Masaru Tateda

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.

Combined therapy after superselective arterial cisplatin infusion to treat maxillary squamous cell carcinoma.

Objective We sought to assess the efficacy of combined therapy after superselective arterial cisplatin infusion (SACI) therapy to treat the maxillary squamous cell carcinoma. Study Design We conducted a retrospective chart review of 50 patients. After completion of two courses of SACI, 25 of the patients were successively treated by concurrent SACI and radiotherapy (AR), while the other 25 patients were treated by surgery with postoperative radiotherapy (ASR). Results Patients with surgery (ASR) had an 88% local control rate with 75% disease-free survival rate at 60 months by Kaplan-Meier analysis, compared with 62% disease-free survival rate for patients with AR treatment. A particularly good outcome was obtained in T4 cases of the ASR group (n = 8) whose 5-year survival rate was 87% and local control rate was 100%. Conclusion/Significance Combined SACI therapy is very effective for the treatment of maxillary squamous cell carcinomas and contributes to the improving prognoses of patients and organ preservation rates.

Complication-Free Laryngeal Surgery after Irradiation Failure with Prostaglandin E1 Administration

To examine the usefulness and efficacy of administration of prostaglandin E1 (PGE1) after laryngeal surgery in patients who were previously treated with radiotherapy, we retrospectively examined the clinical data of 12 patients who had undergone partial laryngectomy and 21 patients who had undergone total laryngectomy. Complications were observed in 5 of the 7 cases treated with partial laryngectomy without PGE1 administration, while no complications were observed in the 5 cases treated with PGE1 after operation. Also, complications, including major leakage, were observed in 6 of the 15 patients who underwent total laryngectomy without PGE1, and no complications were observed in the 6 patients who received PGE1. The hospital stay was shorter for the patients treated with PGE1 than for those not receiving such treatment. Although this study was a small, nonrandomized pilot trial, the results indicated that PGE1 administration may be useful and effective for patients who undergo laryngeal surgery after irradiation failure, in decreasing the risk of postoperative complications and increasing the quality of life of the patients.

Melanoma-associated retinopathy associated with intranasal melanoma

PurposeTo present a case of melanoma-associated retinopathy (MAR) associated with an intranasal melanoma.Case reportA 77-year-old Japanese man visited us complaining of night blindness, blurred vision, and color vision difficulties in both eyes. His best-corrected visual acuity was 0.7 in the right and 1.0 in the left eyes. The rod response of the electroretinogram (ERG) was abolished, and the maximum response had a negative waveform. The a-wave of the single-flash cone response was square shaped, and the b-wave was delayed. The ON-response of the long-flash cone ERG was absent, but the OFF-response was preserved. A severe loss of retinal sensitivity was detected by static perimetry. Positron emission tomography showed no abnormal signs. Six months after the initial examination, an intranasal tumor was detected and surgically removed. The final diagnosis based on histopathology was malignant melanoma.ConclusionOur case demonstrates that MAR can be associated with an intranasal mucosal melanoma. Thus, in cases where the primary lesion cannot be identified in patients with MAR-like symptoms and signs, we recommend that preferential sites of mucosal melanomas be examined.

pH regulation of the globular substance in the otoconial membrane of the guinea-pig inner ear

Physiological and pharmacological characteristics of the globular substance, a precursor of otoconia, are not well understood. In the present study, we investigated the variations and regulation of internal pH (pHi) of the globular substance of the guinea-pig inner ear. The otoconial membrane was dissected out from the utricular macula and loaded with the pH-sensitive fluorophore, carboxyseminaphthorhodafluor-1. Dynamic changes of fluorescence were directly observed under a confocal laser scanning microscope, and pHi was calculated from dual emission ratio. In the NaCl standard solution buffered with 5 mM HEPES/Tris at pH 7.4, the pHi of the globular substance varied from 6.26 to 8.55 with an average of 7.21 (n = 270). Exposure to 25 mM NH+4 induced a rapid increase of the pHi followed by a slow relaxation. The, wash-out of NH+4 caused a prompt and pronounced acidification followed by a gradual pHi recovery to the initial level. This gradual pHi recovery was significantly inhibited by the absence of external Na+, indicating the presence of an external Na(+)-dependent H+ extrusion mechanism. This pHi recovery was also inhibited by 1 mM amiloride and 10 microM 3-amino-N-(aminoiminomethyl)-6-[ethyl(2-propyl)amino]pyrazine-2-ca rboxamide. These results suggest the presence of an Na(+)-H+ exchanger in the globular substance of the guinea pig. However, HCO3(-)-transporting mechanisms were not determined. The working hypothesis for the otoconial formation is discussed.

Transcanal endoscopic resection for leiomyoma of the external auditory canal and a review of the literature

Leiomyoma usually originates from the uterus and alimentary tract, but in extremely rare cases leiomyoma can appear in the external auditory canal. Here we present a 37-year-old man with right auricular fullness. Preoperative findings suggested benign tumor or cholesteatoma in the right external auditory canal. We performed total resection using an endoauricular approach with transcanal endoscopic ear surgery. Histopathological and immunohistochemistry examination confirmed the diagnosis of leiomyoma of external auditory canal. Leiomyoma arising from soft tissue, including that in the external auditory canal, is classified into two types: that from the arrectores pilorum muscles and that from the muscle coats of blood vessels. Only four cases of leiomyoma of external auditor canal have been published in the English literature. The other four cases demonstrated vascular leiomyomas. This is the first report of leiomyoma of the EAC arising from arrectores pilorum muscles.

Carcinoma ex pleomorphic adenoma of the parotid gland: a multi-institutional retrospective analysis in the Northern Japan Head and Neck Cancer Society

Abstract Conclusion: The 3-year progression-free survival rate of non-invasive salivary duct carcinoma (SDC) or adenocarcinoma not otherwise specified (NOS) was significantly better than that of invasive SDC or adenocarcinoma NOS in Carcinoma ex pleomorphic adenoma (CXPA). The presence of invasion is an important prognostic factor for SDC and adenocarcinoma NOS in CXPA. Objectives: CXPA is a rare parotid gland malignant tumor for which therapy is not yet standardized. The purpose of this study was to review the characteristics of CXPA patients and to analyze their outcomes in the Northern Japan Head and Neck Cancer Society. Method: The medical records of 33 patients who had been provided initial treatment in 12 institutes of northern Japan from 2002–2011 were reviewed as a multi-institutional retrospective study. Results: The 3-year overall and progression-free survival rate of all patients was 79.9% and 76.8%, respectively. Both the 3-year overall and progression-free survival rates were 87.5% for patients with non-invasive SDC or adenocarcinoma NOS. The 3-year overall and progression-free survival rates for patients with invasive SDC or adenocarcinoma NOS were 60.4% and 30.5%, respectively. The progression-free survival rates for patients with invasive SDC or adenocarcinoma NOS was significantly poor (p < 0.05).

Introduction of new Laryngeal closure Methods for patients with Intractable Aspiration

The aging population in Japan has recently resulted in a rapid increase in elderly individuals. Airway management is thus being required more and more often. Aspiration pneumonia is a life-threatening problem among patients with swallowing problems. Several new surgical methods of laryngeal closure that are easier and safer than previous methods have been developed. Among these new methods, we have performed the Kano method as closure of the larynx using double flaps of the divided craniad vocal folds and the divided caudad vocal folds with partial resection of the thyroid and cricoid cartilages for patients with intractable aspiration. We encountered minor leakage in two patients, but these soon closed spontaneously. This procedure is less invasive than other methods such as total laryngectomy and tracheal separation and has great advantages in terms of low blood loss and short duration of the operation.

Extraosseous chondroma of anterior neck in pediatric patient

Extraosseous chondroma (EC) is uncommon soft tissue tumor composed of hyaline cartilage without connection to bone or periosteum. The frequent sites of EC are the hands and feet and rarely reported in the pediatric population and anterior neck lesion. We present an extremely rare case of anterior neck mass in a 5-year-old male who underwent total resection, with the final diagnosis of EC. The review of the literature showed that all cases of EC in anterior neck lesion have been found in young age and preoperative diagnosis was difficult.