Kazunori Mori

Management of cancer in the elderly: therapeutic dilemmas.

As the average life span has increased, the number of elderly patients with cancer has increased. One of the greatest dilemmas in the management of cancer in the elderly is the fact that often regular curative treatment cannot be executed. From this viewpoint, 679 patients with head and neck cancer treated during a recent 5-year period were reviewed. They were classified into two age groups: those younger than 75 years (n = 560) and those 75 years and older (n = 119). The frequency with which curative treatment could not be executed was 8.8% in the younger group and 26.1% in the older group. The major reasons were concomitant health problems and failure to obtain the patients consent, and these problems were significantly more common in the older group. The incidence of asthma, pulmonary emphysema, cardiac failure, hypertension, arrhythmia, cerebrovascular disease, and kidney failure was greater in the older group. The overall 3-year survival rate was 18% in the cases with no curative treatment and 77% in those curatively treated.

Vocal fold nodules in children: preferable therapy

BACKGROUND The purpose of this paper is to know the preferable treatment for vocal fold nodules in children. METHODS Two hundred and fifty nine patients with vocal fold nodules (176 males and 83 females) were retrospectively reviewed. Age ranged from 2 to 18 years with a mean age of 9 years. In addition, questionnaire survey was carried out, asking about their present voice. RESULTS Sixteen percent of the patients showed improvement by vocal hygiene advice. Fifty two percent of patients receiving voice therapy showed some improvement. Eighty nine percent of patients showed some improvement by endolaryngeal microsurgery. With respect to the influence of puberty upon the voice, there was no significant difference among vocal hygiene, voice therapy, and no-treatment for pre-puberty cases. Surgical treatment was the only reliable method to acquire voice improvement for pre-puberty cases. In contrast, following puberty there was no significant difference in voice improvement among treatment modalities. CONCLUSION If the patient needs immediate improvement of voice, surgery is preferable. If they need the improvement of voice but do not hurry up, voice therapy should be carried out. If patients have no motivation, vocal hygiene is recommended.

A method that preserves circulation during preparation of the pectoralis major myocutaneous flap in head and neck reconstruction

&NA; The present article describes a method that preserves circulation during” the preparation of the pectoralis major myocutaneous flap used in head and neck reconstruction. The major disadvantage of this flap is its poor circulation and consequent partial necrosis. To solve this problem, we analyzed the circulation and hemodynamics of the pectoralis major myocutaneous flap (the perforator of the anterior intercostal branch located about 1 to 2 cm medial to the areola in the fourth intercostal space is important), evaluated the safe donor sites in the chest wall for a skin island (the perforator is included on the skin islands central axis), improved the surgical procedure for elevating flaps (for preventing perforator injuries), and devised a means to transfer flaps, thereby increasing the range of the flaps (the transfer route is under the clavicle). Using this technique, head and neck reconstruction was performed on 62 patients. The diagnosis included oral cancer (21), oropharyngeal carcinoma (10), parotid carcinoma (10), hypopharyngeal carcinoma (9), and other head and neck malignant tumors (12). Of these, partial or marginal necrosis of the flap caused by circulatory problems was detected in three patients (5 percent). Using our method, the problems associated with inadequate circulation in the pectoralis major myocutaneous flap were greatly alleviated, thus reconfirming the usefulness of this flap in head and neck reconstruction. (Plast. Reconstr. Surg. 102: 2336, 1998.)

Vocal function in patients with unilateral vocal fold paralysis before and after silicone injection

A total of 240 patients with unilateral vocal fold paralysis (UVFP) underwent transcutaneous intrafold silicone injection (TCIFSI) for the purpose of vocal rehabilitation during the period from 1983 to 1993 in the Kurume University Hospital. Their vocal function was evaluated and the effects of TCIFSI upon the vocal function were investigated. The patients with UVFP presented with an increase in airflow during phonation; a decrease in maximum phonation time and fundamental frequency (F0) range and sound pressure level (SPL) range of phonation; and an increase in pitch perturbation quotient, amplitude perturbation quotient and normalized noise energy in the voice signal. TCIFSI resulted in a decrease in airflow, an increase in phonation time and F0 and SPL range of phonation, and a decrease in pitch and amplitude perturbation and noise in the voice signal. Patients own subjective evaluation presented with an improvement of his/her voice after TCIFSI.

Functional reconstruction of swallowing and articulation after total glossectomy without laryngectomy : Money pouch-like reconstruction method using rectus abdominis myocutaneous flap

When a total glossectomy is performed without a laryngectomy, the functional recovery of swallowing and articulation is extremely important in maintaining the patients quality of life. The authors established a money pouch-like reconstruction method in which a round and raised tongue is rebuilt using a rectus abdominis myocutaneous flap. In this method, the skin island of the rectus abdominis myocutaneous flap is created about 20 percent larger than the defect in both width and length. The skin island is sutured to the defect such that the excess skin folds into the shape of a money pouch. This allows the tongue to be reconstructed with its tip and dorsum touching the hard palate and its base bulging in the dorsal and posterior directions. Misswallowing was not detected in the three patients who had this surgery, and each of them had improved articulation sufficient to carry out daily conversations.

Carcinoma ex pleomorphic adenoma of the parotid gland

Background Carcinoma ex pleomorphic adenoma (CXPA) is a rare aggressive epithelial malignancy arising from a primary or recurrent benign mixed tumor. Only a few case reports describing the radiologic features of CXPA have been published. Purpose To describe and characterize the magnetic resonance (MR) imaging findings of CXPA in the parotid gland and correlate them with pathologic findings. Material and Methods The MR images of surgically proven CXPA in the parotid gland of five men and five women ranging in age from 28 to 75 years (mean 52 years) were retrospectively reviewed. All MR images were evaluated with emphasis on the size, margin characteristics, extraparotid infiltration, the presence of an encapsulated component, and signal intensity on T2-weighted or short-inversion-time inversion recovery (STIR) images. Results The average maximal diameter was 4.3 cm. All 10 tumors had ill-defined boundaries, and seven tumors showed extraparotid infiltration, reflecting invasive growth of the malignant component identified on histological examination. Eight tumors had a round encapsulated component and seven of those signal intensities were a mixture of hypo- and hyperintensity on T2-weighted or STIR images. Histological correlation of these components revealed fibrously encapsulated tumors containing hyalinization and myxoid tissue, suggesting degenerated pleomorphic adenoma. Invasive malignant components had non-specific and various signal intensities. Conclusion An invasive parotid mass co-existing with a round encapsulated component is suggestive of carcinoma ex pleomorphic adenoma.

Efficacy of temporal musculopericranial flap for reconstruction of the anterior base of the skull.

Since March 1988 the temporal musculopericranial (TMP) flap has been used as our flap of choice to reconstruct defects of the anterior base of the skull that are larger than 2 3 cm, including the dura mater, in 33 patients. The primary diseases were malignant head and neck tumours ( n = 16), trauma (n = 15), meningioma ( n = 1), and teratoma ( n = 1). The dura mater was reconstructed with a unilateral TMP flap, after which the cranial and nasal cavities were closed with the opposite TMP flap. In addition, bone was grafted by sandwiching the bone between the two flaps and fixing it to the surrounding residual bone. When a large area was resected, making it impossible to use a TMP flap, a frontal musculopericranial (FMP) flap or a free flap (usually the rectus abdominis myocutaneous flap) was used to close the cranial and nasal cavities. Thirty of the 33 patients recovered with no postoperative complications. Two patients developed extradural abscesses in the anterior base of the skull and one developed mild meningitis, but they were successfully treated conservatively. When bilateral TMP flaps were used for the reconstruction, no patient had aesthetic problems in the forehead region. The TMP flap is extremely effective for the reconstruction of the anterior base of the skull because it is minimally invasive and causes few aesthetic problems in the forehead region.Since March 1988 the temporal musculopericranial (TMP) flap has been used as our flap of choice to reconstruct defects of the anterior base of the skull that are larger than 2 x 3 cm, including the dura mater, in 33 patients. The primary diseases were malignant head and neck tumours (n = 16), trauma (n = 15), meningioma (n = 1), and teratoma (n = 1). The dura mater was reconstructed with a unilateral TMP flap, after which the cranial and nasal cavities were closed with the opposite TMP flap. In addition, bone was grafted by sandwiching the bone between the two flaps and fixing it to the surrounding residual bone. When a large area was resected, making it impossible to use a TMP flap, a frontal musculopericranial (FMP) flap or a free flap (usually the rectus abdominis myocutaneous flap) was used to close the cranial and nasal cavities. Thirty of the 33 patients recovered with no postoperative complications. Two patients developed extradural abscesses in the anterior base of the skull and one developed mild meningitis, but they were successfully treated conservatively. When bilateral TMP flaps were used for the reconstruction, no patient had aesthetic problems in the forehead region. The TMP flap is extremely effective for the reconstruction of the anterior base of the skull because it is minimally invasive and causes few aesthetic problems in the forehead region.

Cochlear changes in presbycusis with tinnitus.

OBJECTIVES The pathophysiology of tinnitus is obscure and its treatment is therefore elusive. Significant progress in this field can only be achieved by determining the mechanisms of tinnitus generation, and thus, histopathologic findings of the cochlea in presbycusis with tinnitus become crucial. We revealed the histopathologic findings of the cochlea in subjects with presbycusis and tinnitus. MATERIAL AND METHODS The subjects were divided into 2 groups, presbycusis with tinnitus (tinnitus) group and presbycusis without tinnitus (control) group, with each group comprising 8 temporal bones from 8 subjects. We quantitatively analyzed the number of spiral ganglion cells, loss of cochlear inner and outer hair cells, and areas of the stria vascularis and spiral ligament. RESULTS There was a significantly greater loss of outer hair cells in the tinnitus group compared with the control group in the basal and upper middle turns. The stria vascularis was more atrophic in the tinnitus group compared with the control group in the basal turn. CONCLUSIONS Tinnitus is more common in patients with presbycusis who have more severe degeneration of outer hair cells and stria vascularis.

Reliable, Minimally Invasive Oromandibular Reconstruction Using Metal Plate Rolled with Pectoralis Major Myocutaneous Flap

The purpose of this study was to minimize the surgical invasiveness to the donor site and the amount of the primary reconstruction time after oromandibular tumor resection. Oromandibular reconstruction was performed only using a pectoralis major myocutaneous flap and a metal plate. The pectoralis major myocutaneous flap was grafted to the oral cavity defect by rolling and wrapping around the metal plate with the muscle of the flap. No early postoperative complications have been noted in all seven patients. An average of 2 years and 1 month has past since surgery, and to date no infections, plate exposure, or plate breakage have been observed in any of the patients. The safety of the oromandibular reconstruction using a metal plate was improved by rolling the muscle of the pectoralis major myocutaneous flap around the metal plate. The present method was shown to be a rational technique that allowed primary reconstruction of the oral cavity and mandible in a minimally invasive manner in a short time.

Surgical approach to a giant fibrolipoma of the supraglottic larynx.

This paper describes the surgical procedures for a fibrolipoma that first appeared as a giant tumour in the hypopharynx and extended to the cardiac antrum of the oesophagus. At the initial surgery, a pedunculated tumour originating from the left arytenoid of the larynx was found to occupy the cervical as well as thoracic oesophagus and was thus removed through a lateral pharyngectomy. A histological examination revealed fibrolipoma. However there was a recurrence of the tumour in the arytenoid and the patient suffered from dysponea. In addition, a submucosal tumour was also found in the left false vocal fold. At the second surgery, the masses in the arytenoid and false vocal fold were subtotally removed without damaging the mucosa. The mucosa of the arytenoid was sutured to the thyropharyngeal muscle on the same side and the arytenoid swelling disappeared almost completely. The post-operative course has been uneventful for more than two years.