Tomoo Onoda

Narrow-Band Imaging Provides Reliable Screening for Esophageal Malignancy in Patients With Head and Neck Cancers

OBJECTIVES:The narrow-band imaging (NBI) system is a novel technology that enhances the visualization of microvasculature and mucosal patterns. The aim of this study was to assess the reliability of the NBI system for esophageal cancer screening in patients with head and neck cancers.METHODS:A total of 142 patients with head and neck squamous cell carcinoma (SCC) were examined by NBI endoscopy, followed by Lugol chromoendoscopy between April 2006 and June 2008 at the Okayama University Hospital, Okayama, Japan. Detection of SCC and high-grade intraepithelial neoplasia (HGIN) was conducted.RESULTS:The median age of the patients was 64 years (range: 29–86 years), and approximately three-fourths of all the patients were male. In total, 21 superficial lesions in 16 patients were detected by NBI endoscopy. Of these, 4 lesions were diagnosed histologically as SCC and 11 lesions as HGIN. An additional 22 Lugol-voiding lesions ≥5 mm were detected in 19 patients by Lugol chromoendoscopy. Although 1 of these lesions was diagnosed as HGIN, 21 lesions were diagnosed as low-grade intraepithelial neoplasia or lesions without atypical findings. The sensitivity of NBI endoscopy for detecting esophageal SCC and HGIN was 90.9% (95% confidence interval (CI), 58.7–99.8), specificity was 95.4% (95% CI, 90.3–98.3), and accuracy was 95.1% (95% CI, 90.1–98.0).CONCLUSIONS:NBI seems to be useful and reliable for screening for esophageal SCC in patients with head and neck cancers.

Lugol-Voiding Lesions Are an Important Risk Factor for a Second Primary Squamous Cell Carcinoma in Patients With Esosphageal Cancer or Head and Neck Cancer

OBJECTIVES:Lugol-voiding lesions (LVLs), detected by chromoendoscopy using iodine dye in patients with esophageal squamous cell carcinoma (EC) or head and neck squamous cell carcinoma (HNC), are associated with a second primary carcinoma in the other organ. We undertook a cross-sectional and retrospective cohort study to assess the risk for second primary carcinomas according to the severity of LVLs, on the basis of their number and size.METHODS:A total of 1,060 patients with only EC, only HNC, or both EC and HNC (EC+HNC) underwent esophageal endoscopic examination between January 1994 and January 2010. The patients were classified according to the number of LVLs in an endoscopic visual field and the size of the largest LVLs. Factors associated with the second primary EC or HNC were analyzed.RESULTS:Univariate analysis showed that a larger number and size of LVLs increased the risk for synchronous and early metachronous second primary cancer (P value for trend <0.0001). Multivariate analysis showed that a number of LVLs ≥20 (EC+HNC vs. only HNC, odds ratio (OR)=15.7; EC+HNC vs. only EC, 3.5) and a size ≥10 mm (EC+HNC vs. only HNC, OR=3.1; EC+HNC vs. only EC, 3.2) were independent risk factors for synchronous and early metachronous second primary cancer. A larger number of LVLs was a risk factor for metachronous EC and HNC, and a size ≥10 mm was a risk factor for late metachronous EC.CONCLUSIONS:The severity of LVLs in patients with HNC or EC closely correlated with a second primary carcinoma in the other organ. Patients with LVLs must be followed closely for development of a second primary carcinoma.

Quantitative analysis of free flap volume changes in head and neck reconstruction.

The purpose of this study was to determine whether free flap volume decreases or increases in the long‐term postoperative period.

Chronic rhinosinusitis patients have decreased lung function

The relationship between upper and lower airway diseases has been reported. However, the pulmonary function of patients with chronic rhinosinusitis (CRS) has not been fully examined.

Prevention points for plate exposure in the mandibular reconstruction.

INTRODUCTION The rate of complications for mandibular reconstruction after segmental mandibulectomy is higher with reconstruction plates than with vascularised bone grafts. We have experience of over 100 patients using reconstructive plates for reconstruction immediately after segmental mandibulectomy and have considered factors contributing to plate exposure. PATIENTS AND METHODS Seventeen cases utilised our prevention methods in which reconstructive plates were used for mandibular reconstruction were reviewed. The flaps used with reconstruction plates were rectus abdominis myocutanenous flaps in 10 cases, anterolateral thigh flaps combined vastus lateralis muscle in four cases, and the omentum in one case; no flap was transferred in two cases. RESULTS In only one of 17 cases was a plate exposed at 3 months postoperatively. No plate exposure occurred during the follow-up period in the other 16 cases. Because no flap had been transferred in the patient with plate exposure, a possible contributing factor was the persistence of dead space beneath the plate. CONCLUSION This series suggests that factors other than flap selection contribute to the exposure of reconstructive plates. Use of a reconstruction plate is a useful reconstructive method, especially for patients who cannot tolerate transfer of a vascularised bone graft.

Minimally Invasive Procedure for Accurate Diagnosis of Mucosa-associated Lymphoid Tissue Lymphoma of the Head and Neck

Sonography-guided cutting needle biopsy for the diagnosis of malignant lymphoma has recently come into wide use. However, surgery is sometimes unavoidable for the diagnosis of malignant lymphoma, particularly for low-grade malignant lymphoma such as extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue, because cutting needle biopsy offers limited diagnostic accuracy for low-grade malignant lymphoma. Of course, unnecessary invasive procedures like open biopsy should be avoided wherever possible, given the cosmetic problems and burden on the patient. We tried to diagnose malignant lymphoma using the combination of cutting needle biopsy, flow cytometry and polymerase chain reaction to identify monoclonal rearrangement of immunoglobulin heavy chain genes. We have used this method in two cases in whom malignant lymphoma was suspected in the head and neck region, allowing diagnosis of mucosa-associated lymphoid tissue lymphoma in both cases. One case involved a 23-year-old woman with mucosa-associated lymphoid tissue lymphoma in the parotid glands, and the other involved a 77-year-old man with mucosa-associated lymphoid tissue lymphoma in the thyroid. The combination of cutting needle biopsy, flow cytometry and immunoglobulin heavy chain gene rearrangement testing might offer a useful alternative to open biopsy for the diagnosis of mucosa-associated lymphoid tissue lymphoma. We recommend this procedure, particularly for young women or patients with poor performance status in whom malignant lymphoma is suspected.

Rosai-dorfman disease with extranodal involvement

Rosai‐Dorfman disease is a rare condition of marrow hematopoietic stem‐cell origin. Patients can show extranodal involvement as well as lymphatic involvement, but only about 5% of extranodal cases involve intracranial lesions. A 53‐year‐old male was admitted to our hospital with bilateral cervical lymphadenopathy. Intracranial tumors and bone lesions were also detected. Cervical lymph node biopsy and intracranial tumor resection were performed, and histopathological examination revealed Rosai‐Dorfman disease. The patient showed good clinical course without significant enlargement of the tumor. This study describes the case of a patient with Rosai‐Dorfman disease presenting with massive cervical lymphadenopathy mimicking malignant neoplasm. Laryngoscope, 124:701–704, 2014

Non-occlusive mesenteric ischaemia of a free jejunal flap.

Free jejunal transfer using microsurgery after oesophageal or pharyngeal cancer resection is a useful operative approach. However, the disadvantage of free tissue transfer is the risk of necrosis of the transferred tissue due to impaired blood supply. In addition, jejunal flaps are more prone to blood-flow disorders such as ischaemia and congestion compared with other types of flaps. The causes of local blood supply disorders after microsurgery are divided broadly into two classes: one is thrombosis of an artery and/or vein in the anastomotic region and the other consists of local physical factors such as compressive pressure derived from haematoma formation and the effect of infection of the vascular pedicle. In this report, two rare cases of blood-flow disorder of the transferred free jejunum are described. In both cases, no signs of significant infection or occlusion of the vascular pedicles were present and late necrosis progressed gradually. The patients showed remarkable weight loss and a poor nutritional state due to inadequate preoperative nutritional intake. The necrosis was considered to be a result of non-occlusive mesenteric ischaemia of a free jejunal flap, and the factors contributing to free jejunal necrosis were reviewed.

Using MDCT to search for recipient vessels for free flaps after multiple procedures for head and neck reconstruction

Secondary reconstructive operations are needed when patients with head and neck cancers have complications, tumor recurrence after initial treatment and modification of the function or appearance. The condition of an operative field for a second or subsequent operation has often been altered because of the effects of an earlier operation or chemoradiotherapy. In particular, the rate of microsurgical complications associated with the transfer of free flaps is higher for second reconstructions because good recipient vessels in the head and neck region aremore difficult to find. The utility of multidetector-row computed tomography (MDCT) for identifying perforating vessels were reported. Because perforating vessels vary from case to case in location, number, diameter, and course, having information about perforators is extremely useful for preoperative planning. However there have been few reports of the use of MDCT for identifying recipient vessels preoperatively. Therefore, in the present study, we attempted to identify recipient vessels in the head and neck region by means of preoperative MDCT in patients who had undergone reconstruction of the head and neck region multiple times. MDCT was performed preoperatively at Okayama University Hospital to search for recipient vessels 23 times in 21 patients who had undergone reconstruction in the head and neck region one or more times. Fifteen patients received their initial treatments at another institution, and details of these treatments were not available to us. These patients had previously undergone surgery from 1 to 8 times(mean: 2.5 times). Of the 21 patients, 15 had undergone neck dissection and 16 had received radiotherapy (average dose, 45.6 Gy). All MDCT examinations were performed with an Aquilion 16 scanner (ToshibaMedical Systems Corp., Tokyo, Japan) and the parameters shown. The 3-dimensional (3D) images were rearranged with Virtual Place diagnostic imaging analysis software (AZE Ltd., Tokyo, Japan) and reconstructed by assembling numerous axial images obtained at 0.5-mm intervals.

Relationship Between Serum Albumin Concentration and Periodontal Condition in Patients With Head and Neck Cancer

BACKGROUND Serum albumin concentration is known to be an independent predictor of survival in head and neck cancer. The previous studies suggested relationships between serum albumin concentration and oral health status in populations without serious systemic disorders. However, these relationships remain unclear in patients with head and neck cancer. The purpose of this study is to investigate the relationship between serum albumin concentration and oral health status in patients with head and neck cancer. METHODS Fifty individuals diagnosed with primary head and neck cancer, 25 individuals with normal serum albumin concentration (≥3.85 g/dL), and 25 age- and sex-matched individuals with lower serum albumin concentration (<3.85 g/dL) were analyzed. General status, including cancer stage, body mass index, drinking and smoking habits, and biochemical serum markers, were evaluated. Oral health status, including periodontal condition and occlusion tooth pairs, were also evaluated. RESULTS Mean clinical attachment level (CAL) and C-reactive protein in the lower serum albumin concentration group were greater than those in the normal serum albumin concentration group (P = 0.009 and P = 0.002, respectively). However, there were no significant differences in any other oral and/or serum parameters between the two serum albumin groups. A logistic regression model showed that mean CAL was significantly associated with high or low levels of serum albumin concentration (odds ratio = 9.752; 95% confidence interval = 1.702 to 55.861; P = 0.011). CONCLUSIONS This study suggests an association between periodontal disease and serum albumin concentration in patients with head and neck cancer. Longitudinal studies are necessary to examine the causal relationship between serum albumin concentration and periodontal condition.