Hemitransfixion is one of the approaches for septoplasty. The incision is made approximately 2-to 3 mm cephalad to the caudal end, and provides excellent surgical exposure of the caudal end. In order to correct deviation of the caudal end, we think it is important to observe the condition of the caudal end. If the caudal end is straight, we reinforce it using a batten graft. If the caudal end is curved or dislocated from the anterior nasal spine, we resect the surplus cartilage and rebuild the caudal end with a batten graft.

　We adopted the hemitransfixion approach for 42 cases with caudal end deviation between June 2015 and March 2017, and investigated the relationship between the degree of caudal end deviation and the shape of the caudal end. The degree of deviation of the caudal end was investigated by analyzing the CT data. The details are as follows: we calculated the ratio of the area of the narrower nasal cavity to that of the wider nasal cavity at the entrance of the nostril (the N/W ratio), and classified the degree of caudal deviation as follows: “mild,” N/W ratio 0.8-0.6; “moderate,” N/W ratio 0.6 -0.4; “severe,” N/W ratio less than 0.4. As for the shape of the caudal end, we observed the condition of the caudal end and classified it into the following types: “Type A,” having no flexure at the caudal end; “Type B,” having a flexure at the caudal end; “Type C,” dislocation of the caudal end from the anterior nasal spine. Among the 42 cases, the number of cases with a “moderate” degree of flexure was 34 (81.0%) and that of cases with a “severe” degree of deviation was 8 (19.0%). Among the cases with “moderate” deviation, the percentages of “Type A” and “Type B” were high. On the other hand, among the cases with “severe” deviation, the percentages of “Type B” and “Type C” cases were high.

　We investigated the degree of change of the N/W ratio by comparing the postoperative CT data with the preoperative CT data in 30 cases. The degree of improvement of the N/W ratio in the “Type A” cases was 72.7%, while in the “Type B” and “Type C” cases, the degrees of improvement were 87.5% and 90.9%, respectively.

　We concluded that it is important to resect surplus cartilage at the caudal end and rebuild it tightly with a batten graft.

　Surgery for cervical neurinoma requires a different procedure from that for other common cervical tumors, for nerve preservation. We analyzed the data of 12 cases of cervical neurinoma who underwent surgery at our department between 2000 and 2016. There were 6 males and 6 females, and the average age was 46 years (range, 14-81 years). In regard to the nerve of origin, the vagus nerve was the most common nerve of origin of the tumor (4 cases), followed by the sympathetic nerve and brachial plexus (2 cases each), and sublingual nerve/supraclavicular nerve (1 case each); the nerve of origin remained unknown in 2 cases. At our department, we attempt to perform intercapsular resection to preserve the nerve that is important for maintenance of the postoperative quality of life. Cervical neurinoma is a relatively rare tumor, and it is often not possible to make a definitive diagnosis before surgery. It has been suggested that the shape and the site of the tumor in preoperatively obtained images are important findings in cases of neurinoma. Five of 9 cases (56%) in which we performed intercapsular resection developed postoperative neurological deficits (permanent paralysis in 4 cases, and temporary paralysis in 1 case). Especially, postoperative neurological deficits occurred at a high rate (80%; 4/5 cases) in cases where the tumor was located in the parapharyngeal spaces, at a level higher than the hyoid bone. It is necessary to carefully make surgical decisions taking into consideration the fact that postoperative neurological deficits are highly likely to develop in cases where the neurinoma exists at a level higher than the hyoid bone. When performing intercapsular resection aimed at nerve preservation, it is necessary to pay attention to the incision site on the epineurium.

　A questionnaire survey to investigate hyperacusis in children with autism spectrum disorder (ASD) was carried out targeting their parental guardians. Fifteen children between the second grade of elementary school and third grade of high school who were using hearing protectors were the subjects of the questionnaire survey. The parental guardians were asked to answer 40 questions about their child's symptoms, history of symptoms, and measures taken against the symptoms. Although hyperacusis-associated symptoms were mainly recognized between two and five years of age, most children had normal hearing. The numbers of children whose symptoms improved or remained unchanged with advancing age were almost the same, however, the symptoms became worse in some children. The sounds that the children reacted adversely to differed greatly and the symptoms were not always related to the level of the sound pressure. The most common sounds that the children reacted adversely to were babies' voices or crying voices, although they could tolerate sounds with associated pictures, such as on television. Most children started using hearing protectors at the age of seven years and had become calm since then. Many parental guardians indicated that none of the treatments that they had attempted to help their children get used to sounds were effective, although some parental guardians answered that their children got used to the sounds of a vacuum cleaner after they started using it themselves. The results of the questionnaire survey suggest that environmental changes and hearing protectors are effective against hyperacusis in children with ASD.

　The differential diagnosis of a lateral cervical cyst tends to be difficult before excision. In previous studies, the cyst fluid levels of amylase and thyroglobulin have been measured in an attempt to improve the preoperative diagnosis. A review of the literature indicates that, in general, the amylase levels are high and thyroglobulin levels are low in the cyst fluid of lateral cervical cysts. However, in this paper, we report a case of a lateral cervical cyst in which both the levels of amylase and thyroglobulin in the cyst fluid were high.

　A 41-year-old woman visited our department with a 2-year history of a painless soft swelling in the left neck. Imaging studies revealed a cystic mass (60×40×20mm) containing thin septa. Fine needle aspiration cytology revealed no evidence of malignancy. Both the levels of amylase and thyroglobulin in the cyst fluid were high (4130U/L and 548ng/mL, respectively). Surgical excision was performed, and the final pathological diagnosis was lateral cervical cyst. Immunostaining revealed positive staining results for thyroid transcription factor-1 (TTF-1) and negative staining results for thyroglobulin.

　Because immunostaining result of TTF-1 was positive and the fluid thyroglobulin level was high, an embryological relationship between the lateral cervical cyst and the thyroid was suspected. In regard to the clinical significance of measurement of the amylase and thyroglobulin levels in the cyst fluid, further validation with additional studies is warranted.