Necrotizing fasciitis (NF) is an aggressive soft tissue infection that results in the necrosis of muscle and fascia. It is a serious disease of sudden onset that progresses rapidly. Early diagnosis is difficult as the disease often initially looks like a simple superficial skin infection or cellulitis. LRINEC score (Laboratory Risk Indicator for Necrotizing Fasciitis score) has been introduced as an auxiliary diagnostic tool for NF in the early phase. As there are few reports regarding the availability of the LRINEC score for NF in the head and neck region, we conducted this study to compare the LRINEC score for NF and cellulitis. The NF group consisted of 12 cases encountered by us and 8 cases reported by the Japan medical abstract society. The cellulitis group consisted of 13 cases encountered by us. The average LRINEC score was 7.2 in the NF group and 1.6 in the cellulitis group, with a statistically significant difference in the score between the two groups. The serum CRP and WBC count were also significantly different between the two groups. A score of 6 was found to be a reasonable cutoff value for the diagnosis of NF with a sensitivity of 85%, specificity of 92%, positive predictive value of 94%, and negative predictive value of 80%. We concluded that the LRINEC score is an easily available auxiliary diagnostic tool also for NF in the head and neck region.

　Endoscopic laryngo-pharyngeal surgery (ELPS) is a transoral surgery for superficial laryngopharyngeal carcinoma. At our hospital, we use a curved rigid laryngoscope to expand the laryngo-pharyngeal cavity and then an endoscopist examines the lesion with a magnifying endoscope. Next, a head and neck surgeon resects the lesion using a tip- movable high-frequency knife. During resection, the endoscopist locally injects physiological saline via the forceps port of the endoscope using a needle, with the objective of lifting the area surrounding the lesion and submucosa. In some cases, he/she may also assist the surgeon by making incisions in the mucosa and submucosa. Therefore, coordination between the head and neck surgeon and endoscopist is important. We conducted a short-term, retrospective study of the performance of ELPS at our hospital, by investigating 50 instances of its use in 57 superficial head and neck cancer lesions in 40 patients from August 2014 to December 2017. Regarding the locations of the primary cancers, 43 were in the hypopharynx, 7 in the oropharynx and 7 in other locations. The mean resection time per lesion was 59 minutes, and histopathologically, the numbers of resection margins determined to be pHM0, pHM1 and pHMX were 27, 16 and 14, respectively, and the numbers of resection margins determined as pVM0 and pVM1 were 56 and 1, respectively. The median time to resumption of oral intake was one day. Tracheotomy was needed postoperatively in 2 patients, because of marked laryngeal edema in one case and aspiration in the other. There was local recurrence in 3 patients, recurrence in the cervical lymph nodes in 4 patients, and 2 died of other diseases; all the other patients continue to be cancer-free. Thus, good outcomes are achieved with ELPS at our hospital through coordination with endoscopists.

　Anaphylactic reactions induced by opioids are extremely rare. We encountered an 84-year-old woman with tongue cancer who had a past history of anaphylactic shock induced by codeine phosphate and nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin and loxoprofen. For her cancer diagnosis, she desired only pain relief at home without any detailed examinations or aggressive treatments, including drip or tube feeding. Morphine and oxycodone are structurally similar to codeine. Therefore, we chose fentanyl and acetaminophen, in order to avoid the risk of cross-sensitivity with codeine. We administered palliative sedation with diazepam suppository in the terminal phase. We report the clinical course of this patient, including a review of the literature on opioid allergy, NSAIDs intolerance (hypersensitivity).