Takumi Okuda

Closed suction drains are commonly used after head and neck surgery, but airway obstruction due to postoperative hemorrhaging can be fatal. Some studies have suggested that cervical circumference should be assessed after thyroid surgery to detect such problems early. Rapid responses may be difficult at facilities with limited staffing. We opted for Penrose drains in cases in which the risk of postoperative hemorrhaging was expected to be high, and we examined the effectiveness of this approach in this study. Between October 2022 and December 2023, 25 of 68 (37%) head and neck operations involved the placement of a Penrose drain. Their medical records were reviewed retrospectively. There were 20 cases involving neck dissection, which was performed via a wide range of surgical techniques. Intraoperative findings (e.g., significant oozing of blood) was the most common reason for choosing the open technique (10 cases). The duration of drain placement was < 7 days (mean: 4.68 days). There were no surgical site infections; two cases of postoperative hemorrhaging; and no fatal problems, such as airway obstruction, but delayed wound healing due to wound-edge dehiscence was observed in some cases. There were no cases of airway narrowing due to postoperative hemorrhaging. Penrose drains are considered a good indication for cases with a history of radiotherapy causing postoperative haemorrhage, cases on oral anticoagulants, lesions in the deep parotid to parapharyngeal space that are difficult to recognise for haematoma formation, and cases where negative pressure should be avoided for exposure of anastomotic vessels and nerves, and should continue to be investigated.

In surgically treated cases of head and neck squamous cell carcinoma (HNSCC), even pathological N0 (pN0) cases according to the Tumor, Node, and Metastasis (TNM) Classification, distant metastases can occur relatively early postoperatively. Therefore, we hypothesized that hematogenous distant metastasis may be related to the degree of venous invasion. Lymphatic invasion is considered to be a poor prognostic factor in HNSCC, but knowledge about venous invasion is scarce. We therefore investigated the association between venous invasion and distant metastasis, an important poor prognostic factor, in cases of HNSCC from our institution. Between April 2020 and December 2023 (four years and nine months), there were 89 cases in which a postoperative pathological evaluation of microvascular invasion was conducted after HNSCC surgery at our institution. Of these, 73 were retrospectively reviewed, after excluding six cases with positive margins and 10 cases with extranodal extension of metastatic lymph nodes. The observation period ranged from 13 to 54 months (mean: 32.5 months). The correlations between the presence/absence of venous or lymphatic invasion at the primary site and distant metastasis were investigated. Among the 73 cases, venous invasion was found at 31 primary sites, and lymphatic invasion was observed in 38 cases. Distant metastases were found in 10 cases. All cases showed both venous out lymphatic invasion, and none of the cases where these were negative showed distant metastasis. There were significantly more distant metastases in both the venous invasion-positive group (p=0.001) and the lymphatic invasion-positive group (p=0.004). The absence of distant metastasis in cases that were negative for venous invasion and venous invasion being present in all cases with distant metastasis indicated that venous invasion by the primary tumor is an important factor in distant metastasis. Venous invasion was also found to increase in frequency as the T and N stages progressed.

(1) Background: The incidence of congenital cholesteatoma (CC) has rarely been discussed, particularly from a demographic viewpoint. Therefore, we conducted an epidemiological study of CC using local medical characteristics. (2) Methods: The participants were 100 patients (101 ears) who underwent initial surgical treatment at university hospitals in two rural prefectures between 2006 and 2022. A total of 68% of the patients were males and 32% were females, with a median age of 5 years. We reviewed the medical records for the date of birth, date of surgery, stage of disease, and first symptoms of the disease. (3) Results: The total incidence of CC was calculated to be 26.44 per 100,000 births and tended to increase. No significant difference was found between the incidences in the two prefectures. The number of surgeries performed was higher in the second half of the study period. No difference in the stage of progress was observed based on age. (4) Conclusions: The incidence of CC was estimated to be 26.44 per 100,000 newborn births. The number of patients with CC tended to increase; however, this can be attributed to an increase in the detection rate rather than the incidence.

Background The incidence of congenital cholesteatoma (CC) has rarely been discussed, particularly from the demographic viewpoint. Therefore, we conducted an epidemiological study of CC using local medical characteristics. Materials and methods The participants were 100 patients (101 ears) who underwent initial surgical treatment at university hospitals in two rural prefectures between 2006 and 2022. Sixty-eight percent of the patients were males and 32% were females, with a median age of 5 years. We reviewed the medical records for the date of birth, date of surgery, stage of disease, and first symptom of the disease. Result The total incidence of CC was calculated to be 26.44 per 100,000 births and tended to increase. No significant difference was found between the incidences in the two prefectures. The number of surgeries performed was higher in the second half of the study period. No difference in the stage of progress was observed based on age. Conclusion The incidence of CC was estimated to be 26.44 per 100,000 new-born births. The number of patients with CC has tended to increase; however, this can be attributed to an increase in the detection rate rather than the incidence.

Sequential bilateral cochlear implantation in children becomes less effective as the inter-implant interval increases. However, the cause of this and the age at which speech perception becomes impossible are unclear. We examined the cases of 11 prelingually deaf children who underwent unilateral cochlear implantation at our hospitals before the age of 5 years old, followed by a second implantation procedure on the contralateral side when they were aged ≥ 6 years old (6–12 years old). The subjects’ hearing thresholds and speech discrimination scores for the second cochlear implant were evaluated at 3 postoperative months and 1–7 years. All of the subjects demonstrated improvements in their hearing thresholds to a mean of 30 dB HL at 1 year. Regarding speech perception, one patient (a 12-year-old), who had developed bilateral hearing loss at 30 months of age after contracting mumps, demonstrated a 90% improvement in his speech discrimination score at 1 year. However, among the other congenitally deaf children, there were two patients whose speech discrimination scores had improved by ≥ 80% at > 4 postoperative years. The congenitally deaf children exhibited poor speech perception despite showing improved hearing thresholds in the ears that received second cochlear implants. Assuming that the auditory pathway beyond the superior olivary complex remained functional, the reduced speech perception abilities associated with the second cochlear implants may have been attributable to the loss of the spiral ganglion and cochlear nucleus cells due to a lack of auditory input since birth.

We report a case of amelanotic malignant melanoma (AMM) in a 66-year-old female. AMM of the lingual base was diagnosed based on a biopsy of late metastasis to the bone marrow of the L4 lumbar vertebra. The patient was initially treated with chemoradiotherapy after being misdiagnosed with poorly differentiated human papillomavirus- (HPV-) related squamous cell carcinoma of the oropharyngeal anterior wall. p16 immunostaining is used to diagnose HPV-related oropharyngeal cancer. However, while p16 expression is used as a surrogate marker of HPV infection, it is important to be aware that p16 protein overexpression can also be caused by other factors. Malignant melanoma is known to express the p16 protein. Morphologically differentiating between AMM and poorly differentiated squamous cell carcinoma based on hematoxylin-eosin staining is difficult. Therefore, in cases that are pathologically diagnosed as p16-positive poorly differentiated oropharyngeal squamous cell carcinoma, it is important to rule out AMM.