of nasal congestion. A diagnosis of Bowen's disease was made by biopsy. A mass lesion was indentified based on his right nasal cavity and exclusion productive shade by the computed tomography image (CT), and magnetic resonance imaging (MRI). The tumor mass had reached the anterior cranial base and epipharynx.<br>We need to treat the tumor as carcinoma in situ, and initial choices of surgical procedures were considered on the basis of sufficient safety margin and extirpation without residual lesion.<br>An intranasal tumorectomy with external nasal dissection, anterior cranial base dissection, and forearm flap reconstruction were performed. The ultimate pathological outcome was squamous cell carcinoma. Even in light of the diagnosis of carcinoma in situ, we believe that radical consideration of the optimal procedure is preferable including extended resection for cases of images indicating suspected invasive cancer.

DOI： 10.5106/jjshns.20.201

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Other Link： http://search.jamas.or.jp/link/ui/2011158645

Language：Japanese   Publisher：(一社)日本消化器内視鏡学会  

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Language：English   Publisher：(一社)日本癌学会  

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Language：Japanese   Publisher：耳鼻咽喉科臨床学会  

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2010&ichushi_jid=J00580&link_issn=&doc_id=20100216180006&doc_link_id=10.5631%2Fjibirin.103.131&url=https%3A%2F%2Fdoi.org%2F10.5631%2Fjibirin.103.131&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_2.gif

Publishing type：Research paper (scientific journal)  

DOI： 10.5631/jibirin.103.131

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Language：English   Publishing type：Research paper (scientific journal)  

Resistance to platinum-based chemotherapy frequently poses a serious problem in the treatment of head and neck squamous cell carcinoma. In this study, we isolated cisplatin-resistant cells from a head and neck squamous cell carcinoma cell line. The mismatch repair (MMR) system is known as one of the cisplatin-resistant mechanisms. When the expression levels of hMLH1 and hMSH2, a mismatch repair gene and its gene product, were analyzed, the hMLH1 mRNA and protein expression levels were significantly decreased in the cisplatin-resistant cell lines compared with a cisplatin-sensitive cell line. In addition, the microsatellite instability (MSI) phenotype was examined for the absence of MMR. Our data support the hypothesis that hMLH1 mRNA and protein expression levels are predictors of cisplatin sensitivity, but MSI was not involved in cisplatin resistance. The status of hMLH1 predicts the sensitivity of head and neck squamous cell carcinoma to platinum-based chemotherapy.

PubMed

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Language：Japanese   Publisher：耳鼻咽喉科臨床学会  

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Language：English   Publishing type：Research paper (scientific journal)  

Web of Science

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Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1007/s00280-007-0658-6

Web of Science

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Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.3892/mmr_00000015

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Language：Japanese   Publisher：(一社)日本頭頸部癌学会  

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Language：Japanese   Publisher：The Oto-Rhino-Laryngological Society of Japan, Inc.  

We evaluated the accuracy of staging in 159 patients with head and neck squamous cell carcinoma (HNSCC) scanned by FDG-PET and 116 patients with the same cancer scanned by FDG-PET/computed tomography (CT). The accuracy was measured by comparing the FDG-PET/FDG-PET/CT findings at the primary tumor site, cervical node sites and distant metastatic sites with the clinical diagnosis. Especially, accuracy at cervical sites was evaluated from the screening point of view. Both examinations yielded an accuracy rate of more than 80% for each site, and a negative predictive value of more than 90% for the cervical sites. For the cervical sites, the positive predictive value (PPV) of FDG-PET was 78% and of FDG-PET/CT was 82%. When one cervical lymph node metastasis was detected by FDG-PET, the PPV was 63%, which appears to be comparatively low. Both examinations showed high accuracy for staging of HNSCC. In the near future, excellent screening examination might become possible with the spread of FDG-PET/CT. However, both examinations do not yield the direct image of the carcinoma itself, but only the status of glucose metabolism in the carcinoma. Care must always be exercised in the interpretation, as there are not a few false negative and false positive cases.

DOI： 10.3950/jibiinkoka.110.629

CiNii Books

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Other Link： https://jlc.jst.go.jp/DN/JALC/00300592922?from=CiNii

Language：English   Publishing type：Research paper (scientific journal)  

Induction chemotherapy or concomitant chemoradiotherapy has been used increasingly to improve survival, organ preservation and function in patients with head and neck cancer (HNC). However, this regimen encounters significant side effects with potential adverse reactions causing many disadvantages for patients. Therefore, reliable chemosensitivity assays are needed to accurately predict the response to chemotherapy and guide the selection and treatment of patients with HNC. The main purpose of this study was to examine the optimal drug concentrations for evaluating in vitro chemosensitivity using the histoculture drug response assay (HDRA). The tested tumor specimens included 7 from oral cavities (14.3%), 12 from oropharynx (24.5%), 10 hypopharynx (20.4%), 3 larynx (6.1%), 5 sinonasal (10.2%), 2 salivary glands (4.1%), and 10 from metastatic lymph nodes (20.4%), respectively. Histopathologic types of all 49 specimens were squamous cell carcinoma. We investigated the optimal drug concentrations in HDRA searching at doses of 4-100 microg/ml for cisplatin and 60-1500 microg/ml for 5-FU. We considered the concentration of 20 microg/ml to be appropriate for evaluating cisplatin sensitivity in HNC among the tested dosages. As for cisplatin sensitivity in vitro, the 50% cut-off inhibition index (I.I.) was found to have a significant association with the clinical response to chemotherapy, with an accurate prediction rate of 77.8%. The HDRA shows a predictive value for chemosensitivity in HNC patients using the optimal drug concentration cut-off with this site specificity.

PubMed

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Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1016/j.oraloncology.2006.09.003

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Language：Japanese   Publisher：The Oto-Rhino-Laryngological Society of Japan, Inc.  

Few reports have covered salvage surgery after radiotherapy, especially with chemotherapy for oral, oropharyngeal, and hypopharyngeal squamous cell carcinoma. The feasibility of salvage surgery is unclear. We analyzed postoperative complications and prognosis after salvage surgery for local recurrence after definitive radiotherapy. Subjects were 37 patients with oral, oropharyngeal, and hypopharyngeal squamous cell carcinoma treated from 1994 to 2003. Of these, 14 (37.8%) had postoperative complications. The complication rate was significantly high in the reconstructive operation group (p=0.031) and the chemotherapy group (p=0.049).<br>The 5-year overall survival rate after salvage surgery was 70.7%. Although there was no significant improvement, the prognosis was good in early-stage groups with primary tumors.<br>We found that salvage surgery after definitive radiotherapy was effective for recurrent oral, oropharyngeal, and hypopharyngeal squamous cell carcinoma. We stress the need to pay attention to postoperative complications in reconstructive operation and chemotherapy groups.

DOI： 10.3950/jibiinkoka.110.461

CiNii Books

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Other Link： https://jlc.jst.go.jp/DN/JALC/00296448968?from=CiNii

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1159/000120998

Web of Science

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Language：English   Publishing type：Research paper (scientific journal)  

AIMS: The main purpose of the current study was to find predictive biomarkers that can be routinely used for the response to chemotherapy in head and neck squamous cell carcinoma (HNSCC). METHODS: From this standpoint, we selected the histoculture drug response assay (HDRA) to assess in vitro chemosensitivity, and real-time reverse transcription polymerase chain reaction to investigate the gene expression profile of individual tumors as available predictive biomarkers. Using both surgery and biopsy specimens, we analyzed their gene expression profiles using the 18 markers that we thought were likely predictors of the response to anti-cancer agents. RESULTS: Statistically significant associations were found between 5-fluorouracil (5-FU) sensitivity in HDRA and HER-2 mRNA expression level (p = 0.0030). Moreover, HER-2 expression was significantly associated with cisplatin sensitivity (p = 0.0089). Cisplatin sensitivity in HDRA was also demonstrated to have a significant association with epidermal growth factor receptor (EGFR) expression in which the group with cisplatin resistance tended to have a higher expression level than the sensitive group (p = 0.0385). CONCLUSION: HER-2 and EGFR may be possible reliable predictive biomarkers for anti-cancer therapy, and might help in the decision-making process for individual patients with HNSCC.

DOI： 10.1159/000120998

PubMed

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Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.5981/jjhnc.33.314

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Language：English   Publishing type：Research paper (scientific journal)  

BACKGROUND: The sentinel node concept has become one of the most interesting topics in the treatment of head and neck cancer. The aim of this article is to report the results of our feasibility study and clinical application of sentinel lymph node (SLN) radiolocalization and biopsy in patients with clinically negative neck oral cancer. METHODS: Individuals with previously untreated N0 oral cancer participated in the study. The radioactive tracer used was 99m Tc phytate. Lymphoscintigrams were taken in the feasibility study, and fusion images of SPECT and CT were obtained in the clinical SLN biopsy (SLNB) group. In the feasibility study, metastases to SLNs and other nodes were analyzed in permanent specimens. In the clinical application group, we investigated the comparative effectiveness of multi-slice frozen section analysis and imprint cytology for the intraoperative diagnosis of SLNB. RESULTS: Fifteen individuals participated in the feasibility study. Six SLNs in five patients were cancer-positive, and two thirds of the SLNs were micrometastases. The SLN concept was established, and SLNs with the highest to the third highest radioactivity reflected the patients' neck status accurately. Twelve patients participated in the clinical application group of SLNB. Intraoperative diagnosis of the three hottest SLNs correctly predicted the neck status of 10 patients. Three patients underwent modified radical neck dissection on the basis of the intraoperative diagnosis of cancer metastasis to SLNs, whereas neck dissections were spared in patients with no evidence of such metastases. There were two false-negative cases. One involved a failure of the intraoperative diagnosis of SLNB, and the other had cancer-negative SLNs and cancer-positive non-SLNs. Considering intraoperative diagnosis, multi-slice frozen section analysis was found to be superior to imprint cytology in its sensitivity, specificity, and overall accuracy on a lymph node basis. No differences were found in any of these indices of intraoperative SLNB on a patient basis. The fusion images of SPECT and CT proved very useful during intraoperative SLNB. CONCLUSIONS: The sentinel node concept was established in the head and neck region. Analyzing the three hottest SLNs suffices to predict a patient's neck status. Multi-slice frozen section analysis was shown to be superior to imprint cytology for detecting micrometastasis to SLN. Intraoperative SLNB based on fusion images of SPECT and CT proved to be an easy, accurate, and reliable method.

PubMed

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Language：Japanese   Publisher：The Japan Laryngological Association  

The preservation of larynx function is a particularly important challenge in head and neck cancer therapy. We considered adaptation and problems associated with vertical partial laryngectomies in particular in reviewing the results of functional preservation operations until present.<BR>Vertical partial laryngectomies show a high incidence of complications, such as postoperative fistulation, but in most cases the complications were minor in nature.<BR>There were no cases with grave complications, such as postoperative hemorrhaging or total laryngectomies with necrosis of the remnant cartilage.<BR>We came to the conclusion that the vertical partial laryngectomy operative method could be safely performed even for a recurrence after radical cure treatment.

DOI： 10.5426/larynx1989.18.2_65

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Language：Japanese   Publisher：JIBI TO RINSHO KAI  

We performed 37 cases of maxillary cancer ablation from October 2001 until June 2005. Among them, 28 cases were immediately reconstructed using free flaps, and in 9 cases prostheses were used for maxillary defects. Reconstruction methods were rectus abdomisis musclocutanous flap in 27 cases and fibula osteocutaneous flap in 1 case. In the 28 reconstruction cases, there were complications in 12 cases, and there were major complications requireing additional salvage surgeries occurred in 3 cases. Because of the conservative treatment, even ruptured sutures in the oral cavity did not prolong fasting in the reconstruction cases during the postoperative period. The time until oral intake following operation in the reconstruction cases averaged 15.0 days, against 14.3 days in prostheses cases. There was not statistically significant association between them.

DOI： 10.11334/jibi1954.52.5Supplement3_S220

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Language：Japanese   Publisher：The Oto-Rhino-Laryngological Society of Japan, Inc.  

In patients with cervical adenopathy, especially, those of cervical lymph node metastasis with no detectable primary tumor, diagnosis and treatment planning can become confused.<BR>We evaluated 36 patients with cervical lymph node metastasis of unknown origin between 1985 and 2002.<BR>Primary sites were detected in 20 before treatment. The other 36 patients clearly had no primary lesions when treatment started. Primary sites were 5 cases of oropharynx, 2 of the parotid gland, and 1 each of larynx, nasopharynx, hypopharynx, and malignant lymphoma detected in 11 after treatment for cervical lymph nodes. No primary lesion was found in 28 patients.<BR>The neck LN stage was N1 in 11 patients, N2 in 29, N3 in 11, and unknown in 8.<BR>To detect the primary site, we conducted "random" biopsy, panendoscopy, and radiographic evaluation including FOG-PET Biopsy sites were the nasopharynx, palatine and lingual tonsil, and piriform sinus. Some 35 patients (59.3%) underwent random biopsy, and primary sites were found this way in 5 patients (14.3%).<BR>The 36 who had no primary lesion were treated for cervical lymph nodes, of whom 24 underwent neck dissection. Chemotherapy and radiotherapy were the treatment of choice in many cases.<BR>We analyzed 31 patients for 5-year survival. Overall survival was 63.7%, disease-specific survival 69.2%, and diseasefree survival 46.8%. In another analysis a statistically significant difference was seen in survival among patients who had neck surgery or not (85.7% vs. 38.9%, p=0.029; log rank test).<BR>Analysis suggested that primary sites should be studied by CT. MRI, FDG-PET, and panendoscopy, including random biopsy. The primary site cannot be detected, treatment should initially involve cervical adenopathy with combined surgery, chemotherapy, and radiotherapy. After treatment, the patient should be followed up carefully to find the primary lesion.

DOI： 10.3950/jibiinkoka.108.1083

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Other Link： https://jlc.jst.go.jp/DN/JALC/00271513575?from=CiNii

Language：English   Publishing type：Research paper (scientific journal)  

The clinicopathological significance of cell-cycle proteins has remained unclear in oral tongue squamous cell carcinomas (OTSCC). In the current study, we evaluated several cell-cycle proteins in relation to clinicopathological parameters and disease outcome for OTSCC. A total of 123 previously untreated patients with OTSCC, who underwent surgical treatment, were enrolled. Tumor specimens were examined for expression of p21, p27, p16, p53, and p63 using immunohistochemistry, with reference to clinicopathological factors and disease outcome. It is noteworthy that differences in p21 immunoreactivity were evident between the shallow region and invasive front of tumors within the same specimens. Loss of p21 expression in invasive fronts was found to be associated with clinicopathological factors of tumor progression and poor prognosis. p21 expression in invasive fronts is a significant indicator for impact on survival. Moreover, p21 is one of the important factors that regulate the progression of malignant cells in OTSCC.

PubMed

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Stage I and II oral tongue cancers (OTC) generally have a favorable prognosis, but there are some early OTC cases with a poor prognosis. OTC is known for its propensity for subclinical nodal metastasis and, moreover, we must devise a strategy that takes account of the possibility of recurrence and distant metastasis. In the current study, 90 previously untreated patients with stage I or II OTC who underwent surgical treatment were eligible for review. The authors investigated the associations of their clinico-pathologic factors with disease outcomes, and also examined the postoperative course for patients with a poor prognosis. The most common cause of death was distant metastasis and late cervical lymph node metastasis (LCM) was the significantly independent prognostic variable. Since LCM can be treated with salvage surgery, the central issue is to control patients with distant metastises who are free of disease in their loco-regional sites.

PubMed

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Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1097/01.PRS.0000130940.46400.7F

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PubMed

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Language：Japanese   Publisher：The Society of Practical Otolaryngology  

Background.<br>This is a retrospective review of medical and financial records, conducted to test the hypothesis that the use of clinical pathways specifically designed for the management of the operation for thyroid and parotid tumors will result in the improved outcomes of patients.<br>Methods.<br>Twenty-six patients before implementation of a clinical pathway for thyroid tumor were compared with forty-six patients after implementation of the pathway. Also, twenty-five patients before implementation of a clinical pathway for parotid tumor were compared with twenty-nine patients after implementation of the pathway. Analyses of clinical outcome, length of hospitalization, and cost were performed. An unpaired t-test was used for statistical analysis.<br>Results.<br>‹Thyroid tumor clinical pathway›<br>For pathway patients, the average number of days using a drain tube was decreased to 2.8±1.1 days, versus 3.5±1.2 days for prepathway patients (p=0.03). The average length of hospitalization was decreased to 10.8±3.5 days, versus 15.2±4.7 days (p<0.0001). The average length of postoperative hospitalization was decreased to 6.5±2.3 days, versus 8.5±3.0 days (p=0.004). The average cost was decreased to 56, 994±15, 296 points (1 point=10 yen), versus 65, 619±18, 083 points (p=0.03).<br>‹Parotid tumor clinical pathway›<br>For pathway patients, the average length of hospitalization was decreased to 12.0±1.0 days, versus 22.0±3.2 days for prepathway patients (p=0.002). The average length of post-operative hospitalization was decreased to 6.9±0.8 days, versus 13.1±2.5 days (p=0.01). The average cost was decreased to 60, 424±3, 217 points (1 point=10 yen), versus 86, 286±12, 801 points (p=0.04).<br>Conclusions.<br>In using clinical pathways for thyroid and parotid tumors, we have maintained the quality of the operation and patient care, and have decreased the length and cost of hospitalization. With this study, we have concluded that implementing clinical pathways for thyroid and parotid tumors is beneficial for all parties.

DOI： 10.5631/jibirin.97.555

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Other Link： https://jlc.jst.go.jp/DN/JALC/00239517645?from=CiNii

Language：English   Publishing type：Research paper (scientific journal)  

DOI： 10.1016/S0385-8146(99)00036-X

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PubMed

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Language：Japanese   Publisher：The Oto-Rhino-Laryngological Society of Japan, Inc.  

In our department, all patients with advanced carcinoma of the oropharynx and hypopharynx are treated by retropharyngeal (RP) node dissection in addition to primary resection and standard neck dissection. Records of 42 patients (11 oropharynx, 29 hypopharynx and 2 retromandibula) who received RP node dissection from 1992 to 1996 in our department were examined for metastasis to RI' nodes and for preoperative radiographic diagnosis (MRI or CT). The criteria for radiographic involvement of RP nodes are as follows: a diameter greater than 10mm on axial images or central necrosis within the nodal substance. Of the 42 patients, 6 (14.3%) had pathologically positive RP nodes and of those 6 patients, 5 were able to be diagnosed preoperatively by either CT scan or MRI.Results of radiographic diagnosis (MRI or CT) were as follows: by CT scan the sensitivity, specificity and accuracy were all 100% and by MRI the sensitivity, specificity and accuracy were 83.3%, 100% and 97.0% respectively. It is our conclusion that preoperative radiographic diagnosis (MRI or CT) is very useful and effective for diagnosis of metastasis to RP nodes.

DOI： 10.3950/jibiinkoka.101.5_573

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Other Link： http://search.jamas.or.jp/link/ui/1998198129

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Oto-Rhino-Laryngological Society of Japan Inc.  

DOI： 10.3950/jibiinkoka.101.5_595

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PubMed

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Japanese Society of Clinical Cytology  

DOI： 10.5795/jjscc.36.424

CiNii Books

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Society of Practical Otolaryngology  

DOI： 10.5631/jibirin.90.573

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Language：Japanese   Publisher：Japan Society for Head and Neck Cancer  

When total thyroidectomy is performed without regard for the parathyroid glands, permanent hypoparathyroidism is a frequent result. To avoid the hypofunction, it is necessary to presrve the blood supply of at least one gland or transplant more than two glands of the parathyroid.<br>The superior parathyroid gland generally lies along the posterior aspect of the thyroid at the crico-tracheal junction. It is a small lustrous oval of about 5mm, its color a pale orange (similar to that of sea urchin).<br>Method of preservation: The superior parathyroid gland and inferior parathyroid artery are identified and gradually dissected away from the thyroid. If there is a feeding artery from the posterior branch of the superior thyroid artery, this should be preserved.<br>Method of autotransplanation: The parathyroid glands which can be transplanted after total thyroidectomy should be removed at once. A slice of tissue is submitted for frozen section study to assess histologically. The gland is cut into slice (10-15 slices) using a fine pair of scissors. Several transplantation beds are made in the muscle of the neck and chest (the pectoralis major, sternocleidomastoid and posterior neck muscle) to transplant the slices. Knowledg of the anatomy and careful technique are required when operating on the parathyroid glands.

DOI： 10.5981/jjhnc1974.22.406

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Other Link： http://search.jamas.or.jp/link/ui/2012315384

J-GLOBAL

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J-GLOBAL

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Language：English   Publishing type：Research paper, summary (international conference)  

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Language：English   Publishing type：Research paper, summary (international conference)  

Web of Science

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J-GLOBAL

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J-GLOBAL

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J-GLOBAL

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J-GLOBAL

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J-GLOBAL

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Language：English   Publishing type：Research paper, summary (international conference)  

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Language：English   Publishing type：Research paper, summary (international conference)  

Web of Science

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Language：English   Publishing type：Research paper, summary (international conference)  

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J-GLOBAL

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J-GLOBAL

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J-GLOBAL

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J-GLOBAL

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J-GLOBAL

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Language：English   Publishing type：Research paper, summary (international conference)  

Web of Science

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Language：Japanese   Publisher：耳鼻と臨床会  

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Language：Japanese   Publisher：耳鼻咽喉科臨床学会  

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Language：Japanese   Publisher：耳鼻咽喉科臨床学会  

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Language：Japanese   Publisher：(一社)日本頭頸部癌学会  

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Language：Japanese   Publisher：(一社)日本頭頸部癌学会  

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Language：Japanese   Publisher：(一社)日本耳鼻咽喉科学会  

DOI： 10.3950/jibiinkoka.121.582

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Language：English   Publishing type：Research paper, summary (international conference)  

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Language：English   Publisher：日本癌学会  

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Language：Japanese   Publisher：耳鼻咽喉科臨床学会  

DOI： 10.5631/jibirin.110.445

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2017&ichushi_jid=J00580&link_issn=&doc_id=20170710320003&doc_link_id=10.5631%2Fjibirin.110.445&url=https%3A%2F%2Fdoi.org%2F10.5631%2Fjibirin.110.445&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_2.gif

Language：Japanese   Publisher：耳鼻咽喉科臨床学会  

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Language：Japanese   Publisher：耳鼻咽喉科臨床学会  

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Language：Japanese   Publisher：耳鼻咽喉科臨床学会  

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Language：Japanese   Publisher：(一社)日本頭頸部癌学会  

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Language：Japanese   Publisher：(一社)日本耳鼻咽喉科学会  

DOI： 10.3950/jibiinkoka.120.567

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Language：Japanese   Publisher：(一社)日本耳科学会  

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Language：Japanese   Publisher：(一社)日本耳科学会  

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Language：Japanese   Publisher：(一社)日本耳科学会  

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Language：Japanese   Publisher：耳鼻咽喉科臨床学会  

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Language：Japanese   Publisher：(一社)日本耳鼻咽喉科学会  

DOI： 10.3950/jibiinkoka.119.643

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Language：Japanese   Publisher：耳鼻咽喉科臨床学会  

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Language：Japanese   Publisher：耳鼻咽喉科臨床学会  

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Language：Japanese   Publisher：(株)医学書院  

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Language：Japanese   Publisher：(一社)日本耳鼻咽喉科学会  

DOI： 10.3950/jibiinkoka.118.613

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Language：Japanese   Publisher：(一社)日本耳科学会  

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Language：Japanese   Publisher：耳鼻咽喉科臨床学会  

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Language：Japanese   Publisher：愛知医科大学医学会  

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Language：Japanese   Publisher：(一社)日本耳科学会  

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Language：Japanese   Publisher：(一社)日本耳科学会  

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Language：Japanese   Publisher：(一社)日本耳科学会  

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Language：Japanese   Publisher：耳鼻咽喉科臨床学会  

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DOI： 10.5631/jibirin.106.582

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Other Link： http://search.jamas.or.jp/link/ui/2013286008

Language：Japanese   Publisher：(一社)日本耳鼻咽喉科学会  

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Language：Japanese   Publisher：愛知医科大学医学会  

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Language：Japanese   Publisher：(一社)日本耳科学会  

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Language：Japanese   Publisher：(一社)日本耳科学会  

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Language：Japanese   Publisher：(一社)日本耳科学会  

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Language：Japanese   Publisher：耳鼻咽喉科臨床学会  

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Language：Japanese   Publisher：日本頭頸部癌学会  

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Language：Japanese   Publisher：(NPO)日本小児がん学会  

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Other Link： https://search.jamas.or.jp/index.php?module=Default&action=Link&pub_year=2009&ichushi_jid=J00638&link_issn=&doc_id=20090323080084&doc_link_id=%2Fex9syoni%2F2009%2Fs04601%2F078%2F0069-0069%26dl%3D0&url=http%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fex9syoni%2F2009%2Fs04601%2F078%2F0069-0069%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：(NPO)日本小児がん学会  

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CiNii Books

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Language：Japanese   Publisher：(一社)日本癌治療学会  

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Language：Japanese   Publisher：(一社)日本頭頸部癌学会  

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