In 102 patients who performed contrast-enhanced MRI and underwent surgery for a tumor of the parotid gland, we compared the preoperative diagnoses made by fine needle aspiration cytology (FNAC) and imaging diagnoses made by enhanced MRI, including a dynamic study and calculation of the apparent diffusion coefficient (ADC). In contrast-enhanced MRI, the ADC values of pleomorphic adenomas were significantly higher than those of Warthin's tumors. In addition, the ADC values of carcinomas were significantly lower than those of pleomorphic adenomas and significantly higher than those of Warthin's tumors. The patterns of the time-signal intensity curve in the dynamic study were as follows: persistent pattern in 23 cases, washout pattern in 38 cases, and the plateau pattern in 41 cases. Contrast-enhanced MRI was performed in 102 cases and a pathological diagnosis was available for 85 cases. The diagnostic accuracy rate of contrast-enhanced MRI in the 85 cases for which a pathological diagnosis was available was 82.3% (70 cases/85 cases), 70 cases with the correct diagnosis was 68.6% (70 cases/102 cases) in which contrast-enhanced MRI was performed. FNAC was performed in 93 cases and pathological diagnosis was available for 46 cases. The diagnostic accuracy rate of FNAC in the 46 cases for which a pathological diagnosis was available was 84.7% (39 cases/46 cases). 39 cases with the correct diagnosis was 41.9% (39 cases/93 cases) of cases in which FNAC was performed. There were 34 cases in which the preoperative diagnosis made by FNAC and that made by MRI were in agreement and the diagnostic accuracy rate in them was 94.1% (32 cases/34 cases).

　Transoral resection is considered to be a minimally invasive surgery that contributes to maintenance of a patient's quality of life (QOL). Several quantitative assessments for a patient's QOL are available. We conducted a prospective quantitative QOL and swallowing function analysis of tonsillar cancer patients treated by transoral resection.

　Nine patients with T1 or T2 tonsillar cancer treated at our institution between 2009 and 2016 were included. We evaluated the patients' QOL and swallowing function preoperatively, and 3 and 6 months postoperatively. The EORTC QLQ C30 and EORTC QLQ H&N35 questionnaires were employed to evaluate the QOL. To evaluate the swallowing function, the endoscopic swallowing evaluation score and functional outcome swallowing scale (FOSS) were employed.

　Patients underwent transoral resection, with or without neck dissection. None of the items in the QOL scale worsened postoperatively. All patients could take a normal diet, with endoscopic swallowing evaluation scores of less than 4. Eight patients were classified into stage 0 in the FOSS, and into stage 1 in 1 patient.

　In conclusion, transoral resection for tonsillar cancer contributes to maintenance of the patients' QOL and swallowing function.

　Japan's population is aging more rapidly than that of any other country. According to a publication by the Cabinet Office in 2015, 33 million people, or 26.0% of the population, are 65 years old or older, and this proportion is predicted to further increase. Naturally, the occurrence of cancers in elderly people is also likely to increase. Indeed, the percentage of patients with head and neck cancer who are 70 years old or older increased from 35.9% in 2003 to 40.8% in 2012 according to the head and neck cancer registry of the Japan Society for Head and Neck Cancer. Determining appropriate treatment methods is particularly difficult when treating elderly patients because the life expectancy of each patient varies greatly among individuals depending on their general decline in physiological function, the presence of comorbidities, and their social background. The greatest problem in the treatment of cancers in the elderly is the lack of evidence for the selection of therapeutic methods, even though various rating systems have been considered.

　We retrospectively reviewed all head and neck cancer patients age 75 years or older who received first-line treatment at Saitama Medical University International Medical Center between April 2007 and December 2014. Among the 348 eligible patients, the oral cavity was the most common tumor site, followed by the larynx, thyroid, hypopharynx, and oropharynx. Two hundred and thirty-eight patients received curative treatment, while 85 cases were treated palliatively. Among the 182 operations that were performed, 144 were curative resections, 30 were reconstructive operations (free flap), and 8 were palliative operations. Among the 67 patients who underwent radiotherapy, 50 patients underwent curative treatments. Chemoradiation was performed in 14 cases, all of which were curative. Eighty-five cases (81 palliative care and 4 palliative radiotherapy) chose palliative care.

　Postoperative complications were observed in 28 of the 174 patients. These complications included delirium in 7 patients (of which two had dementia prior to surgery) and heart failure in one patient. Among the 32 reconstructive operations, two cases required reoperations because of trouble with a free flap. The 5-year disease-specific survival rate for patients receiving curative treatment was 77.2%.

　Our results show that the outcome of curative treatment in elderly patients was comparable to that in non-elderly patients and that reconstructive operations can be successful in elderly patients as long as they are in good general condition. However, whether curative treatment should be selected needs to be determined on an individual basis after evaluating the patient's comorbidities, psychological condition, and expected quality of life after treatment.

　Tracheostomy in obese patients is associated with technical problems, such as difficulty accessing the trachea and retraction of the surrounding tissues because of peripherally distributed fat. Postoperative management of a tracheal cannula is also complicated by obesity. The aim of this study was to investigate the feasibility of cricoid cartilage fenestration in obese patients. Among 16 patients who underwent a tracheostomy at our institution, 6 obese patients with a body mass index (BMI) greater than 25 kg/m² (2 men, 4 women; age range, 28-82 years; mean BMI, 38.6±11.8 kg/m²) were included in the study. Data such as patient background, hemorrhage volume, surgical procedures, complications, risk factors, and the advisability of fenestration closure were investigated retrospectively. In addition, the distance from the surface of the neck skin to the cricoid cartilage was measured on computed tomography images, and the correlation between this distance and the BMI score was examined. All 6 of the obese patients had diabetes, and a lower positioning of the laryngeal structure at the level of the clavicle was seen in 5 of the patients. The mean volume of bleeding during surgery was small. A spiral-reinforced-tracheotomy tube was used in 4 cases. Postoperatively, subcutaneous emphysema and wound dehiscence were observed in one case each, but no serious complications occurred. Fenestration closure was achieved in 2 cases. A high correlation was found between the skin-cricoid cartilage distance and the BMI.

　These results suggest that cricoid cartilage fenestration might be a useful procedure in obese patients, with few complications. The skin-cricoid cartilage distance can be estimated from the BMI, and this correlation might be useful for airway management in obese patients.