Eiichi Ishida

An analysis of clinical risk factors of deep neck infection.

OBJECTIVES To clarify the clinical risk factors that aggravate deep neck infection. PATIENTS AND METHODS Sixty-five patients with deep neck infection (abscess or cellulitis), 42 males and 23 females, who were treated at the ear, nose, and throat department in Iwaki Kyoritsu General Hospital in the past 10 years, were retrospectively reviewed. Cases of inflammation of the upper airway including the oral cavity, laryngopharynx, palate tonsil and salivary gland, and cases of lymphadenitis were investigated. These patients were divided into five localized types and one wide range type according to the abscess locations as follows: oral cavity floor type, upper deep cervical type, submandibular type, submental type, retropharyngeal type, and wide range type. RESULTS Seventeen of the 65 patients had diabetes, and significantly more diabetics had the wide range type than the localized type (P<0.05, Fishers test). Diabetes complication was more often seen in the upper deep cervical type among patients aged 61 years or older, and in the wide range type among males aged 41 years or older and elderly women aged 61 years or older. No patients with odontogenic infection or sialolithiasis had associated diabetes mellitus. Two cases developed mediastinitis, and one was caused by retrotonsillar abscess and needed thoracic drainage. More than half of the wide range type cases and more than a quarter of each of the localized type cases except the upper deep cervical type also had laryngeal edema, and eight of them needed emergency tracheotomy. Thirteen of the 40 cases had bacteria belonging to the Streptococcus milleri group (SMG), and all were detected in patients who underwent surgical drainage. Four of the 13 cases where SMG was detected showed drug resistance to some sorts of antibiotics. CONCLUSION Oral disorders can develop deep neck infection independently of the presence of diabetes mellitus, compared with other causes. The presence of diabetes mellitus is associated with deep neck infection, aggravating parotitis and wide spread of inflammation. Retrotonsillar abscess often spreads to the retropharyngeal and parapharyngeal spaces, causing mediastinitis, so caution is necessary. Infection due to SMG tends to form abscess independently of diabetes mellitus. Since more than half of the wide range type and more than a quarter of each of the localized types except the upper deep cervical type were associated with laryngeal edema, airway management should be considered.

Case report of mammary analog secretory carcinoma of the parotid gland

Mammary Analog Secretory Carcinoma (MASC) is a new entity of malignant salivary gland tumors that morphologically resembles mammary secretory carcinoma and carries the identical ETV6‐NTRK3 fusion gene. We report our first case of MASC in Japan occurring in the parotid gland of a 37‐year‐old female patient with a t (12; 15) (p13; q25) translocation. Histologically, the tumor was composed of monomorphic cuboidal cells with low‐grade vesicular nuclei and pale eosinophilic cytoplasm, and formed microcystic and tubular spaces with periodic acid‐Schiff‐positive secretion. Immunohistochemically, the tumor cells tested positive for cytokeratin, vimentin, and S‐100 protein. MASC is a morphological mimicker of acinic cell carcinoma, but is a distinct neoplasm characterized by a specific chromosomal translocation. An accumulation of similar case studies is mandatory in order to clarify biological behaviors.

Effect of HMB/Arg/Gln on the Prevention of Radiation Dermatitis in Head and Neck Cancer Patients Treated with Concurrent Chemoradiotherapy

OBJECTIVE This prospective randomized Phase II study was designed to evaluate the preventive effect of an oral nutrition supplement composed of beta-hydroxy-beta-methylbutyrate, arginine and glutamine (beta-hydroxy-beta-methylbutyrate/arginine/glutamine) on radiation dermatitis in head and neck cancer patients. METHODS Forty patients with histologically proven head and neck cancer, treated with concurrent chemoradiotherapy involving cisplatin were recruited. They were randomly assigned to the beta-hydroxy-beta-methylbutyrate/arginine/glutamine supplement treatment group (Group A) or the control group that received no supplement (Group B). The primary endpoint of this study was the percentage of patients developing ≥Grade 3 dermatitis. The secondary endpoints were the percentage of patients developing ≥Grade 2 dermatitis, and the duration of each grade of dermatitis relative to the observation period. RESULTS The incidence of ≥Grade 3 dermatitis did not differ between the two groups. However, as secondary endpoints of this study, the incidence of ≥Grade 2 dermatitis was lower in Group A than B (62.6 vs. 94.4%; P < 0.05), and the duration of ≥Grade 1 dermatitis was shorter in Group A than B (44.8 vs. 56.7%; P < 0.01), as was the duration of ≥Grade 2 dermatitis (16.5 vs. 26.5%; P < 0.05). CONCLUSIONS Our study indicated that beta-hydroxy-beta-methylbutyrate/arginine/glutamine supplementation was potentially effective in the prevention of radiation dermatitis in head and neck cancer patients.

Unusual Parapharyngeal Extension of Peritonsillar Abscess to the Masticator Space: Successfully Drained by Extraoral and Intraoral Endoscopic Approaches

Objective: The object was to describe 2 novel cases of peritonsillar abscess showing peculiar extension to the masticator space. Methods: The methods included clinical case records, including computed tomography and surgical approaches. Results: Both patients we encountered were suffering from systematic diseases, with case 1 involving a 75-year-old man with diabetes mellitus and case 2 involving a 90-year-old woman taking immunosuppressive medications. The abscesses were peritonsillar in origin, extending primarily to the parapharyngeal space, with unusual secondary extension to the masticator space. Extraoral drainage conducted in case 1 was useful for assessing the masticator space and surrounding spaces, but endoscopy-assisted intraoral drainage in case 2 was less invasive, obviating the need for identifying the facial nerve. Conclusions: It is important to bear in mind that patients suffering from systemic diseases may display unusual extension of deep head and neck infections, and enhanced computed tomography is a useful modality for evaluating such extensions.

Unique Extension of Peritonsillar Abscess to the Masticator Space Encountered in the Early Phase of Antiviral Therapy for Hepatitis C

Background: To describe a unique case of peritonsillar abscess showing peculiar extension to the masticator space, encountered in the early phase of telaprevir therapy in combination with peginterferonalfa-2b and ribavirin for hepatitis C virus (HCV) infection. Methods: Review of clinical case records, including computed tomography and surgical approaches. Results: A 64-year-old woman was taking medications for HCV, including telaprevir therapy in combination with peginterferonalfa-2b and ribavirin every one week. She was also receiving medical treatment for diabetes mellitus. Her symptoms started 3 days after the commencement of antiviral therapy. She underwent surgery for drainage of the abscess, including endoscopy-assisted intraoral drainage and quinsy tonsillectomy. Conclusions: It is important to bear in mind that a patient suffering from multiple systemic diseases may display unique clinical presentations with head and neck infections. Endoscopy-assisted intraoral drainageof the lateral masticator space was less invasive than other approaches, obviating the need for identifying the facial nerve.