Postoperative saliva leakage associated with wound dehiscence is one of the serious postoperative complications of major head and neck oncological surgery. Usually, a pharyngocutaneous fistula has to be formed for appropriate drainage of the infectious saliva to protect cervical vital structures, including the carotid artery. After the microvascular circulation around the fistula becomes stable, the fistula can be closed safely using a hinge flap and local rotation or a free island flap. Conventionally, the pharyngocutaneous fistula is maintained by plugging it with ointment gauze and covering it tightly with dry gauze and adhesive tapes; the tracheal stoma has to be managed with a cuffed cannula to prevent aspiration of saliva. However, this conventional method is associated with heavy distress to the patient, such as skin damage and pain due to frequent replacement of gauze and tapes, and increased cough and sputum induced by the tracheal cannula insertion. In recent years, various alternative methods have been reported for mitigating the patients' burden associated with fistula management. However, these methods cannot solve the pharyngocutaneous fistula-specific problems which are attributed to the three-dimensional structure and mobility of the neck. Therefore, we developed a new management method for fistula using a combination of a urine collection bag or a stoma pouch and a clay-like skin protecting agent, which enabled us to flexibly manage various cases by adjusting the attachment-plate area of the pouch and shaping a wall with clay-like skin protectant. As a result, we could reduce the frequency of fistula coverage replacement from daily to once every 3 to 4 days, which resulted in decreased skin damage and pain, and avoidance of tracheal cannulation. Furthermore, the daily material cost was also greatly reduced. In conclusion, we believe that this new method can overcome the disadvantages of the conventional method, reduce the burden on the patients, and reduce the cost, yielding medical economic benefit. In addition, the cooperation of the patients themselves and a certified nurse familiar with handling the pouch materials appears to be helpful for successful management.

　To clarify the effect of gargling on the removal of oral mucosal epithelial cells with adherent bacteria, in addition to its cleaning action, the numbers of epithelial cells and bacteria adhering to the epithelial cells in the gargled water were counted after tap water gargling three times. Furthermore, the numbers of bacteria adhering to the scraped buccal mucosal epithelial cells three hours after purified water, sodium azulene sulfonate, and or povidone iodine garglings were also counted and compared. Examination revealed numerous epithelial cells with adherent bacteria in the gargled water, and the numbers of epithelial cells and bacteria adhering to the epithelial cells in the gargled water decreased significantly with the number of times a person gargled. Three hours after purified water or sodium azulene sulfonate gargling, numerous bacteria were found adhering to scraped buccal mucosal epithelial cells. In contrast, the number of bacteria adherent to the epithelial cells in the scraped buccal mucosal epithelial cells was remarkably decreased after povidone iodine gargling. The findings suggest that gargling removes epithelial cells with adherent bacteria, which might be an important objective of gargling. Bacteria which proliferate several hours after gargling adhere again to the epithelial cells, and gargling with povidone iodine significantly reduced the number of bacteria adhering to the epithelial cells as compared to purified water or sodium azulene sulfonate gargling. However, as povidone iodine also damages the normal bacterial flora and mucosal epithelial tissue, development of a new compound(s) for gargling that would inhibit bacterial adherence to the buccal mucosal epithelial cells without these harmful effects is desired.

　We report a case in which administration of mycophenolate mofetil proved effective against liver dysfunction arising as an immune-related adverse event during treatment with nivolumab. A 70-year-old man had received 4 courses of nivolumab for local recurrence of laryngeal cancer, regional lymph node recurrence, and lung metastasis. Nivolumab was discontinued after four courses, due to disease progression. The patient presented with generalized malaise about 5 months after transition to the next treatment, and blood tests showed elevated serum levels of the hepatobiliary enzymes. Liver biopsy revealed inflammatory cell infiltration in the portal vein area, inflammatory destruction of the marginal plates, and necrosis in the lobules, and immunohistochemistry revealed infiltration primarily with CD8-positive lymphocytes. High-dose steroid treatment for this liver dysfunction proved ineffective, however, the liver function improved following addition of mycophenolate mofetil (off-label use) to the steroid treatment.

　Cowden syndrome is an autosomal-dominant hereditary disease caused mainly by mutation of the PTEN gene, and the mutation is recognized in about 80% of patients. The most common feature of Cowden syndrome is the presence of hamartomas, associated with an increased risk of development of malignant tumors in the thyroid gland and breast. In addition, gastrointestinal polyposis is reported in many patients. Because of the wide variety of lesions, there are few reports from otolaryngologists. We present the case of 46-year-old woman who visited our hospital with a thyroid tumor that was found to extend into the mediastinum. There were characteristic skin lesions, possibly lipoma, and multiple polyps in the gastrointestinal tract. Postoperative histopathology after thyroidectomy revealed the diagnosis of papillary thyroid cancer, and the patient was diagnosed as having Cowden syndrome. We later learned that the patient's brother had a similar diagnosis. Comprehensive follow-up is required to detect malignant tumors early, although the patient has no evidence of cancer now.

　The woman patient was diagnosed as having parotid pleomorphic adenoma. Partial parotidectomy is a well-established treatment for benign parotid tumors. The main trunk of the facial nerve is identified in the first step, and then some necessary branches in order to remove the parotid tumor. However, when the tumor is located directly above the main trunk, identification of the main trunk is often difficult. In our case reported herein, after identifying the mastoid process and the tip of the pointer's cartilage, the parotid tissue around the tumor at the cranial and anterior portion was first resected. This improved the mobility of the tumor and provided a sufficient surgical field for identification of the main trunk. Since the parotid tissue around the tumor is resected before identifying the nerve, fine dissection by using electric knife is essential in such cases. As a result, identification of the main trunk became as easy as in conventional partial parotidectomy, and we were able to perform safe and reliable tumor removal.