Unfortunately, the prognosis of patients with malignant tumors of the maxillary sinus is still poor. Some of the issues related to treatment of malignant maxillary sinus tumors are the poor prognosis and diminished quality of life of the patients after treatment. The low incidence of malignant maxillary sinus tumors has precluded the conduct of high-evidence clinical trials. The anatomy of the maxillary sinus is such that it interferes with complete resection, thereby leading to a diminished quality of life. Under these circumstances, multidisciplinary therapy, consisting of surgery, irradiation, and intra-arterial infusion of 5-fluorouracil, has been undertaken for the treatment of malignant maxillary sinus tumors in Japan, and better results than those reported from other countries have been obtained. Recently super-selective high-dose intra-arterial infusion of cisplatin with concomitant radiotherapy has been employed. At present, a clinical study non-surgical treatment for advanced maxillary sinus carcinoma by the Japanese Clinical Oncology Group (JCOG1212) is underway. Surgical treatments, including as part of multidisciplinary therapy, and non-surgical treatments have both yielded similar good outcomes in Japan. However, cases with T4b disease still show a poor prognosis. Based on the National Comprehensive Cancer Network (NCCN) guidelines treatment strategy of T4b cases is written as three options consisted of clinical trial, definitive radiation, or systemic therapy/radiation. However, the prognosis of patients who received treatment according to the NCCN guidelines was still poor. Therefore, effective treatment for malignant maxillary sinus tumor patients with T4b disease remains an issue that needs to be addressed. At Jichi Medical University Hospital, about two-thirds of patients with T4b disease receive multidisciplinary therapy, consisting of surgery, irradiation, and intra-arterial infusion of 5-fluorouracil. The majority of T4b cases at this hospital are diagnosed as cases with T4b disease because of middle cranial extension. Segmental resection of the outer portion of the middle cranial lesion could be performed as multidisciplinary therapy. Such segmental resection has been shown to be safe and to allow complete resection. The 5-year overall survival rate of patients with T4b cancer extension is about 50%. Surgical resection of middle cranial lesions could improve the prognosis of T4b cases.

HDR syndrome is an autosomal dominant disorder characterized by hypoparathyroidism, sensorineural deafness, and renal dysplasia. Herein, we present a case of HDR syndrome caused by a GATA3 mutation.

A 12-year-old girl presented with congenital bilateral sensorineural hearing loss. She had presented to our hospital in early childhood for assessment of her hearing ability. Conditioned orientation response audiometry and auditory brainstem response examination had demonstrated bilateral moderate sensorineural hearing loss at the age of 6 months. She received bilateral hearing aids after the diagnosis. She presented with cramping pain in her hands and legs after the age of 8 years. Physical examination revealed signs of hypoparathyroidism. Her father also presented with cramping pain in his hands and legs, and was diagnosed as having hypoparathyroidism. His hearing examination demonstrated bilateral hearing loss. On the basis of these findings, the girl and her father were suspected as having HDR syndrome. Mutation analysis revealed a heterozygous nonsense mutation in the GATA3 gene, which confirmed the diagnosis of HDR syndrome in both the girl and her father.

We analyzed her hearing ability from 4 to 12 years of age, which revealed that her hearing loss progressed with age. The average annual threshold deterioration was 1.3 dB/year until the 10 years of age and 8.3 dB/year after the age of 10 years. These results indicate that subjects with HDR syndrome may show progressive sensorineural hearing loss in childhood, especially after 10 years of age.

Herein, we report a case of a branchial fistula with the characteristics of both first and second branchial cleft anomalies. A 17-year-old boy presented to us with a history of repeated episodes of otorrhea since childhood. A congenital fistula was detected in the lateral neck, which ran from the external auditory canal to the tonsillar fossa. The fistula tract was resected via a cervical approach. Part of the tract was surrounded by the styloglossus muscle. Injection of gentian violet was useful for identifying the tract. Although the facial nerve was preserved, transient facial palsy occurred. The possibility of such an unusual tract of the fistula must be borne in mind.

Postoperative maxillary cyst is a cystic disease that is known to occur after Caldwell-Luc operation of the maxillary sinus. The curative treatment for this condition is surgery. In recent years, endoscopic sinus surgery for open cysts has been widely performed and good treatment outcomes have been reported. However, the symptoms recur in same cases as a result of stenosis or closure of the fenestrae after surgery, and it is rather difficult to treat such cases. In particular, when the cyst is in front of the maxilla and in contact with the osseous nasolacrimal duct, it is difficult to open the cyst widely during normal endoscopic sinus surgery. For such cases, endoscopic modified medial maxillectomy can be used to treat cysts in a wide operative field. Furthermore, by opening the nasolacrimal ducts, the cysts can be widely fenestrated to the nasal cavity.

A parotidectomy may cause facial contour defects or Frey’s syndrome, which are significant sources of cosmetic morbidity and postoperative dissatisfaction. Various grafts have been used to reconstruct these defects, such as a platysma flap, sternocleidomastoid muscle flap, and free dermal fat graft (FDFG). These pedicle flaps have a good blood supply but have restrictions in the coverable area, such as being limited to the upper and medial sides of the parotid gland. On the other hand, the FDFG has advantages in covering upper and medial side defects, and in being able to be trimmed to match the dimensions of the recipient site.

We report herein on the case of a 22-year-old woman with a pleomorphic adenoma of the parotid gland. She underwent lateral parotidectomy with FDFG reconstruction to fill the defect of the parotid gland. She achieved a favorable cosmetic result and did not develop Frey’s syndrome.

Postoperative management included careful observation of the surgical site, especially for the recipient site. Although few complications associated with FDFGs have been reported, infection and necrosis of the graft may develop. Since smoking, diabetes, and a comorbid vascular disease status could impact the survival of the graft, it is important for clinicians to be attentive to comorbid disease. The FDFG achieves revascularization through the dermal side of the graft, and the graft should be sutured in place with the dermal side adjacent to the hyper-vascular site (which is the skin flap side in head and neck surgery). Previous work indicated that the FDFG is expected to contract by up to 33% in the months after transplantation, and overcorrection of 20–30% is recommended due to the expected resorption.

We report herein on a very rare case of a pharyngeal and esophageal submucosal abscess cured with conservative treatment. A 71-year-old man was admitted to the emergency department of our hospital with a sore throat and dysphagia, and visited our department the following day. Laboratory tests revealed leukocytosis and elevated C-reactive protein levels. At the initial visit, Endoscopic findings revealed a noticeably swollen pyriform sinus and a white elevated lesion in the left arytenoid region. CT showed low density areas in the left hypopharynx and esophageal right wall. On the same day, upper gastrointestinal endoscopy revealed edema-like swelling of inner wall of the esophagus over almost its entire length, and an ulcerous lesion was found at the entrance. We could not, however, detect any foreign body on CT and upper gastrointestinal endoscopy. Inflammation was confined to under the mucosa and had not spread out of the esophageal wall, so we selected conservative treatment. On the sixth day after admission, an endoscopic examination confirmed drainage into the cavity was via multiple fistulae on the inner wall of the esophagus. Therefore, we continued conservative treatment without any external incision. He recovered steadily thereafter and was discharged on the 28th day after admission. In cases with sore throat, dysphagia and a marked inflammatory response, it is important to perform a CT examination of the chest and make an early diagnosis.

We report herein on a case of a fishbone foreign body which had migrated through the thyroid. A 77-year-old female noticed a sore throat after she had eaten snapper for dinner. She visited at our hospital the same night, because the symptom did not improve after swallowing cooked rice. No foreign body was observed in the pharyngeal cavity. However, CT imaging revealed the presence of foreign body in the thyroid gland. As the foreign body was close to the common carotid artery, the foreign body was removed with a external incision in the neck. It is very rare for a foreign body to migrate through the thyroid gland. When encountering any such case, the clinician needs to select the extraction method carefully.

Introduction

Although many tumors arising from parapharyngeal space are benign, we sometimes find malignant tumors. We have attempted to examine the clinical findings of parapharyngeal tumor in our institution and to consider how to deal with malignant tumor.

Materials

There were 29 cases of parapharyngeal space tumors involving malignancies in our institution.

Results

There were 20 benign cases composed of 7 cases of schwannoma, 6 cases of pleomorphic adenoma, 3 cases of paraganglioma, and one case each of cavernous haemangioma, cyst and meningioma, basal cell adenoma. On the other hand, there were 4 malignant tumors composed of one case each of malignant schwannoma, carcinoma ex pleomorphic adenoma, adenoid cystic carcinoma and malignant paraganglioma. We presumed that one cases out of the 4 malignancies cases was a malignant tumor from the preoperative image findings. However, it was difficult to diagnose the other 3 cases with malignancies by investigation.

Discussion

Malignant tumors occurring in the parapharyngeal space were distributed salivary gland tumors and others. Because salivary gland tumor grow earlier and invade muscles, nerves and vessels rapidly, it is difficult to treat them radically. On the other hand, because the tumors arising from the salivary gland have a specific pathology, and exhibit slow growth, patients can expect a long life term despite having such tumors. In our examination, death occurred in one case only, the carcinoma ex pleomorphic adenoma.

A patient with the supraglottic type of laryngeal cancer (T4aN2cM0 Stage IVA) underwent chemoradiotherapy as the initial treatment, and a complete response had been observed. Eleven months later, however, he was diagnosed as having lung metastatic recurrence of laryngeal cancer. The lung metastasis disappeared following administration of medium-dose docetaxel for about four years. It has been reported that an average life expectancy of 120 days is associated with the chemotherapeutic outcome of treatment for metastasis to the lung from head and neck squamous cell carcinoma. In our case, however, survival of more than 5 years from onset of metastasis has been achieved. The patient has not suffered from any serious adverse event besides mild depilation and myelosuppression during the treatment. The burden on the patient was small with continuation of all activities of daily living. This infusion method could therefore be considered as a treatment that could preserve the quality of life of similar patients.