Keiichi Chijiwa

Indication of Preventive Neck Dissection for Carcinoma of the Tongue.

The validity of supraomohyoid neck dissection (SOND) for T1/T2 carcinoma of the tongue was investigated. One hundred eight patients underwent CO2 laser resection between March 1980 and April 1997 in Kurume University Hospital. Metastatic lymph nodes were recognized in 41 patients (38%) throughout the follow-up intervals, and radical or modified radical neck dissection was performed in these patients. Occult neck metastasis was seen in 20 patients (19%). Five patients died of neck metastasis, and all of them showed recurrence at the neck after initial treatment. Twenty patients showed positive neck metastasis in the initial treatment. Metastatic lymph nodes were limited to the supraomohyoid area in patients who underwent RND or m-RND as an initial treatment. In contrast, in 21 patients who received RND or m-RND after the initial treatment, metastatic nodes were detected in jugular regions, too. Metastasis to the caudal deep cervical lymph nodes were seen in 2 patients. These results indicate that: (1) supra-omohyoid neck dissection would be satisfactory as an initial treatment to prevent neck dissection for T1/T2 carcinoma of the tongue, and (2) radical neck dissection is required for patients with neck recurrence.

A Case with Bridge-Like Subglottic Glanuloma

A 60-year-old female with bridge-like subglottic granuloma, caused by long-term endotracheal intubation was reported. She successfully underwent resection of this granuloma under direct laryngoscopy with a CO2 laser. In general, intubation granuloma occurs around the arytenoid cartilage. It was supposed that this subglottic granuloma occurred symmetrically and due to the remittent inflammation both granulomas had adhered at the midsagittal plave and achieved the bridgelike shape, causing remittent dyspnea.