We discuss the efficacy and safety of superselective intra-arterial cisplatin infusion with concomitant radiation therapy (RADPLAT) for patients with squamous cell carcinoma of the base of tongue (SCC-BOT). Thirty-eight patients with SCC-BOT were treated by RADPLAT between 2000 and March 2017 at Hokkaido University Hospital. The 5-year local control rate and overall survival rate were 91.9% and 77.6%, respectively. Normal swallowing, precluding the need for a feeding tube, and normal speech were achieved after treatment in all the surviving patients.

One of the keys to the success of intra-arterial chemotherapy is the careful use of the superselective catheter technique. In addition, RADPLAT also requires time and effort. At our institution, RADPLAT yielded excellent survival rates and involved organ function rates in patients with SCC-BOT.

We consider SCC-BOT as a suitable indication for RADPLAT, and believe that a prospective multi-institutional trial of RADPLAT for patients with SCC-BOT is warranted in the near future.

Labyrinthine fistula is a common complication of cholesteatoma, whereas cochlear fistula is rather rare. We report two cases of cochlear fistula: one post radical tympanomastoidectomy and the other in a patient with underlying cholesteatoma.

Case 1: A 76-year-old man, who had undergone radical tympanomastoidectomy 50 years previously, developed a cavity problem in the right ear. Despite being unable to hear from that ear, he hoped to undergo a reoperation to have the mastoid cavity cleaned up. A cochlear fistula at the promontory was identified during the surgery. The bone at the basal turn of the cochlea was absent, but the lateral wall of the cochlear duct was intact, with no perilymphorrhea. The epithelium covering the lateral wall of the cochlear duct was carefully peeled off without damage to the cochlea. This patient was diagnosed as having a Dornhoffer type IIa cochlear fistula. The lateral wall of the cochlear duct was covered with fascia, cartilage and adipose tissue, and then firmly sealed with fibrin glue. Postoperative improvement was noted in the problem with the right mastoid cavity.

Case 2: A 79-year-old man with cholesteatoma presenting with the complaints of dizziness, right otalgia, and otorrhea, as well as high fever and neck stiffness, was diagnosed as having otogenic meningitis and treated conservatively. Subsequently, surgery was performed, which revealed widespread destruction of the bony shell of the cochlea. Pathological granulation had spread from the tympanic cavity to the epitympanum. The inner space of the cochlea was obliterated by granulation, with no lymphorrhea. The necrotic osseous spiral lamina and the modiolus were excised during extirpation of the intra-cochlear granulation. This patient, in whom the dizziness improved postoperatively, was diagnosed as having a Dornhoffer type III cochlear fistula.

We also reviewed the characteristics of 26 additional cases of cochlear fistula reported since 1977.

We found that postoperative hearing was preserved only in cases with less than Dornhoffer type IIa cochlear fistula. Therefore, more careful surgical manipulation for Dornhoffer type IIa cochlear fistulas is warranted.

Pseudocyst of the auricle (PCA) is a painless, spontaneous cystic swelling of the upper anterior auricle, characterized histologically by an intracartilaginous cavity without epithelial lining.

We report the case of a 31-year-old man who presented with PCA of the right ear that recurred on three occasions and was treated each time by intralesional triamcinolone acetonide injection. One out of the three times, the lesion was precipitated by boxing injury. The PCA disappeared in about one month after each injection.

Unlike auricular hematoma, severe trauma is not necessarily always the cause of a PCA, but repeated minor trauma is thought to be one of the most common causes of PCA. Several treatment methods for PCA have been described in the literature. Intralesional corticosteroid injection is one of the effective and simple treatment methods; this treatment places little burden on the patient, so that it is often used as the first treatment option, even though there is a possibility of recurrence. PCA and auricular hematoma are clinically different conditions, so that their treatment methods are also different.

We describe a case in which subglottic stenosis developed after intubation with a double-lumen endotracheal tube.

An 81-year-old woman underwent video-assisted thoracoscopic surgery.

Tracheal intubation was carried out with a 35-French double-lumen tube, with some resistance encountered while the tube was negotiated through the subglottis. A few days later, the patient complained of dyspnea. Fiberoptic laryngoscopic examination revealed subglottic stenosis. Emergency tracheotomy was performed under local anesthesia. She was also treated with intravenous and inhaled steroids. Within 10 days after the start of this treatment, the subglottic stenosis improved.

In this case, subglottic stenosis occurred because of the damage caused by the difficulty in negotiating the tube through the subglottis during intubation. Therefore, attention should be paid to the possible development of subglottic stenosis for several days after extubation.

The recently reported modified Killian (MK) method for endoscopic examination allows clear visualization of the hypopharyngeal space up to as far as the vicinity of the hypopharyngeal-esophageal junction in routine medical practice. However, even with the MK method, the entire hypopharyngeal space can still not be visualized. Herein, we report a case in which a pedunculated superficial hypopharyngeal carcinoma was diagnosed by subsequently examination using the Sato curved laryngoscope under general anesthesia, after upper gastrointestinal endoscopy and the MK method failed to reveal any lesion. The patient was a man in his 50s. Since he showed a positive result of sputum cytology, and a bronchoscopy performed at the department of thoracic surgery of our hospital revealed a tumor in the hypopharynx, the patient was referred to our department for further examination. We could not identify any tumor on endoscopic examination by the MK method at our outpatient department. However, upper gastrointestinal endoscopy performed as subsequently examination, revealed superficial esophageal carcinoma. Suspecting double cancer, we examined the hypopharnynx using the Sato curved laryngoscope under general anesthesia, and recognized a pedunculated tumor, which was resected. Our present case serves to underscore the fact that examination by the MK method is not absolutely foolproof and that examination by the Sato curved laryngoscope is useful for the diagnosis of hypopharyngeal diseases. When sputum cytology or PET examination incidentally reveals possibility of hypopharyngeal cancer and various types of endoscopic examinations fail to reveal the lesion, there should be no hesitation performing further subsequently examination under general anesthesia.

Spindle cell carcinoma (SpCC) is a rare malignant tumor that accounts for about 1% of all laryngeal cancers. It is a variant of squamous cell carcinoma (SCC), and is characteristically a biphasic tumor consisting of SCC and malignant spindle cell components, with a mesenchymal appearance. Herein, we present five cases of SpCC of the head and neck diagnosed at our department between 2003 and 2017. The diagnosis of SpCC rests on the histological confirmation of epithelial differentiation. The characteristic transition between the surface epithelium and the spindle cell element was evident in three of our patients, and immunohistochemical staining for both epithelial and mesenchymal markers was positive in four. A complete excisional biopsy combined with immunohistochemical analysis would be ideal for accurate diagnosis. One of our patients had a history of radiation therapy, which is considered to be a risk factor for SpCC occurrence. According to reports published in the literature, the prognosis of patients with multiple cervical lymph node metastases is poor. The fact that two of our patients died within one year indicates that at least in some cases, SpCC is aggressive and carries an unfavorable prognosis. One patient with SpCC of the tongue, one of the oropharynx, and two of the larynx were treated by surgical resection, while the remaining one with SpCC of the epipharynx who received chemoradiation therapy is currently recurrence-free. Although several reports indicate that surgery offers the most favorable prognosis, the effects of chemotherapy or chemoradiation therapy on SpCC have not yet been clearly elucidated. Further investigation to determine the most suitable treatments and prognosis of SpCC is required.

While malignant neoplasms of the residual thyroglossal duct are rare by themselves, distant metastasis from thyroglosssal duct cancers is exceedingly rare, and has never previously been reported in Japan. Herein, we report the case of a 50-year-old woman who was diagnosed as having papillary carcinoma of the thyroglossal duct. Although fine-needle aspiration cytology revealed a class III lesion, contrast-enhanced computed tomographic examination revealed an osteolytic change of the hyoid bone and enlarged lymph nodes in the superior cervical region. Therefore, the possibility of a malignant tumor was considered, and excision of the cervical tumor was performed by the Sistrunk method, along with neck dissection. Postoperative histopathological examination revealed the diagnosis of papillary carcinoma of the thyroglossal duct. As lung metastases developed six months after the surgery, total thyroidectomy was performed, followed by radioactive iodine treatment.

Merkel cell carcinoma (MCC) is a rare primary cutaneous neuroendocrine tumor, most often occurring in the head and neck region in the elderly; it is a highly aggressive tumor, with a high frequency of recurrence. Despite the highly malignant course of MCC, there have been a few reports of spontaneous regression of this tumor.

We report the clinical course of an 80-year-old female patient with MCC. The patient presented with two tumors occurred in the subcutaneous region of the left lower jaw and parotid gland. Fine-needle aspiration cytology from the tumor of the lower jaw revealed high-grade atypical cells, and surgery was planned as for malignancy of the parotid gland. But at the first hospitalization, the patient showed almost complete regression of the tumor in the lower jaw, even prior to the surgery, with only a small residual tumor in the parotid gland. Therefore, excision of the tumor in the parotid gland and of the primary subcutaneous tumor of the lower jaw was performed, with neck lymph node dissection. The tumor in the parotid gland was finally diagnosed as a lymph node metastasis from MCC, however, there was no evidence of MCC in the lesion of the lower jaw. After the surgery, the patient was given adjuvant radiation therapy, and until now, there has been no evidence of recurrence.

In most previously reported cases of spontaneous tumor regression, the regression had occurred following initial incisional biopsy of the tumor. Our case revealed that even minor physical stimulation, such as fine-needle aspiration, can trigger the spontaneous regression of MCC.

Recurrent or metastatic squamous cell carcinoma of the head and neck (RM-SCCHN) is markedly difficult to cure and the prognosis is poor. Death usually results in 2 to 4 months if the condition is left untreated, while chemotherapy has been shown to prolong the overall survival and improve the QOL. At our hospital, the Head and Neck Cancer Medical Oncology Division was established in 2016. Collaboration among experts in head and neck surgery, radiation oncology, and dental and co-medical care is increasing, and treatment options are expanding. Herein, we summarize the current status of this division, as well as future plans, development of treatment guidelines, and results of clinical trials at this division.