Human papillomavirus (HPV) infection is frequently observed in the head and neck region and has become a common cause of oropharyngeal squamous cell carcinoma (OPSCC), although the detailed mechanism underlying the pathogenetic process from infection to carcinogenesis remains unclear. A new staging system has been proposed in the 8th edition of the American Joint Committee on Cancer (AJCC) Staging Manual, which reflects the HPV infection status in determining the clinical stage of OPSCC. The 8th edition of the AJCC Staging Manual adopted p16 immunohistochemistry as a surrogate marker of HPV infection. Although p16 immunoreactivity is a clear indicator of HPV-mediated OPSCC, the significance of p16 immunoreactivity in other head and neck cancers has yet to be confirmed. It is very important to employ polymerase chain reaction (PCR) assay for the detection of HPV infection, while using appropriate control conditions and ensuring adequate sample quality, to prevent false-negative as well as false-positive results. In addition, establishment of a risk classification system and less-invasive treatment protocol for HPV-mediated head and neck cancer is also necessary.

The low-risk types of HPV infection, namely, HPV-6 and -11, are observed in nearly all cases of recurrent laryngeal papilloma. Patients, especially children, suffer from laryngeal papilloma because of frequent recurrence and airway obstruction, although the rate of malignant transformation is low. Elucidation of the mechanism of recurrence is important to devise a new treatment protocol.

We present a rare case of isolated congenital fixation between the immature suprastructure of the stapes and the facial canal, associated with congenital cholesteatoma. A 7-year-old girl showed left conductive hearing loss on pure-tone audiometry. CT showed abnormal calcification in the tympanic cavity. During surgery, we observed that the suprastructure of the stapes was an immature dumbbell-shaped bone fixed on the horizontal portion of the facial canal and separated from the footplate, which displayed good mobility. A stapedial tendon was present. After resection of the immature bone from the suprastructure, a congenital open-type cholesteatoma was noted on the footplate. The congenital cholesteatoma was extirpated and type IV tympanoplasty was performed using Apaceram^®-T.

Hearing improvement was noted postoperatively. We think that the stapes-facial canal fixation in this case was a result of disturbance of the attachment between the stapes anlage and Reichert’s cartilage in the late stage of development of the stapes. The cause of transformation of the stapedial suprastructure seemed to be disturbed remodeling of the stapes anlage in the embryo at around 19 weeks of development. A review of the literature revealed such cases with stapedial abnormality, including stapes-facial canal fixation, immature suprastructure and concomitant congenital cholesteatoma are very rare. We regard this case report as providing important insights into the development of the stapes.

Facial nerve paralysis is unilateral in most cases, and cases of bilateral facial nerve paralysis are rare. In particular, simultaneous bilateral facial nerve paralysis is very rare. We encountered a patient with malignant lymphoma who developed bilateral simultaneous facial nerve paralysis during chemotherapy. A 72-year-old man diagnosed as having Hodgkin’s disease was hospitalized during the second course of AVD therapy with suspected febrile neutropenia, 5 days before our first examination. He complained of difficulty in moving his lips, and was referred to our department the following day. Examination at our department revealed scarce facial movements on either side. A head MRI, and blood and cerebrospinal fluid examinations revealed no remarkable findings. Considering that the patient was in an immunocompromised state, we started the patient on steroid therapy (administered for 10 days) two days after our first examination. Even though cerebrospinal fluid examination was performed three times, only a mild increase in cell number and protein level was observed; all other laboratory data were also negative, and we diagnosed the patient as a case of simultaneous bilateral idiopathic facial nerve paralysis. The facial movements improved gradually, with complete recovery achieved at one year four days after our first examination. Bilateral facial nerve palsy is often a symptom of systemic disease. Since various tests to identify the cause were negative in this case, we considered the condition as idiopathic in origin; however, since cerebrospinal fluid examination revealed an increase in both the cell number and protein level, the patient may have had mild viral meningitis. ENoG monitoring may allow evaluation in cases of bilateral paralysis.

Ramsay Hunt syndrome (RHS) is characterized by facial nerve paralysis, herpetic vesicles around the ear, and pain; it is most frequently associated with VIII cranial nerve involvement, but on rare occasions, other cranial nerves are affected as well. We present the case of a 63-year-old woman of RHS with involvement of the V, VII, VIII, IX, X and XI cranial nerves. The patient was a 63-year-old woman with complaints of left hearing impairment, left facial palsy, dizziness, sore throat, hoarseness, and dysphagia. Physical examination revealed left vocal cord paralysis. Examination of hearing and vestibular functions revealed left sensorineural hearing loss and left canal paresis. The patient showed significant improvement after treatment with acyclovir and prednisolone. RHS should be recognized as polycranial neuritis characterized by damage of both sensory and motor nerves, including the facial nerve and the auditory-vestibular apparatus.

Kimura disease, or eosinophilic granuloma of the soft tissue, is a chronic inflammatory granuloma arising from the subcutaneous soft tissues or lymph nodes of the head and neck. We report the case of a 51-year-old male patient with Kimura disease who presented with a bulky left preauricular mass. The peripheral blood eosinophil count and serum levels of IgE and antibodies against candida antigens were elevated. Contrast-enhanced MRI revealed involvement of the parotid gland, and the patient was treated by resection of the bulky mass and of the superficial lobe of the parotid gland. Histopathological examination of the resected specimen showed proliferation of the lymphoid follicles with marked eosinophilic infiltration in the lesion, and we made the diagnosis of Kimura disease. After the surgery, the peripheral blood eosinophil count as well as the serum levels of IgE and antibodies against candida antigens decreased, with no evidence of relapse for at least three years after the surgery. Our findings suggest that type I allergy to Candida albicans plays an important role in the development of Kimura disease.

Retropharyngeal hematoma is characterized by the formation of a hematoma in the retropharyngeal space following trauma or the like. Because of the anatomical features of that region, a hematoma in the retropharyngeal space can easily spread and lead to airway stenosis. Therefore, appropriate diagnosis and prompt treatment is important.

Case 1: A 57-year-old man was referred to our department with dyspnea that developed after he used an ab roller. We performed tracheal intubation immediately. Because we thought that the hematoma could increase in size rapidly, we performed surgical treatment. Case 2: An 85-year-old woman was referred to our department with a history of sustaining injuries when she fell down the stairs. We performed tracheal intubation in this case too. The hematoma resolved with conservative treatment.

Hematomas can be treated by surgery or conservative treatment. Surgical treatment is selected for hematomas that increase rapidly in size or when a hematoma does not improve within 2 weeks.

Background and aims:

Chronic aspiration, of varied etiology, can be a life-threatening disorder. Laryngotracheal separation has been used as a surgical procedure in the treatment of intractable chronic dysphagia. We performed subglottic closure as another surgical technique, and evaluated the clinical outcomes. We report our cases, along with some review of the literature.

Materials and methods:

We performed this surgical procedure in 17 cases over a period of 46 months from June 2014 to March 2018. Data on the patients’ demographics, presenting clinical feature(s), respiratory care, length of hospitalization, postoperative complications and oral intake were retrospectively analyzed.

Results:

Of the 17 patients, minor anastomotic leakage was noted in only one case, and there were no cases of severe postoperative complications.

Conclusion:

This procedure was performed safely in all the cases. These findings indicated that this procedure is effective and can yield favorable outcomes.

Parathyroid cysts are classified into two categories, nonfunctional cysts and functional cysts. It is difficult to distinguish nonfunctional parathyroid cysts from thyroid cysts preoperatively, because the serum levels of parathyroid hormone (PTH) and calcium are within the reference values even in patients with nonfunctional parathyroid cysts. As a result, some cases of nonfunctional cysts are actually diagnosed as thyroid cysts and treated by hemithyroidectomy.

We report a case of a nonfunctional parathyroid cyst that was diagnosed preoperatively by analysis of the cyst fluid and treated by surgical excision. A 38-year-old woman was admitted to our hospital for the treatment of trachelophyma. Ultrasonography revealed a cystic mass located in the inferior pole of the left lobe of the thyroid. The serum levels of PTH and calcium were within the reference values. Fine needle aspiration biopsy of the cyst was performed under the guidance of ultrasonography. The cyst fluid was clear and colorless, and showed elevated levels of intact PTH (i-PTH) (1790 pg/mL). Therefore, we diagnosed the cyst as a parathyroid cyst. After follow-up of the patient for 3 years, surgical excision of the cyst was performed because of enlargement of the cyst and presence of evidence of the compression syndrome. Histopathological examination of the surgical specimen revealed a parathyroid cyst. After operation, the patient developed no complications such as recurrent laryngeal nerve paralysis, hypothyroidism, or hyperparathyroidism. Surgical excision of the cyst is preferable to hemithyroidectomy for the treatment of parathyroid cysts, because hemithyroidectomy is associated with a higher risk of postoperative recurrent laryngeal nerve paralysis and hypothyroidism.

Analysis of the i-PTH level in aspirates from the cysts is potentially useful for preoperative diagnosis of nonfunctional parathyroid cysts.

We report on referrals to our department from other departments for swallowing function assessment. We investigated the data of 338 cases in which videoendoscopic evaluation of swallowing was performed at the request of other departments at Kindai University Hospital between September 2016 and August 2017.

The mean age of the patients was 72.4 years old. About 70% of the patients were 70 years old or older. The largest number of requests came from the Department of Respiratory Medicine and Allergology, followed by the Department of Neurology. The most common disease upon hospital admission was pneumonia, followed by malignant disease. Of all the requests, 72% were to determine whether oral ingestion was possible without pneumonia. After the assessments, when the patients were examined to determine if they had pneumonia or not, it was found that 31 patients had aspiration pneumonia. The results were the worst in the 23% of patients in whom it was suggested that “direct therapy is possible.” The important thing for each department was to know, more than the etiological or pathological diagnosis of dysphagia, whether the patient was or was not capable of oral intake. Our department receives many requests for such assessment from other departments. Accurate assessment of a large number of cases is necessary, but many issues still remain to be resolved in ensuring proper maintenance of the swallowing function and prevention of pneumonia.

There is still ongoing debate about the optimal follow-up strategy for head and neck cancer patients after primary treatment. The purpose of this study was to review the data of cases with recurrence and evaluate our follow-up strategy.

The patients with head and neck cancer enrolled in this study underwent surgery or chemoradiotherapy as the primary treatment between 2012 and 2016. All the patients were carefully followed up at our institution by intensive clinical examination, and routine CT and PET/CT.

Recurrence was detected in 20 of the 91 patients treated by surgery, and 25 of the 96 patients treated by chemoradiotherapy. In over 90% of the cases, the recurrence occurred within two years of the primary treatment. Among the patients with recurrence, 11 patients showed local recurrence, 17 patients showed regional recurrence, and 17 patients showed distant metastasis. In almost all of the patients with distant metastases, the recurrence was detected by the imaging examinations (CT or PET/CT), while among the patients with local or regional recurrence, the recurrence was detected, at least in some cases, based on the patients’ complaints and the results of clinical examinations, including endoscopic examination and ultrasonography. Finally, only salvage surgery was associated with disease-free survival after recurrence.

It was considered that analysis of the recurrence pattern and appropriate surveillance can lead to improved salvage treatment for patients with recurrence.