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Objective: To evaluate the treatment results of late course accelerated hyperfractionation (LCAHF) compared with conventional fractionation (CF) for stage II laryngeal cancer., Methods: Fifty-nine consecutive patients treated for stage II laryngeal cancer were retrospectively reviewed. Thirty-two patients underwent LCAHF, twice-daily fractions during the latter half with a total dose of 69 Gy. Twenty-seven patients received CF of 70 Gy., Results: The local control rates (LCRs), overall survival (OS), and disease-specific survival (DSS) at 5 years were 80.6%, 74.0%, and 90.4%, respectively, after LCAHF and 64.7%, 68.2%, and 90.5%, respectively, after CF. There were no significant differences in LCR, OS, and DSS (p = .11, 0.68, and 0.69, respectively). In a small number of patients with supraglottic cancer, LCAHF was associated with a significantly higher LCR at 5 years compared with CF (100% vs. 41.7%; p = .02)., Conclusions: This is the first report that compared the results of LCAHF and CF for stage II laryngeal cancer. We could not find significant differences in LCR, DSS, and OS rates between LCAHF and CF groups. Although in a small number of patients with supraglottic cancer, LCAHF may improve the LCR compared with CF.

Conclusions: In microsurgical head and neck reconstruction, a higher rate of post-operative wound complication could be predicted by a lower pre-operative neutrophil ratio (< 64.9%), neutrophil-lymphocyte ratio (NLR) (< 3.5), and platelet-lymphocyte ratio (PLR) (< 160)., Objectives: To evaluate the predictor of post-operative wound complications in microsurgical head and neck reconstruction., Methods: Patients who were undergoing tumor ablation and microsurgical reconstruction from April 2011 to March 2014 were analyzed retrospectively. The pre-operative hematological data, age, sex, co-morbidities, body mass index (BMI), adjuvant therapies, smoking, operation time, blood loss, total protein, T-stage, and Anesthesiologists Performance Status (ASA-PS) score were collected. Cases of post-operative wound healing failure were reviewed., Results: One hundred and three consecutive patients were enrolled. Among these, the results of 77 patients who were younger than 70 years of age were analyzed. The distributions of the neutrophil ratio (p = .0005), lymphocyte ratio (p = .0166), monocyte ratio (p = .0341), NLR (p = .005), and PLR (p = .008) differed significantly between the patients with and without post-operative wound healing failure. Neutrophil ratio, NLR, and PLR cut-off values of 64.9, 3.5, and 160 were significantly associated with the rate of wound healing failure rate (p = .0002, .00021, .0042, respectively).

Conclusion: Radiographic visualization of the vestibular aqueduct (VA) from a lateral inside view was effective in assessing patients with Meniere's disease (MD). There were no VA shapes specific to MD on radiography, except for an obliterated VA. This technique could yield more accurate images and functional assessment of the VA for MD evaluation in a clinically useful and convenient manner, without requiring morphologic measurement., Objective: To visualize the detailed images of the VA using three-dimensional (3D) computed tomography (CT) and discuss its clinical utility in assessing MD., Subjects and Methods: The VAs in 13 healthy subjects and 25 MD patients, who were definitely diagnosed according to criteria described by the Committee on Hearing and Equilibrium of the American Academy of Otolaryngology, Head and Neck Surgery (AAO-HNS), were imaged from the medial and lateral sides using 3DCT and compared to conventional CT images., Results: Examination of the VA from both the lateral outside and inside views on 3DCT yielded more precise images than generated by conventional CT and could be useful to estimate the VA function. The estimated VA function in the MD ears was significantly abnormal compared to the function in healthy ears. An obliterated VA was characteristic of affected MD ears.

Conclusion: Malignant tumors of Stensen's duct are often squamous cell carcinomas. Surgery is the treatment of choice, and maintaining an adequate safety margin and performing parotidectomy may help to reduce postoperative recurrence., Objectives: Since malignant tumors of Stensen's duct are extremely rare, the number of cases is limited in single-facility studies, making it difficult to perform a sufficient number of clinical examinations. Therefore, we reviewed 26 cases with Stensen's duct malignancies to examine their clinical features., Methods: We conducted a retrospective study of 26 cases with Stensen's duct malignancies, including 1 patient whom we treated and 25 cases previously reported in the English literature, and analyzed their clinical parameters, including age, sex, affected side, chief complaint, tumor size, histopathology, treatment method, and treatment outcome., Results: Most cases were diagnosed in patients between 40 and 69 years of age. The chief complaint was swelling in the cheek in 24 patients, in 14 of whom the swelling was painful. The most common tumor diameter range was 10-19 mm. Squamous cell carcinoma was the most frequent histopathology. The recurrence rate in surgical patients who did not undergo parotidectomy was 60%, whereas in patients who underwent parotidectomy, the recurrence rate was only 7%.

Conclusion: B-cell non-Hodgkin's lymphoma (B-NHL) in the head and neck most commonly affected the oropharynx and the cervical lymph node in sexagenarian patients, with more than 70% of these cases being diffuse large B-cell lymphoma (DLBCL). Accordingly, B-NHL should be considered one of the most important differential diagnoses of head and neck malignancies., Objectives: It has previously been reported that the majority of head and neck malignant lymphomas are B-NHLs. This analysis aimed to assess the site-specific profiles of B-NHL of the head and neck., Methods: The medical records of patients with B-NHL of the head and neck diagnosed between January 2004 and December 2013 were retrospectively reviewed. The clinical parameters of these patients, including age, sex, site distribution, and histopathologic sub-type, were analyzed., Results: A total of 153 cases (95 males; 58 females) were included in this analysis (male-to-female ratio = 1.64:1). The patient age at the time of diagnosis ranged from 30-92 years (median = 68 years). The oropharynx was the most commonly affected site (40.5%), followed by the cervical lymph nodes (33.3%). The most common histopathologic sub-type was DLBCL (71.9%), followed by follicular lymphoma (11.1%), and extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (9.2%).

The functional and esthetic results of reconstructive surgery after extended total maxillectomy or extended orbital exenteration greatly depend on the quality of the orbital reconstruction. We developed dynamic eye socket reconstruction using temporalis transfer to achieve good orbital reconstruction, and examined the usefulness of our technique. Five patients (three men and two women, aged 44-72 years) who underwent extensive resection of midfacial malignancies were treated with dynamic eye socket reconstruction using temporalis transfer. In most cases, eye socket reconstruction was performed approximately 1 year after the initial surgery, and temporalis transfer was used after maturation of the eye socket. The follow-up period ranged from 16 to 120 months (average 63.8 months). Movement of the upper and lower eyelids was achieved in all cases, and definite creases at the lateral canthus were observed in two patients. A good shape in the reconstructed medial and lateral canthal areas was maintained in all patients. Our reconstruction technique is extremely effective in creating natural creases ('crow's feet') at the lateral canthus during smiling, enabling movement of the upper and lower eyelids, and maintaining a sharp palpebral morphology.

Conclusion: Three-dimensional cone beam computed tomography (3DCT) images revealed characteristic malformations of the membranous labyrinth of the inner ear in Meniere's disease (MD). The morphology of the membranous region between the vestibular cecum of the cochlea and the saccule of ears with MD was compared to that of healthy ears. The present study supports the hypothesis proposed earlier that reuniting duct blockade is a result of the dislodgement of saccular otoconia., Objective: To visualize the membranous labyrinth using 3DCT and to investigate the pathology of MD., Methods: A preparatory study was conducted to determine the optimal 3DCT window settings for the detection of water, muscle, calcium carbonate (CaCO3), and bone. Based on this preparatory study, the ears of 13 healthy volunteers and 25 MD patients definitely diagnosed according to the criteria issued by the Committee on Hearing and Equilibrium of the American Academy of Otolaryngology, Head and Neck Surgery (AAO-HNS), were visualized., Results: The differences in the membranous labyrinth between MD ears and healthy ears could be visualized using 3DCT. The images were classified into three types based on their morphological pattern. The ears of patients with MD were different from normal ears in terms of this classification.

Conclusion: The accuracy and sensitivity of fine-needle aspiration cytology (FNAC) in this analysis were not satisfactory, and the false-negative rate seemed to be higher than for parotid tumours. The possibility of low-grade malignancy should be considered in the surgical treatment of accessory parotid gland (APG) tumours, even if the preoperative results of FNAC suggest that the tumour is benign., Objectives: Little is known about the usefulness of FNAC in the preoperative evaluation of APG tumours, probably due to the paucity of APG tumour cases. We examined the usefulness of FNAC in the detection of malignant APG tumours., Methods: We conducted a retrospective analysis of 3 cases from our hospital, along with 18 previously reported Japanese cases. We compared the preoperative FNAC results with postoperative histopathological diagnoses of APG tumours and evaluated the accuracy, sensitivity, specificity and false-negative rates of FNAC in detecting malignant APG tumours., Results: There were four false-negative cases (19.0%), three of mucoepidermoid carcinomas and one of malignant lymphoma. One false-positive result was noted in the case of a myoepithelioma, which was cytologically diagnosed as suspected adenoid cystic carcinoma. The accuracy, sensitivity and specificity of FNAC in detecting malignant tumours were 76.2%, 60.0% and 90.9%, respectively.

Conclusion: The necessity of considering cervical tuberculous lymphadenitis (CTL) should be emphasized even today for the differential diagnosis of cervical lymphadenopathy, particularly when it is located in the posterior triangle and supraclavicular regions even in patients without active pulmonary tuberculosis (PTB)., Objective: This study was conducted to highlight the characteristics of patients with CTL without active PTB who were treated in our department., Methods: Between 2004 and 2011, 21 cases of CTL without active PTB were included in this retrospective study. Histological examination after excisional biopsy of the affected lymph node was performed in 18 patients using hematoxylin and eosin staining and Ziehl-Neelsen (Z-N) staining for acid-fast bacilli (AFB) identification. Growth of Mycobacterium tuberculosis was detected by culturing and/or nucleic acid amplification tests including polymerase chain reaction (PCR) and transcription-mediated amplification (Mycobacterium Tuberculosis Direct: MTD)., Results: The male to female ratio was 1:1.3. Patient ages ranged from 22 to 89 years. Eighteen patients (85.7%) complained of indolent unilateral cervical lymphadenopathy in the posterior triangle (26.5%), internal jugular (24.5%), or supraclavicular nodes (18.4%). Positive rates of AFB according to Z-N staining and culturing of M. tuberculosis and/or PCR or MTD were 33.3% (6/18) and 72.2% (13/18), respectively.

Conclusion: In the present study, classification of the patterns of 3D CT images of the ductus reuniens (reuniting duct) (RD), saccular duct (SD), and endolymphatic sinus (ES) gave more precise information for assessing the pathological condition of Meniere's disease (MD) than our previous study., Objective: This study attempted to provide more detailed information on MD by classifying the patterns of 3D CT images of the RD, SD, and ES in patients with MD., Methods: We examined the ears of 62 patients with definitely diagnosed unilateral MD based on the criteria of the Committee on Hearing and Equilibrium of the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) using 3D CT. The 3D CT images of bony grooves of RD, SD, and ES (BRD, BSD, and BES) were classified into patterns according to aspects of their patency., Results: BRD could be classified into six types by assessing their patency defined using the criteria in this study. In the ears on the affected side of patients with MD, the BRD, BSD, and BES lost continuity in 3D CT images along their bony routes and were significantly different from normal healthy ears (p < 0.01). There were no significant differences among each stage of MD in the distributions of BRD and BES except for BSD.

Conclusions: Our reconstruction method using a V-Y island flap was minimally invasive and yielded a satisfactory esthetic result without impairing the patient's postoperative quality of life (QOL)., Objective: Malignant skin tumors of the head and neck often affect the patient's appearance and QOL. Therefore, surgery for terminally staged patients with malignant skin tumors may be a treatment of choice for surgeons in a palliative care team to improve and sustain the patient's QOL., Methods: We describe our experience of surgical treatment of a large primary malignant skin tumor in the head performed as part of palliative care in a 38-year-old woman in the terminal stage. We developed a V-Y island flap that did not result in postoperative alopecia., Results: After surgery, the patient did not have alopecia and her hair hid the scar. The patient and her family were greatly satisfied with the result. Although the surgery did not extend her life, it alleviated her depressed condition caused by the uncomfortable primary tumor.

Conclusion: Most hematolymphoid malignancies in the head and neck were malignant lymphomas that most often occurred in sexagenarian men. Approximately 80% of them were B-cell lymphomas with a predominance of diffuse large B-cell lymphoma (DLBCL) in both nodal and extranodal sites. Our results were compatible with those in a previous study that was conducted in the central part of Japan., Objectives: This analysis was performed to describe the anatomic distribution of hematolymphoid malignancies that were diagnosed by biopsy in our department., Methods: Clinical medical records of 122 patients with hematolymphoid malignancies in the head and neck from January 2004 to December 2010 were retrospectively reviewed. The anatomic site of origin according to the histopathology of each malignancy was analyzed., Results: The incidence ratio of hematolymphoid malignancies was 15.1%. The male:female ratio was 2.3:1. Ages ranged from 17 to 89 years (median, 66). Of the 122 cases, 121 were lymphoid neoplasms (4 cases of Hodgkin lymphoma and 117 cases of non-Hodgkin lymphoma) and the remaining 1 was myeloid. The most common histopathology was DLBCL (54.9%), followed by follicular lymphoma (8.2%), and peripheral T-cell lymphoma (8.2%). Most commonly, the oropharynx (36.1%) and the cervical lymph node (34.4%) were affected.

Conclusion: Significant reduced visualization of the reuniting duct (ductus reuniens; RD), saccular duct (SD) and endolymphatic sinus (ES) in Meniere's disease (MD) compared with normal control ears on three-dimensional (3D) CT imaging suggests the blockage of endolymphatic flow there with radiodense substances, which may be explained by dislodged otoconia from the saccule. These structures could be involved in the pathogenesis of MD., Objective: This study was designed to visualize and assess the RD, SD and ES in patients with MD using 3D CT., Methods: Sixty-two patients with a definite diagnose of unilateral MD, based on criteria proposed by the Committee on Hearing and Equilibrium of the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS), were compared with contralateral ears and normal controls (26 ears) using 3D CT. The RD, SD and ES were scrutinized for patency on 3D CT images., Results: MD ears showed loss of continuity of the RD, SD and ES based on evaluation of 3D CT images, and differed significantly from normal healthy control ears (p < 0.01).

Conclusion: Our new method for hard tissue maxillary reconstructions using artificial bone implants provides stable results during long-term follow-up., Objective: To date, vascularized bone/cartilage grafting has been the most popular method for hard tissue reconstruction after total maxillectomy; however, such three-dimensional reconstruction requires complex and lengthy invasive surgery. We have developed a simple maxillary reconstruction procedure using artificial bone., Methods: This study included six patients who had undergone hard tissue reconstructions using artificial bone (Ceratite(TM)) implants after total maxillectomies between October 2002 and October 2010. We considered the following five key points to ensure success: (1) the procedure was conducted in two stages without communicating with the nasal cavity and sinuses; (2) when constructing the artificial bone, the curvature was reduced; (3) the space for the implant was kept to a minimum; (4) the artificial bone implant was closely and accurately fixed to the stump of the zygomatic arch; and (5) the artificial bone implant was wrapped with a vascularized tissue flap., Results: The follow-up period ranged from 12 to 94 months. The postoperative zygomatic contour was maintained satisfactorily in all patients with no signs of late complications.

Spindle cell carcinoma (SpCC) of the tongue is a relatively rare malignancy. We treated a patient with metachronous early squamous cell carcinoma (SCC) in both margins of the tongue (right side first followed by left side). Eight years after treatment for the first SCC by surgery and radiotherapy, the second SCC occurred in the contralateral margin of the tongue. Surgical resection was performed for the second SCC, with local recurrence 8 months later associated with pathological change from SCC to SpCC. The SpCC was completely resected with wide surgical margins in combination with bilateral neck dissection. However, the patient developed pulmonary metastasis and died of respiratory failure 4 months after the final surgery. Postoperative inflammatory reaction followed by scar formation in the previously irradiated surgical site might have caused the transition from SCC to SpCC during the process of recurrence.

Myxoma is a rare benign tumor, and occurs most commonly in the mandible and maxilla in the head and neck region. Myxoma of the larynx is extremely rare and is frequently misdiagnosed as a vocal polyp. We present the first female case of myxoma on a vocal cord and review the literature on this subject. The patient was 74 years old. She had undergone laryngomicrosurgery for a vocal cord polyp 20 years previously, but did not know the histological diagnosis. We performed laryngomicrosurgery for bilateral edematous vocal cords. Microscopic laryngoscopy demonstrated a mass in the submucosal space of the right vocal cord. The pathologic diagnosis of the mass was myxoma. Myxoma is a connective tissue tumor composed of multinucleate stellate cells suspended in an edematous, mucopolysaccharide-rich stroma. Since myxomas may infiltrate surrounding tissue, they have a high incidence of local recurrence. To prevent recurrence, myxoma should be surgically excised with surrounding normal tissue. Although no local recurrence has been detected, as myxoma is characterized by a slow growth rate, long-term follow-up is needed in this case.

Formation of carotid artery pseudoaneurysm is uncommon after intensive treatment for head and neck cancer. We encountered a case of postoperative formation of pseudoaneurysm at the left carotid bifurcation in a diabetic man. The risk factors for carotid artery pseudoaneurysm in the patient included diabetes mellitus, previous radiotherapy to the neck, neck dissection, and postoperative Staphylococcus aureus infection secondary to accidental pharyngocutaneous fistula. We successfully obliterated this pseudoaneurysm using a Smart stent and detachable coils without neurological deficits. The possibility of vascular injury after treatment for head and neck cancer must be considered, especially in patients with risk factors for it due to previous treatment.

Conclusions: With our method, general improvement is obtained as compared with traditional split-thickness skin grafting of the radial forearm flap donor site. As our method is simple and easy, the same results can be obtained wherever and by whomever it is performed., Objective: The radial forearm flap is associated with complications of graft take and a poor aesthetic appearance despite its usefulness in reconstructing the oral cavity and oropharynx. We describe a simple technique for improvement of the radial forearm donor site., Patients and Methods: We studied 12 patients who underwent reconstruction with radial forearm free flaps following resection of oral or oropharyngeal tumors. We covered the donor site defect using traditional split-thickness skin grafts and performed aftercare with a hydrocolloid dressing and an adhesive sponge to retain moisture and apply compression. After the treatment series, color matching, texture matching, depressive deformity, and hypertrophic scar were evaluated., Results: The results of comprehensive evaluation of the two patients with premature discontinuation of compression were good. One patient was assigned only 1 point for hypertrophic scar, and another only 1 point for color match. The evaluation of the other 10 patients was excellent.

Intraductal papilloma arising in the major salivary gland is uncommon. We treated intraductal papilloma of the parotid gland in a 41-year-old man with a 3-week history of a painless mass in his right parotid gland. Radiologic imaging studies revealed a well-circumscribed solitary mass, 1 cm in diameter, at the posterior edge of the right parotid superficial lobe. Complete excision of the mass was performed under general anesthesia. Pathologically, the mass consisted mainly of a cystically dilated salivary duct filled with dark brown muddy components and a cluster of growing papillary cells, leading to the diagnosis of intraductal papilloma. The literature on intraductal papillomas of the major salivary glands is reviewed, with particular focus on preoperative diagnosis of this condition.

We previously reported that long-term exposure to glutamate (Glu) induced death of cochlear outer hair cells (OHCs). However, the mechanisms of OHC death induced by Glu were unclear. In the central nervous system, Glu is known to interfere with a cystine-Glu antiporter, leading to a decrease in cystine uptake and reducing the intracellular glutathione level. We therefore investigated the effect of cystine supplementation on degeneration of OHCs caused by long-term exposure to Glu. Supplementation of cystine significantly decreased the number of dying OHCs. These findings suggest that a cystine-Glu interaction may be involved in the mechanism of OHC degeneration caused by Glu.

Acute electrophysiological and morphological changes in the cochlea following destruction of the semicircular canals (SCCs) were investigated to elucidate differences in cochlear vulnerability to surgical procedure under two conditions: normal healthy condition and a pathological condition induced by Pseudomonas aeruginosa exotoxin A (PaExoA). Frequency-specific auditory brainstem response recording and examination by light microscopy (LM) and scanning electron microscopy (SEM) were performed in the acute stage, immediately following, and 2, 5, and 10 days after the intervention. All normal healthy rats showed noticeable hearing loss immediately after the operation, predominantly in lower frequency areas, followed by complete recovery within 5 days. LM revealed rupture and slight distension of Reissner's membrane. SEM revealed considerable disarray of the stereocilia, especially on the outer hair cells (OHCs) of the third row in the upper half-turns of the cochlea. By contrast, all rats under pathological conditions showed delayed and incomplete hearing recovery from postoperative hearing loss. LM revealed various kinds of cochlear reaction, such as distension of Reissner's membrane, infiltration of inflammatory cells into the cochlea, and severe inflammatory change. Damage both of inner hair cells in the basal turn and of OHCs in the upper half-turns was more noticeable, compared with that under normal conditions. These findings indicate that SCC destruction under pathological conditions induced by PaExoA is detrimental to postoperative hearing recovery, even if the preoperative hearing level had appeared electrophysiologically normal.

Heterologous tumor cells (human chronic myelogenous leukemia K-562 cells) were injected into the perilymph and skin in guinea pigs in order to study the induction of NK cell activity in the inner ear. An in vitro transmission electron microscopic and immunohistochemical study showed that K-562 cells were attacked by guinea pig large granular lymphocytes. K-562 cells injected through the round window membrane were found to be targeted by NK cells emerging from surrounding venules after 7 to 9 days. During this time morhological changes occurred in the organ of Corti and stria vacularis. These findings suggest that the inner ear response to foreign cells induces activation and invasion of NK cells which occur relatively late compared with those in other organs such as skin.

Blood circulation in the cochlear lateral wall after exposure to a non-physiological level of sound (120-125 dB SPL, 3 h) was investigated immunohistologically. Kanamycin (KM), which was expected to function as a tracer of blood flow, was administered to guinea pigs 5 min to 21 h after sound termination. At 5-30 min, KM was scarce in the capillaries of the stria vascularis (CSVs), whereas abundant KM was present in the spiral ligament vessels. These findings differed markedly from those in non-sound-exposed animals. After the initial period, KM gradually did enter into the CSVs, but its pattern of existence there differed from the normal pattern. These observations suggest that acoustic trauma causes blood stagnation in the strial capillaries, leading to strial dysfunction.