Typical causes of facial nerve paralysis are Bell's palsy and Ramsay Hunt syndrome. Facial nerve paralysis caused by a neoplastic lesion is a relatively rare occurrence. We herein report a very rare case of facial nerve paralysis that was caused by the meningeal metastasis of bladder cancer. The patient was a 59-year-old male who had a history of cystectomy for superficial bladder cancer 6 months prior to the onset of facial palsy. He underwent systemic steroid treatment at another hospital, but his facial nerve function did not recover. At our hospital, he had paralysis in the right glossopharyngeal nerve and right vagal nerve, in addition to the facial nerve. A gadolinium-enhanced MRI examination revealed a thickened dura matter and soft tissue in the mastoid antrum. A cytological examination of his otorrhea revealed that his middle ear carried a malignant neoplasm of uncertain pathology. A pathological diagnosis was made tissue findings obtained by an open biopsy following mastoidectomy. In the case of facial nerve paralysis due to a poor response to steroid treatment, palsy due to a primary or metastatic tumor should therefore be considered in the differential diagnosis.

The prevalence of chronic obstructive pulmonary disease (COPD) in Japan is increasing as the country's population continues to age. Augmentation rhinoplasty is a frequently performed cosmetic surgery procedure and many patients who have undergone this procedure may now be suffering from COPD. Once an infection occurs around the prosthesis, it cannot be cured without its removal, even if the rhinoplastic surgery was performed many years previously. We herein report two cases of facial cellulitis that were caused by devices for COPD and which were treated by prosthesis removal. The first case is that of a 63-year-old woman who was first treated with the long-term administration of antibiotics. When her symptoms did not improve, a prosthesis removal procedure was performed. The second case is that of an 84-year-old woman in whom prosthesis removal was the first line of treatment. These two cases suggest the possibility that otorhinolaryngologists may have to increasingly in the future treat facial cellulitis in elderly patients who have undergone rhinoplasty and who are now suffering from COPD.

The patient was a 56-year-old male. Although a mass lesion was noted at right kidney in 1986, he left it without any treatment. The size of the mass increased and his right kidney was completely resected. The pathological diagnosis was clear cell carcinoma. Interferon-α was injected as adjunct therapy. No recurrence had been noted up to 1997. In 2005, the patient felt throat numbness. He visited an ENT doctor and a tumor at the epiglottis was noted. A cauliflower-shaped mass was observed on the laryngeal side of the epiglottis. The mass was removed through direct laryngoscopy. The pathological image suggested the metastasis of clear cell carcinoma from the kidney. The patient was referred to the urological department for further treatment. Space-occupying lesions were recognized at the left kidney, both lungs, the right mediastinum and the left deltoid muscle. He was treated with a combination of TAE, interferon-α and interleukin-2 therapy, and subsequently achieved complete remission. However, local recurrence occurred and he died of disease in 2012. No recurrence of the laryngeal lesion had been noted.

The patient was a 63-year-old woman who had been diagnosed with rheumatoid arthritis over 40 years previously and had been taken methotrexate (MTX) and tacrolimus for 10 years. She visited an ENT clinic due to a left parotid mass and pain in August 201X. Parotid MRI revealed a tumor in the left parotid gland and fine needle aspiration cytology showed class Ⅲ b. According to these findings, we suspected a malignant parotid tumor and she was referred to our hospital for surgical resection. She underwent total parotidectomy due to suspicion of a malignant parotid tumor. The pathological diagnosis was diffuse large B-cell lymphoma (DLBCL) and the patient was positive for EBER. Therefore, the patient was diagnosed with methotrexate-associated lymphoproliferative disorder (MTX-LPD). After the diagnosis, MTX was discontinued and the patient has not exhibited disease relapse. MTX-LPD should be kept in mind for patients with rheumatoid arthritis treated with MTX.

Angiolymphoid hyperplasia with eosinophilia (ALHE) is a rare idiopathic condition that manifests in adults as deep-red papules and nodules in the skin of the head and neck. We herein present the case of a 29-year-old man who was admitted with a pulsatile parotid tumor. A CT scan showed that an expanded small blood vessel carried through the tumor was enhanced at the same level of the blood vessel. MRA showed that a branch of the superficial temporal artery flowed into the tumor. According to these findings, the preoperative diagnosis was an aneurysm. In the intraoperative findings, the tumor was located in the deep lobe and a blood vessel flowed into the tumor. The tumor was composed of a proliferation of thick or thin-walled blood vessels lined by plump epithelioid endothelial cells, accompanied by fibrous stroma and infiltration of eosinophils. Immunohistochemically, these plump endothelial cells were positive for CD31 and CD34. Therefore, the postoperative diagnosis was ALHE. We herein review the current understanding of ALHE and discuss how to differentiate it from Kimura's disease.