鈴木 政美

Retropharyngeal goitre extending to the oropharyngeal level is rare. We present a case of papillary thyroid carcinoma (PTC) with a retropharyngeal cystic goitre extending to the uvular level. A woman in her 50s presented with swelling of the neck and dyspnoea. CT and MRI findings showed a primary tumour in the left lobe of the thyroid gland and a retropharyngeal dumbbell-shaped cystic goitre extending to the uvular level. Total thyroidectomy, central neck dissection and tracheostomy were performed. During the surgery, we opened the retropharyngeal space, and no mass was found. The pathological findings showed that the primary PTC (pT2) was surrounded by benign lesions, including the dumbbell-shaped cystic goitre. We speculated that the dumbbell-shaped cystic goitre extended from the visceral space (VS) into the pharyngeal mucosal space (PMS) and reached the uvular level because the thyroid gland is in the VS, and the VS and PMS are continuous spaces.

Reported postoperative complications of mediastinal goitre include recurrent laryngeal nerve palsy, hypoparathyroidism and tracheomalacia. Voice and swallowing symptoms after thyroid surgery have been associated with laryngopharyngeal reflux, but it is unclear whether the retrograde flow of gastric contents into the oesophagus, larynx and pharynx worsens after thyroid surgery. We present the case of a man in his 40s with gastro-oesophageal reflux disease (GERD) who developed heartburn and laryngeal granuloma after total thyroidectomy for mediastinal goitre. Vonoprazan therapy effectively controlled these symptoms. Although the exact cause remains unclear, we suggest that changes in pressure dynamics after thyroidectomy may worsen the retrograde flow of gastric contents into the oesophagus, larynx and pharynx, contributing to GERD symptoms and laryngeal granuloma. This case highlights the need to consider the management of retrograde flow of gastric contents into the oesophagus, larynx and pharynx in the postoperative care of mediastinal goitre resections.

Squamous cell papilloma with elongated villous projections may occur in the hypopharynx and present with symptoms observable on physical examination.

BACKGROUND/AIM: Lingual lymph node (LLN) metastasis from tongue cancer occurs at four subsites. However, subsite-related prognosis is unknown. This study aimed to analyze the association between LLN metastases and disease-specific survival (DSS) with respect to these four anatomic subsites. PATIENTS AND METHODS: Patients with tongue cancer treated between January 2010 and April 2018 at our institute were reviewed. The four subgroups of LLNs were median, anterior lateral, posterior lateral, and parahyoid. DSS was evaluated. RESULTS: LLN metastases occurred in 16 of the 128 cases; six and 10 cases were identified during initial and salvage therapy, respectively. Zero, four, three, and nine cases were median, anterior lateral, posterior lateral, and parahyoid LLN metastases, respectively. The 5-year DSS of patients with LLN metastasis was significantly poor on univariate analysis; parahyoid LLN metastasis showed the worst prognosis. Multivariate analysis indicated that only advanced nodal stage and lymphovascular invasion were significant survival factors. CONCLUSION: Parahyoid LLNs may require the most caution in tongue cancer. The significance of LLN metastases alone for survival was not confirmed on multivariate analysis.

Inconsistency in the definition of LLNs may be a hurdle in ensuring the accuracy of the evidence. Refinements in the classification of LLNs, based on the fascial anatomy and lymphatic vessels, are warranted.

BACKGROUND/AIM: We investigated whether laryngopharyngeal reflux (LPR) is a risk factor for radiation-induced mucositis. PATIENTS AND METHODS: This was a retrospective cohort study using our departmental database. The study included patients with stage I or II laryngeal and hypopharyngeal cancers treated with radiation therapy alone between April 2009 and March 2014. Based on endoscopic findings, baseline laryngeal signs were evaluated using the reflux finding score (RFS), and the severity of mucositis was assessed during and after radiation therapy. RESULTS: Fifty-eight patients were enrolled. Thirty-one patients were categorized as high RFS (LPR-likely), while 27 patients were categorized as low RFS (LPR-unlikely). Grade 3 mucositis occurred more frequently in the high RFS group (p<0.042). Furthermore, grade 3 mucositis developed earlier in the high RFS group (p<0.001). CONCLUSION: High RFS (i.e., increased likelihood of LPR) appears to be a potential risk factor for developing severe radiation-induced mucositis.

Presently, the relationship between laryngopharyngeal reflux (LPR) and radiation-induced mucositis has not been fully explored. In the present study, we report 2 cases of laryngeal cancer in which radiation-induced mucositis ameliorated after proton pump inhibitor (PPI) administration. Case 1 was diagnosed with T1aN0M0 right glottis carcinoma and was treated with radiation therapy. Grade 3 mucositis occurred after administration of 46Gy irradiation. PPI was administered and mucositis ameliorated quickly without cessation of radiation therapy. Case 2 was diagnosed with T2N0M0 supraglottic cancer and was treated with concurrent chemoradiation therapy. Grade 3 mucositis occurred after administration of 44Gy irradiation. PPI was administered and mucositis ameliorated quickly without cessation of chemoradiation therapy. In both cases, a remarkable therapeutic effect of PPI was observed in the perilaryngeal areas including the epiglottic vallecula, arytenoid, and postcricoid area. In both cases, LPR involvement was suspected before the onset of radiation therapy. The two cases presented here, indicated a causal relationship between LPR and radiation-induced mucositis. In cases of severe mucositis in the perilaryngeal area in patients with LPR prior to radiation therapy, PPI administration may be an effective therapeutic option.

OBJECTIVE: To assess the efficacy and safety of a single administration of vitamin D3 for postoperative hypoparathyroidism. PATIENTS AND METHODS: Twelve patients with postoperative hypoparathyroidism were enrolled for this study. They had taken calcium and vitamin D3 orally after the surgery and had shown no symptoms of hypoparathyroidism. Then, all patients had changed their regimen to a single administration of vitamin D3 (1α(OH)D3) with monitoring of serum calcium, urine calcium (u-Ca) and creatinine (u-Cre). The dose of vitamin D3 was started at 2.0μg/day and appropriately adjusted to maintain the ratio of u-Ca and u-Cre (u-Ca/u-Cre) at less than 0.3. The physical findings were carefully checked and the serum intact-parathyroid was also estimated. Those data and physical findings were monitored for at least two years. RESULT: The maintenance dose of vitamin D3 varied from 0.5 to 3.5μg/day, and the mean dose was 2.04μg/day. All patients tolerated changes of regimen without any symptoms of hyper-/hypocalcemia. CONCLUSION: A single administration of vitamin D3 is not only safe but also an easy and cost-effective regimen. This also makes drug control easy and worthwhile both for patients and clinicians. LEVEL OF EVIDENCE: 2c.

OBJECTIVE: Stenosis of a permanent tracheostoma after total laryngectomy lowers postoperative quality of life (QOL), and its prevention is clinically important. METHODS: From April 2003 to March 2009, the authors performed 87 permanent tracheostomies. For the purpose of prevention of tracheostomal stenosis, we had applied new technique from October 2005. RESULTS: The incidence of the tracheostomal stenosis was retrospectively reviewed. Until September 2005, conventional permanent tracheostomy was applied for 33 cases and tracheostomal stenosis developed in 6 cases (18.2%). On the other hand, stenosis did not develop in any of the 54 cases in which the new technique was used. The triangular method was significantly superior to the conventional method in preventing stenosis. Stomal recurrence did not develop in either technique. CONCLUSION: The key point of the new technique is as follows: at the upper end of trachea, the posterior part of tracheal cartilage is preserved and the anterior edge of the tracheostoma is made much lower. The shape of the tracheostoma approximates a triangle, and the area is greater than with other methods. From our experience, this technique is safe and effective for the prevention of tracheostomal stenosis.