Bone conduction is an excellent sound transmission system, and the pathways and characteristics of bone conduction are gradually being better understood. Advances have been made in the development of bone conduction implants, although these are not yet widely used in Japan. Baha^® is the most traditional bone conduction implant, and in recent years, new products with improved performance have been introduced and the indications have been expanded. BONEBRIDGE^® is a new bone conduction implant that began to be covered by the national health insurance in 2021 and can be used in Japan. A new product called Osia^® has also been developed and is increasingly used overseas. In addition, we are developing a novel bone conduction implant using a giant magnetostrictive material (GMM) that offers high output, simplicity of use, a simplified structure (fixed with one screw), and minimally invasive surgery in Japan, to aim for clinical application in the near future.

The objectives of treatment of cholesteatoma associated with otitis media are complete removal of the middle ear lesions, prevention of recurrence, and hearing improvement, as reported in the past. Herein, we reviewed the data of patients who did not show hearing improvement, and patients who were diagnosed to have recurrence at the 2nd stage of surgery performed for obtaining hearing improvement. We set a target of 51 patients and 52 ears who underwent single surgery or staged surgery for cholesteatoma arising in the pars flaccida during the two-year period from November 2016 to November 2018 (all cases were operated by first author) and had undergone pure-tone audiometry a year after the surgery. The results showed that the success rate for hearing improvement was 80.4%. Of the 52 cases in the observation period in the present study, reformation recurrence was detected in only 1 case, and residual recurrence was detected in 2 cases. On the other hand, of the cases of recurrence diagnosed at the 2nd surgery (31 cases), reformation recurrence was detected in 10 cases, and residual recurrence in 13 cases. Residual recurrence at the 2nd surgery was more likely to be seen in cases in which the lateral aspect of the superior tympanic cavity had been reconstructed with bone pate. After we changed the reconstruction method from bone pate to sliced cartilage, the frequency of reformation recurrence obviously decreased. We consider that the cause of the reformation recurrence in the patients who undergo reconstruction using sliced cartilage is re-extension through the front portion of the cartilage. Therefore, we think that is important to tightly fill the gap between the reconstructed plate and the sliced cartilage during the initial surgery.

With the recent advances in antimicrobial agents and imaging studies, otogenic intracranial complications have become rare. Herein, we present the case of a patient with multiple brain abscesses that developed 2 months after repeated exacerbations and remissions of refractory otorrhea. A 55-year-old man was diagnosed as having mastoiditis by CT, although he did not present with typical symptoms, and was treated with antimicrobial agents for about 2 weeks. During the follow-up, he presented with fever, headache, and vomiting and was referred to our university hospital. Along with the fact that the latter symptoms appeared shortly after the end of the antimicrobial treatment, the CT and MRI findings suggested masked mastoiditis, which caused sigmoid sinus thrombosis and multiple brain abscesses. After 4 months of antimicrobial therapy and several craniotomies, the patient recovered. Factors contributing to the severity of the disease in this patient included underlying diabetes mellitus, immunosuppressive state induced by steroid therapy, and infection with Streptococcus intermedius. Appropriate early diagnosis, examination, and treatment, as well as adequate follow-up are mandatory for the prevention of severe cryptogenic mastoiditis.

The incidence of allergic diseases has been increasing in recent years. Although sublingual immunotherapy and molecular-targeted drugs have emerged as treatments for allergic rhinitis in recent years, drug therapy is still the mainstay of treatment in Japan. Recently, new non-sedative antihistamine drugs that do not cross the blood-brain barrier have been introduced. Therefore, we conducted a questionnaire survey of patients to determine the patient satisfaction level with the prescribed drug, the drugs selected, and presence of subjective drowsiness, in order to devise an algorithm for selection of the appropriate drug based on patients’ lifestyle and needs for second-generation antihistamines. This survey was divided into two parts: a lifestyle and drug needs survey and a survey of the second-generation antihistamines actually taken.

In regard to the desires of the patients in respect of the antihistamine to be prescribed, such as “immediate effect,” “persistent effect,” “no serious side effects,” “inexpensive,” “infrequent oral use,” and “strong effect even with side effects,” the results showed that the former three were desired more frequently by the patients than the latter three. A comparison of the subjective drowsiness level between patients who took a drug that calls for avoidance of extra attention to be paid while driving and patients who took a drug that did not call for the above revealed that the subjective drowsiness level was statistically significantly higher in the former group (p=0.021: Chi-squared test).

In the future, in addition to the previously reported desire of patients to be prescribed drugs with “strong efficacy,” we believe that it is necessary to also develop new drugs focusing on the desires of patients for “immediate efficacy,” “persistence,” and “no serious side effects.”

Doctors will need to make drug selections tailored to the living conditions of each person. In addition, it is necessary to examine whether daytime sleepiness is secondary to the allergic symptoms or to antihistamines. Considering that impaired performance is reduced even when there is no drowsiness, it is necessary to improve the QOL while treating the allergic symptoms, by appropriately selecting drugs that would not interfere with learning and dangerous work, or pose obstacles in daily life. The above issues must be borne in mind while prescribing antihistamines in clinical practice.

Glomangiopericytoma (GAPC) is a type of hemangiopericytoma that develops in the sinonasal cavity; the first case was reported as a hemangiopericytoma in 1942. Based on the WHO classification of tumors, GAPC was independently defined in 2005, as a type of hemangiopericytoma originating from the sinonasal cavity. GAPC is rare among paranasal sinus tumors, accounting for approximately 0.5% of all paranasal tumors, and develops from the paranasal cavity in most cases. Herein, we report a case of GAPC that developed from the superior nasal turbinate. A 75-year-old woman visited our hospital with the chief complaint of snoring. Nasal endoscopy revealed a tumor mass in the olfactory cleft and a biopsy was obtained. The tumor was diagnosed as a GAPC from the histopathological and immunohistochemistry findings (vimentin-positive and alpha-SMA-positive). We performed endoscopic resection of the tumor, and no recurrence was observed for five years following the surgery. The histopathology provided a definitive diagnosis of GAPC. GAPC is generally a low-grade malignancy, but some case with high-grade malignancy have been reported. The latter cases require complete surgical removal. Endoscopic removal of the tumor is recommended as the first-line therapy. However, embolization and surgical incision should be considered in patients with large tumors and those in whom excessive bleeding from the tumor is expected. We did not undertake the above in our case, as the tumor was small and no excessive bleeding from the tumor was expected.

Spindle cell carcinoma is often characterized by a biphasic morphology, composed of sarcomatous proliferation of spindle-shaped cells and squamous cell carcinoma, and its occurrence in the paranasal sinuses is extremely rare. Herein, we report a case of spindle cell carcinoma of the maxillary sinus that was difficult to diagnose. A 43-year-old man visited our department with the chief complaint of recurrent left epistaxis. This nasal tumor appeared macroscopically as a hemorrhagic granulation, like a hematoma, but MRI showed a gyrus-like high-intensity region in the left maxillary sinus. We performed biopsy twice, but histopathology revealed suspected hemorrhagic granulation with necrotic tissue, and no definitive diagnosis could be obtained. Then, to obtain a definitive diagnosis, we performed biopsy under general anesthesia via a rigid endoscope. Although a sufficient amount of specimen was obtained, heavy bleeding from the tumor surface and deep parts could not be controlled, so that the tumor shrank, and as a result, the tumor could be removed from the surface of the maxillary sinus mucosa to accomplish hemostasis. Postoperative pathological diagnosis showed intraepithelial squamous cell carcinoma components showing a transition to spindle-shaped cells, and immunohistochemistry showed partially positive staining of the squamous cell component, but negative staining of the spindle cell component, for AE1/AE3. Based on the findings, we made the diagnosis of spindle cell carcinoma. It took one and a half months from the first visit to this diagnosis. We recommended subtotal maxillectomy to the patient as additional treatment, but he refused consent for the surgery, and we selected chemoradiotherapy instead. Five years have elapsed since, and the patient’s general condition remains good, with no evidence until date of local or distant metastasis. It often takes long before a precise diagnosis of spindle cell carcinoma can be made, because of its special histological type, and this diagnosis should be borne in mind in patients presenting with non-specific epistaxis.

Ameloblastic carcinoma is a rare odontogenic tumor, and in most cases, develop in the lower jaw. Herein, we report a rare case of ameloblastic carcinoma that developed in the maxilla.

The patient was a 72-year-old man who visited our dental surgery department with the chief complaint of left upper gingival swelling. Surgical treatment performed under the provisional diagnosis of a radicular cyst revealed a tumorous lesion that had advanced to the maxillary sinus. Therefore, the patient was referred to the otorhinolaryngology department, where tumor resection with maxillectomy was perfomed. The postoperative pathological diagnosis was ameloblastic carcinoma. Until now, more than 5 years after the surgery, the patient has shown no evidence of recurrence or distant metastasis.

Surgical resection is recommended for the treatment of ameloblastic carcinoma, but careful observation of the course is still necessary, because of the high rate of postoperative recurrence.

Desmoid tumor, a benign mesenchymal tumor arising from the muscle tissue or organ walls, is characterized by proliferation of fibrotic tissue. The tumor is histologically benign, but clinically malignant, as complete surgical excision of the tumor is often difficult because of the locally invasive nature of the tumor. We report a case of cervical desmoid tumor, in which postoperative tumor recurrence was treated successfully by radiotherapy.

An 80-year-old man visited us complaining of a cervical swelling. A hard and fixed tumor was palpable on the right side of the neck. No definitive diagnosis of the tumor could be made by CT, MRI, blood chemistry, or fine needle aspiration cytology. Surgical excision of the tumor performed for a definitive diagnosis, and histopathological examination of the excise specimen revealed the diagnosis of desmoid tumor. Recurrence of the tumor was observed 3 months after the operation, which was treated by radiation. The radiotherapy resulted in remarkable shrinkage of the tumor, which has remained sustained for more than two years.

It is important to include desmoid tumor in the differential diagnosis of hard and fixed cervical tumors that are difficult to diagnose by routine inspection. Postoperative radiotherapy should be considered in cases of desmoid tumor where surgical resection is incomplete.

Background and Purpose: Advanced hypopharyngeal cancer patients with lymph node metastases exhibit a poor prognosis. In particular, evaluation and management of metastatic retropharyngeal lymph nodes (Rouviere’s lymph nodes), which are known to influence the patients’ outcome, are quite difficult. In order to potentially circumvent these issues, at our department, we routinely perform bilateral dissection of Rouviere’s lymph nodes in all advanced hypopharyngeal cancer patients undergoing total pharyngolaryngoesophagectomy (TPLE) and radical neck dissection including those with and without imaging findings suggestive of metastasis in these lymph nodes. We conducted this retrospective study to examine the effectiveness of routine bilateral Rouviere’s lymph node dissection for potentially preserving Rouviere’s lymph node metastasis in patients with advanced hypopharyngeal cancers.

Materials and Methods: The subjects were a total of 51 patients of advanced hypopharyngeal cancer who had undergone Rouviere’s lymph node dissection between 2009 and 2018. The presence/absence of Rouviere’s lymph node metastases was examined in preoperative CT, MRI, and FDG-PET images obtained for subsite localization and staging of the tumors. We compared the results of preoperative image evaluation and postoperative examination of resected specimens for metastatic lesions in the nodes.

Results: Postoperative histopathological examination of the resected specimens revealed metastases in Rouviere’s lymph nodes in 12 out of the 51 patients. In only 3 out of these 12 patients with metastatic lesions in the Rouviere’s lymph nodes were the metastases suspected form the preoperative imaging findings. The 3-year overall survival rate was 72.7% in patients with metastases in Rouviere’s lymph nodes, and 79.3% in those without metastases in this group of nodes. The 5-year overall survival rate was 41.5% in the patients with metastases in Rouviere’s lymph nodes and 74.0% in those without metastases in this group of lymph nodes. No postoperative recurrence was detected in any of the cases.

Conclusions: These results suggest that in patients with advanced hypopharyngeal cancers, performance of bilateral retropharyngeal lymph node (Rouviere’s lymph nodes) dissection would appear to be useful to obtain a better prognosis.

Undifferentiated carcinoma of the accessory parotid gland is extremely rare. We report the case of an 83-year-old woman with undifferentiated carcinoma of the accessory parotid gland. The patient was referred to our hospital for detailed investigation and treatment of a mass in the left cheek. MRI revealed a solid tumor with an irregular edge in the masseter muscle. The findings of fine-needle aspiration cytology led to suspicion of the tumor being an adenocarcinoma. Therefore, the tumor was surgically resected by a direct approach via a cheek incision. The buccal branch of the facial nerve was present within the tumor, so that it was sacrificed. Histologically, the tumor was diagnosed as an undifferentiated carcinoma. Postoperative radiation therapy was administered, but one year six months after the surgery, the patient was diagnosed as having metastases in the submandibular lymph nodes. We performed dissection of the neck lymph nodes and administered additional postoperative radiation therapy for the submandibular region. The patient has had no recurrence or metastasis in the four years since until now.

There are various surgical approaches for resection of tumors of an accessory parotid gland, and it is necessary to select the most suitable approach after considering the advantages and disadvantages of each approach. Also, undifferentiated carcinoma of the salivary gland has a high recurrence rate and a poor prognosis, and multimodality treatment is important to control postoperative recurrence.

In 2010, Skálová et al. were the first to propose mammary analogue secretory carcinoma (MASC) as a new subtype of salivary gland carcinoma characterized by the presence of the ETV6-NTRK3 fusion gene. MASC was earlier often categorized as an unusual variant of salivary acinic cell carcinoma, because the histological appearance of MASC is sometimes similar to that of acinic cell carcinoma. Herein, we present the case of a 52-year-old male patient who presented with a submucosal tumor in the upper lip and was diagnosed as having MASC. The tumor was 1 cm in diameter and was initially diagnosed as a benign submucosal cyst in the upper lip and excised. Histopathology of the surgically resected specimen revealed the diagnosis of MASC. No additional treatment was administered to the patient and he remained free of tumor at the follow-up examination conducted 18 months after the surgery. It was difficult to suspect malignant tumor initially in this case, underscoring the importance of bearing in mind the possibility of malignant submucosal cyst in the differential diagnosis. It is important to keep in mind the possibility of MASC in patients presenting with a submucosal cyst of the lip.