Cisplatin is a potent and pivotal anticancer drug in the treatment of various solid tumors including head and neck cancers. Since the beginning of its clinical use in the early 1980s, cisplatin has been one of the most prevailing and reliable anticancer drugs. Its major limitation, however, is the development of resistance during the courses of chemotherapy.
The mode of action of cisplatin is mediated by the formation of DNA adducts, which activate several signal transduction pathways, eventually leading to cellular apoptosis. Cisplatin resistance depends on a number of factors that reduce drug uptake, promote cytoplasmic detoxification, and increase DNA repair activity. We herein review a novel mechanism of cisplatin resistance involving the transcriptional regulation of DNA repair genes by ZNF143.
ZNF143 is overexpressed in cisplatin-resistant cells, and its knockdown increases sensitivity to cisplatin but not to oxaliplatin, etoposide, or vincristine. We show that ZNF143 is associated with p73, but not with p53. p73 enhances the action of ZNF143 by facilitating the binding of ZNF143 to ZNF143 binding sites and cisplatin-modified DNA. We further present direct evidence that DNA repair genes, Rad51 and FEN-1, are targeted by ZNF143 and overexpressed in cisplatin-resistant cells.
These lines of evidence indicate that the interplay among ZNF143, p73, and ZNF143 target DNA repair genes is responsible for cisplatin resistance. Prediction of cisplatin sensitivity and molecular targeted therapy for ZNF143 remain to be conducted in future basic and clinical studies for managing cisplatin-resitant cancers.

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We report a rare preschool case of Ramsay Hunt syndrome with delayed herpes zoster oticus presentation over a week following facial paralysis.
A 5-year-old girl found by her guardians to have right facial palsy had neither herpetic eruptions nor the eighth cranial nerve disorders on the first visit. She was therefore diagnosed with severe Bell’s palsy (6/40 points) and administered steroid—10 mg/kg of hydrocortisone—alone intravenously for 7 days. On the evening of the last infusion day, she reported right earache and was found to have auricular swelling, after which and the diagnosis was changed to Ramsay Hunt syndrome. Intravenous administration of acyclovir with the same dose of steroid was given, but electroneuronography (ENoG) was 0% on the last infusion day. Following this assessment, transmastoid decompression surgery was conducted on day 16. Her facial movement recovered up to 34/40 3 months postoperatively. Serologically, anti-VZV IgG was significantly elevated.
Viral facial nerve paralysis origin is believed to be by far rarer than pediatric idiopathic facial palsy, so steroid alone is usually administered. Those insufficiently immune to VZV, however, risk early viral reactivation, if acyclovir was given for chicken pox or subjects were affected by varicella before becoming 1 year old. Our case underscores the need to use concomitant antiviral agents with the steroid. Acyclovir should be considered especially in those with suspected low VZV immunity.

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Schwannoma is a neurogenic tumor arising in peripheral nerve sheath Schwann cells. Most head and neck schwannomas occur as acoustic neurinomas, with sinonasal involvement accounting for 3%. Complete resection is vital to preventing local recurrence. Extended resection may be difficult however due to paranasal sinus location. We report a case of sinonasal schwannoma resected in endoscopic sinus surgery and discuss the usefulness of and about indications for intranasal schwannoma treatment.

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Chemosurgery with Mohs’ paste created by Frederic E. Mohs, is microscopically controlled to treat common skin cancer. This was repeated for a 68-year-old woman with recurrent malignant spindle cell carcinoma of the maxillary sinus, who suffered from repeated bleeding and malodorous discharge from outgrowth tumor. After treatment with Mohs’ paste without apparent side-effects, the tumor coagulated, relieving her distress. Chemosurgery with Mohs’ paste is thus useful to improve the quality of life (QOL) in such terminal cases.

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A 65-year-old man admitted for a left parotid tumor and high fever unresponsive to peroral antibiotics was found in gallium scintigraphy to have “hot” spots in the left parotid gland and left maxillary sinus. The ineffectiveness of intravenous antibiotics necessitated open biopsy to histologically diagnose the man’s condition. Surgical parotid gland and maxillary sinus specimens showed necrotizing granulomas with giant cells. Elevated proteinase-3 antineutrophil cytoplasmic antibody (PR3-ANCA) comfirmed a clinical diagnosis of Wegener’s granulomatosis. Treatment with prednisolone and cyclophosphamide led to clinical improvement.
Major salivary gland involvement is rarely a presenting symptom in Wegener’s granulomatosis and correctly diagnosing this condition may increase morbidity due to disease progression.

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Combined small cell carcinoma (CSCC) involves small cell carcinomas and nonsmall cell carcinomas including squamous cell carcinoma (SCC). CSCC of the hypopharynx is extremely rare, with just 5 cases described to date in English literature. A 75-year-old man with CSCC of the hypopharynx seen for abnormal upper gastrointestinal endoscopic findings was found in video hypopharyngoscopy to have a right pyriform sinus tumor. Pathological biopsy findings showed SCC in situ (cTisN0M0). Radiotherapy with 70 Gy brought complete remission. A relapse three months later thought to be recurrent SCC (rT2N2cM0) at the tumor site necessitated total laryngopharyngectomy and bilateral neck dissection and free rectus abdominis flap reconstruction. Pathological findings showed small cell carcinoma. Most radiation-induced cancer arises 10 years later. We think the primary tumor was likely CSCC with SCC. After undergoing two chemotherapy courses (CBDCA+VP-16) for small cell carcinoma, the man died 4 months after surgery. We review the literature and discuss clinical features and management of this rare tumor.

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We report a case of penetrating head injury caused by a chopstick, and report it in the context of the current literature.
A two-year-old girl falling on the morning of September 2, 2009, while walking with a chopstick in her mouth got the chopstick stuck in her throat. Her mother, when removing the chopstick, found the tip gone and the girl was seen for the problem. She presented with a contused wound in the left soft palate, but optical fiberscopy showed no foreign substance. Head and neck computed tomography (CT) and magnetic resonance imaging (MRI) showed a low-density area breaking into the skull from the atlantooccipital joint, consistent with a wooden chopstick. In joint emergency surgery by the neurosurgery and plastic surgery departments, the soft palate was incised along the median line for enhanced visibility and vertebral body C1 confirmed. The mucosa was incised on the median line and vertebral body C1 confirmed. Desquamation was continued and the foreign object found and removed. Neither the epidural venous plexus or dura was damaged. After lavage, fibrin glue was applied, the wound sewn up, and the surgery completed.
The postoperative course was good and the girl was discharged on September 10, postoperative day 8.

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We reported a rare case of venous aneurysm of the right anterior jugular vein. A 60-year-old woman seen for right anterior neck swelling had a soft mass under the platysma that was enlarged by Valsalva’s maneuver. Physical findings, ultrasonography, computed tomography (CT), and magnetic resonance imaging (MRI) suggested a venous aneurysm. Complete surgical resection under general anesthesia involved no complications. Histopathologically, the aneurysm had thrombosed. The postoperative course has remained uneventful.

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We report a case of actinomycosis involving penicillin allergy. A 39-year-old man was referred to us with left upper neck mass with tenderness. After antibiotic therapy, the neck mass was surgically excised under general anesthesia. The pathological diagnosis was actinomycosis. Due to his penicillin allergy, the man was administered clarithromycin for three months after surgery. No recurrence has occurred in the 2 years since treatment.
The incidence of symptomatic actinomycosis, an unusual chronic infectious granulomatous disease caused by the anaerobic gram-positive bacterium Actinomyces israelii, has decreased as antibiotics use has spread. Because actinomycosis commonly appears as a pseudotumor mass, it must be differentiated from other tumors, particularly malignancies. Almost all actinomycosis require long-term penicillin therapy. Our case demonstrates an alternative to penicillin for those with actinomycosis but allergic to penicillin.

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CDDP and 5-FU (CF) therapy is widely used chemotheraphy in head and neck cancer, although acute neurotoxicity is rare and poorly recognized. We report a case of CF-induced hyperammonemia encephalopathy in epipharynx cancer. A 68-year-old man with a epipharynx cancer history underwent CDDP 100 mg/body weight and 5-FU 1000 mg/body weight continuously infused for 5 days. During the second chemotherapy cycle, suddenly he showed onset of confusion and cognitive disturbances unexplained by any other radiographic examinations or laboratory tests except hyperammonemia. High-volume drip infusion within 24 hours resolved the encephalopathy. Ammonia accumulates in the body under insufficient catabolism due to impaired urea cycle. Excessive ammonium production from 5-FU catabolites and aggravating factors such as renal dysfunction, constipation, and body weight loss may explain such transient hyperammonemia. The incidence of 5-FU-induced hyperammonemia is thus an adverse event to be monitored and decreased by being aware of renal dysfunction, taking measures against constipation, and implementing nutritrional management.

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With complex nasal sinus anatomy difficult to understand, we designed a three-dimensional (3D) cubic paper sinus model for ENT residents. Seven subjects then put the model together and took it apart. Their understanding of sinus anatomy was assessed in multiple-choice questionnaires before and after training. All subjects’ scores improved through training (167%, p=0.005)—particularly identification of anatomical parts in the axial plain schema (308%, p=0.007). These results show that 3D anatomical understanding improved dramatically. Training with the 3D cubic paper model thus proved cost-effective for ENT residents.

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