The complications of parotid gland surgery include facial nerve paralysis, Frey syndrome, salivary fistula, postoperative bleeding, and hypoesthesia of the greater auricular nerve. However, the risk of recurrence of tumors also needs to be considered. In addition, the first bite syndrome may develop when tumors of the salivary gland originating from the deep lobe present in the parapharyngeal space. These complications, besides facial nerve paralysis, can also reduce the postoperative QOL of patients after parotidectomy. It is necessary to obtain informed consent from the patients before the surgery, and to take preventive measures and consider appropriate treatments for complications that might arise. In this article, among the complications of surgery for parotid gland tumors, Frey syndrome, salivary fistula, sensory abnormalities around the auricle, and first bite syndrome, which are the second most common complications after facial nerve paralysis, are reviewed and data are introduced. In addition, recent findings on the management for postoperative complications after parotid gland surgery are reviewed, and surgery for recurrent pleomorphic adenoma of the parotid gland is described.

Cerebrospinal fluid (CSF) leakage from the temporal bone into the middle ear can occur in patients with temporal bone fractures, complications of temporal bone operations, tumors, or cholesteatoma. Diagnosis of spontaneous CSF leakage into the middle ear is often challenging, because the symptoms are similar to those of otitis media with effusion. Here, we report a rare case of fatal bacterial meningitis with spontaneous CSF leakage into the middle ear. A 52-year-old man was brought to us with the chief complaints of fever, headache, nausea, and impaired consciousness. He had a medical history of repeated episodes of otitis media during childhood. Neurologists initially suspected bacterial meningitis caused by Streptococcus pneumoniae. Otolaryngological examination revealed a pulsating tympanic membrane with serous effusion in the right ear, and the glucose concentration in the effusion fluid was 51 mg/dL. High-resolution computed tomography (HRCT) of the temporal bone revealed a single 4-mm-sized fistula in the tegmen mastoideum, suggesting spontaneous CSF leakage through the bony defect. We deduced that this condition was the cause of the bacterial meningitis. We performed intact canal wall mastoidectomy to close the fistula. The fistula was closed in multilayers using several autologous tissues (temporalis fascia, a piece of bone, bone pate, and connective tissue membrane). No recurrence of meningitis or CSF leakage were observed until 3 months after the operation. In this case, the repeated otitis media episodes during childhood could have caused a bone defect or erosion of the tegmen. HRCT and examination of the glucose concentration in the middle ear effusion fluid could be useful for the diagnosis of CSF leakage into the middle ear.

Cochlear implant surgery has been introduced successfully and is now one of the commonly performed surgeries. However, the surgical strategy of cochlear implantation in patients with chronic middle ear diseases, such as chronic otitis media and cholesteatoma, has not yet been fully established. In the present report, we describe the surgical technique adopted and prognosis of two patients with severe adhesive otitis media who underwent cochlear implant surgeries. Both underwent one-stage cochlear implantation combined with external auditory canal closure (blind-sac closure). Mastoidectomy with removal of the whole canal wall was performed to remove the otitis lesion thoroughly, and external auditory canal wall closure was performed to prevent recurrence of the lesion. A pneumatized tympanic cavity was observed and canal wall closure was maintained in both cases. Both patients acquired fair hearing ability with the cochlear implants. No severe complications have occurred until now, four years since the cochlear implantation. Although external ear canal closure destroys the natural structure of the external ear, one-stage cochlear implant surgery combined with canal closure is useful for elderly patients with systemic complications who desire shortening of hearing-deprived period.

Surgery is indicated for intratemporal facial nerve schwannoma with severe facial palsy, but even if nerve transplantation or a hypoglossal-facial nerve anastomosis is performed after complete tumor resection, only insufficient resolution of the facial palsy is obtained. Follow-up with imaging is usually undertaken for cases of intratemporal facial nerve schwannoma without facial palsy. Herein, we present a case of intratemporal facial nerve schwannoma without facial palsy which was followed up for 10 years using imaging studies.

A 59-year-old male patient presented with the chief complaint of right hearing loss. On examination, the right tympanic membrane was not visible due to the presence of a very large tumor in the right external acoustic meatus. Computed tomography (CT) and magnetic resonance imaging (MRI) revealed that the tumor in the mastoid segment of the facial nerve canal had spread outside the external acoustic meatus, damaging its posterior wall. Moreover, the tumor extended to the parotid gland, forming a dumbbell-like shape. There was no facial paralysis, although an audiogram indicated slight, right hearing loss. Based on the imaging findings, the patient was diagnosed as having intratemporal facial nerve schwannoma. His symptoms and tumor size were monitored by MRI yearly. There was no facial palsy, although the tumor increased gradually in size in the external acoustic meatus, parotid gland, and the mastoid segment of the facial nerve canal. His right conductive hearing showed only moderate deterioration.

The basic therapy for intratemporal facial nerve schwannoma is nerve transplantation after complete tumor resection or nerve-sparing stripping. However, both methods have disadvantages, and neither is sufficient to resolve the facial palsy completely. Thus, in the absence of facial palsy, surgery is not indicated in cases of intratemporal facial nerve schwannoma, unless malignancy or intracranial tumor invasion is suspected. The present case required careful follow-up despite the absence of facial palsy, because of the steady growth of the tumor.

Benign fibrous histiocytoma is a soft tissue tumor of unknown etiology that arises from the subcutaneous tissue, which accounts for 15% of all soft tissue tumors. The incidence of benign fibrous histiocytoma in the head and neck region is rather low, being on the order of a few percent, and there are scarce reports of its occurrence in the oral cavity. In addition, the tumor predominantly occurs in those over 25 years old, and onset in infants is quite rare.

We report a case of a two-month-old boy with benign fibrous histiocytoma arising from the tongue. The tumor in the tongue was detected at 40 days after birth. However, the child was brought to our department at a later date, because the tumor had grown and the child had difficulty in swallowing. The tumor, 25 mm×25 mm in size, was found on the left edge of the tongue. Tumor resection under general anesthesia was performed, and histopathology of the resected tumor revealed a benign fibrous histiocytoma. There has been no recurrence of the tumor, dysarthria, or dysphagia until now, three years after the surgery. Tumors of the tongue are rare in infants, but benign fibrous histiocytoma should be included in the differential diagnosis in infants presenting with tumors of the tongue.

Adenoid cystic carcinoma is known as one of the malignant carcinomas included in the WHO Classification of Salivary Gland Tumors. Despite its slow-growing nature, it is often associated with local recurrence and distant metastasis. Herein, we report a case of sublingual gland carcinoma that was diagnosed during pregnancy.

The patient was a 32-year-old pregnant woman, with a 3-year history of tongue numbness and atrophy, the cause of which had remained undiagnosed despite detailed examination.

Pregnancy in the patient had been established through infertility treatment. The patient developed fatigue and abdominal symptoms during the mid-trimester of pregnancy, and detailed examination revealed the diagnosis of sublingual adenoid cystic carcinoma with multiple distant metastases.

Although the patient received systemic chemotherapy, her general condition deteriorated and emergency caesarean section was performed at 24 weeks of pregnancy.

She died 6 days after the caesarean section, while her baby is now receiving care at the NICU.

The findings of this case are consistent with the characteristics of adenoid cystic carcinoma. Considering the symptoms, it is assumed that she had paralyses of the lingual and hypoglossal nerves. It is estimated that 1 in every 1000 pregnant women is diagnosed as having carcinoma, but to the best of our knowledge, there are no reports until date of fatal sublingual adenoid cystic carcinoma diagnosed during pregnancy. It is considered that the pregnancy induced a state of immune tolerance, promoting growth of the cancer cells and rapid exacerbation.

Since there are few cases of head and neck malignant carcinomas diagnosed during pregnancy, and there are no established guidelines for cancer management during pregnancy, it is important to publish case reports.

We present, herein, a case report of subglottic mucoepidermoid carcinoma (MEC), with a review of the literature. A 56-year-old man presented to us with a two-month history of hoarseness and pharyngeal pain. Endoscopic examination showed fixation of the left vocal cord, and CT showed a tumor extending from the subglottic region to the left lobe of the thyroid. Since the subglottic region could not be observed directly through the laryngeal endoscope, fine-needle aspiration biopsy was performed through the left lobe of the thyroid; the result was “suspicious for squamous cell carcinoma (SCC).” PET-CT indicated left regional neck lymph node metastasis and distant metastasis in the right hilar lymph node and right gluteus minimus muscle. As the clinical stage was cT4bN2bM1, total pharyngo-laryngectomy and cervical esophagectomy, bilateral neck dissection, and reconstruction with a free jejunal graft were performed. Since the histopathological diagnosis was high-grade MEC, the patient received post-operative radiotherapy. At 4 months after the surgery, progression of the right hilar lymph node metastasis and new development of distant metastasis in the left ventricular heart muscle were detected, and the patient was given chemotherapy. However, the metastatic lesions failed to show treatment response despite several courses of chemotherapy. Furthermore, at 12 months after surgery, the patient developed disturbance of the left eye field because of a left choroid metastasis, and the other distant metastases had also worsened. The patient died of tracheal bleeding from the hilar lymph node metastasis at one year 11 months after surgery. Subglottic MEC is rare and only a few cases have been reported. It is often difficult to distinguish between MEC and SCC in the small tissue fragment obtained by biopsy. Although there is no standard treatment for MEC, surgery is the primary treatment and radiotherapy may be moderately effective.

Lymphoepithelial carcinoma (LEC) is a rare malignancy of the head and neck with identical morphological features to those of undifferentiated carcinoma of the nasopharynx (WHO type 3), that is usually treated by radiotherapy or chemoradiotherapy. Herein, we report a rare case of LEC of the hypopharynx, along with some review of the literature. A 65-year-old man was referred to our department for a mass in the left arytenoid region. Based on the findings of clinical examination, we made the diagnosis of hypopharyngeal squamous cell carcinoma (cT4aN2cM0), and performed total laryngopharyngectomy with cervical esophagectomy, bilateral modified neck dissection, and reconstructive surgery using a free jejunal flap. Histopathological study of the surgical specimen revealed the diagnosis of LEC. We did not recommend postoperative chemoradiotherapy, according to the treatment policy for head and neck squamous cell carcinoma. Examination at the 5-year follow-up revealed no evidence of locoregional or distant metastases.

Introduction: Salivary gland tumors are often difficult to diagnose precisely preoperatively. Although intraoperative pathological examination by frozen sections (FS) is useful for perioperative diagnosis, we sometimes encounter a mismatch of diagnoses between FS and paraffin-embedded specimens. Here, we studied the usefulness of FS for salivary gland tumors.

Method: We conducted a retrospective analysis of the data of 250 patients with salivary gland tumors who underwent intraoperative FS examination between January 2013 and December 2019 at our hospital. The sensitivity and specificity of FS were calculated, and the diagnostic accuracy was statistically compared between parotid gland tumors and submandibular gland tumors.

Results: The sensitivity and specificity of diagnosis of salivary gland tumors by FS were 80% and 99%, respectively. The diagnostic accuracy for submandibular gland tumors was lower than that for parotid gland tumors. The time required for a precise histopathological diagnosis was longer when there was a mismatch between the intraoperative diagnosis and the histopathological diagnosis.

Conclusion: FS was useful for perioperative examination of salivary gland tumors. Accurate diagnosis of submandibular gland tumors was more difficult than that of parotid gland tumors. A combination of various examinations is necessary to determine the most suitable operative method for salivary gland tumors.

Chemotherapy decreases fertility in childhood, adolescent and young adult (CAYA) cancer patients. We previously conducted a questionnaire survey of 275 otorhinolaryngologists to determine how they handled fertility issues in their patients. The number of physicians who had actually referred patients to an egg and sperm storage facility was only 17.5%, which was significantly lower than the number in other departments. Therefore, in order to raise awareness about fertility issues of their patients, we investigated the actual status of fertility care provided to patients in our department. Among 20 CAYA cancer patients who received chemotherapy at our department during the study period, only two had received explanations about fertility and only one had received oocyte preservation therapy. Based on these results, our department reviewed the explanatory documents provided to the patients prior to chemotherapy and strengthened cooperation with the department in charge of reproductive medicine. Although subsidy systems and regional reproductive health networks are gradually being established, it is important to make reforms at the departmental and physician levels in order to create an effective system.

With the rapid aging of the population, the number of patients with dementia requiring surgery for various diseases is expected to increase. Since the risk of airway obstruction caused by infiltration of adjacent organs is increased in cases of thyroid cancer, surgery is often selected as the best treatment option even for elderly patients.

Our patient reported herein, a 78-year-old woman with dementia, who showed wandering behavior at night, was diagnosed as having advanced papillary thyroid cancer. Total thyroidectomy, cervical dissection, mediastinal dissection, and vagal nerve resection were performed. After the operation, the patient was managed in the intensive care unit, and rehabilitation was started early. Due to the early start of rehabilitation, the patient was able to return to the society immediately after discharge.

In elderly patients with dementia, special attention needs to be paid to the possible need for emergency airway management for postoperative complications such as postoperative bleeding and aspiration caused by recurrent nerve paralysis, and to airway maintenance.