Authorship：Lead author,　Corresponding author   Publishing type：Research paper (scientific journal)   Publisher：Ovid Technologies (Wolters Kluwer Health)  

File： Verbalization,_Categorization,_and_Evaluation_of.4.pdf

DOI： 10.1097/as9.0000000000000059

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Authorship：Lead author,　Corresponding author   Language：English   Publishing type：Research paper (scientific journal)  

OBJECTIVE: Basic surgical skills such as knot-tying and suturing are important for all otolaryngologists, regardless of subspecialty. The present study was undertaken in order to assess basic surgical techniques such as knot-tying and suturing required for novice otolaryngology residents with taking the variety of subspecialties into consideration, and evaluate the impact of a proficiency-based training curriculum based on these techniques. METHODS: A prospective study was performed for developing of proficiency-based knot-tying and suturing curriculum for otolaryngology residents in the third post-graduate year (PGY-3). The proficiency-based training curriculum was developed based on the tasks selected by RAND/UCLA method with expert panel, which is an iterative and anonymous survey used to establish consensus among participants. Expert panelists were selected from various divisions to reflect variety of their subspecialties. PGY-3 residents trained with the developed curriculum that included proctored pre-test, self-training to proficiency, and proctored post-test. Visual analogue scale (VAS) of trainees' overall competence in the operating room was self-assessed by each resident, before and after completing the training curriculum. RESULTS: Nine PGY-3 residents were enrolled as trainees. Eleven experts chosen as panelists had various subspecialty, including 2 from otology, 2 from rhinology, 2 from laryngology, 2 from head and neck surgery, and 3 from general otolaryngology. Seven tasks were selected from RAND/UCLA method and used to develop the curriculum. Trainee scores at pre-test were significantly lower than expert scores for all 7 tasks (p < 0.01) and each coefficient of variation of trainee score was larger than that of expert score (p < 0.05), supporting construct validity. The mean of composite scores between pre-test and post-test had statistical significance (68.6 ± 11.6 vs 95.9 ± 3.6, p < 0.01), documenting substantial improvement after training. Self-assessment VAS was also improved pre- to post-training (1.2 ± 0.9 vs 4.5 ± 1.4, p < 0.01). A follow-up questionnaire showed that trainees felt the educational curriculum to be beneficial. CONCLUSION: In the present study, seven basic technical skills were selected using the RAND/UCLA method and used to create a proficiency-based training curriculum. Our results indicate that this curriculum significantly improves proficiency of basic surgical skills of junior otolaryngology residents.

DOI： 10.1016/j.anl.2019.11.005

PubMed

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Authorship：Lead author   Language：English   Publishing type：Research paper (scientific journal)  

Delayed cervical lymph node metastasis (CLNM) is the most negative prognostic factor of tongue squamous cell carcinoma (SCC). This study analyzed the relationship between clinicopathologic factors, including anatomic invasive depth (AID), and CLNM. A total of 212 patients with clinically node-negative (cN0) tongue SCC who had undergone partial glossectomy through the mouth were eligible for this retrospective study. The deepest portions where tongue SCC cells invaded as determined by microscopic analyses were classified into 5 categories, including epithelial and submucosal tissue, lateral extrinsic tongue muscle (ETM), intrinsic tongue muscles (ITM), paralingual and sublingual spaces, and medial ETM according to AID. We examined the relationship between clinicopathologic factors including AID and delayed CLNM. Multivariate analysis demonstrated that AID was an independent predictive factor for delayed CLNM (P=0.0022; odds ratio=7.1). Deeper invasion than ITM, including ITM, paralingual and sublingual spaces, and medial ETM, had high sensitivity and negative predictive value for delayed CLNM (94.4% and 95.7%, respectively). Precise elucidation of AID may be useful for the preoperative decision for performing elective neck dissection. None of 11 patients in whom the deepest portion where tumor invaded to lateral ETM (according to AID) showed delayed CLNM, although tongue SCC T4a tumor is defined by the presence of invasion of cancer cells to ETM. Tumors with invasion to lateral ETM might have to be excluded from the pathologic T4a category.

DOI： 10.1097/PAS.0000000000000667

PubMed

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DOI： 10.21203/rs.3.rs-5119611/v1

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Language：Japanese   Publisher：日本喉頭科学会  

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2023&ichushi_jid=J02852&link_issn=&doc_id=20231226240022&doc_link_id=10.5426%2Flarynx.35.148&url=https%3A%2F%2Fdoi.org%2F10.5426%2Flarynx.35.148&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

Authorship：Lead author   Publishing type：Research paper (scientific journal)   Publisher：Japan Broncho-Esophagological Society  

DOI： 10.2468/jbes.74.338

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Language：Japanese   Publisher：(NPO)日本頭頸部外科学会  

頸部郭清術は頭頸部外科医の登竜門的術式であるが,立体解剖の理解が要求され,その習得は若手医師にとって容易とはいえない。今回,学習者のニーズに対応した頸部郭清術教材を開発することを目的とした。ニーズ調査の結果に基づき,頸部の3Dモデルや3DVR動画を含む新しい教材を開発した。開発した教材は,耳鼻咽喉科頭頸部外科医20名によるアンケートで評価され,3Dで立体解剖をイメージできる点や,動画で手術の流れが確認できる点,ステップ分けして知識が解説されている点で,従来の教材と比較して優れているとされた。この教材は,頸部郭清術を学習する若手耳鼻咽喉科頭頸部外科医の新たな教育ツールとして価値があると思われた。(著者抄録)

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Authorship：Lead author   Language：Japanese   Publisher：(NPO)日本頭頸部外科学会  

DOI： 10.5106/jjshns.33.177

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Language：Japanese   Publisher：(一社)日本耳鼻咽喉科頭頸部外科学会  

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Publishing type：Research paper (scientific journal)   Publisher：Japan Society for Head and Neck Surgery  

DOI： 10.5106/jjshns.33.97

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Authorship：Lead author  

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Language：Japanese   Publisher：日本喉頭科学会  

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2022&ichushi_jid=J02852&link_issn=&doc_id=20230111160002&doc_link_id=10.5426%2Flarynx.34.51&url=https%3A%2F%2Fdoi.org%2F10.5426%2Flarynx.34.51&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

Authorship：Last author   Language：English   Publishing type：Research paper (scientific journal)  

OBJECTIVE: This study aimed to reveal the efficacy and safety of intratympanic steroid therapy (ITST) in patients with Bell's palsy and Ramsay Hunt syndrome. METHODS: A literature search was conducted in PubMed, Embase, Ichushi-Web, and Cochrane Central Register of Controlled Trials. Published randomized controlled trial and observational studies, which compared the combination of intratympanic corticosteroids with systemic corticosteroid versus systemic corticosteroid for Bell's palsy and Ramsay Hunt syndrome, were included for meta-analysis. The primary outcome was non-recovery at the end of the study follow-up. Data was analyzed using Review Manager software, and pooled odds ratio with 95% CI were calculated. RESULTS: Three randomized controlled trial and two cohort studies met the eligible criteria, and 350 individuals included for meta-analysis. The timing of intratympanic corticosteroid was varied from once or twice a week to consecutive 10-days. Patients treated with combination of systemic corticosteroids and intratympanic corticosteroids were likely to achieve recovery of normal facial function (OR = 0.36 [95% CI 0.12-1.14]). The subgroup analysis of the timing revealed that daily ITST reduced non-recovery (OR = 0.14 [95% CI 0.04-0.50). However, non-daily ITST did not reduced non-recovery (OR 0.93 [95% CI 0.37-2.34]). CONCLUSION: Intratympanic corticosteroid have a potential to reduce non-recovery in patients with Bell's palsy and Ramsay Hunt syndrome. The methods of intratympanic corticosteroid varied among included studies. Further well-designed randomized controlled trial is needed to confirm the effectiveness and to identify an adequate method of intratympanic corticosteroid in these patients.

DOI： 10.1016/j.anl.2021.12.005

PubMed

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Language：English   Publishing type：Research paper (scientific journal)  

OBJECTIVE: To determine the efficacy of a surgical training model for fluorescence-guided cancer surgery and validate its utility to detect any residual tumors after tumor resection using electrocautery. METHODS: We developed surgical training models containing indocyanine green (ICG) for near-infrared (NIR) fluorescence imaging using a root vegetable organic material (konjac). After the fluorescence assessment for the models, the surgical simulation for fluorescence-guided cancer surgery using electrocautery was performed. ICG-containing tumors were divided into two surgical groups: "Enucleation" (removal of the entire visible tumor) and "Complete resection" (removal of the tumor with an appropriate 5-mm surgical margin). RESULTS: All 12 ICG-containing tumors were clearly visible from the normal view but not from the flipped view. The tumor resection time was significantly longer in the "Complete resection" group than in the "Enucleation" group (p < .001). The ICG-containing tumors showed a high tumor-to background ratio from the normal (average = 45.8) and flipped (average = 19.2) views, indicating that the models including ICG-containing tumors were useful for a surgical simulation in fluorescence-guided surgery. The average mean fluorescence intensity of the wound bed was significantly higher in the "Enucleation" group than in the "Complete resection" group (p < .01). No decrease in fluorescence signal was found in the wound bed even at 2 days postresection. CONCLUSION: Our surgical training model containing a fluorescent agent is safe, inexpensive, not harmful for humans, and easy to dispose after use. Our model would be beneficial for surgeons to learn NIR fluorescence imaging and to accelerate fluorescence-guided cancer surgery into clinical application.

DOI： 10.1002/lio2.858

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Authorship：Lead author   Language：Japanese   Publisher：愛媛医学会  

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Language：Japanese   Publisher：耳鼻咽喉科臨床学会  

症例1(6歳男児)。反復する左頸部膿瘍の精査目的で入院となった。造影CT検査で甲状腺左葉上極内側に含気が認められ、左下咽頭梨状陥凹瘻の疑いで手術が行われた。内視鏡下に送気することで左梨状陥凹に瘻孔が同定されたため摘出した。術後は合併症なく経過し、術後8日に退院となった。症例2(0歳男児)。出生時より左頸部に腫瘤が認められた。画像検査で嚢胞性腫瘤と気管の圧排が認められたため、当科へ紹介となった。造影MRI検査では甲状腺左葉外側に単胞性の嚢胞性病変が認められ、気管は圧排され、右側に偏位していた。鑑別として側頸嚢胞や下咽頭梨状陥凹瘻が挙げられ、生後3ヵ月時に手術が行われた。嚢胞内にピオクタニンブルー溶液を注入することで瘻管を同定され、摘出した結果、術後は経過良好で術後15日で退院となった。

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2022&ichushi_jid=J00580&link_issn=&doc_id=20220610470011&doc_link_id=10.5631%2Fjibirin.115.513&url=https%3A%2F%2Fdoi.org%2F10.5631%2Fjibirin.115.513&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_2.gif

Language：English   Publishing type：Research paper (scientific journal)  

OBJECTIVES/HYPOTHESIS: To determine the relationship between signal intensity on gadolinium (Gd)-enhanced magnetic resonance images and growth of vestibular schwannomas (VSs). STUDY DESIGN: Cross-sectional study. METHODS: In this cross-sectional study, we retrospectively reviewed the data of 31 patients with VSs who underwent magnetic resonance imaging (MRI). The mean signal intensities within the regions of interest in the tumor, pons, and temporal muscles were measured on Gd-enhanced T1-weighted MRI. Relative intensity ratios were calculated as follows: T/N pons ratio (T/Np) is the tumor signal intensity/pons signal intensity and T/N muscle ratio (T/Nm) is the tumor signal intensity/temporal muscle signal intensity. Volume measurements were used to assess the tumor size. Growth rate was determined by assessing previous imaging studies. Growing VS was defined as a tumor with a growth rate >100 mm3 /year. RESULTS: The mean (standard deviation) T/Np and T/Nm were 1.47 (0.27) and 1.50 (0.24), respectively, in nongrowing tumors and 1.78 (0.17) and 1.90 (0.12), respectively, in growing tumors. The T/Np and T/Nm differed significantly between the two groups (T/Np, P < .001; T/Nm, P < .001). Receiver operating characteristic curve analysis showed that cutoffs of 1.56 and 1.76 for T/Np (93.33% sensitivity, 75.00% specificity) and T/Nm (100.00% sensitivity, 93.75% specificity), respectively, could be used to diagnose a growth rate of >100 mm3 /year. The area under the curve was 0.85 (95% confidence interval, 0.70-1.00) for T/Np and 0.94 (0.82-1.00) for T/Nm. CONCLUSION: Growing VSs show higher signal intensities on Gd-enhanced MRI. Thus, measuring the signal intensity of VS on Gd-enhanced MRI may aid in predicting VS growth. LEVEL OF EVIDENCE: 3 Laryngoscope, 132:198-203, 2022.

DOI： 10.1002/lary.29834

PubMed

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Authorship：Lead author,　Last author   Language：Japanese   Publisher：(一社)日本耳鼻咽喉科頭頸部外科学会  

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2021&ichushi_jid=J07551&link_issn=&doc_id=20211201440017&doc_link_id=10.3950%2Fjibiinkotokeibu.124.11_1543&url=https%3A%2F%2Fdoi.org%2F10.3950%2Fjibiinkotokeibu.124.11_1543&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

Language：English   Publishing type：Research paper (scientific journal)  

Surgeons must visually distinguish soft-tissues, such as nerves, from surrounding anatomy to prevent complications and optimize patient outcomes. An accurate nerve segmentation and analysis tool could provide useful insight for surgical decision-making. Here, we present an end-to-end, automatic deep learning computer vision algorithm to segment and measure nerves. Unlike traditional medical imaging, our unconstrained setup with accessible handheld digital cameras, along with the unstructured open surgery scene, makes this task uniquely challenging. We investigate one common procedure, thyroidectomy, during which surgeons must avoid damaging the recurrent laryngeal nerve (RLN), which is responsible for human speech. We evaluate our segmentation algorithm on a diverse dataset across varied and challenging settings of operating room image capture, and show strong segmentation performance in the optimal image capture condition. This work lays the foundation for future research in real-time tissue discrimination and integration of accessible, intelligent tools into open surgery to provide actionable insights.

DOI： 10.1038/s41598-021-93202-y

PubMed

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Publishing type：Research paper (scientific journal)   Publisher：Japan Society for Head and Neck Cancer  

DOI： 10.5981/jjhnc.47.366

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Language：Japanese   Publisher：(一社)日本耳鼻咽喉科頭頸部外科学会  

小児深頸部膿瘍は成人例と異なり、保存的治療で治癒に至る症例が多いため、穿刺や切開排膿等の外科的治療の適応について判断に苦慮することがある。小児ではリンパ節炎が成因であることが多く、抗菌薬治療等の保存的治療が有効である一方で、扁桃炎や唾液腺炎などリンパ節炎以外の原因で生じたと思われる症例では、外科的治療が必要となる場合がある。外科的治療の適応について、これまで感染部位や成因から検討した報告はない。今回われわれは、当科で治療した小児深頸部膿瘍の11例について検討した。感染部位は、咽頭後間隙4例、扁桃周囲3例、耳下腺間隙2例、顎下間隙1例、後頸間隙1例であった。全体で保存的治療のみで治癒に至った症例は11例中7例であり、4例に外科的治療を施行した。感染部位に応じた検討をしたところ、咽頭後間隙の症例は全例保存的治療で軽快したが、扁桃周囲・耳下腺間隙・後頸間隙の症例では、4例に穿刺排膿を施行し、3例は軽快したが生後1ヵ月の女児の1例は排膿不十分で頸部外切開を要した。咽頭後間隙膿瘍では保存的治療を第一選択とするが、扁桃周囲および耳下腺間隙など部位によっては、早い段階での穿刺排膿が有用であると考えられた。(著者抄録)

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2020&ichushi_jid=J01099&link_issn=&doc_id=20201225460005&doc_link_id=1391412881272011520&url=https%3A%2F%2Fcir.nii.ac.jp%2Fcrid%2F1391412881272011520&type=CiNii&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00003_3.gif

Language：Japanese   Publisher：(NPO)日本気管食道科学会  

特発性舌下間隙血腫は非常に稀な疾患であるが、気道閉塞をきたす危険性が高く、気道管理が非常に重要な疾患である。今回、特発性舌下間隙血腫の1例を経験したので報告する。症例は60歳代後半の女性で当院内科に成人T細胞白血病リンパ腫(ATLL)の終末期として入院中であった。症状緩和目的のステロイドでのハーフパルス療法後より咽頭痛、嚥下困難感、口腔内出血を認めたため当科紹介受診した。当科初診時、舌根部に粘膜下血腫による腫脹を認めたが、気道は保たれていた。画像検査から舌下間隙血腫と診断し、4時間後に再度確認したところ血腫は明らかに増大しており、造影CTでその中央部に出血点と思われる造影剤の漏出を認めたため、気管切開と止血、血腫除去術を施行した。術後、血腫は消退傾向を示していたが、術後3日目よりATLLの中枢浸潤と考えられる意識レベルの低下を認め、術後14日目に永眠された。特発性舌下間隙症例に対して、気道に注意して経過をみることで比較的安全に気道確保を行うことができた。出血と血腫に対しては、危険因子に対する治療を行うことで軽快することが多いが、合併症には注意が必要である。(著者抄録)

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2018&ichushi_jid=J01054&link_issn=&doc_id=20180816280006&doc_link_id=%2Fea4broes%2F2018%2F006904%2F006%2F0261-0267%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fea4broes%2F2018%2F006904%2F006%2F0261-0267%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Authorship：Lead author   Language：Japanese   Publisher：(一社)日本耳鼻咽喉科頭頸部外科学会  

頸部神経鞘腫に対する手術は、神経温存を目指した被膜間摘出術など、そのほかの一般的な頸部腫瘍に対する術式とは異なった手技を要する。今回、2000～2016年の間に当科で手術を施行した頸部神経鞘腫の12例について臨床的検討を行い報告する。男性、女性それぞれ6例ずつで、平均年齢は46歳(14～81歳)であった。起源神経は、迷走神経が4例と最多で、交感神経、腕神経叢がそれぞれ2例、舌下神経、鎖骨上神経がそれぞれ1例、不明が2例であった。当科では、術後QOLに重要と考えられる神経については、被膜間摘出術を基本とし、温存を試みている。頸部神経鞘腫は比較的まれな腫瘍であり術前に確定診断を得られないことが多いが、術前の画像検査での腫瘍の形状や部位は、神経鞘腫を疑う上で重要な所見であると考えられた。被膜間摘出術を施行した9例中5例(56%)に術後神経脱落症状を生じた(永続性麻痺4例、一過性麻痺1例)が、特に腫瘍が舌骨より高位である副咽頭間隙に存在した症例で80%(4/5例)と高率であった。舌骨より高位に存在する神経鞘腫では、術後神経脱落症状を生じる可能性が高いことを考慮した上で、慎重に手術適応を検討する必要がある。また、神経温存を目指して被膜間摘出術を行う際には、神経上膜の切開部位に注意を要する。(著者抄録)

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2018&ichushi_jid=J01099&link_issn=&doc_id=20180604410007&doc_link_id=%2Fdz0jibik%2F2018%2F012105%2F007%2F0673-0678%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fdz0jibik%2F2018%2F012105%2F007%2F0673-0678%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Oto-Rhino-Laryngological Society of Japan Inc.  

Surgery for cervical neurinoma requires a different procedure from that for other common cervical tumors, for nerve preservation. We analyzed the data of 12 cases of cervical neurinoma who underwent surgery at our department between 2000 and 2016. There were 6 males and 6 females, and the average age was 46 years (range, 14-81 years). In regard to the nerve of origin, the vagus nerve was the most common nerve of origin of the tumor (4 cases), followed by the sympathetic nerve and brachial plexus (2 cases each), and sublingual nerve/supraclavicular nerve (1 case each)
the nerve of origin remained unknown in 2 cases. At our department, we attempt to perform intercapsular resection to preserve the nerve that is important for maintenance of the postoperative quality of life. Cervical neurinoma is a relatively rare tumor, and it is often not possible to make a definitive diagnosis before surgery. It has been suggested that the shape and the site of the tumor in preoperatively obtained images are important findings in cases of neurinoma. Five of 9 cases (56%) in which we performed intercapsular resection developed postoperative neurological deficits (permanent paralysis in 4 cases, and temporary paralysis in 1 case). Especially, postoperative neurological deficits occurred at a high rate (80%
4/5 cases) in cases where the tumor was located in the parapharyngeal spaces, at a level higher than the hyoid bone. It is necessary to carefully make surgical decisions taking into consideration the fact that postoperative neurological deficits are highly likely to develop in cases where the neurinoma exists at a level higher than the hyoid bone. When performing intercapsular resection aimed at nerve preservation, it is necessary to pay attention to the incision site on the epineurium.

DOI： 10.3950/jibiinkoka.121.673

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Language：Japanese   Publisher：(一社)日本頭頸部癌学会  

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Language：Japanese   Publishing type：Research paper (scientific journal)   Publisher：Japan Society for Head and Neck Cancer  

Cetuximab, a human–mouse chimeric IgG1 monoclonal antibody used against the epidermal growth factor receptor, is approved for the treatment of squamous cell carcinoma of the head and neck. Currently, cases of hypersensitivity to cetuximab are attributed to the production of an IgE antibody specific for galactose-alpha-1,3-galactose (α-Gal) positioned on the Fab portion of the cetuximab heavy chain. Because such IgE antibodies bind to various mammalian proteins, red meat allergy is also related to α-Gal. In addition, tick bites also induce the production of this IgE antibody against α-Gal. Therefore, we retrospectively investigated 17 patients diagnosed with head and neck cancer for the incidence of infusion reactions, following cetuximab chemotherapy from January to December 2013 at the Department of Otolaryngology-Head and Neck Surgery, Ehime University Hospital. We conducted serological analysis for specific IgE reactions to beef, pork, chicken, α-Gal and interviewed the patients to see whether or not they had tick bites. Infusion reactions were observed in 4 patients (23.5%) and IgE antibodies specific for pork, chicken, or α-Gal were detected in 3 of these 4 patients. These data suggest that the infusion reactions resulted from allergic reactions induced by cetuximab-containing α-Gal.

DOI： 10.5981/jjhnc.40.485

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Authorship：Lead author   Language：Japanese   Publisher：(一社)日本頭頸部癌学会  

紡錘細胞癌は同一組織内に扁平上皮癌成分と肉腫様成分を含んだ稀な悪性腫瘍である。また、放射線治療既往を有する症例の割合が高く、再発癌か放射線誘発悪性腫瘍か鑑別を要することがある。症例は62歳、女性。舌右側縁扁平上皮癌(T3N2bM0)にて、超選択的動注化学放射線療法(CDDP+TXT、RT:total 60Gy)を施行した。その後、外来で経過観察していたが、初回治療から約4年後に、舌右側縁後方に有茎性腫瘤の出現を認めた。生検にて肉腫疑いの結果で、舌部分切除術を施行した。病理組織学的検査で紡錘細胞癌と診断した。臨床経過より、本腫瘍は舌扁平上皮癌が放射線治療後に紡錘細胞癌に変化した再発癌であると考えた。現在、術後1年を経過しているが再発は認めていない。(著者抄録)

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2014&ichushi_jid=J04195&link_issn=&doc_id=20141106440011&doc_link_id=10.5981%2Fjjhnc.40.334&url=https%3A%2F%2Fdoi.org%2F10.5981%2Fjjhnc.40.334&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_3.gif

Authorship：Lead author   Language：Japanese   Publisher：日本喉頭科学会  

39歳男性。患者は既往として生下時より多発性の血管腫がみられ、15歳時には頸部血管腫に対する部分切除術が行われた。今回、家人から睡眠時の無呼に対する指摘と居眠り運転で3回交通事故を起こしたため、著者らの施設へ受診となった。内視鏡では上咽頭から軟口蓋・咽頭後壁・左披裂部にかけて連続した血管腫がみられ、左披裂部の血管腫は吸気時に声門に引き込まれていた。また、CTやMRIでもほぼ全身性に広範囲な血管腫が確認され、一方、睡眠時無呼吸検査ではapnea hypopnea index 77.5と高値であった。以上より、本症例では原因と考えられる咽頭血管腫に対し気管切開術後に硬化療法が予定されていたが、気管壁にメスを入れた瞬間に大出血を来し、カニューレ挿入後、人工呼吸下にICU入室となった。対処として自己血・濃厚赤血球輸血が行われたが、咽頭や全身に血管腫の増大が認められ、出血の鎮静化には約1ヵ月を要した。以後、出血量減少と血管腫の縮小を認め、ICU退室後は経口摂取可能となり、カニューレ装着にて患者は退院となった。

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2010&ichushi_jid=J02852&link_issn=&doc_id=20100722390010&doc_link_id=%2Fea7kotou%2F2010%2F002201%2F010%2F0039-0043%26dl%3D0&url=https%3A%2F%2Fwww.medicalonline.jp%2Fjamas.php%3FGoodsID%3D%2Fea7kotou%2F2010%2F002201%2F010%2F0039-0043%26dl%3D0&type=MedicalOnline&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00004_2.gif

Language：Japanese   Publisher：The Society of Practical Otolaryngology  

DOI： 10.5631/jibirin.115.1005

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2022&ichushi_jid=J00580&link_issn=&doc_id=20221108220014&doc_link_id=10.5631%2Fjibirin.115.1005&url=https%3A%2F%2Fdoi.org%2F10.5631%2Fjibirin.115.1005&type=J-STAGE&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00007_2.gif

Language：Japanese   Publisher：(NPO)小切開・鏡視外科学会  

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Language：Japanese   Publisher：(一社)日本頭頸部癌学会  

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Language：Japanese   Publisher：(一社)日本頭頸部癌学会  

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Language：Japanese   Publisher：(一社)日本頭頸部癌学会  

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Language：Japanese   Publisher：(一社)日本頭頸部癌学会  

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Language：Japanese   Publisher：(一社)日本耳鼻咽喉科頭頸部外科学会  

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Language：Japanese   Publisher：(一社)日本耳鼻咽喉科頭頸部外科学会  

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Language：Japanese   Publisher：(一社)日本耳鼻咽喉科頭頸部外科学会  

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Language：Japanese   Publisher：(一社)日本耳鼻咽喉科頭頸部外科学会  

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Language：Japanese   Publisher：The Japan Laryngological Association  

DOI： 10.5426/larynx.33.230

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Other Link： https://search.jamas.or.jp/default/link?pub_year=2021&ichushi_jid=J02852&link_issn=&doc_id=20211228200032&doc_link_id=1390291767737256576&url=https%3A%2F%2Fcir.nii.ac.jp%2Fcrid%2F1390291767737256576&type=CiNii&icon=https%3A%2F%2Fjk04.jamas.or.jp%2Ficon%2F00003_3.gif

Language：Japanese   Publisher：(一社)日本耳鼻咽喉科頭頸部外科学会  

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Language：Japanese   Publisher：(一社)日本頭頸部癌学会  

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Language：Japanese   Publisher：(NPO)日本気管食道科学会  

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Language：Japanese   Publisher：(NPO)日本気管食道科学会  

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