Chemotherapy is one of the most important treatment modalities for patients with head and neck cancer. The purpose of this article is to report the roles of chemotherapy in head and neck cancer. The standard regimen for induction chemotherapy (IC) is a combination of cisplatin, docetaxel and 5-fluorouracil. In patients with unresectable cancer, no improvement of the survival with IC has been demonstrated. On the other hand, in patients with recectable cancer, administration of IC may be useful to judge whether concurrent chemoradiotherapy (CCRT) would be effective or not [are the corrections appropriate?]. The standard regimen used in combination with radiotherapy in CCRT for head and neck cancer is a cisplatin­-based regimen. A phase III study performed in Japan to evaluate the efficacy of S-1 in comparison to UFT (control) in patients with stage III, IVA or IVB squamous-cell carcinoma of the head and neck (ACTH-HNC) who have already received curative therapy. A total of 526 patients were enrolled, and 505 were eligible for the analysis. The 3-year disease-free survival (DFS) rate was 60.0% in the UFT group and 64.1% in the S-1 group (HR, 0.87; 95% CI, 0.66–1.16; P=0.34). The 3-year overall survival (OS) rate was 75.8% in the S-1 group and 82.9% in the UFT group (HR, 0.64; 95% CI, 0.44–0.94; P=0.022). Although no significant difference in the DFS was observed between the two groups, the OS was significantly better in the S-1 group than in the UFT group. Thus, S-1 is considered as a useful treatment agent for patients with stage III, IVA or IVB squamous cell carcinoma of the head and neck who have received curative therapy.

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Malignant external otitis is a severe infection of the external auditory canal, most commonly caused by Pseudomonas aeruginosa in elderly patients with diabetes. Due to the host’s immunocompromised state, malignant external otitis may easily lead to osteomyelitis of the skull base, which may be associated with potential life-threatening complications needing urgent treatment.
Treatment of osteomyelitis consists of debridement, systemic antibiotic administration and management of the immunosuppressed state of the patient. However, in the case of skull base osteomyelitis, complete debridement is often difficult because of anatomical constraints.
We present a case of atypical temporal bone osteomyelitis occurring in a healthy woman without diabetes or pseudomonas infection. A 25-year-old woman was admitted to our hospital with the chief complaint of severe right otalgia which could not be controlled even by thrice-daily intake of painkillers. A slightly reddened skin lesion was found in the bony ear canal; however, neither active aural discharge nor inflammatory stenosis of the canal was found. CT scan showed an osteolytic lesion in the right bony ear canal. Malignancy, osteomyelitis or other unspecified lesion was suspected, and exploratory surgery was performed. Elevation of the tympanomeatal flap revealed eroded bones just beneath the reddened skin, which were completely drilled out by retroauricular mastoidectomy. The dissected specimens were composed of eroded bones, with fibrosis and infiltration by lymphoid and plasma cells. Therefore, the patient was finally diagnosed as having osteomyelitis of the temporal bone. Her clinical symptoms resolved immediately after the surgery, suggesting that complete debridement was effective for controlling the disease.
In cases of prolonged and severe otalgia not responsive to ordinary treatments, osteomyelitis should be considered and CT is recommended for early diagnosis and surgical intervention.

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In surgery for carcinoma of the external auditory canal, in cases where the cancer has spread to the surrounding tissues, it is often necessary to resect the parotid gland and mandibular joint together with the auditory canal. After the resection, to fill the defect, free flaps are commonly used, although pedicle flaps and transposed fats are also frequently used. However, in cases with a post-surgical complications such as infection or necrosis, it is often difficult to preserve the morphology and function in follow-up surgeries. Recently, when operating on cases of carcinoma of the external auditory canal, we have been able to preserve the facial nerve function, while removing the ear canal as well as the parotid gland and part of the mandibular joint. We have encountered cases where, after performing a fat transposition procedure in the area, within half a year, the transposed fat becomes infected and necrotic. In such cases, it is often effective to use a pedicle temporalis muscle flap in the follow-up surgery. The temporalis muscle flap may also be used for reconstruction even at the initial surgery for carcinoma of the external auditory canal, and even in cases where it proves difficult to expose the facial nerve, it is possible to preserve the nerve function.

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Introduction: It has been reported that invasive fungal infections of the paranasal sinuses can lead to cerebrovascular disorder. Herein, we report two cases of invasive mycosis of the paranasal sinuses in which MRI/MRA revealed stenosis of the internal carotid artery.
Case 1: A 78-year-old male patient presenting with a 4-month history of visual field loss on the left side was diagnosed as having left optic perineuritis. CT revealed bilateral soft-tissue density within the sphenoethmoidal cells. MRI revealed that the lesion spread from the left orbital tip to the cavernous sinus. Bilateral endoscopic sinus surgery (ESS) was performed. We found fungal spores in both the sphenoethmoidal cells and in the defect in the left optic canal bone. Histopathology confirmed that the spores belonged to Aspergillus species, and the patient was started on treatment with oral voriconazole. MRI/MRA performed 1 month post-surgery showed stenosis of the left internal carotid artery siphon. No evidence of cerebral infarction was observed, presumably because of collateral cerebral blood flow. Until now, 4 years since the surgery, follow-up has revealed no evidence of recurrence of the lesion, although MRI/MRA reveals stenosis in the same region.
Cases 2: A 61-year-old male patient presenting with a 2-month history of visual disturbance on the left side was admitted to our ophthalmology department. CT showed a soft-tissue density within the left ethmoid and sphenoid sinuses. MRI revealed orbital and intracranial invasion. Biopsy was performed via endoscopic sinus surgery (ESS), and a final histopathological diagnosis of Mucor infection was made. The patient was started on treatment with liposomal amphotericin B. One month post-surgery, MRI/MRA showed stenosis of the left internal carotid artery siphon. The patient suffered multiple organ failure, and died 131 days after hospital admission.
Conclusion: We report two cases of internal carotid artery stenosis associated with invasive mycosis. Patients diagnosed with invasive mycosis should be considered to be at a high-risk for potential cerebral infarction and cerebral hemorrhage, and undergo cerebrovascular evaluation by MRI/MRA.

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A cranial nerve disorder with sphenoid sinus disease is known to occur in rhinogenic optic neuropathy or orbital apex syndrome, or as a symptom of cavernous sinus thrombosis. Paralysis of the hypoglossal nerve associated with sphenoid sinus disease is a rare complication, and it has never been reported in isolation. We report herein on a case of sphenoid sinus mucocele associated with isolated paralysis of the hypoglossal nerve. A 36-year-old woman who had a headache and difficulty extending her tongue was referred to our hospital. On physical examination, she showed no neurological abnormalities except isolated right hypoglossal nerve paralysis. Computed tomography and magnetic resonance imaging suggested the presence of a single sphenoid sinus mucocele with osteoclastic changes but no other nervous system disease. In this case, the lower portion of the sphenoid sinus had grown inferiorly onto the hypoglossal canal. Therefore, we diagnosed the hypoglossal nerve paralysis as being caused by this sphenoid sinus mucocele. The patient underwent endoscopic sinus surgery on the 2nd day after admission. Her headache vanished immediately after this operation, and complete hypoglossal nerve recovery was achieved 3 months after the surgery.
Sphenoid sinus disease may cause paralysis of the hypostatic cranial nerve because the shape of the sphenoid sinus varies amongst individuals. During the course of diagnosis of such paralysis, clinicians should consider the possibility of posterior sinus disease.

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Concurrent chemoradiation therapies such as superselective arterial infusion and concomitant radiotherapy (RADPLAT) have been successful in treating sinonasal malignancies. One often neglected side effect of sinonasal chemoradiation therapy is nasolacrimal obstruction due to the proximity of the sinonasal sinus to the orbit. This causes dacryorrhea and the reduction in quality of life is inevitable. A dacryocystorhinostomy (DCR) is an effective method to reconstruct lachrymal passage. To our knowledge, however, there is no report of this method being employed to treat nasolacrimal obstruction caused by radiation therapy of sinonasal malignancies.
We performed DCRs for lachrymal passage reconstruction on 6 patients (5 male, 1 female with median age of 64.5 yr), who had exhibited nasolacrimal obstruction after radiation therapy for sinonasal malignancies. Dacryorrhea completely disappeared in 4 patients within one week postoperatively, and the symptom was alleviated significantly in the other two patients. Although the number of cases studied so far is limited, DCR is probably effective in reducing the symptom rather rapidly. We propose to continue performing DCRs on patients suffering from nasolacrimal obstruction after radiation therapy and to examine its long-term effectiveness.

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Warthin’s tumor is the second most commonly occurring benign tumor of the parotid gland. Skin ulceration over a Warthin’s tumor is extremely rare. We report the clinical course of a 75-year-old man with Warthin’s tumor of the right parotid gland, who showed ulceration of the skin overlying the tumor. The patient, presenting with a mass of the parotid gland, had been diagnosed 8 years previously as having Warthin’s tumor of the parotid gland. There were no signs of malignancy. One year prior to admission to our hospital, ulceration of the skin overlying the tumor was observed. Although Warthin’s tumor is generally considered as a benign tumor, skin ulceration over a Warthin’s tumor may be suggestive of malignant transformation. Therefore, we performed partial parotidectomy with dissection of the overlying ulcerated skin despite the advanced age and low ADL of the patient. However, histopathology revealed no evidence of malignant transformation. The patient did well postoperatively and did not develop facial nerve palsy.

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As we know, most foreign bodies are often removed easily. We experienced a case of a foreign body removed by transcervical approach. A 61 year-old-male had a sore throat for two days after ingesting a fish. At the first medical examination, we were unable to find the foreign body at his tonsilla palatina, pharynx or larynx, so the patient underwent a follow-up examination. One week later, his sore throat continued, and computed tomography (CT) revealed the foreign body in his oral floor. It was possible to remove it by the transoral approach at that time, and we proposed removing it immediately, but the patient did not accept. Forty three days later, the foreign body moved downwards. We removed it by not via the transoral but the transcervical approach. Granulation tissues had surrounded the foreign body. The patient’s postoperative progress was favorable. There are some points for consideration regarding not performing the operation immediately. There are severe complications associated with foreign bodies; such as abscess formation, vascular injury and so on. Furthermore, the transcervical approach is more invasive than the transoral one. Fortunately, our patient had no complications. On the other hand, he had peristent scars on his neck. From the above, we should perform CT imaging at the first visit, and remove any foreign body as soon as possible.

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We report two rare cases of lipoma in the nasal cavity and pharynx.
Case 1: A 9-year-old girl was brought to our hospital with the chief complaint of a mass in the left nasal cavity. CT revealed a smooth mass with fat density in the left nostril. The mass was attached to the anterior part of the nasal septum and was resected using a rigid endoscope under general anesthesia. Case 2: A 36-year-old woman noticed a yellowish and smooth mass in the right side of the oropharynx. MRI demonstrated the mass in the right side of the oropharynx, and fat suppression imaging revealed the diagnosis of lipoma. The mass was located below the right palatine tonsil and was removed with a Weerda laryngoscope.
The tumors were histopathologically diagnosed as lipomas in both cases. In case 1, additional plastic surgery is being planned in the future for a residual tumor. In case 2, the clinical course has remained uneventful since the surgery.

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Epithelial-myoepithelial carcinoma (EMC) is a rare tumor, most commonly arising from the parotid gland. We present the case of an 80-year-old woman who presented with the chief complaint of nasal bleeding and was diagnosed as having EMC of the nasopharynx. Fiberopic endoscopy revealed a mass with erosion on the left side in the posterior wall of the nasopharynx. Computed tomography (CT) and magnetic resonance imaging (MRI) showed a tumorous shadow limited to the nasopharynx, not extending into the surrounding tissue. Histological and immunohistochemical examination of biopsy specimens confirmed the diagnosis. Full-dose radiation therapy was administered. The tumor disappeared completely, and no evidence of recurrence or metastasis has since become apparent. We considered that radiation therapy is one of the valid treatment options for patients with inoperable EMC.

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During the last 70 years, “endolymphatic hydrops,” which is a histologic marker for Meniere’s disease, has been shown only in specimens obtained at autopsy. Recently, however, it has been shown that endolymphatic hydrops can be identified on MRI after gadolinium administration. In this paper, the results obtained from our recent study is discussed.

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