There are several treatment choices for hypopharyngeal cancer according to the practice guidelines issued by the Japan Society for Head and Neck Cancer, which include definitive radiotherapy, chemotherapy (concurrent, induction, and adjuvant), and curative surgery. Surgical procedures are classified into endoscopic resection, transoral partial pharyngectomy, excisional larynx-preserving partial pharyngectomy, and larynx-sacrificing wide resection (e.g. total pharyngo-laryngo-esophagectomy). Various clinical trials have been performed and efforts have been made in these treatment modalities to improve the survival rate and the larynx-preservation rate of patients with hypopharyngeal cancers in Japan. In this article, the treatment strategies and outcomes for hypopharyngeal cancer in Japan are overviewed by reviewing the recent reports in the literature describing the survival rate and larynx-preservation rate of Japanese patients with hypopharyngeal cancers.

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A 3-year 8-month-old girl visited our clinic complaining of a feeling of fullness in the right ear. She had passed the newborn hearing screening (NHS) with the automated auditory brainstem response (automated ABR) test. CT imaging of the right temporal bone revealed internal auditory canal stenosis. MRI showed that the right cochlear nerve was thin, but continuous. No ABR was evoked even by 90 dB nHL of click stimuli to the right ear. Distortion product otoacoustic emission (DPOAE) response from the right ear was not clear. These results indicate that hearing impairment might appear after birth in patients with congenital unilateral internal auditory canal stenosis.

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Bilateral hearing loss in a 44-year-old mother and her 17-year-old daughter was thought to be related to osteogenesis imperfecta (OI), although the other typical clinical signs and symptoms were scarce. Both showed a normal stature and no bone deformities. The mother has been followed up for 7 years as a case of sensorineural hearing loss, with one episode of acute deterioration in the lower frequencies about one year ago. She gave a history of suffering from bone fractures four times. The daughter showed bilateral mixed hearing loss and a blue sclera, but no history of bone fractures. CT images of the daughter showed extensive decalcified foci, suggestive of otosclerotic changes, in the otic capsule, however, no such changes were confirmed in the mother’s CT.
In diagnosing the cause of sensorineural hearing loss, careful checkup of the family and past history and physical signs of OI, such as bone deformities and blue sclera, and CT should be considered. We should be aware that sensorineural hearing disorders in cases of OI may occur in the absence of the characteristic physical features.

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We report herein on two cases of otogenic complications caused by a cholesteatoma.
Case 1: The patient was a 33-year-old male who was hospitalized because of confusion, fever, and anorexia. Computed tomography (CT) scan and magnetic resonance imaging (MRI) showed that he had an ear cholesteatoma with bone destruction of the cranial base, an abscess in the left temporal lobe of brain abscess and subperiosteal abscess. After drainage of the brain abscess, he underwent a radical mastoidectomy with meatoplasty. We finished the operation leaving some remnant cholesteatoma on the dura because of very strong dural adhesion by the cholesteatoma. The patient was transferred to a convalescent hospital without any side effects.
Case 2: The patient was a 65-year-old female who was hospitalized because of left otitis media, meningitis and hydrocephalus. CT scan and MRI showed that she had a left side cholesteatoma with bone destruction of the cranial base and a fistula in the lateral semicircular canal. She underwent radical mastoidectomy with meatoplasty. We finished the operation leaving some remnant cholesteatoma on the dura for similar reasons as with case 1. The patient was transferred to a convalescent hospital without any side effects.

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Secondary cholesteatoma is relatively rare, but can develop by extension of the tympanic epithelium into the tympanic cavity through perforation of the marginal membrane. The subject reported herein was a 68-year-old male patient with a history of persistent bilateral otorrhea since childhood. Examination revealed a large perforation in the tympanic membrane on both sides, with debris observed on the promontory of the right tympanic cavity. The hearing level was 66.7 dB in the right ear, and 65 dB in the left ear. Subsequently, a secondary cholesteatoma, with the cholesteatoma matrix extending continuously from the upper edge of the tympanic membrane perforation was observed, a tympanoplasty was attempted under general anesthesia on the right side. Among the ossicles, only the stapedial footplate and the handle of the malleus were found to remain, and the horizontal portion of the facial nerve canal was also broadly destroyed. While the antrum mastoideum was filled by the cholesteatoma extending from the tympanic cavity, the cholesteatoma matrix and the dura mater of the middle cranial fossa were tightly adherent and very difficult to separate. Therefore, the plasty method, referred to as the “open method tympanoplasty”, was employed, allowing the cholesteatoma matrix in the mastoid antrum to remain. Until now, five years after the surgery, no recurrence has been observed. Thus, in patients with chronic otitis media associated with tympanic perforation and pesistent otorrhea in whom the perforation is found to extend to the handle of the malleus, the possibility of a secondary cholesteatoma should be borne in mind. In such cases, rather than continuing with conservative treatment, it is important to examine the patient carefully, bearing in mind the possibility of secondary cholesteatoma.

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Multiple fractures of the facial bones occasionally cause nasolacrimal duct obstruction, resulting in epiphora and dacryocystitis. Herein, we report the case of a 25-year-old man who developed nasolacrimal duct obstruction secondary to facial fractures sustained in a motorcycle traffic accident. He was operated upon by plastic surgeons for his facial injuries. However, epiphora in the right eye persisted, for which endoscopic dacryocystorhinostomy was performed after 11 months. We used a dacryoendoscope to establish the orientation. A 2.5-mm diamond bur was used for the dacryocystorhinostomy. A Nunchaku-type silicon tube was inserted successfully, which was removed 3 months after the surgery. The epiphora disappeared within one year of this procedure.

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We encountered a patient with a cystic neck metastasis from oropharyngeal carcinoma, which was detected after extraction of a cystic neck mass under the diagnosis of a lateral cervical cyst. The patient was a 64-year-old woman with a one-month history of swelling in the left side of the neck. The swelling was diagnosed preoperatively as a lateral cervical cyst, however, histopathological examination of the resected specimen revealed the diagnosis of squamous cell carcinoma (SCC). One year and ten months later, when the patient presented with a new swelling in the left-upper-neck region, she was referred to another medical institution for further examination and treatment. Transoral endoscopic examination with NBI revealed the primary lesion in the left palatine tonsil; biopsy revealed SCC and the specimen was positive for p16. Reexamination of the previous cystic specimen suggested that it might have been a p16-positive lymph node metastasis from the overlooked tonsillar cancer.
Lymph node metastases from HPV-positive oropharyngeal cancer tend to show cystic degeneration, and sometimes appear as neck metastases from cancer of unknown primary origin. Care must be taken when examining the cystic mass, with the possibility of oropharyngeal cancer borne in mind.

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Accordiry to previous reports, lymph node metastasis from primary-unknown melanoma usually involved the axillary or inguinal lymph nodes, and more rarely, the head and neck lymph nodes. We report a case of metastatic melanoma in a parotid lymph node from the unknown primary site.
A 28-year-old woman was detected to have a left parotid tumor by a neighborhood doctor and referred to our hospital. Aspiration biopsy revealed parotid lymph node metastasis from a malignant melanoma, however, the primary site could not be identified. We resected the lymph node, followed by administration of chemotherapy (DAC-Tam; DITC, ACNU, CDDP, and Tamoxifen). However, the patient presented with metastasis to the lungs, brain, breast, femoral muscle, cervical lymph nodes, axillary lymph nodes, and intraabdominal lymph nodes, and died two years three months after she was first medically examined.

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Metastatic laryngeal tumors are very rare. We encountered a rare case of laryngeal metastasis from a lung adenocarcinoma. A 74-year-old female had been treated for lung cancer four years earlier. She presented to us with a 3-week history of persistent hoarseness of the voice. Fiberoptic laryngoscopy and computed tomography of the neck showed a subglottic tumor. Although the patient did not complain of breathlessness, because of the tumor size, tracheotomy and laryngomicrosurgery were performed, and the tumor was resected. Histological examination revealed the diagnosis of metastatic adenocarcinoma from the lung. Later, recurrence of the lung cancer was also found, and the patient was started on chemotherapy for lung cancer. At one year two months after the surgery, the laryngeal tumor could no longer be detected.

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Aspiration pneumonia resulting from cerebrovascular or neurodegenerative disorders could be a fatal disease. In patients with repeated episodes of aspiration pneumonia despite conservative management, surgeries to prevent aspiration, such as laryngectomy and laryngotracheal separation, may be indicated.
Here, we report two patients with intractable aspiration pneumonia in whom we performed laryngotracheal separation using the B-type tracheal flap method, with no postoperative complications. Both patients were relieved from the frequent sputum-sucking after the surgery, which resulted in an improved QOL for both the patients themselves and their caregivers.
The tracheal flap method is less invasive than Lindeman surgery, because the membranous portion of the trachea is left intact in this method, whereas the trachea is cut circumferentially in Lindeman surgery; this could lead to the shorter operation time and lower incidence of postoperative complications of the tracheal flap method. Furthermore, in this method, in which the skin flap is sutured directly to the tracheal membrane, a wider tracheal stoma can be obtained, leading to the possibility of tracheotomy-tube-free management. Thus, this surgery is beneficial to improve the QOL of both patients with repeated episodes of aspiration pneumonia and their caregivers.

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Amyloidosis is caused by amyloid substance deposition in various organs and tissues. Herein, we report the case of a 70-year-old patient of systemic amyloidosis who presented with swelling of the tongue and submental region as the initial symptoms. Systemic amyloidosis was considered in the differential diagnosis based on the presence of other symptoms such as hypothyroidism, carpal tunnel syndrome, and heart failure. A biopsy specimen taken from the tongue and submucosal tissue revealed deposition of amyloid. The result of DFS staining for amyloid was positive. Furthermore, the serum level of the free Kappa immunoglobulin light chain was increased. Based on these findings, the patient was diagnosed as amyloidosis. He was followed up at the department of internal medicine.

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