Corrective surgery of the nasal cavity, such as submucosal turbinectomy or septoplasty, is important procedures for improvement of nasal obstruction and treatment and prevention of nasal diseases. On the other hand, corrective surgery of the nasal cavity is also introductory procedures of endoscopic nasal surgery, and residents at medical educational institutions should receive training for such procedures at an early stage. However, the detailed name of the form of turbinate is poor, which results in a number of difficulties being faced at the time of the surgical planning conference and surgery guidance. Therefore, we devised and used the morphology classification or part name a new system of nomenclature for parts of the inferior turbinate and the middle turbinate, which are thought to be useful for surgery, with reference to the CT imaging, endoscopic and visual examination findings. This led to communication improving at surgical planning conferences and during surgery guidance.

We report the case of a patient who presented with vertigo and acute sensorineural hearing loss due to multiple cerebral infarctions caused by basilar artery occlusion. A 55-year-old man was admitted to our hospital complaining of fullness in his right ear and vertigo. No other neurological deficits were noted. Neurological examination revealed right-sided sensorineural hearing loss, however, no nystagmus was seen, even with the intense subjective symptom of vertigo. Based on the findings, the patient was diagnosed as having sudden deafness with vertigo.

After hospitalization, he developed symptoms of cranial neuropathy. Magnetic resonance imaging (MRI) demonstrated cerebellopontine and medulla oblongata infarctions. The symptoms were suspected to be due to occlusion of the basilar artery, because the patient subsequently developed the locked-in syndrome, in which vertical eye movements and blinking occur spontaneously.

We have previously treated one patient with anterior inferior cerebellar artery syndrome and six patients with posterior inferior cerebellar artery syndromes. In all of these cases, the diagnosis was made early by MRI examination conducted at an early stage. Even in patients with suspected inner ear disorders, it is important to pay attention to the possibility of a cerebrovascular disorder and perform neurologic and MRI examinations, especially in cases with underlying diseases that increase the risk for arteriosclerosis, such as hypertension and diabetes mellitus.

Corticosteroids have been applied historically for the treatment of idiopathic sudden sensorineural hearing loss (ISSHL). We analyzed the data of 58 patients who were diagnosed as having ISSHL at Kyoto University Hospital. Of the 58, 25 patients seen between March 2009 and April 2011, and 33 patients seen between May 2011 and December 2014 were treated with initial prednisolone doses of 200 mg and 100 mg (200 mg and 100 mg groups), respectively. The corticosteroid dose was tapered over 9 days in both groups.

Hearing recovery was evaluated at 1 month after treatment completion by determination of the averaged pure-tone audiogram thresholds for five frequencies from 250 Hz to 4 kHz. In the 200-mg group, a 19.0-dB improvement in the averaged hearing threshold was seen, whereas in the 100-mg group, a 25.8-dB improvement in the hearing threshold was observed. Of the patients of the 200-mg group, 72.0% showed slight recovery and 20.0% showed marked recovery; on the other hand, in the 100-mg group, 78.8% showed slight recovery and 42.4% showed marked recovery.

No statistically significant difference in the effect of treatment was observed between the two groups. Therefore, prednisolone treatment with a starting dose of 100 mg followed by tapering is preferable to that with a starting dose of 200 mg followed by tapering for patients with ISSHL.

Patients with abnormal eye movements and dizziness are often encountered at the department of otolaryngology.

We report on 2 patients with dizziness who were referred to our otolaryngology department for examination, and were finally diagnosed as having paraneoplastic neurological syndrome (PNS).

In cases with abnormal eye movements, attention should be paid to the neurologic symptoms. PNS should be considered in the differential diagnosis, as it represents an important clue to the presence of an underlying malignant tumor.

It is necessary to perform whole-body CT or PET-CT, and tests for tumor markers and anti-neuronal autoantibodies. Since the neurologic symptoms often precede the discovery of the tumor and the initial tests for anti-neuronal autoantibodies could be negative, it is important to repeat these screening tests.

We investigated the data of 28 patients (23 men and 5 women) with sinonasal inverted papilloma who were treated at our hospital between January 2002 and December 2015. The average age of the patients was 60.1 (range, 38–77 yo). The most common presenting symptom, unilateral nasal obstruction, was seen in 75% of cases. Of the 28 patients, one case had inverted papilloma accompanied by squamous cell carcinoma. The tumors were classified by the Krouse staging system based on the findings in computed tomographic (CT) images, as follows; T1, 3 cases; T2, 16 cases; T3, 6 cases; T4, 2 cases (1 case with no data on the imaging findings was excluded). Preoperative magnetic resonance imaging (MRI) was performed in 8 patients, and we considered that the MRI was useful to evaluate the tumor extent. According to the result of preoperative biopsy or intraoperative rapid diagnosis, 15 cases were diagnosed as having inverted papilloma before or during surgery. All patients were treated by surgery. Endoscopic sinus surgery (ESS) was mainly performed for the T1 and T2 cases, while ESS combined with other procedures was performed for the T3 and T4 cases. Postoperative recurrence occurred in 8 cases (29.6%).

In conclusion, preoperative biopsy or intraoperative rapid diagnosis, preoperative imaging studies, and adequate tumor removal by the best surgical approach are important to avoid recurrence of the tumor.

The necessity to differentiate between Kawasaki disease and retropharyngeal abscess has been emphasized in recent years, as the clinical symptoms and laboratory findings of the two conditions may be similar. One of the findings useful to distinguish between the two is that on contrast-enhanced computed tomography (CT), a retropharyngeal abscess is visualized as a low-density area (LDA) with ring enhancement, whereas Kawasaki disease is usually visualized as a LDA without ring enhancement. We report three cases of Kawasaki disease mimicking retropharyngeal abscess, in which enhanced CT revealed a LDA with partial or total ring enhancement in the retropharyngeal space. The patients presented with high fever, neck pain and cervical swelling, and since cervical lymphadenitis was suspected, they were treated with antibiotics, although these proved ineffective. The patients were finally diagnosed as having Kawasaki disease, and improved promptly with intravenous immunoglobulin (IVIG) therapy and aspirin. Thus, even in cases showing a LDA with ring enhancement on enhanced CT, the possibility of Kawasaki disease cannot be entirely excluded.

Adenoid cystic carcinoma (ACC) of the head and neck is one of the most frequently encountered malignancies of the salivary gland, accounting for 10–20% of all salivary gland malignancies. Data of the 18 cases of ACC of the parotid gland seen at our institution between 1999 and 2016 were collected through a medical chart review and analyzed. Of all the patients, 83% complained of pain or tenderness in the parotid region associated with histological perineural spread of the tumor. Fine-needle aspiration cytology and ultrasound scan/MRI had been performed for all patients. However, in three of the patients, surgery was performed under the tentative diagnosis of a benign parotid tumor. Advanced T stage and the solid-type of tumor histopathology were associated with a worse survival. Seventeen patients underwent surgery with or without postoperative radiotherapy. One patient receive chemotherapy and radiation. The 5- and 10-year disease-specific and disease-free survival rates were 78% and 47% and 52% and 27%, respectively.

The patients with ACC frequently presented with pain, and low/intermediate grade ACC was encountered at high frequency. Pain in the parotid region is an important feature of parotid cancer, and particular attention should be paid to it, particularly for the diagnosis of ACC.

The majority of all small cell carcinomas originate in the lungs, and small cell carcinomas of extrapulmonary origin are rare. Small cell carcinomas originating in the head and neck region account for approximately 10% of all extrapulmonary small cell carcinomas. We report our experience with a case of small cell carcinoma of the submandibular gland.

A 48-year-old woman was referred to our department with a suspected submandibular gland tumor. Computed tomography and magnetic resonance imaging of the neck revealed marked swelling of the right submandibular gland with a heterogeneous internal structure. Lymphadenopathy was observed in the right submandibular and supraclavicular regions. Fluorodeoxyglucose positron emission tomography revealed accumulation in the right submandibular gland and lymph nodes, and in the inferior-medial deep cervical lymph nodes. Based on the findings, total excision of the right submandibular gland with radical right neck dissection was performed immediately. Based on the results of hematoxylin-eosin staining and immunological staining of resected specimens, we made the final diagnosis of primary small cell carcinoma of the submandibular gland. Metastases were detected in the right submandibular lymph nodes and inferior-medial deep cervical lymph nodes (T3N2bM0); therefore, after the surgery, the patient was administrated five cycles of etoposide and cisplatin chemotherapy (100 mg/m² etoposide and 80 mg/m² cisplatin). Postoperative radiotherapy (60 Gy) was applied to the neck. Five years post-treatment, the patient remains under observation, without any sign of recurrence. In case of primary salivary gland small cell carcinoma where the tumor is resectable, we recommend surgery and application of multimodal therapy, including chemotherapy and radiotherapy, consistent with the recommendations for the treatment of pulmonary small cell carcinoma.

We report a case of adenomatous goiter in a patient with complete situs inversus. The patient was a 64-year-old woman who was referred to our department because of an incidentally detected thyroid tumor. Thyroid tumor was suspected on chest CT, which was performed because of detection of an abnormal opacity on a plain chest X-ray performed during the course of a health checkup. Cervical ultrasonography and CT revealed a mass lesion measuring 40 mm in diameter in the right lobe of the thyroid gland. In addition, thoracic and abdominal CT revealed complete situs inversus. However, there were no vascular abnormalities suggestive coexistence of anomaly of the right recurrent laryngeal nerve, such as an aberrant subclavian artery. When performing a right thyroid lobectomy, in accordance with the preoperative estimation of the course of the right recurrent laryngeal nerve, the nerve was observed to run between the trachea and esophagus and beneath the right common carotid artery at the inferior cervical part, as if it were a normal left recurrent laryngeal nerve. The diagnosis of adenomatous goiter was established by histopathology. Since situs inversus is associated with visceral organs in reversed or mirror-image positions, the non-recurrent laryngeal nerve, if any, would also be expected to exist on the reverse side, i.e., on the left side. In cases with situs inversus, it is of particular importance to carry out careful preoperative assessment of the major vessels embryologically related to the recurrent laryngeal nerve prior to thyroid surgery.