Identification of appropriate tumor markers could improve the survival and functional preservation rates in patients with head and neck cancer.

In this review, four representative serum tumor markers for head and neck cancer—squamous cell carcinoma related antigen (SCC-Ag), CYFRA21-1, carcinoembryonic antigen (CEA), and tissue polypeptide antigen (TPA)—are initially outlined.

Subsequently, the results of a systematic review of original articles published between 1990 and 2015 on the four tumor markers are presented. The sensitivities of SCC-Ag, CYFRA21-1, CEA, and TPA as markers for the diagnosis of head and neck cancer were found to be 30.7%, 50.8%, 23.8%, and 43.9%, respectively. The sensitivity of all four markers increased with progression of the tumor stage. In addition, many reports have shown that SCC-Ag and CYFRA21-1 are also useful for prognostic prediction and as follow-up tumor markers after definitive therapy. The anti-p53 antibody has recently emerged as a novel tumor marker for esophageal, colorectal and breast cancers, the test for this marker being covered by public healthcare insurance in Japan, and its usefulness as a marker for head and neck cancer is also expected.

Finally, our investigation on Midkine, a new serum-tumor-marker candidate for head and neck cancer, is presented. Our results show that Midkine can aid in the detection of head and neck cancer as well as in the prediction of a patient’s prognosis and response to induction chemotherapy. Although the currently known tumor markers exhibit moderate usefulness for prediction of the prognosis and early detection of recurrence after definitive therapy, no sensitive tumor marker exists for the screening of head and neck cancer. Progress in research on sensitive tumor markers for head and neck cancer, including the development of novel substances, is expected.

We report the case of 39-year-old female patient who was diagnosed as having bacterial meningitis (BM) complicating acute otitis media. The patient presented with 5-day history of acute otitis media and a 4-day history of headache, vomiting, and high fever. We diagnosed her as having BM based on clinical evidence of meningeal involvement and the result of a cerebrospinal fluid analysis. The patient was started on intravenous prednisolone and meropenem for empiric treatment of both the BM and sensorineural hearing loss. These treatments led to rapid relief of the patient’s symptoms without any sequela. Temporal-bone CT showed the suggestion of a partial bone defect in the temporal tegmen. Exploratory tympanotomy of the right ear confirmed the presence of the bone defect in the temporal tegmen and the attic was obliterated with a bone plate.

BM is considered as a neurological emergency. The possibility of BM should be borne in mind in patients with otitis media presenting with persistent meningeal symptoms.

Herein, we report three cases diagnosed as having facial palsy concomitantly with herpes zoster in the head and neck region. Case 1 presented with Ramsay Hunt syndrome, and was concomitantly diagnosed as having herpes zoster in the neck skin innervated by the ipsilateral C3 nerve. Case 2 showed facial palsy and herpes zoster in the cheek skin innervated by the ipsilateral 2nd and 3rd branches of the trigeminal nerve. Case 3 showed facial palsy and herpes zoster in the cheek skin innervated by the contralateral 2nd branch of the trigeminal nerve. We treated all three cases using methylprednisolone and aciclovir (or valaciclovir), and both the facial palsy and herpes zoster resolved within four months.

We speculated that in cases 1 and 2, the varicella zoster virus (VZV) that was reactivated in the geniculate ganglion or the trigeminal ganglion was transmitted to other ipsilateral nerves via neural anastomosis. In case 3, we propose two possible mechanisms. The first is that VZV was reactivated in the geniculate ganglion and contralateral trigeminal ganglion simultaneously, although this patient developed neither herpes zoster in the auricle nor complained of hearing loss or vertigo. The second is that herpes simplex virus (HSV) was reactivated in the geniculate ganglion and VZV was reactivated in the contralateral trigeminal ganglion simultaneously.

An 8-year-old girl was brought to the emergency room of our hospital with a right temporal bone fracture sustained when she received a strong blow to the right side of her head in a traffic accident.

She was found to have total right facial palsy on the following day, and was referred to the otolaryngological department 3 days after the injury. Decompression surgery of the right facial nerve was attempted 5 days after the injury, however, at surgery, the patient was found to have developed complete neurotmesis of the facial nerve in the horizontal portion, with a defect about 20 mm in length, caused by the impact of the temporal bone fragments. This was a very rare case of traumatic facial palsy caused by a temporal bone fracture.

The great auricular nerve was used to reconstruct the facial nerve. The nerves were not sutured to each other, but stuck to each other with fibrin glue.

Approximately a year after the operation, the paralysis grade had improved from grade IV to grade III (House-Brackmann grade), and the Yanagihara score from 0 to incision 24.

In a case presenting with severe temporal bone fracture, it is necessary to recognize the possibility of neurotmesis of the facial nerve and prepare to reconstruct the facial nerve. Various methods of reconstruction of the facial nerve have been discussed in the literature.

Transplantation of the great auricular nerve in the present case was very simple and resulted in a good outcome.

We encountered a patient who developed an infection and eye complications after the use of Gore-Tex^® to treat an orbital floor fracture.

The patient was a 38-year-old man who had undergone plastic surgery for a left orbital floor fracture at another hospital about 20 years earlier. The patient recently experienced the development of left exophthalmos and diplopia and visited an ophthalmologist. A computed tomography examination revealed a calcification shadow in the left maxillary sinus, and the patient was referred to our department. He was diagnosed as having left maxillary sinusitis-induced eye complications, and left nasal endoscopic surgery was performed under general anesthesia. A material assumed to be Gore-Tex^® was present in the maxillary sinus, and this material was considered to have been the cause of the infection. An incision of the canine fossa was performed, and the Gore-Tex^® in the maxillary sinus was removed endoscopically. The postoperative course was favorable, with a reduction in the exophthalmos and an improvement in the diplopia. The possibility of late-onset complications caused by the use of artificial materials to reduce orbital floor fractures should be considered in cases that present with exophthalmos and diplopia.

Injuries of the oral cavity and pharynx are fairly frequent in children, because they often play with foreign objects in their mouths. In most cases, the injury is superficial and heals without any complications. However, objects penetrating into deeper tissues may need to be surgically removed.

We report a pediatric case of an intraoral penetration injury caused by a long piece of a chopstick embedded in the epipharynx after piercing the soft palate. A 1-year-old male child was referred to our hospital emergency unit due to oral bleeding. By the time of the examination, the bleeding from injured soft palate had stopped, and his general condition was good. The chopstick piece was not visible in his mouth or epipharynx. However, computed tomography (CT) revealed the chopstick piece embedded in the epipharynx after piercing the soft palate. We removed the foreign body under general anesthesia on the same day. After the operation, there were no problems, and the child was discharged four days later.

In the case of a child, it is difficult to assess the subjective condition of the patient, identify the site of pain or determine the circumstances of the accident. Even if the foreign body is not identified, it is important to carry out a quick and thorough examination and provied appropriate treatment. In the present case, CT was useful for the diagnosis of the foreign body embedden in the epipharynx, which was not visible from the mouth.

Compensatory hypertrophy of the lingual tonsil can develop after extraction of the palatine tonsil, causing dyspnea and a feeling of suffocation. Sometimes, such patients present with physical airway obstruction, and in some cases, surgical treatment is warranted for the enlarged lingual tonsil. Our patient reported herein presented with inspiratory dyspnea caused by compensatory hypertrophy of the lingual tonsil 20 years after she had undergone enucleation of the palatine tonsil passed after palatine tonsil. We performed extraction of the lingual tonsil using an FK-WO retractor and obtained good results. We present the case herein.

The patient was a 54-year-old woman who presented to our department with the chief complaint of dysphagia, mild dyspnea and dysphonia. The patient had undergone bilateral palatine tonsil enucleation as treatment for sleep apnea syndrome 20 years earlier. The endoscopic findings at the initial diagnosis consisted of a markedly enlarged lingual tonsil with constriction of the pharyngeal cavity at the site. Moreover, a portion of the enlarged tonsil hung down like a pendulum and invaginated into the glottis during inspiration. The patient was diagnosed as having airway stenosis due to compensatory hypertrophy of the lingual tonsil. Because of the difficulty in intubation caused by the enlarged lingual tonsil, we undertook airway maintenance by tracheotomy and induced general anesthesia of the patient. Then, we carried out resection of the enlarged tonsil by Transoral Video-Laryngoscopic Surgery (TOVS) using the FK-WO retractor. We also resected a portion of the epiglottis, because the transformed epiglottis has already become useless. At present, one year since the surgery, there has been no recurrence of the symptoms and the airway continues to be maintained well too.

There have been no other case reports of inspiratory airway obstruction caused by hanging down into the airway, like a pendulum, of a part of an enlarged lingual tonsil.

Malignant tumor originating from the nasal septum accounts for a relatively small number of cases of head and neck cancer. In the early stages, as in cases of other head and neck squamous cancer, resection of the tumor by nasal surgery is the treatment of choice, although some cases with early carcinoma of the nasal septum have been treated by endoscopic surgery. We encountered a case of nasal septum cancer, in which we conducted nasal surgery and reconstructed the nasal bone using a graft from the ilium. The patient was a 63-year-old man who visited our hospital with the chief compliant of recurrent nosebleeds. Examination revealed a tumor of the nasal septum in the left nasal cavity. Contrast-enhanced CT and MRI revealed a mass measuring about 30 mm in diameter showing heterogeneous contrast enhancement. The lesion was found to have invaded the nasal septum cartilage. However, there was no spread to the mucosa lining on the opposite side of the nasal septum. The head side of the lesion was very close to the nasal bone. Therefore, we could not rule out invasion of the nasal bone. On biopsy, the lesion was diagnosed as a squamous cell carcinoma. There was no swelling of the cervical lymph nodes. PET-CT revealed accumulation only in the nasal cavity. There was no evidence of cervical lymph node metastasis or distant metastasis. We scheduled surgery under the diagnosis of nasal cavity cancer, cT2N0M0. By using a nasal endoscope, it was disconnected nostril side and the nasal cavity the bottom side of the tumor. The nasal cavity was accesed by the midfacial degloving method. We excised a part of the nasal bone, the outer nose cartilage and a part of the nasal septal mucousa with a sufficient safety margin. We reconstructed the nasal bone and the outer nose cartilage with a graft obtained from the ilium. The patient has shown no evidence of postoperative recurrence. We selected surgical therapy without radiation therapy/chemotherapy. As a result, we were able to avoid disabling systemic chemotherapy and radiation, and reserve these treatments for any recurrences.

We report the case of a 69-year-old man with NK/T cell lymphoma who developed a recurrent lesion in the larynx after radiotherapy. He presented with the chief complaint of hoarseness, and endoscopic examination revealed inflammation with plaques in the right subglottic area. The diagnosis of extranodal NK/T cell lymphoma was confirmed by biopsy of the laryngeal lesion, and the tumor was treated by radiotherapy. At the 1-year follow-up, endoscopic examination of the larynx revealed that it was tumor-free, and FDG-PET showed no evidence of recurrence. Laryngeal NK/T cell lymphoma is very rare, and a definitive histopathological diagnosis is often difficult due to the location of the tumor and the perilesional inflammation and necrosis.

Idiopathic carotidynia is a rare disease of unknown origin characterized by unilateral cervical pain of carotid-sheath origin and soft-tissue infiltration surrounding the carotid sheath on imaging examination. Herein, we report the case of a 65-year-old male who presented with the chief complaint of left cervical pain. Otorhinolaryngological examination showed mild swelling and tenderness of the left carotid sheath. A plain CT showed soft-tissue infiltration surrounding the left carotid sheath at the level of the left hyoid bone. Laboratory test results were normal. These clinical manifestations and the findings of CT were consistent with a diagnosis of idiopathic carotidynia. The above symptoms were relieved by one-day treatment with an anti-inflammatory drug. Although soft-tissue infiltration of the carotid sheath of in cases of carotidynia on contrast-enhanced CT has been described in previous reports, it was observed on plain, non-contrast CT images in this patient, which allowed avoidance of any anxiety from the point of view of potential contrast medium allergy in our case. From the reports in the literature and data from our own case, we propose a revised classification of carotidynia, dividing it into five categories (i.e. idiopathic, migrainous, arteriosclerotic, drug-induced, and others).

Sven Ingelstedt (1918–1979) was born in Jordberga in southern Sweden. Sven’s friend, Professor Charles D. Bluestone, wrote that during World War II, Sven helped the victims of Nazis who had escaped from Denmark, crossing the Baltic Sea in small boats to Swedish shores. From 1945 to 1971, he studied and subsequently worked at the Department of Otolaryngology, first established at the University of Lund in Sweden. In 1971, Sven was elected Professor of the Department of Otolaryngology in Malmö. The research team led by Ingerstedt is known internationally for its studies of the ears using a pressure chamber. In 1976, Prof. Ingelstedt presented an important report on the treatment of Meniere’s disease based on middle ear micro-pressures produced in a pressure chamber; this led to the development of trans-tympanic micro-pressure treatment for this disease after the professor died. I do not know if he would have supported trans-tympanic micro-pressure treatment, but Prof. Ingelstedt was the pioneer who was the first to find that micro-pressures produced in the middle ear could be used for the treatment of Meniere’s disease.

Acknowledgment: The author appreciates the help of Drs Örjan Tjernström and Margaretha Casselbrant for writing this article.