We reviewed orbital floor fractures that were treated surgically at our department. A total of 22 subjects treated between 2014 to 2021, all of whom had undergone endoscopic endonasal repair surgery, were included in this study. The percent Hess area ratio (HAR%) and diplopia grade were assessed before and after the surgery as quantitative and qualitative measures of the surgery outcomes. We defined cure as follows: HAR%>85%, diplopia grade≤1. Cure within 3 months of the surgery was achieved in 73% of the patients, and within 6 months of the surgery in 85.7% of patients. None of the patients needed any additional surgeries. The preoperative HAR% and preoperative diplopia grade were identified as being statistically significantly associated with early cure, and preoperative HAR%<52% and diplopia grade 3 were identified as risk factors for preventing early cure. The results of the present study suggested that diplopia associated with orbital floor fracture improved at least to some degree within 3 months of surgery, but that healing was delayed in cases with severe diplopia prior to the surgery.

　　Morphometrics of the trachea provides useful information to otolaryngologists undertaking clinical interventions such as tracheostomy and tracheostomy tube management. The aim of this study was to measure the morphometrics of the tracheal rings in Japanese subjects. In addition, we examined whether it might be possible to predict the appropriate size of tracheostomy tube for patients from the transverse dimension of the trachea.

　　This study was conducted in 60 patients who underwent ultra-high resolution computed tomography (UHRCT) for the diagnosis and treatment of laryngeal diseases. Patients with perichondritis, tracheostomy, and hypopharyngeal and/or laryngeal carcinoma were excluded. The morphometric measurements were eventually conducted in 44 patients (average age: men, 60.3 years; women, 46.1 years; male/female ratio, 31/13), while the dimeters of the tracheal lumen at the level of various tracheal rings were measured in 46 patients (average age; men, 58.8 years; women, 49.8 years; male/female ratio, 34/12).

　　The mean transverse and sagittal dimensions at the level of the second tracheal ring were 19.2 mm and 18.8 mm in men, and 13.9 mm and 14.0 mm in women, retrospectively. Both the transverse and sagittal dimensions were significantly greater in men as compared with women (Both, p<0.01). No significant difference in the transverse or sagittal dimension at the level of the second tracheal ring was observed between the men and women in this study. The mean transverse and sagittal dimensions at a level above the top of the aortic arch were 21.1 mm and 19.2 mm in men and 16.0 mm and 15.6 mm in women, retrospectively. In regard to the morphometrics of the second tracheal ring, an elliptical shape and C-shape of the tracheal lumen were the most common, while at the level of the seventh tracheal ring, a U shape was the most common.

　　Our study suggests that the transverse and sagittal dimensions of the trachea in Japanese adults are clinically significant parameters for the selection and management of tracheostomy tubes.

　　Eosinophilic granulomatosis with polyangiitis (EGPA) is a syndrome characterized by an early prodrome of bronchial asthma, allergic rhinitis, and eosinophilic chronic rhinosinusitis, eventually accompanied by the development of vasculitis and eosinophilia. The pathogenic mechanism has not yet been precisely clarified. Therefore, we conducted a study to clarify the clinical factors predictive of the onset of EGPA in patients with eosinophilic chronic rhinosinusitis. The subjects were patients who underwent endoscopic sinus surgery for eosinophilic chronic rhinosinusitis during the five-year period between April 2014 and March 2019. They were divided into two groups according to the presence or absence of EGPA. We compared items including the peripheral blood differential eosinophil count and the presence/absence of allergic diseases in the patients. The preoperative and postoperative items compared included the nasal polyp scores, sinus CT scores, and olfactory function test results. EGPA was eventually diagnosed in 3 of the 84 cases. The average differential eosinophil count in the peripheral blood in the EGPA group was 20.6%, which was significantly higher than that in the non-EGPA group (9.2%) (p<0.01). The CT score improvement, that is, the difference between the preoperative and postoperative CT scores, was significantly lower in the EGPA group (p<0.01), and the postoperative middle nasal polyp score was also higher in the EGPA group (p=0.01). In addition, all of the patients in the EGPA group had bronchial asthma and also had a severe group of eosinophilic chronic rhinosinusitis. Among the predictive factors for the development of EGPA in patients with eosinophilic chronic rhinosinusitis, we identified peripheral blood eosinophilia, presence of allergic diseases, and presence of severe eosinophilic chronic rhinosinusitis. Poor improvement of the CT scores and recurrence of nasal polyps after endoscopic sinus surgery were other significant predictors.

　　We report a case of severe recurrent epistaxis that was treated by thalidomide and arterial embolization in a patient with hereditary hemorrhagic telangiectasia who required frequent blood transfusions and had undergone nostril closure surgery with limited effect. The patient was a 68-year-old woman with a history of frequent episodes (about 1.5 times a month, on average) of hemorrhagic shock caused by nasal bleeding that necessitated frequent blood transfusions (she had received a total of 60 units of red cell concentrate over the previous 10 months). Daily oral treatment with 50 mg of thalidomide and four sessions of arterial embolization reduced the frequency and duration of the epistaxis. Although thalidomide is effective in reducing the frequency and duration of epistaxis and improving patients' quality of life, it was not very effective in this case. Particular caution is needed in view of the risk of thromboembolism as an adverse effect of this drug. Although arterial embolization has no long-term effects, it should be considered for the treatment of active hemorrhage.

　　In endoscopic endonasal sinus surgery for postoperative a maxillary mucocele, draping a mucosal flap over the bony border of the opened mucocele is important to prevent stenosis or closure. The mucosa of the inferior meatus is often used to drape the bony edge of a mucocele adjacent to the inferior meatus. However, the mucosal flap cannot be applied to a mucocele adjacent to the nasolacrimal duct. Therefore, we utilized the nasolacrimal duct as a mucosal flap to drape over the bony edge in cases with an opened mucocele adjacent to the nasolacrimal duct. We present one case and demonstrate the nasolacrimal duct flap technique. Furthermore, we describe the postoperative course of four consecutive subjects who underwent surgery with use of the nasolacrimal duct flap technique. In all four subjects, no lacrimation or epiphora was observed and the patency of the mucoceles was confirmed during the follow-up period. The nasolacrimal duct flap as a mucosal flap to cover the edge of the mucocele adjacent to the nasolacrimal duct not only prevented stenosis or closure, but also created a drainage pathway through the inside of the nasolacrimal duct, without posing an obstacle to the nasolacrimal drainage system.