Recurrent or metastatic head and neck squamous cell carcinoma (R/M HNSCC) is an aggressive disease characterized by rapid progression and resistance to treatment and thus has a poor prognosis. The median survival time of R/M HNSCC patients is only 6 months to 12 months, and treatment goals now focus not only on prolonging survival but on improving the patient’s quality of life. Traditional treatments, including cisplatin-based chemotherapy and combination therapy with the monoclonal antibody cetuximab, have provided limited success. Patients with cancers resistant to platinum-based therapies used to have no standard treatment options, which severely restricted available treatment choices.

The 2016 Checkmate-141 trial, led by Ferris and colleagues, demonstrated the efficacy of the immune checkpoint inhibitor nivolumab in R/M HNSCC patients, and it significantly improved overall survival. Based on the CheckMate-141 trial, in 2017, nivolumab was approved for the treatment of recurrent or metastatic head and neck cancer in Japan.

This article discusses the effectiveness and safety of nivolumab, and draws on real-world data obtained in research conducted by the author. It also addresses challenges and prospects for improving treatment outcomes in R/M HNSCC.

We report a case of acoustic trauma of the right ear caused by airbag inflation. A 45-year-old man became involved in a car accident, in which as he was stopping his car, another vehicle collided with his car from behind and at the moment of the collision, the driver’s air bag inflated. Soon after the accident, he noticed hearing loss in the right ear. Examination revealed normal tympanic membranes bilaterally. Pure-tone audiometry revealed a moderate sensorineural hearing loss (41.3 dB) in the right ear. The patient was treated for 9 days with a tapering course of methylprednisolone injections, but the hearing loss persisted.

The case underscores the importance of being aware that airbag inflation can produce hearing loss.

We conducted a clinical study of 65 patients (83 fistulas) with congenital aural fistula who had undergone surgical treatment at our hospital during the 12-year period from January 2012 to December 2023. The 65 patients included 23 male and 42 female patients aged between 2 and 89 years (mean age, 24.7 years; median age 17 years); the majority were teenagers. The site of occurrence of the fistula was the pre-helix in 65 fistulas (78.3%), the crus helix in 15 fistulas (18.1%), and the crus antihelix in 3 fistulas (3.6%). Bacteriological examinations were carried out for 25 fistulas. The results revealed only aerobic bacteria in 7 fistulas (28.0%), only anaerobic bacteria in 3 fistulas (12.0%), aerobic plus anaerobic bacteria in 4 fistulas (16.0%), commensal bacteria in 1 fistula (4.0%), and harmful bacteria in 10 fistulas (40.0%). The operation was performed in the presence of inflammation in 34 fistulas (50.0%), within one month of resolution of inflammation in 9 fistulas (13.2%), more than one month after resolution of inflammation in 12 fistulas (17.6%), and the time of resolution of inflammation was unknown in 13 fistulas (19.1%). The duration of operation and postoperative hospitalization period did not differ significantly between single and multiple infected fistulas, or between fistulas operated upon in the presence of inflammation and those operated upon after resolution of the inflammation. Among the 68 fistulas operated upon in the presence of inflammation or after resolution of the inflammation, recurrence occurred in 3 fistulas (4.4%). Based on the results of this study, we concluded that aggressive wide excision surgery, including removal of the scar tissue and abscesses, should be actively performed in cases where the conservative treatment period may be prolonged or skin damage may remain even during infection, regardless of the number of infectious episodes, in order to quickly relieve the patient distress.

We present a comprehensive analysis of 13 cases of pyogenic granuloma (PG) occurring in the nasal cavity, a relatively uncommon site of occurrence of this vascular tumor. This study was focused on cases that underwent surgical excision of these tumors in our operating room over the 10-year period from April 2013 to March 2023. Detailed examinations and reviews of the patient’s charts were conducted to investigate the age at the time of surgery, gender, pregnancy-related factors, laterality, symptoms, preoperative imaging findings, site of occurrence, surgical methods used, pathological findings, and observation periods.

The age at surgery varied across a broad spectrum, encompassing both young and elderly individuals. Nasal bleeding emerged as the predominant symptom, with a higher incidence of the tumor in the anterior nasal septum and inferior turbinate regions. Surgical interventions were consistently conducted through an intranasal approach, with no instances of external incisions or preoperative arterial embolization. The excised tumors ranged in size from 4 to 27 mm, with those originating from the lateral nasal wall being larger than those arising from the nasal septum side.

Pathologically, the tumors were lined with squamous epithelium, suggesting a potential link to inflammation induced by external stimuli, particularly in the anterior nasal cavity, possibly triggering squamous metaplasia. Despite the observation period extending up to a maximum of 5 months, there were no instances of recurrence, indicating a favorable outcome in these cases of nasal PG cases.

Postoperative maxillary cysts are lesions that occur after Caldwell-Luc surgery. For the cysts that are widely in wide contact with the lateral wall of the nasal cavity, fenestration can be performed using a standard endoscopic sinus surgery procedure. It has been reported that it is important to cover the fenestrated bone wall with a mucosal flap to prevent reclosure of the cyst wall. In recent years, there have been reports of application of the endoscopic modified medial maxillectomy (EMMM) approach for various maxillary sinus lesions.

Herein, we report a case of performing surgery using the EMMM approach for a patient with a postoperative maxillary cyst. The patient was a 60-year-old woman who presented with the chief complaint of right cheek pain. She gave a history of having undergone bilateral Caldwell-Luc surgery at the age of 15 years. Computed tomography revealed the presence of bilateral maxillary postoperative maxillary cysts. The cyst on the left side was in contact with the lateral wall of the inferior meatus, whereas the cyst on the right side located cranially, lateral to the nasolacrimal duct, showed almost no contact with the inferior meatus. We performed fenestration using the EMMM approach for the cyst on the right side using a navigation system. The fenestration was covered with a middle meatal mucosal flap to prevent cyst reclosure.

Until now, 6 months since the surgery, the cheek pain has not recurred, and CT showed that the cyst cavity opened into the middle meatus.

Forestier’s disease is characterized by continuous ossification of the anterior longitudinal ligament of the vertebral bodies, leading to pharyngeal discomfort and dysphagia, although bilateral vocal cord motion impairment has rarely been reported. We report a case of Forestier’s disease who presented with concurrent bilateral vocal cord motion impairment. A 77-year-old man presented to our department with a 2-month history of persistent hoarseness. Laryngoscopy revealed swelling of the posterior wall of the hypopharynx and impaired motion of the left vocal cord. Over the next 2 days, the patient developed progressive dyspnea, reduced oral intake, and audible stridor and returned to our department, where examination revealed bilateral vocal cord motion impairment. We urgently admitted the patient to the hospital and performed a tracheotomy on the same day. Endoscopic examination of the pharynx under general anesthesia revealed an ulcerative lesion in the postcricoid area. Computed tomography (CT) showed anterior osteophytes at the fourth to fifth cervical vertebrae, and videofluoroscopy (VF) revealed contact between the osteophytes and the postcricoid area during swallowing, which led us to attribute the vocal cord motion impairment to Forestier’s disease. The clinical presentation strongly indicated the involvement of Forestier’s disease in the vocal cord motion impairment. As radical treatment, we performed cervical osteophytectomy in collaboration with our orthopedic surgery department, and the patient showed postoperative improvement of vocal cord motion and swallowing function.

Forestier’s disease should be considered as a cause of vocal cord motion impairment, and endoscopic examination may be useful for evaluating ulcer formation. It is necessary to consider indications for surgery, as in some cases, vocal cord motion impairment due to this disease can be corrected by osteophytectomy.

Spindle cell lipoma is a subtype of lipoma, and is a relatively rare tumor of the head and neck region. In this report, we describe a case in which the tumor was initially suspected as a schwannoma, because aspiration cytology revealed spindle-shaped cells and MRI revealed no evidence of a lipoma.

Case: 32-year-old, male. Main complaint: Tumor on the right side of the neck. Current medical history: The patient presented to us for the first time with an 8-year history of discomfort on the right side of the neck. Thorough examination by a local doctor performed 5 years before his first visit had revealed no evidence of malignancy, and the patient was kept only under observation. Due to gradual increase in size of the tumor, 2 months prior to his visit to our hospital, the patient visited the same doctor; an imaging study ordered by the doctor revealed signs of a schwannoma. A subsequent fine-needle aspiration cytology also detected spindle-shaped cells, which led to the diagnosis of schwannoma. The patient was then referred to our department for surgery. Although we suspected schwannoma based on the shape of the tumor on the MRI findings, we also considered the possibility of solitary fibrous tumor or Castleman’s disease in the differential diagnosis, and scheduled the patient for surgery with informed consent. If it was a schwannoma, we thought it would be of sympathetic origin, but there was no intraoperative continuity with the nerve, and the entire tumor could be removed intact, with no postoperative neurological deficits occurred. The postoperative histopathological findings indicated that the tumor was a spindle cell lipoma.

Spindle cell lipoma in the neck is relatively rare, and there are reports of cases in which the rare tumor is initially suspected as a schwannoma. We report this case with a review of the literature.

Among surgical cases of malignant thyroid tumors, metastatic tumors are rare. The most common primary sites for metastatic thyroid tumors are the kidney, lung, and breast, and metastasis from colon cancer is quite rare. In this study, we report a rare case of a 65-year-old man who was diagnosed as having a thyroid metastasis after surgery for colon cancer. One year after undergoing partial colon resection and combined diaphragmatic resection for colon cancer at our department of surgery, he was referred to our department because of an enlarged mass in the right lobe of the thyroid gland noted on a CT scan. Three months after his initial visit to our department, we performed right lobe thyroidectomy + D1 dissection. Postoperative histopathological examination revealed moderately differentiated adenocarcinoma, and we made the diagnosis of thyroid metastasis from colorectal cancer. One month after the thyroid surgery, the patient was initiated on treatment with 8 courses of mFOLFOX6 + panitumumab therapy administered once every 3 weeks. Until now, 2 years and 2 months since the thyroid surgery, the patient has shown no evidence of recurrence. There have been only 27 case reports of thyroid metastasis from colorectal cancer in Japan. There is still no consensus on whether surgery should be recommended or not. Many reports indicate that surgery is the treatment of first choice when the primary tumor is under control and resectable and there are no synchronous metastases in other organs. Chemotherapy is selected as the treatment of first choice in many cases. The number of chemotherapy regimens for colorectal cancer has been increasing in recent years, and we hope that the prognosis of patients with thyroid metastases from colorectal cancer will also improve further in the future. It may be necessary to recognize the possibility of thyroid metastasis as well as primary thyroid cancer in patients with a history of colorectal cancer.

Hemangiomas and vascular malformations commonly occur in the extremities and head and neck region, and were previously often referred to collectively as “hemangiomas.” However, it has been proposed that hemangiomas and vascular malformations be distinguished from each other, based on the difference in the vascular endothelial cell dynamics. Most of these diseases in adults that were previously called “hemangiomas” are thought to have been vascular malformations. Herein, we present a case of a vascular malformation in the submandibular region that was accompanied by the formation of internal phleboliths. We report the case here along with a review of the literature.

The patient was a 64-year-old woman who presented to us with a left submandibular mass that she first noticed about a month and a half before visiting our department. She was referred to our department for detailed examination and treatment. On physical examination, we found a hard and highly mobile mass measuring 30 mm in diameter in the left submandibular region, that was not tender to palpation or accompanied by facial nerve palsy. Based on the findings of ultrasonography imaging, fine-needle aspiration cytology, etc., we made the diagnosis of a vascular malformation with a phlebolith, and performed surgical resection. It has been reported that 5%–20% of all vascular malformations in the head and neck region show formation of phleboliths. Among these, phlebolith formation appears to be the most common in vascular malformations occurring in the submandibular region, as in this case. In the patient reported herein, the vascular malformation in the submandibular region was slightly deep under the body surface, and it was expected that there would be phlebolith formation inside and no feeding vessels. In this case, surgical resection was performed as in previous reports.

When selecting a chemotherapy regimen for recurrent or metastatic head and neck cancer, we believe that it is important to aim to extend the survival while also maintaining and improving the quality of life as much as possible. In recent years, outpatient cancer chemotherapy has been increasing in Japan. Since 2007, we have been providing outpatient chemotherapy for patients with digestive cancers, such as colorectal cancer, at our hospital by administering 5-fluorouracil intravenously using a portable infusion pump (PIP).

In this study, outpatient cancer chemotherapy using PIP was introduced and successfully performed for the first time at our hospital in a 48-year-old patient with distant metastasis from submandibular gland cancer. As compared with inpatient therapy, a greater effort to reduce patient anxiety is needed in outpatient cancer chemotherapy.

For managing PIP and dealing with the side effects of cancer chemotherapy, we believe that it is important not only to improve the facilities and expertise of medical professionals, but also to provide thorough explanations and guidance to patients and their families.