Fish Tank Granuloma Presenting as a Nasal Cavity Mass.

Mycobacterium marinum is a free-living nontuberculous mycobacterium that is widely distributed in freshwater and seawater around the world. Granulomatous skin infection from M. marinum in people who are exposed to fish or aquatic environments is a rare condition known as fish tank granuloma. The granuloma mainly occurs on the skin of the upper limb, in a few cases on the face, and rarely in the nasal cavity. We describe a case of M. marinum infection that presented as a nasal cavity mass. A 57-year-old woman who was receiving infliximab for psoriatic arthritis visited our hospital with a complaint of right nasal obstruction. A granulomatous mass with an irregular surface was found in the anterior part of the right nasal cavity. Tissue biopsy revealed granulation tissue. Since the application of steroid ointment did not reduce the size of the mass, the tumor was resected under local anesthesia, and the base was cauterized. The pathological finding was an inflammatory granuloma with negative Ziehl-Neelsen staining. The granuloma recurred 3 months after resection. The interferon-gamma release assay (IGRA) test was positive, and therefore, a mycobacterial tissue culture test was performed because of suspected nasal tuberculosis, which identified M. marinum. The nasal cavity mass disappeared 2 months after the administration of minocycline, followed by clarithromycin, and subsequent discontinuation of infliximab. M. marinum infection can cause an intranasal mass. IGRA and the mycobacterial tissue culture test are useful for diagnosis. As in this case, the nasal lesion may be excised as an inflammatory nasal granuloma, and therefore, there may be many more "hidden" cases of M. marinum infection. If nasal granulation is present, the possibility of M. marinum infection should be considered.

Proposal for a Modified Jaw Opening Exercise for Dysphagia: A Randomized, Controlled Trial.

OBJECTIVE: To verify the feasibility and effectiveness of a newly developed modified jaw opening exercise (MJOE) in post-stroke patients with pharyngeal residue who completed a sixweek exercise regimen. DESIGN: Double-blind, randomized, controlled trial. PARTICIPANTS: 16 patients with stroke-related dysphagia. INTERVENTIONS: Participants were allocated to an intervention group (MJOE: one set of five repetitions at 80% maximum voluntary contraction (MVC) for 6 seconds) or a control group (isometric jaw closing exercise: one set of five repetitions at 20% MVC for 6 seconds). Each group performed four sets a day, five times a week, for a total of six weeks. MAIN OUTCOME MEASURES: A videofluorographic swallowing study was performed before and after exercise. The distance between the mental spine and the hyoid bone (DMH) and hyoid displacement (HD) were measured. RESULTS: Twelve participants completed the study. No pain in the temporomandibular joint and/or anterior region of the neck occurred during the exercise period. In the intervention group (N=6), a decrease in DMH where anterior HD ended and an increase in anterior HD were seen. In the control group (N=6), no changes were seen. CONCLUSIONS: MJOE is feasible without any adverse events in poststroke patients, and it promotes anterior HD during swallowing.

[Promoter hypermethylation of tumor-associated genes in head and neck cancer].

An important pathway of gene transcriptional inactivation is hypermethylation at the CpG islands of promoter regions. Some tumor suppressor genes have been reported to harbor promoter hypermethylation in head and neck cancer. We studied DNA hypermethylation of 4 genes in 42 cases of primary head and neck cancer. We applied methylation specific PCR for p16, RAR-beta, RASSF1A, and Fhit genes. Hypermethylation was detected at p16 in 43%, at RAR-beta in 40%, at RASSF1A in 12%, and at Fhit in none of the cases. Hypermethylation of at least one gene was detected in 26 (62%) of the 42 cases. No significant correlation was seen between methylation status and clinicopathological findings or prognosis. Hypermethylation of several tumor-associated genes plays an important role in tumorigenesis of head and neck cancer. We discuss clinical implications and their application.

A case of accessory parotid gland tumor.

We herein describe a case of accessory parotid gland tumor, including diagnosis and surgical approach. The accessory parotid gland is salivary tissue separated from the main parotid gland and lying on masseter muscle. It has secondary duct empting into the Stensen's duct. The accessory parotid gland exists in 21-61 % of individuals. However, the appearance of an accessory parotid tumor is rare, with a reported frequency of 1-7.7 % of all parotid gland tumors. Surgical resection is the treatment of choice for the accessory parotid gland tumor. It is important to identify the buccal branch of the facial nerve to avoid injury to the facial nerve. The tumor in our case was surgically resected without facial nerve injury. The histopathological diagnosis was pleomorphic adenoma.

Airway management during the laryngoscopic surgery for the benign laryngeal obstructive disease.

The airway management and anesthesia maintenance during the laryngoscopic surgery is essential for a safe operation. For the benign laryngeal obstructive disease such as a large mass or a foreign body of the upper airway, it is difficult to secure the airway. Sometimes they might be hazardous and potentially lethal. We present two cases of a large laryngeal polyp and a laryngeal foreign body of pressthrough-package (PTP). They were successfully operated on with laryngomicrosurgery under neuroleptanalgesia (NLA) without intubation. The choice of the operation and airway management were discussed.

[Prophylactic neck dissection for submandibular gland cancer].

The indication and preferred dissection field for prophylactic neck dissection for submandibular gland cancer are controversial and have not been standardized. We reviewed 27 patients who underwent a definitive operation for previously untreated submandibular gland cancer. The 27 patients consisted of 13 patients with adenoid cystic carcinoma, 6 patients with mucoepidermoid carcinoma, 6 patients with adenocarcinoma, and 2 patients with squamous cell carcinoma. The diagnostic accuracies of malignancy and histology with fine needle aspiration cytology were 86% and 56%, respectively. In sixteen out of 21 cases without neck lymph node metastasis, a prophylactic neck dissection was performed and pathological neck lymph node metastases were detected in five cases. On the other hand, in five cases that did not receive a prophylactic neck dissection, latent neck lymph node metastasis was observed in 2 cases. In both cases of neck lymph node metastasis, pathological positive lymph nodes were observed in only level 2 or level 3. The rates of occult neck lymph node metastasis according to the T stage were 0% in T1, 33.3% in T2, 57.1% in T3 and 100% in T4. The rates of occult neck lymph node metastasis according to the histopathology were 46.2% in adenoid cystic carcinoma, 50% in mucoepidermoid carcinoma, 50% in adenocarcinoma, and 50% in squamous cell carcinoma. In conclusion, we believe that supraomyohoid neck dissection is suitable for N0 cases of submandibular gland cancer because of four reasons: 1) rate of occult neck lymph node metastasis in submandibular gland cancer is high, 2) pathological neck lymph node metastasis in N0 cases and latent neck lymph node metastasis were observed in level 2 and level 3, 3) the prognosis of cases with neck lymph node metastasis was poor, and 4) same skin incision can be used not only for the primary resection but also for the neck dissection.

Concurrent chemoradiotherapy with docetaxel for T2 laryngeal carcinoma.

OBJECTIVE: To evaluate the efficacy and safety of concurrent chemoradiotherapy with docetaxel (DOC) for T2 laryngeal carcinoma. METHOD: Twelve patients with T2 laryngeal cancer received concurrent chemoradiotherapy (60-70Gy) with weekly DOC (10 mg/m2) (CCRT group). The clinical files of the patients were retrospectively reviewed and survival rates and laryngeal preservation rates were analyzed compared with the group treated with conventional radiation therapy alone (RT group). RESULTS: Complete response was observed in 11 of 12 patients (91.7%) in the CCRT group. Overall 5-year survival rates by Kaplan-Meier's method were 90% for the CCRT group and 78% for the RT group. The disease free survival with anterior commisure involvement was 90% in CCRT group and 53% in RT group, respectively. Toxicity over grade III was noticed in 3 patients. CONCLUSION: Concurrent chemoradiotherapy with DOC is a feasible and effective treatment modality for organ preservation in T2 laryngeal cancer in the outpatient setting. Efficacy and safety of this treatment modality in an outpatient setting were discussed.

A survey of head and neck malignancy at Tokai University Hospital.

Patients with head and neck malignancy who visited Tokai University Hospital over seven years were statistically surveyed. Six hundred and eighty-three patients were newly registered in this period. The most frequent primary lesion was the larynx (29.3%), followed by the hypopharynx (20.6%), oral cavity (11.9%), oropharynx (11.9%), and nose and paranasal sinus (8.6%). About two-thirds of the patients had advanced cancers. The patients were referred from adjacent regions, most frequently from the Shonan area. Referred patients with malignancy were increasing each year. The trends in head and neck cancers and the treatment modality were discussed. After the opening of a new hospital building in 2006, a further increase in the number of referred patients and operations is expected.