A rise in the incidence of human papilloma virus (HPV)-related oropharyngeal squamous cell cancer has been recorded over the past decade. HPV-related oropharyngeal cancer has been identified as a distinct clinical and biological entity. Although there are still only a few reports about the involvement of HPV in tumors of the head and neck other than oropharyngeal cancer, we should bear in mind the possibility of HPV involvement in any head and neck tumors. Since the tumor HPV status may be a prognostic factor and a predictive marker of the response to treatment, not only in cases of oropharyngeal cancer, but also in cases with other head and neck tumors, development of a feasible methods to precisely detect HPV in head and neck tumors is necessary. We should consider risk stratification and methods for primary and secondary prevention, including use of HPV vaccine, in patients with HPV-related head and neck tumors.

We retrospectively studied the hearing outcomes in 35 patients (35 ears) with cholesteatomatous otitis media complicated by labyrinthine fistula, who underwent tympanomastoidectomy at our department between 2007 and 2016. The patients consisted of 25 men and 10 women, with a mean age of 62.3 years (range, 17 to 82 years). Such cases accounted for 11.8% of all cholesteatoma operations during this period. The fistula was located in the lateral semicircular canal in 32 cases (91.4%). The cholesteatoma was totally removed in a one-stage operation in all cases, and the fistula was closed with bone chips, bone powder and temporal fascia. The depth of the fistula was classified as Dornhoffer’s grade I, II and III in 24, 9 and 2 cases, respectively. Ossicular reconstruction was performed in 13 cases: type I in 4 cases, type II in one case, and type III in 8 cases. Dexamethasone was administered intravenously in 22 cases in the perioperative period.

No significant change of either air- or bone-conduction hearing level was observed postoperatively. Air- and bone-conduction hearing deteriorated by ≥10 dB in 4 (11.4%) and 3 (8.6%) cases, respectively. Negative bone-conduction hearing gain was significantly more frequent in patients aged ≥60 years than in those aged ≤59 years (14/24 vs. 1/11, P=0.010). Bone-conduction hearing gain tended to be negatively correlated with the patients’ age (r=-0.323, P=0.058). Negative air- or bone-conduction hearing gain was not associated with fistula symptoms, steroid use, depth of the fistula, ossicular reconstruction or postoperative vertigo. Of the 13 patients who underwent ossicular reconstruction, 5 (38.5%) showed successful hearing improvement according to the criteria of the Otological Society of Japan.

These results indicate that hearing was satisfactorily preserved overall, but older patients were at a higher risk of development of inner ear damage after the removal of a cholesteatoma with a labyrinthine fistula. Furthermore, the results also suggested that steroid use, which did not prove to be helpful for hearing preservation, should be reconsidered.

Hereditary hemorrhagic telangiectasia (Osler disease) is an autosomal dominant disease affecting blood vessels throughout the body, and patients often present with a history of recurrent epistaxis. Therefore, it is necessary to bear in mind the possibility of Osler disease in the differential diagnosis of patients presenting with recurrent and serious epistaxis. We report a case of Osler disease who developed hemodynamic instability due to anemia caused by recurrent and serious epistaxis.

The patient visited our hospital with a history of recurrent and serious epistaxis. On examination, he was found to have hypotension and in need of blood transfusion. He was as having Osler disease based on the characteristic physical findings and symptoms. We planned for surgical treatment after the patient’s hemodynamic status stabilized with nasal packing for the control of epistaxis.

We performed nasal dermoplasty, removing the nasal mucosa of the anterior potion of the nasal septum, nasal floor and nasal lateral wall. Nasal packing was continued until the induction of general anesthesia. After the operation, the frequency of epistaxis decreased significantly and the patient’s quality of life improved.

In patients with Osler disease presenting with serious, difficult condition to control epistaxis, continuous nasal packing followed by nasal dermoplasty may be a useful treatment option.

An accessory parotid gland refers to the presence of salivary gland tissue in front of the main parotid gland. It is reported to occur at a rate of approximately 21%–70% in the general population, and a tumor arising from an accessory parotid gland is rare, accounting for 1%–7% of all parotid gland tumors. Herein, we report a case of accessory parotid gland tumor encountered by us.

The patient was a 45-year-old woman who visited our hospital with the chief complaint of a right accessory parotid gland tumor. Based on the findings of MRI and cytodiagnosis, a diagnosis of accessory parotid gland tumor was made. The patient was treated by resection of the right accessory parotid gland tumor, and histopathological examination of the resected specimen revealed the diagnosis of pleomorphic adenoma. In the 2 years since the surgery, there has been no obvious evidence of recurrence.

Extracardiac rhabdomyomas are rare benign tumors that originate from the striated muscle. Histologic analysis is essential for definitive diagnosis. The curative treatment for rhabdomyomas is surgical excision. We report a case with adult-type rhabdomyoma of the larynx. A 43-year-old female patient presented to us with a one-year history of hoarseness. Flexible laryngoscopic examination showed a smooth submucosal swelling of the left false cord. The tumor was removed using microlaryngeal surgical techniques. Histologic examination revealed an adult-type rhabdomyoma. At the 6-month follow-up, she exhibited no evidence of tumor recurrence and her voice was normal. Long-term follow-up is necessary, as recurrence can occur several years later.

Liposarcoma is a commonly encountered sarcoma, that arises predominantly in the extremities or retroperitoneum. According to a study conducted by the Armed Forces Institute of Pathology (AFIP), liposarcoma accounts for approximately 14% of all sarcomas, and only 3.8% of all liposarcomas are found in the head and neck region. Liposarcoma has been classified into four histological subtypes. The clinical features depend on the type of the tumor. Recently, numerous advances have been made in molecular and biologic analyses of liposarcomas, and several gene mutations have been found. These findings are useful for diagnosis of the tumor subtypes. We report two cases of liposarcoma arising in the head and neck region, in which immunohistochemistry was useful for the diagnosis.

Case 1 was a 77-year-old woman who presented with swelling of the left oropharyngeal wall. She had undergone surgery of the left mandible 17 years earlier and was diagnosed as having a lipoma. Surgical resection of the tumor was performed, and the histological diagnosis was liposarcoma (well-differentiated type).

Case 2 was a 23-year-old woman who presented with swelling of the floor of the mouth on the left side. She had undergone operations for an oral floor tumor twice in the previous 10 years. The histological diagnosis on both occasions was liposarcoma (well-differentiated type). Surgical resection was performed again and the histological diagnosis was recurrence of liposarcoma (well-differentiated type).

The tumor showed normal-appearing adipocytes intermixed with atypical adipocytes in both the cases. Immunohistochemical analysis revealed the MDM2+/CDK4+/p16+ immunophenotype in both cases. Immunohistochemistry has proved to be useful for distinguishing among the various subtypes of liposarcoma, in particular, the well-differentiated type.

Neuroendocrine carcinoma (NEC) is rare in the head and neck region, but such tumors show high-grade malignancy. We report a patient who presented with hoarseness of voice, which was found to be attributable to right vocal cord paralysis, after radiation therapy for left vocal cord squamous cell carcinoma. The patient had cervical lymph node enlargement with a thyroid tumor, and fine needle aspiration biopsy was suspected thyroid papillary carcinoma. We performed thyroid lobectomy and neck dissection. The right vocal cord paralysis was found to have been caused by a metastatic neuroendocrine carcinoma to the cervical lymph nodes. However, the site of the primary neuroendocrine carcinoma could not be detected. After 9 years, the patient presented with dyspnea, and the primary neuroendocrine carcinoma was found in the subglottic region. Total laryngectomy was performed. At present, 2 years since the total laryngectomy, the patient has lung metastasis, controlled by chemotherapy. Patients with “primary unknown NEC” in the head and neck region, should be followed up carefully, especially those with laryngeal regions.

Patients with fibrous dysplasia in the craniofacial region are usually followed up, in case there are no problems or pain. In very rare cases, fibrous dysplasia undergoes malignant transformation. Herein, we report a case of osteosarcoma of the temporal region that arose in a region of fibrous dysplasia.

A 60-year-old man consulted our hospital with a chief complaint of pain and swelling of his right temple. He had previously undergone surgery at other hospitals for fibrous dysplasia at multiple sites of the body, including the maxilla, rib, femur and humerus. CT revealed tumors that appeared to be fibrous dysplasia, located within and continuous with the maxilla, while a tumor with bone destruction was observed in the right temporal and cheek bones. Biopsy revealed the diagnosis of osteosarcoma. Skull base surgery was performed after administration of chemotherapy with cisplatin and doxorubicin.

The right eyeball was preserved and the tumor was excised en bloc. However, we could not obtain a sufficient margin. Histopathological examination of the resected specimen revealed that the preoperative chemotherapy had had little effect and that the surgical margin was positive.

Radiotherapy and chemotherapy were administered as postoperative adjuvant treatments. One year eight months later, the tumor relapsed near the clivus.

Although it is rare, patients with fibrous dysplasia should be made aware of the possibility of malignant transformation of the lesion after a prolonged period and should immediately consult their physician in the event that they experience pain.

Methotrexate (MTX) is mainly used for the treatment of rheumatoid arthritis (RA), and is a widely used anchor drug for RA treatment. In this study, we encountered a case of methotrexate-associated lymphoproliferative disorder (MTX-LPD) in a patient who had a tumor in her upper gingiva. The patient was a 64-year-old woman, and she had been taking MTX orally for the treatment of RA. A swelling in her left cheek was her chief complaint at the time of her admitance to our medical center. We conducted a tissue biopsy as we suspected an upper jaw cancer, but the results indicated granulomatous changes because of chronic inflammation. As we could not rule out the possibility of malignancy, we conducted a second tissue biopsy, and, this time performed immunostaining. The results confirmed the presence of EBER-positive cells in addition to, CD20, CD79a and CD3 positivity. Based on these results, we diagnosed her as having MTX-LPD and suspended her intake of MTX. In the two months following the suspension of MTX, her cheek swelling improved, and an MRI examination confirmed the disappearance of the tumor. A sequestration of the jawbone persisted and was subsequently removed surgically. When a patient who has been taking MTX develops a tumor in the head or neck, careful examination and treatment, taking the possibility of MTX-LPD into consideration, is needed.

Calcific tendinitis of the longus colli muscle, which often manifests as neck pain and stiffness, is not yet an adequately recognized disease among otolaryngologists. Herein, we report a case of calcific tendinitis of the longus colli muscle in a 47-year-old female patient who presented with the complaints of severe neck stiffness and pain on swallowing. She visited our outpatient clinic after initially visiting a local orthopedic clinic and neurosurgery clinic, both of which cleared her of any abnormalities related to their respective fields. On examination, the range of motion of the neck was found to be very limited, and otorhinolaryngological examination revealed no evidence of tumor or inflammation. Contrast-enhanced computed tomography revealed a small calcification anterior to the cervical vertebra at the C1-C2 level and a low-density area without ring enhancement in the retropharyngeal space. T2-weighted magnetic resonance imaging showed the longus colli muscle as a hyperintensity. Based on these imaging findings, we made the diagnosis calcific tendinitis of the longus colli muscle. The patient was then hospitalized and treated conservatively with a non-steroidal anti-inflammatory drug, and the neck stiffness and pain on swallowing improved within a week.