記述言語：英語   出版者・発行元：Molecular and Clinical Oncology  

Endoscopic cricopharyngeal myotomy (ECPM) is a safe and minimally invasive technique that is used to treat patients whose esophageal inlet fails to open because of specific diseases, such as Wallenberg's syndrome and neuromuscular diseases. The present study described the performance of a new, safe and simple ECPM using a curved rigid laryngoscope, which is used for endoscopic laryngopharyngeal surgery for patients with dysphagia due to pharyngeal residue after swallowing. The patient was an 80-year-old woman with laryngeal palsy caused by lower cranial nerve palsy after cranial base schwannoma surgery. ECPM was performed with a curved rigid laryngoscope. The postoperative course was good; postoperative rehabilitation eliminated the residue after swallowing a thickened solution and mealtimes were shorter than before surgery. This procedure allows the hypopharynx to be widely expanded and it is possible to develop a wider surgical field than when using a direct laryngoscope. In addition, this procedure appears to be relatively easy to perform if the surgeon is familiar with the curved rigid laryngoscope technique.

DOI： 10.3892/mco.2023.2606

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PubMed

記述言語：英語   出版者・発行元：Dysphagia  

This study evaluated the safety of laryngeal closure and post-surgical changes in swallowing function of patients with amyotrophic lateral sclerosis (ALS) and proposed an appropriate surgical strategy for patients with ALS. Clinical and surgical data of 26 consecutive patients with ALS who underwent laryngeal closure at Nagoya University Hospital in Japan between 2003 and 2020 were retrospectively analyzed. Changes in swallowing functions were evaluated before and approximately 1 month post-surgery using Neuromuscular Disease Swallowing Status Scale (NdSSS), and Functional Oral Intake Scale (FOIS). The median operation time was 126 min (range, 51–163 min), and the median intraoperative blood loss was 20 mL (range, 0–88 mL). Among the 26 ALS patients who underwent laryngeal closure, grade 1 (mild) complications occurred in three patients (12%); however, no severe complications were observed. After surgery, 25 patients (96%) maintained the swallowing function and only one patient (4%) had deteriorating NdSSS and FOIS scores. No patients were referred to our hospital due to severe aspiration pneumonia after the surgery. Two patients did not require a feeding tube after the surgery and returned to oral intake. Laryngeal closure may be a safe surgical procedure for preventing chronic aspiration and may also maintain swallowing function of patients with ALS. Further multicenter prospective studies using the gold standard videofluoroscopic swallowing examination are required to support our findings.

DOI： 10.1007/s00455-022-10454-0

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記述言語：英語   出版者・発行元：Journal of Neurological Surgery Part B Skull Base  

Objective Surgical indications for advanced-stage squamous cell carcinoma (SCC) of the external auditory canal (EAC) are highly dependent on the skull base surgery team. The aim of this study was to evaluate the surgical outcomes in patients with SCC of the EAC and to clarify the surgical indication of far advanced cases using the T4 subclassification. Methods Patients with SCC of the EAC who underwent curative treatment from 2002 to 2021 at our hospital were retrospectively reviewed. Clinical and surgical results, including operative data, overall survival (OS), and disease-specific survival (DSS), were analyzed. To clarify the surgical indication for advanced-stage tumors, we proposed the T4 subclassification. Results In the 46 patients included in the study, 8 patients had T1 tumors, 10 had T2 tumor, 5 had T3 tumors, and 23 had T4 tumors. The 5-year DSS with T1, T2, T3, and T4 tumors were 100, 85.7, 100, and 61.7%, respectively. No prognostic impacts for margin status were found between the 5-year OS and DSS (p = 0.23 and 0.13, respectively). Patients with far-advanced-stage (T4b) tumors were significantly associated with shorter DSS than those with early-stage (T1/T2) and advanced-stage (T3/T4a) tumors (p = 0.007 and 0.03, respectively). Conclusion The present study focused on patients with SCC of the EAC at a university hospital over a period of 20 years, especially with skull base involvement, and a T4 subclassification was proposed. Complete tumor resection in an en bloc fashion could help achieve a good survival rate even in patients with locally advanced tumors.

DOI： 10.1055/a-1733-2585

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記述言語：英語   出版者・発行元：Nagoya Journal of Medical Science  

Primary laryngeal cryptococcosis is an extremely rare infection and presents with non-specific symptoms such as hoarseness or sore throat, resulting in delayed diagnosis. Here, we report the patient of a 56-yearold female patient with primary laryngeal cryptococcosis, who was being treated with oral and inhaled steroids for rheumatoid arthritis and bronchial asthma. The patient suffered from prolonged hoarseness and sore throat, and endoscopic biopsy was performed several times under local anesthesia, demonstrating only inflammatory cell infiltration. Considering the possibility of laryngeal malignancy, a third biopsy was performed by endoscopic laryngomicrosurgery under general anesthesia. Intraoperative frozen section revealed non-neoplastic laryngeal mucosa with erosion and severe inflammatory cell infiltration. However, we could not confirm the definite diagnosis of the lesion in the intraoperative consultation. Postoperative histopathological examination revealed a small number of yeast-type fungi and a definitive diagnosis was established by special stains including Alcian blue stain. Finally, the patient was diagnosed as primary laryngeal cryptococcosis. Daily oral administration of fluconazole (400 mg/day) was performed for 6 months according to the treatment protocol for pulmonary cryptococcosis. The symptoms gradually improved, and endoscopy revealed no recurrence 6 months post-treatment. Clinicians should consider the possibility of laryngeal cryptococcosis when severe inflammation is found in the larynx and discuss the disease history and pathological results with pathologists more closely.

DOI： 10.18999/nagjms.84.4.900

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記述言語：英語   出版者・発行元：Laryngoscope Investigative Otolaryngology  

Objective: To determine the efficacy of a surgical training model for fluorescence-guided cancer surgery and validate its utility to detect any residual tumors after tumor resection using electrocautery. Methods: We developed surgical training models containing indocyanine green (ICG) for near-infrared (NIR) fluorescence imaging using a root vegetable organic material (konjac). After the fluorescence assessment for the models, the surgical simulation for fluorescence-guided cancer surgery using electrocautery was performed. ICG-containing tumors were divided into two surgical groups: “Enucleation” (removal of the entire visible tumor) and “Complete resection” (removal of the tumor with an appropriate 5-mm surgical margin). Results: All 12 ICG-containing tumors were clearly visible from the normal view but not from the flipped view. The tumor resection time was significantly longer in the “Complete resection” group than in the “Enucleation” group (p <.001). The ICG-containing tumors showed a high tumor-to background ratio from the normal (average = 45.8) and flipped (average = 19.2) views, indicating that the models including ICG-containing tumors were useful for a surgical simulation in fluorescence-guided surgery. The average mean fluorescence intensity of the wound bed was significantly higher in the “Enucleation” group than in the “Complete resection” group (p <.01). No decrease in fluorescence signal was found in the wound bed even at 2 days postresection. Conclusion: Our surgical training model containing a fluorescent agent is safe, inexpensive, not harmful for humans, and easy to dispose after use. Our model would be beneficial for surgeons to learn NIR fluorescence imaging and to accelerate fluorescence-guided cancer surgery into clinical application.

DOI： 10.1002/lio2.858

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記述言語：日本語   出版者・発行元：耳鼻咽喉科臨床学会  

Dermoid cysts are rare lesions of the head and neck that usually present with few symptoms. Complete resection is the mainstay of treatment for dermoid cysts, however, airway management after surgery is essential, especially in children. We report the case of sublingual dermoid cyst arising from the floor of the mouth in a 6-year-old female child. CT/MRI images demonstrated a 50×40×30 mm cystic mass in the sublingual space. Fine-needle aspiration was performed under ultrasound guidance, and the findings were suggestive of a dermoid cyst in the floor of mouth. The cyst was surgically removed via a transoral approach. After the surgery, the patient was returned to the intensive care unit under tracheal intubation for safe airway management. After some days, she was extubated and the postoperative course was good. There was no evidence of recurrence during the 6-month follow up period. When encountering sublingual dermoid cysts arising from the floor of the mouth in a pediatric case, it is important to consider not only the appropriate surgical procedure, but also about postoperative airway management, even during the preoperative period.

DOI： 10.5631/jibirin.115.277

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記述言語：英語   出版者・発行元：Auris Nasus Larynx  

Objective: The aim of this study is to establish a unilateral tongue atrophy model by cutting the hypoglossal nerve and to evaluate the safety and feasibility of a fat injection of adipose-derived stem cells (ADSCs) to restore swallowing function. Methods: A total of 12 rabbits were randomized to three groups; the ADSCs+fat group (n=4), the fat group (n=4) and the control group (n=4). All rabbits were treated with denervation of the left hypoglossal nerve and their conditions including body weight and food intake were checked during follow-up periods (8 weeks). At 4 weeks after the transection of the nerve, rabbits received the injection therapy into the denervated side of the tongue with 1.0mL fat tissue premixed with 0.5mL ADSCs in the ADSCs+fat group, 1.0mL fat tissue premixed with 0.5mL PBS in the fat group and 1.5mL PBS in the control group. Rabbits were euthanized 8 weeks post-treatment and resected tongues were collected, formalin-fixed and paraffin embedded. To evaluate the change of the intrinsic muscles of the tongue, muscle fibers around the treatment area was analyzed by evaluating 5 consecutive hematoxylin-eosin slides per rabbit. Results: Food intake did not decrease upon nerve denervation, and none of the rabbits displayed adverse effect such as aspiration, surgical wound dehiscence or infection. No significant body weight changes were found between the three groups at 4 and 8 weeks after nerve transection (p>0.05). In the control group, the denervated side of tongue had significantly smaller muscle fiber areas and diameters compared to the non-denervated side (p<0.05). The ADSCs+fat group demonstrated a larger area of inferior longitudinal muscle fibers compared to the control and the fat groups (582±312µm² vs. 405±220µm² and 413±226µm²; p<0.05). A significant thicker lesser diameter of inferior longitudinal muscle fibers was found in the ADSCs+fat group compared to the control and the fat groups (24±8µm vs. 20±6µm and 20±7µm; p<0.05). Conclusion: The rabbit tongue atrophy model was found suitable for the assessment of muscle change after nerve transection. Fat injection therapy with ADSCs demonstrated great potential to prevent the muscle atrophy after denervation and to promote the muscle regeneration around the injection area.

DOI： 10.1016/j.anl.2020.08.003

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記述言語：英語   出版者・発行元：International Journal of Oral and Maxillofacial Surgery  

In the head and neck region, preoperative evaluation of the free flap volume is challenging. The current study validated preoperative three-dimensional (3D) virtual surgical simulation for soft tissue reconstruction by assessing flap volume and evaluated fat and muscle volume changes at follow-up in 13 head and neck cancer patients undergoing anterolateral craniofacial resection. Patients received 3D virtual surgical simulation, and the volume of the planned defects was estimated by surgical simulation. Following en bloc resection of the tumor, the defect in the skull base was covered using a rectus abdominis myocutaneous flap. Following surgery, computed tomography scans were acquired at day 1 and at 6 and 12 months. Virtual planned defect was on average 227 ml (range, 154–315) and was 10% smaller than the actual flap volume in patients without skin involvement of the tumor. Between day 1 and 12 months post-surgery, the volume of fat and muscle tissue in the free flap dropped by 9% and 58%, respectively. Our results indicate that 3D virtual surgical simulation provides essential information in determining the accurate volume of the required free flap for surgical defect repair and may thus help improve surgical planning and functional and esthetic outcome.

DOI： 10.1016/j.ijom.2020.07.025

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記述言語：日本語   出版者・発行元：日本頭頸部癌学会  

顔面神経を温存した耳下腺癌手術症例の，術後の顔面神経麻痺の推移と予後の関係を検討した報告は少ない。当科の耳下腺癌の治療方針は，術前から顔面神経麻痺がある場合は神経合併切除と一期的再建，麻痺がない場合は組織型にかかわらず原則温存としている。過去15年間の顔面神経を温存した耳下腺癌手術症例31例について検討した。観察期間中央値は60ヶ月，全摘24例，葉切除が7例であった。手術直後の顔面神経麻痺スコアは平均24点，中央値は27点であった。術後顔面神経麻痺の推移は，一過性に完全麻痺の症例もあったが，最終的に平均39.5点まで回復した。回復期間は多くの症例が術後6ヶ月までに回復した。治療成績は，5年全生存率・5年無病生存率・局所制御率それぞれ96.0％・89.5％・93.5％と良好な結果であった。術前顔面神経麻痺のない耳下腺癌症例は，病理型に関わらず神経を温存しても治療成績は担保されると考える。

DOI： 10.5981/jjhnc.47.316

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