Long-term discussions on how to manage labyrinthine middle-ear fistulas have produced numerous surgical techniques, but our review of these rational, often successful techniques showed that no single uniform surgical technique fits all cases, and management remains controversial. We used fluid-attenuated inversion recovery (FLAIR) in magnetic resonance imaging (MRI) in cases of acute inflammation-induced sensorineural hearing loss (SNHL) due to different conditions, and evaluated its advantages in investigating these ear-disturbance etiologies, focusing on labyrinthine fistulas.

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Creutzfeldt-Jakob disease (CJD), a degenerative condition of the central nervous system, involves rapidly progressive dementia and ataxia as yet incurable and with a 1-2 year life expectancy after onset. We report a classic case of CJD with transient nystagmus. A 60-year-old man seen for dizziness demonstrated no nystagmus but was not spontaneous and had difficulty in communicating. Suspecting central nervous disease, we recommended a neurologist. Diffusion-weighted magnetic resonance imaging (DWI) showed high signal areas in right hemispheric dominance. Electroencephalography (EEG) showed periodic synchronous discharge (PSD). Spinal fluid was not examined. Symptoms, brain MRI findings, and EEG let to the CJD diagnosis.

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We report two cases of breast cancer with head and neck metastasis. Case 1 was a 60-year-old woman undergoing left breast cancer mastectomy 13 years earlier, and seen for diplopia. Computed tomography (CT) and magnetic response imaging (MRI) showed an enhancing lesion filling the left sphenoid bone, necessitating endoscopic sinus surgery. Immunohistochemistry was positive for estrogen and progesterone receptors, yielding a diagonosis of breast cancer metastatic to the sphenoid bone. Case 2 was a 63-year-old woman undergoing right breast cancer mastectomy 7 years earlier, with chemotherapy and seen for a nasal obstruction. Endoscopy showed a nasopharyngeal tumor. Biopsied specimens confirmed breast carcinoma metastasis. Both cases required radiotherapy and hormonal therapy and as yet have shown no recurrence. The possibility of metastatic disease should thus be considered in those with a history of breast cancer.

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Salivary duct carcinoma (SDC) is rare, and originating mainly in the parotid gland.
In the 15-years from 1995 to 2010, we treated nine subjects with parotid gland SDC. None undergoing fine-needle aspiration biopsy or frozen section was diagnosed with SDC preoperatively. One had partial parotidectomy and the remainder wide resection of parotid gland masses. All nine underwent surgery, but only two remained cancer-free. Neither postoperative radiation nor chemotherapy was effective in tumor control. SDC prognosis thus requires new diagnositic techniques, therapeutic modalities, and surgical procedures.

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Epithelial-myoepithelial carcinoma (EMC) of the parotid gland, a rare low-grade malignant tumor, consists of ductal and myoepithelial cells. We report an extremely rare case of giant EMC of the parotid gland.
A 71-year-old man seen for a 13 cm×12 cm tumor of the left parotid gland was found in magnetic resonance imaging (MRI) to have multiple cystic lesions and a solid lesion appearing to arise from the parotid gland. The completely resected tumor was histopathologically diagnosed as EMC. The postoperative course was uneventful and 8-month follow-up showed no clinical evidence of recurrence.
We discuss EMC pathology and review 16 cases of giant parotid tumor in Japan in this report.

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Synovial sarcoma accounts for 14% of soft tissue sarcomas, generally occurs in the extremities, and is rare in the head and neck. We report the case of a 10-year-old boy seen for sleep apnea and dysphagia with orohypopharyngeal synovial sarcoma. He underwent preoperative chemotherapy with cyclophosphamide, ifosfamide, etoposide, and adriamycin. Because of his age, we selected preserved the voice, using a cervical incision. Neither recurrence nor metastasis has been seen in the 39 months (3 years and 3 months) of follow-up.

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Endoscopic examination, including narrow-band imaging (NBI), is being increasingly used to detect early hypopharygeal cancer. Because these high-risk cases have already often undergone radiotherapy for esophageal cancer, early hypopharygeal cancer is a good indication for endoscopic mucosal resection (EMR) and endoscopic submucosal dissection (ESD). Slightly larger tumors, however, require partial hypopharyngotomy preserving the larynx. Since reconstruction with a free flap may be highly invasive, we reported using an anterior chest skin flap as a useful alternative in pharyngeal reconstruction.

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Desmoids, although pathologically benign, are called “locally malignant tumors”, due to their infiltrative growth and tendency to recur locally. They are roughly classified as abdominal (90%) or extra-abdominal (10%), with 12-20% of extra abdominal occurring on the head and neck.
We report a case of extra abdominal frontal neck desmoid. A 47-year-old woman was seen for a frontal neck. Unable to pathologically diagnose the tumor preoperatively, we suspected a schwannoma, leiomyoma, or solitary fibrous tumor. After two total resections and immediate local recurrence, we suggested that she undergo neck radiotherapy.
No recurrence has occurred in the 6 months since postoperative 50 Gy radiation. Neck tumor occurrence should thus suggest the possibility of desmoids.

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Methotrexate-associated lymphoproliferative disorder (MTX-LPD) involves lymphoid proliferations or lymphomas in subjects with autoimmune disease, especially rheumatoid arthritis (RA) treated with methotrexate (MTX). The relationship of MTX medication and LPD development has been discussed, and we report four cases of MTX-LPD.
Case 1: A 54-year-old woman administered MTX for RA since April 2007 was seen for right cheek and submandibular swelling in August 2008. Magnetic resonance imaging (MRI) showed cervical lymphadenopathy, necessitating lymph node biopsy revealing diffuse large B-cell lymphoma. MTX was discontinued and lymph nodes shrank within a month. In May 2009, general lymphadenopathy relapsed and she underwent chemotherapy.
Case 2: A 63-year-old man administered MTX for RA since June 1999 was seen for 1-year right submandibular swelling in January 2009. MRI showed submandibular lymph node swelling, necessitating lymph node removal yielding a pathological diagnosis of MTX-LPD similar to nodular lymphocyte predominant Hodgkin lymphoma. MTX was discontinued and the man has shown no sign of recurrence.
MTX-LPD incidence is expected to increase as MTX is used increasingly to treat RA. We should therefore take MTX-LPD in consideration when examining subjects treated with MTX.

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Omohyoid muscle syndrome (OMS) featuring marked omohyoid muscle bulging during swallowing, not present at rest, was first reported by R.B. Zachary in 1969. We report a case of this condition. A 41-year-old woman reporting right neck discomfort during swallowing was found to have bulging corresponding to the omohyoid muscle course, diagnosed as OMS. We excised the muscle, found to be of normal size, at the central tendon under general anesthesia. No recurrence has been seen in the 12 months post operative. Pathological findings included omohyoid muscle degeneration, hypertrophy, and atrophy. Cases reported in Japan numbered 22 since 1983, 10 of which were treated surgically and remedied satisfactorily. No common features were seen, although normal and abnormal findings were present in macroscopic and pathological intra- or postoperative examination. OMS is benign, and warrants surgery only in cases of severe subjective symptoms or at the subject's request.

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