Is tooth conservation possible in odontogenic sinusitis? Prospective evaluation of affected teeth condition-based protocol.

BACKGROUND: Affected tooth conservation is an often-overlooked problem in odontogenic sinusitis (ODS) treatment. Treatable dental conditions are improperly managed with extractions imposing an unnecessary health burden on patients. Furthermore, no down-to-earth protocols have been proposed for the clinical management of these patients. AIM: This study aims to prospectively validate a treatment protocol for ODS based on dental mobility, an indirect sign of poor long-term tooth survival. The protocol suggests endoscopic sinus surgery (ESS) alone followed by dental treatment for immobile affected teeth, and concomitant ESS and extraction for mobile teeth. Extraction of immobile teeth is considered if inflammation persists after the treatment. MATERIAL AND METHODS: Forty cases treated with our protocol were prospectively examined about ODS cure and preservation of affected teeth. RESULTS: Among the 35 patients with immobile affected teeth, only one required extraction for complete ODS cure after ESS. All five cases with mobile teeth and one with postoperative extraction had marginal periodontitis. CONCLUSION AND SIGNIFICANCE: Ninety-seven percent of immobile affected teeth were preserved with complete ODS cure in this study. In case marginal periodontitis is present, extraction is likely to be necessary, although ESS should be prioritized over blanket extractions to preserve the teeth for patients' quality life.

A Case of Acquired Factor V Inhibitor Following Nivolumab Administration.

Acquired factor V inhibitor (AFVI) is a very rare disease. We presented herein a case of hypopharyngeal cancer in which AFVI developed after nivolumab administration. Blood test findings two weeks after the first dose of nivolumab showed a significant prolongation of prothrombin time (PT) and activated partial thromboplastin time (APTT), indicating a marked abnormality in the coagulation function. Factor V activity had decreased significantly and was below the detection limit (<3%), and the factor V inhibitor level was as high as 16 Bethesda units (BU)/mL. His underlying illness was a malignant tumor, but we considered that nivolumab administration was the cause of AFVI, considering the time when coagulation abnormality developed. No significant bleeding tendency was observed in the subsequent course, and the AFVI was followed up without treatment. To the best of our knowledge, the present study is the first to report AFVI occurrence after immune checkpoint inhibitor administration.

Smoking-induced radiation laryngeal necrosis after definitive radiotherapy alone for T1a glottic squamous cell carcinoma: A case report.

BACKGROUND: We report the case of a patient with smoking-induced radiation laryngeal necrosis (RLN) after undergoing definitive radiotherapy (RT) alone for T1a glottic squamous cell carcinoma. CASE: The patient was a 63-year-old man who had a history of heavy smoking. He quit smoking when he was diagnosed with glottic squamous cell carcinoma. The RT dose was 63 Gy, delivered in 28 fractions with the three-dimensional conventional RT technique for the larynx. After RT completion, the initial treatment response was complete response. He then underwent follow-up examinations. At 13 months after RT, the patient resumed smoking. At 2 months after resuming smoking, he had severe sore throat and hoarseness. Laryngoscopy revealed a large tumor in the glottis. Surgical excision was performed, and the patient was histologically diagnosed with RLN, as late toxicity without cancer recurrence. At 3 weeks postoperatively, the patient had dyspnea, and laryngoscopy revealed total laryngeal paralysis. Thus, he underwent an emergent tracheostomy. The administration of steroids affected RLN, and laryngeal paralysis gradually improved. CONCLUSIONS: This case suggests that smoking may have the potential to induce RLN after RT. Moreover, continuing smoking cessation is significantly important for patients with glottic cancer who receive RT. Rather than leaving smoking cessation up to the patient, it would be necessary for clinicians to actively intervene to help patients continue their effort to quit smoking.

T-Cell/Histiocyte-Rich Large B-Cell Lymphoma Presented as T-Lymphoid Hyperplasia Involving the Central Nervous System.

We herein report a case of T-cell/histiocyte-rich large B-cell lymphoma which initially presented as a self-limiting T-lymphoproliferative disorder involving multiple extranodal and extrapulmonary organs, such as the salivary gland, the liver, and the central nervous system. Repeated biopsies only revealed polyclonal T-lymphocytosis without the presence of atypical B-cells. Angiocentric cellular infiltration was absent, thus ruling out lymphomatoid granulomatosis. A recurrence in the lymphatic system finally revealed a small population of pathognomonic atypical B-cells, which led to the diagnosis. The clinical dilemma in the diagnosis and management of this indeterminate condition points to limitations in the current nosology.

Surgical treatment of substernal goiter: An analysis of 44 cases.

OBJECTIVE: Substernal goiters are classified as primary or secondary intrathoracic goiters. Here, we report the diagnosis, symptoms, treatment, and postoperative complications of 44 substernal goiters (2 primary mediastinal goiter and 42 secondary mediastinal goiters). METHODS: A retrospective chart review of 351 patients undergoing thyroidectomy at the Department of Otolaryngology-Head and Neck Surgery of the Tokyo Metropolitan Tama Medical Center. Between 2009 and 2015, 44 patients underwent surgery for substernal goiter. RESULTS: The frequency of primary and secondary mediastinal goiters was 0.5% and 11.9%, respectively. The preoperative symptoms were neck mass, dyspnea, and dysphagia. Eight patients were asymptomatic. Thirty-nine patients had benign masses and 5 patients had malignant masses. Most patients were operated on for adenomatous goiters (52.2%). In ten cases beyond the aortic arch, the tumors were benign and there were eight cases of adenomatous goiter. All patients underwent a successful transcervical incision without sternotomy. Even the primary intrathoracic goiters were extracted after total thyroidectomy via the cervical approach without complications. Although one case showed unilateral recurrent nerve paralysis as a postoperative complication, phonetic function improved in 6 postoperative months. No instances of postoperative bleeding or definitive hypoparathyroidism occurred, and tracheostomy was not performed in any of the cases. CONCLUSION: The cervical approach was safely performed in almost all substernal goiters without an extracervical procedure. Selected cases of primary mediastinal goiter may be excised via the cervical approach.

A clinical review of 38 cases of cervical tuberculous lymphadenitis in Japan - The role of neck dissection.

OBJECTIVES: After tuberculous pleurisy, lymphadenitis arising from cervical lesion is the second most common form of extrapulmonary tuberculosis. It is generally treated with antituberculosis agents, but some patients resist chemotherapy. In such cases, surgical resection is often considered as an alternative treatment. This study aims to evaluate the therapeutic outcome of cervical tuberculous lymphadenitis and the future course of treatment of this disease. METHODS: We retrospectively reviewed the clinical charts of patients diagnosed at the Tokyo Metropolitan Tama Medical Center between 2009 and 2015 and identified 38 cases of cervical tuberculous lymphadenitis. Precisely 798 patients were registered for primary tuberculosis at our institution during the same period. RESULTS: Patient ages ranged from 21 to 85 years (average: 58.9 years), and the male-to-female ratio was 1:1.2. The range of tuberculosis progression was as follows: 30 (78.9%) in only the cervical lymph node, 3 in the other (axillary, mediastinal, and abdominal) lymph nodes, 1 in the lung and vertebrae lumbales, 2 in the lung, and 1 in the pleural membrane. All 38 patients were initially treated with antituberculous drugs at the Department of Pulmonary Medicine based on guidelines for tuberculosis cases in Japan. In seven cases, the antituberculous drugs were replaced due to side effects. Four cases involved a single drug-resistant strain, and one case involved a double drug-resistant strain. Thirty-three (86.8%) cases were cured by chemotherapy alone. The three patients resistant to chemotherapy were successfully treated through neck dissection. Thirty-six cases (94.7%) were cured by chemotherapy or chemotherapy and surgery. CONCLUSION: Local therapy could prove effective in cervical tuberculous lymphadenitis patients who exhibit an inadequate response to drugs. The role of neck dissection in cervical tuberculous lymphadenitis remains an important consideration.

Endoscopic transoral and transmaxillary excision of the infratemporal fossa hemangioma.

Hemangiomas in the infratemporal fossa (ITF) are extremely rare benign vascular tumors. For many tumors of the ITF, with the exception of some small hemangiomas, a lateral facial approach has often been required. Recently, however, there have been some reports that minimally invasive endoscopic surgery can be used in the ITF; this would reduce the risk of surgical complications. To date, there has been no report of a hemangioma of the ITF exceeding 6 cm being resected by the endoscopic approach without facial incisions. Here, however, we report two cases of ITF hemangiomas that were completely extracted endoscopically, using a transmaxillary and transoral approach, without facial incisions or surgical complications.

T-cell lymphoblastic lymphoma in a child presenting as rapid thyroid enlargement.

The majority of lymphomas of the head and neck in children present as an enlarged cervical lymph node; however, malignant lymphoma arising from the thyroid gland is extremely rare. We report a case of a 12-year-old child who was admitted to our hospital because of a history of rapidly progressive anterior neck swelling. Histopathological studies revealed this case to be T-cell lymphoblastic lymphoma. We performed chemotherapy and the patient has kept recurrence-free survival for 18 months after the beginning of the treatment. This is the 2nd case of T-cell lymphoblastic lymphoma in the thyroid gland in a child.

Modified nasal specula and flexible holder for endoscopic nasal surgery.

The use of an endoscope in nasal surgery has now extended to surgery on the nasal septum as well as to sinus surgery. We devised the use of the modified nasal specula with Yasargil's flexible holder to resolve the technical problems in using an endoscope for septal surgery. One nasal speculum has two plates for connecting to the Yasargil's flexible holder. This speculum allows the surgeon to use both hands freely and also functions as a guide for stabilizing an endoscope. Another nasal speculum has two long adjustable wings. This speculum can widen the working space between the cartilage or bone of the nasal septum and detached mucosa. Our modified nasal specula are readily applicable to resolve the problems such as unstable endoscope and narrow working space in septal surgery under endoscopic view.

Malignant melanoma of nasal cavity: report of 16 Japanese patients.

BACKGROUND: Primary malignant melanoma of the nasal cavity is a rare disease that has a poor prognosis. There are significant racial differences in the incidence of melanomas in the nasal cavity. METHODS: Sixteen Japanese patients treated at the Hospital of Tokyo University were reviewed retrospectively. RESULTS: Fourteen patients were treated with surgery. Two patients received treatment with radiotherapy alone. Seven patients had microscopically negative surgical margins and seven patients had positive surgical margins. The 2- and 5-year actuarial survival rates for all patients were 63.6 and 31.8%, respectively. No statistically significant difference could be shown in the overall survival rate between patients with positive surgical margins and those with negative surgical margins. CONCLUSIONS: Clinical features of nasal melanoma in Japanese are not different from nasal melanoma in Caucasians. The negative surgical margins were not predictive of a better prognosis.

Schwannoma of the trachea; a new resection technique.

Tumors of the trachea are rare, especially schwannoma. We diagnosed a 27-year-old man with schwannoma of the trachea after he was admitted to our hospital with complaints of progressive dyspnea and wheezing. He was treated as having bronchial asthma initially, but his signs and symptoms did not improve with conventional therapy. Flexible fiberscopy revealed the presence of a submucosal tumor in the subglottic area. Tracheal tomography, computed tomography (CT) and magnetic resonance imaging (MRI) revealed the presence of a mass in the trachea that extended from the cricoid cartilage level to the second tracheal ring. After tracheostomy, we removed the tumor from a tracheostoma upwards to the larynx without a laryngofissure, using forceps and scissors usually used for laryngomicrosurgery and endoscopes usually used for sinus surgery. No complications developed during or after the procedure. To our knowledge, this is the first report of the removal of a tracheal schwannoma by this technique.