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.

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.

Plunging ranula intruding into the parapharyngeal space treated with OK-432.

We report a very rare case of a plunging ranula extending into the parapharyngeal space, which was treated successfully with OK-432. A 27-year-old woman presented with a 4-month history of right submandibular swelling. Based on computed tomography and magnetic resonance imaging findings, we established a diagnosis of plunging ranula intruding into the parapharyngeal space. The patient was treated with an intracystic OK-432 injection that was administered under ultrasonographic guidance. At 6 weeks after the injection, computed tomography showed complete disappearance of the cystic mass. No recurrence was noted during the 10-month follow-up.

New surgical procedure for laryngotracheal separation without a cannula or postoperative treatment.

OBJECTIVES: Laryngotracheal separation is a surgical procedure used in the treatment of intractable aspiration. As with total laryngectomy and laryngotracheal diversion, this procedure requires postoperative pressure above the suture location to prevent leakage at the anastomosis. To date, there have been no reports regarding laryngeal separation without postoperative treatment. The purpose of this study was to evaluate a new surgical procedure for laryngotracheal separation that is performed without a cannula and requires no postoperative treatment. METHODS: We performed the new surgical procedure in 7 patients. The mucosa of the cricoid cartilage was sutured to achieve tracheal closure. The closure was covered with a musculocutaneous flap of strap muscle; gauze was then tied over the skin and a 2-0 nylon suture was used to pierce the posterior part of the cricoid cartilage. In addition, a permanent tracheostoma was constructed without a tracheal cannula. RESULTS: No patients required a tracheal cannula or treatment after the operation. Additionally, aspiration pneumonia was prevented without complications in all patients. CONCLUSIONS: This new surgical procedure eliminates the need for a cannula and postoperative treatment. The effects of this method in terms of aspiration prevention are comparable to those of other surgical techniques.