Sentinel lymph node (SN) biopsy for head and neck cancer has already been recognized as a standard procedure in Europe and the United States. In Japan, it has only been described in the Japanese Clinical Practice Guidelines for Head and Neck Cancer (2018), and should be regarded as a standard procedure to be covered by insurance in the future. For this purpose, the results of the multicenter phase III trial on SN biopsy for oral cancer as a part of the “Cancer Clinical Research Project” (director Yasuhisa Hasegawa), supported by the Health Labor Sciences Research Grant, will be published in the near future.

The SN forms a microenvironment susceptible to metastasis due to the effects of vascular/lymphangiogenic and immune factors secreted by primary tumors. Therefore, basic research on the SN is significant for elucidating the mechanism of lymph node metastasis. In the future, clinical and basic research on the SN will be simultaneously conducted.

Cochlear implantation (CI) is a major treatment for inner ear deafness. We have recently performed the procedure in cases with labyrinthitis or ossified cochleas, which were previously considered as contraindications, because it is now possible to assess cochlear ossification by high-performance CT and also assess the cavities of the cochlea by three-dimensional MRI. We encountered 9 adult cases of ossified cochleas detected intraoperatively, and assessed the auditory thresholds and speech recognition scores (word and sentence) according to the grades and causes of ossification in these cases.

We performed CI surgery in 370 adult cases from 1985 to 2014, and found ossified cochleas in 9 of the 370 patients (2.4%; male:female, 4:5). We classified the 9 cases into grade I or grade II, depending on the extent of ossification of the cochlea, and into a group with deafness caused by meningitis or another with deafness of other causes, depending on the cause of the deafness. We compared speech recognition among all the groups. In the comparisons in the groups classified by the extent of ossification, the mean auditory threshold was 35.0 dB in the grade I group, and 33.6 dB in the grade II group; the mean word recognition score (WRS) was 38.0% in the grade I group, and 71.0% in the grade II group; the mean sentence recognition score (SRS) was 35.0% in the grade I group, while it was 72.4% in the grade II group. While no significant difference was apparent in the auditory threshold between the two groups, the WRS and SRS were better in the grade II group than in the grade I group. In the comparison of the groups classified according to the cause of ossification, the mean auditory threshold in the group with deafness secondary to meningitis was 44.5 dB, while that in the group with deafness secondary to other causes was 26.0 dB. The mean WRS/SRS in the two groups were 18.8%/19.5% and 86.4%/84.8%, respectively. Thus, all of the auditory threshold, WRS and SRS were significantly better in the group with deafness secondary to other causes than in the group with deafness secondary to meningitis. These results may be attributable to the small number of residual spinal ganglion cells in the cochleas in cases of deafness associated with meningitis or labyrinthitis. We expect good speech recognition after CI in cases with suspected cochlear ossification, based on the imaging findings, without meningitis or otitis interna.

An imaging study, especially magnetic resonance imaging (MRI), is essential in order to differentiate idiopathic sudden sensorineural hearing loss from acute sensorineural hearing loss of any other etiology. As for MRI modalities to examine a tumor in the internal auditory canal and/or cerebellopontine angle, T1-weighted enhanced and T2-weighted imaging is useful. Recent reports indicate that fluid attenuated inversion recovery (FLAIR) imaging is sensitive in detecting elevated protein levels in fluid. A high intensity signal on FLAIR imaging in the inner ear suggests some pathology of the perilymph and endolymph such as hemorrhage, inflammation, or neoplasm (e.g. a schwannoma). We herein present four cases of acute sensorineural hearing loss with vertigo, which showed abnormal signals in the inner ear on FLAIR imaging and T1-weighted imaging. In all cases, the hearing levels showed no or little improvement despite high dose steroid therapy. These cases indicate the importance of evaluation of FLAIR and T1-weighted imaging in patients with acute sensorineural hearing loss and the possibility of novel etiological concepts of acute sensorineural hearing loss with vertigo established by MRI examinations.

We herein report a case of a perilymphatic fistula (PLF) that developed following parturition, confirmed by the detection of cochlin-tomoprotein, a specific protein found in the perilymph. A 32-year-old woman presented with vertigo, sudden hearing loss, ear fullness, and streaming water-like tinnitus in her left ear immediately after parturition. She had intense spontaneous and gaze-evoked nystagmus toward the right side. A pure-tone audiogram showed severe mixed-type hearing loss in her left ear. Exploratory tympanotomy was performed 7 days after the symptom onset, because conservative medical treatment had resulted in an insufficient response. Perilymph leakage from the round window was observed in the Trendelenburg position, but no leakage was observed from the oval window. Both windows were sealed with soft tissue grafts. The test for cochlin-tomoprotein was positive in the middle ear lavage fluid. Although the left hearing acuity was unchanged after the operation, the vertigo and nystagmus improved immediately and did not recur. In conclusion, the development of a PLF following parturition is a particularly rare occurrence, and the symptoms of PLF, especially vertigo, are expected to improve with surgery. Therefore, we should recognize PLF as a complication of parturition.

A 56-year-old man visited our hospital with the chief complaint of facial palsy. Although a mass was detected in his right middle ear, he refused to undergo further examination and failed to return for follow-up. When he revisited the hospital 2 years later due to right otalgia, a tumor invading the skull was detected. Because the patient did not wish to undergo surgery, chemoradiotherapy was administered, which resulted in a reduction of the tumor volume. After another 2 years, the tumor regrew and the facial palsy became more severe. Chemotherapy was administered again; however, it was less effective this time, and the tumor gradually became larger and gave rise to multiple metastases in the lung, liver, and bone.

Middle ear carcinoids are relatively rare, and only a few cases of this condition presenting with facial palsy have been reported. These carcinoids are generally considered to be slow-growing, and often follow a favorable course. However, our patient did not wish to receive standard care, and ultimately developed multiple metastases, with an unfortunate outcome.

Thyroid and parotid tumors are commonly encountered by head and neck surgeons, however, it is relatively rare for these tumors to reach giant sizes. There have been no reports of simultaneous treatment of giant thyroid tumors and giant parotid tumors. We report simultaneous resection of a giant thyroid tumor and giant parotid tumor in a 62-year-old woman who had presented with an indolent swelling in the anterior cervical region 10 years earlier, and another in the left parotid region 2 years earlier. In the present medical history, she visited our department due to bleeding from the left parotid tumor. The giant tumor in the anterior neck measured 10×8 cm in size and was elastic in consistency, and the giant parotid tumor measured 9×8 cm in size, with skin infiltration. The cytological findings of preoperative fine needle aspiration cytology from the thyroid tumor and parotid tumor were classified as class I and class III, respectively. We performed simultaneous resection of both tumors. There were no surgical complications, such as recurrent nerve paraly or facial nerve palsy. Histopathological examination of the thyroid tumor revealed follicular adenoma, while that of the parotid tumor revealed carcinoma ex pleomorphic adenoma with extracapsular infiltration, which is suggestive of a high risk of recurrence and metastasis. Therefore, strict follow-up is necessary in the future.

A 66-year-old man presented with the complaint of dyspnea. At the first medical examination, he was found to have cardiac tamponade, which was relieved by pericardiocentesis. Examination of the pericardial fluid revealed malignant cells, and the findings of PET-CT suggested pulmonary metastases from a thyroid cancer. We performed right thyroid lobectomy and histopathological examination revealed histological findings consistent with papillary adenocarcinoma in the form of lymphangiosis carcinomatosa. The patient was then diagnosed as having lung cancer with metastasis to the thyroid gland and cardiac tamponade due to malignant pericarditis. He received chemotherapy for extensive-stage small-cell lung cancer. One year after the surgery, the tumor size of the lung remains small and there is no evidence of any recurrence of cardiac tamponade.

Development of a thyroid metastasis or cardiac tamponade due to malignant pericarditis would seem to represent the terminal stage of lung carcinoma, however, prompt diagnosis and appropriate treatment sometimes improve the prognosis of the patient.

Trousseau syndrome refers to a hypercoagulable state associated with malignancies. It is characterized by venous, and more rarely, arterial thrombosis. The most common pathology encountered in cases with arterial thrombosis is cerebral infarction, which is often multiple and diffusely distributed. Trousseau syndrome is commonly reported in cases of adenocarcinoma and is relatively rare in cases of squamous cell carcinoma. We report a rare case of multiple cerebral infarcts due to Trousseau syndrome in a patient with oropharyngeal squamous cell carcinoma.

A 61-year-old patient who had been treated for Stage IVB oropharyngeal carcinoma presented to our emergency department with double vision, nausea and difficulty in walking. Clinical examination revealed upbeat nystagmus and, raised D-dimer levels, and MRI showed multiple bilateral cerebral infarcts. Anticoagulant treatment was commenced, but the patient died one month after detection of the cerebral infarctions due to disease progression.

When encountering patients with multiple infarctions or recurrent thrombotic episodes, it is important to suspect Trousseau syndrome, and to carry out investigation to detect the responsible occult carcinomas and promptly commence treatment.

We investigated the clinical characteristics and preoperative diagnosis rate of Warthin’s tumor (WT) of the parotid gland. The subjects were 189 patients who underwent operation at the Department of Otolaryngology, Head and Neck Surgery in Osaka Medical College between September 1999 and August 2017. We compared the data of the189 patients with WT with those of 466 cases of pleomorphic adenoma (PA) of the parotid gland seen during the same period.

Among the 189 patients with WT, there were 163 males and 26 females, with a median age of 62 years. The sites of origin of the tumors in the parotid gland were distributed as follows: superficial lobe, 64 cases; deep lobe, 14 cases; lower pole, 111 cases. The median maximum diameter of the tumor was 30 mm. The median operative time and the median operative blood loss were 120 minutes and 20 mL, respectively. The diagnosis had been made accurately prior to the surgery in 72% of the patients, by fine needle aspiration cytology. Postoperative facial nerve dysfunction occurred in 39 cases (20.6%), however, it was transient in all cases. The transient facial nerve dysfunction recovered within 2 months in 50% of cases, within 6 months in 90% of cases, and within 1 year in 100% of cases. The features that were especially frequently encountered in the cases with postoperative facial dysfunction were origin of the tumor in the deep lobe of the parotid and large size of the tumor; furthermore these cases also required a longer operative time.

As compared to PA, WT occurred more often in male patients. The WTs occurred more often in the lower pole and they were larger in size. The operative blood loss was greater. As for the incidence of postoperative facial nerve dysfunction and the operative time, there were no significant differences.