The incidence of thyroid diseases is markedly higher in women than in men, and operations for surgical treatment of these diseases results in the formation of a scar on the anterior neck that is exposed when open-necked clothing is worn cosmetically unappealing, especially for women wishing to wear open-necked clothing. Therefore, a technique for endoscopic endocrine neck surgery that results in a better cosmetic appearance is more cosmetically acceptable results would be desirable, and its demand is expected to increase further in the future. Gagner reported endoscopic parathyroid surgery in 1986, and the world’s first endoscopic thyroid surgery was reported by Yeung and Hüscher in 1997. In 1998, for the first time in Japan, Shimizu reported video-assisted neck surgery (VANS method) using the neck skin lifting method. The following year, Ikeda reported the axillary approach, which has now become the world’s major approach the most popular approach around the world. The procedure began to be covered by insurance for benign tumors, parathyroid gland tumors, and Graves’ disease in 2016, and for malignant tumors in 2018. Currently, in Japan, the VANS method is the most popular method for endoscopic thyroidectomy. In our department, we introduced VANS in 2016, and by August 2022, we had had experience of more than 200 cases.

In this paper, we report on the safety and cosmetic benefits of the VANS method.

Inner ear malformations are among predisposing factors for recurrent meningitis. Adult cases are, however, rare, as most cases are treated in early childhood. A 47-year-old woman with a history of recurrent bacterial meningitis visited our hospital complaining of fever, ear pain, and watery rhinorrhea. Her past medical history was significant in that she had congenital hearing loss in the right ear. Examination revealed a pulsatile eardrum and colorless effusion. An audiogram showed complete deafness in the right ear. CT of the temporal bone revealed the cystic cochleovestibular malformation and absence of the modiolus. T2-weighted images of head MRI showed high-intensity fluid in the tympanic cavity and mastoid cavity. We diagnosed cerebrospinal fluid (CSF) leakage due to incomplete partition type I, which is one of the inner ear malformations, and performed surgery. Leakage was observed from the fistula of the stapes footplate, and CSF gushed out when the stapes was removed. This CSF gusher was repaired by multiple layer packing of the vestibule with adipose tissue, bone putty, and cartilage plate. The postoperative course was uneventful. There has been no recurrence of CSF leakage or meningitis until now, 4 years since the surgery.

In the case of meningitis with deafness, it is important to carefully search for inner ear malformations and CSF leakage using CT and MRI. Multiple layer packing was useful in this case as a surgical procedure for recurrent meningitis.

Eosinophilic otitis media (EOM), which is characterized by effusion caused by the accumulation of eosinophils in the middle ear mucosa, is a type of refractory otitis media that is often associated with asthma and chronic rhinosinusitis with nasal polyps (CRSwNP). Despite the critical need for management of the eosinophilic inflammation of the middle ear and of the comorbid airway diseases using topical and systemic steroids, no well-established treatments exist currently. Dupilumab, an anti-interleukin (IL)-4R alpha monoclonal antibody, has been approved for the treatment of atopic dermatitis, severe asthma, and refractory CRSwNP. This report presents the case of patient with EOM complicated by severe asthma and eosinophilic chronic rhinosinusitis (ECRS), in whom the EOM symptoms improved after dupilumab administration. After the resolution of EOM was clinically confirmed, regenerative treatment was administered using a trafermin kit (Retympa^®) for the tympanic membrane perforation caused by the EOM. At the 6-month follow-up, the patient’s hearing level had improved and the tympanic membrane had healed successfully. Thus, optimized therapy for eosinophilic inflammatory diseases including type 2 inflammatory agents, such as IL-4 and -13, may be important to manage the clinical condition of EOM associated with asthma and ECRS.

Langerhans cell histiocytosis (LCH) is a disease characterized by the proliferation of Langerhans cells, one of the antigen-presenting cells, that can manifest in a variety of symptoms involving various parts of the body, such as the skin, bones, and internal organs. It is a relatively rare disease, occurring at an incidence of about five cases per million children. Although it is a rare disease, 39% of LCH patients have some kind of otologic symptoms and often visit otolaryngologists for otorrhea and external ear masses. In the present study, we report two cases of LCH in which the patients initially presented to otolaryngologists for external auditory canal symptoms and were later diagnosed as having multisystem LCH.

The prognosis of multisystem LCH is often poor, and the patients often suffer from sequelae. Therefore, early diagnosis and initiation of treatment are very important. Otolaryngologists encountering intractable otitis externa or masses in the external auditory canal in children should bear in mind the possibility of LCH and collaborate with pediatricians for biopsy and search for a systemic cause.

We studied 160 ears of 147 patients who had been diagnosed as having external auditory canal cholesteatoma between 2006 and 2021 at our hospital.

The average age of the patients was 66.9 years, with the patients ranging in age from 7 to 95 years; 65% were women, and the annual number of patients increased steadily after 2014. There were significant underlying conditions in 66% of the cases. Osteoporosis (30%) was the most common, followed by diabetes mellitus (8.8%), maintenance dialysis (7.5%), and rheumatoid arthritis (5.6%). Several of the patients were using steroids or bisphosphonate drugs. Aging and menopause are known to be predisposing factors for primary osteoporosis, and each of the background factors mentioned above is thought to predispose to secondary osteoporosis. These results suggest that osteoporosis plays a major role in the formation of external auditory canal cholesteatoma. Many lesions in the cases of external auditory canal cholesteatoma were found around the lower wall of ear canal (75%). We selected conservative or surgical treatment depending on the extent of progression.

The results of this survey suggest that external auditory canal cholesteatomas are more common in women and the elderly, and that their incidence has been increasing in recent years. Since 66% of cases of external auditory canal cholesteatoma had underlying conditions and/or were taking drugs known to affect bone fragility, we believe that it is important to consider the background factors when treating patients with external auditory canal cholesteatoma.

Background: Carcinomas of the lacrimal drainage system are rarely encountered/reported. More than half of the tumors of the lacrimal drainage system are malignant, and squamous cell carcinoma is the most common histological type. Initially, it is often difficult to distinguish this cancer from chronic inflammation, and it takes an average of 3 years from the onset to diagnosis. The tumor is usually treated by surgery and postoperative irradiation or chemoradiation therapy. Excision including the orbit and paranasal sinuses is necessary for advanced tumors. Human papilloma virus (HPV) has been reported to contribute to the development of carcinoma of the lacrimal drainage system. We report three cases of carcinoma of the lacrimal drainage system.

Method: Case report and literature review.

Results: Of the three cases, the carcinoma arose from the lacrimal sac in two cases, and from the nasolacrimal duct in one case. In 2 of the three cases, the tumor was extensive and grew relatively rapidly, and we selected extended combined resection, including orbital contents removal, and reconstructive surgery as the treatment. In 1 case, the extent of progression was limited, and function preservation was possible by chemoradiation therapy alone. HPV was detected in 2 cases, including in one case each of carcinoma of the lacrimal sac and carcinoma of the nasolacrimal duct.

Conclusion: For tumors of the lacrimal drainage system, early diagnosis and therapeutic intervention are desirable. Therefore, repeated biopsies and cooperation with other departments are necessary. Probing possible HPV involvement in carcinoma of the lacrimal drainage system may be useful for diagnosis.

Sebaceous gland carcinoma is a rare but highly invasive tumor that usually occurs on the eyelids, face, neck, and trunk in patients over 60 years of age.

Herein, we report the case of a 71-year-old man who presented with a mass lesion of the right lower eyelid and right preauricular region. Histopathological examination revealed the diagnosis of sebaceous carcinoma with lymph node metastasis. After resection and reconstruction of the right lower eyelid tumor, we performed lobectomy of the right parotid gland with right neck dissection and postoperative irradiation for the right lower eyelid and right whole neck, and the patient is doing well.

Resection of the primary tumor is recommended for the treatment for sebaceous gland carcinoma, but there is still a lack of evidence and no clear recommendation in regard to the extent of lymph node dissection. Lymphatic flow from the lower eyelid differs between the inner and outer halves: the flow from the inner half is via the submandibular region, while that from the outer half is via the parotid region into the neck. Radiation has been reported to be effective. The treatment strategy should be determined by considering the extent of neck dissection based on the location of the primary tumor and adjuvant postoperative irradiation based on the degree of progression.

Fish bones are among the most frequently encountered ingested foreign bodies in the pharynx and cervical esophagus. We report a case in which a mistakenly ingested fish bone had migrated from the hypopharynx to the subcutaneous tissue of the neck and had to be removed through esophagogastroduodenoscopy.

A 70-year-old man who had eaten boiled rockfish visited our hospital complaining of sore throat. Laryngoscopic examination revealed no foreign bodies. However, computed tomography (CT) showed a foreign body between the thyroid cartilage and cricoid cartilage, and esophagogastroduodenoscopy was performed for its removal. In this case, CT was useful for identifying an extrapharyngeal fish bone foreign body. An appropriate removal method needs to be selected for foreign bodies lodged in unusual areas.

Actinomycosis is a relatively rare infectious disease that is caused by Actinomyces israelii, which habitually resides as an intraoral normal bacterial flora. The head and neck region is susceptible to actinomycosis infection, but this infection only rarely affects the tongue. On the other hand, Behçet’s disease is a refractory systemic inflammatory disorder characterized by the following four primary symptoms: recurrent oral ulcers, cutaneous symptoms, ocular symptoms, and pubic ulceration. The following three secondary symptoms are also common: intestinal tract lesions, vascular lesions, and central nervous system lesions. Similarly, gastrointestinal Behçet’s disease is defined as a variant in which the primary manifestations are gastrointestinal symptoms. Herein, we report the case of a patient with suspected intestinal Behçet’s disease along with tongue actinomycosis, which was difficult to diagnose due to the rare disease overlap. The patient was an 80-year-old woman who presented with sore throat, and biopsy of the tongue ulcer revealed actinomycosis of the tongue. The sore throat relapsed after the patient received treatment for actinomycosis, and the patient was suspected as having intestinal Behçet’s disease based on the findings of positron emission tomography/computed tomography (PET-CT) and upper-lower gastrointestinal endoscopy. The patient eventually died of pneumonia caused by the long-term steroid therapy. In this case, Behçet’s disease was difficult to diagnose because of the relatively rare affliction of the affected part also by actinomycosis.

Primary thyroid malignant lymphoma (PTL) is a rare disease that accounts for 1%–5% of all thyroid malignancies. PTL is classified as a low-grade mucosa-associated lymphoid tissue (MALT) lymphoma or intermediate-grade diffuse large B-cell lymphoma (DLBCL). We report a case of MALT lymphoma of the thyroid gland that was diagnosed and treated by completion total thyroidectomy.

The patient was a 54-year-old man who has been under follow-up for Hashimoto’s disease and adenomatous goiter for 3 years. Regular ultrasonography showed gradual enlargement of the left lobe of the thyroid gland. A diagnosis of primary MALT lymphoma of the thyroid gland was made by completion total thyroidectomy. The low frequency of non-gastric primary MALT lymphoma makes large-scale clinical trials difficult, and optimal treatment has not yet been established.

The treatment options include radiation therapy, surgery, and chemotherapy, all of which have been reported to yield good outcomes be effective treatments. For localized-stage tumor, the main treatment is local radiation or surgery. In recent years, numerous reports have indicated that total thyroidectomy alone is effective for the treatment of localized-stage MALT lymphoma. Our case reported herein was successfully treated by total thyroidectomy without recurrence.

Epidermal inclusion cysts (EIC) are common benign lesions of the skin, but EIC is extremely rare in the thyroid gland. Only 14 cases of EIC in the thyroid gland have been reported worldwide until date. To the best of our knowledge, the case reported herein is the first case reported in Japan. A thyroid mass was accidentally detected in a 67-year-old man. Examination of the thyroid mass by ultrasound-guided fine-needle aspiration revealed anucleated and a few nucleated squamous cells. Since the possibility of malignancy could not be ruled out, we performed hemithyroidectomy. Postoperative histopathologic examination confirmed the diagnosis of EIC. This case report suggests that the possibility of EIC should be considered upon detection of squamous cells in ultrasound-guided fine-needle aspiration. And because the possibility of malignancy cannot be ruled out in such cases, hemithyroidectomy often needs to be selected. However, the etiology of EIC in the thyroid gland remains unclear.

Thyroglossal duct cyst is a benign cystic disease that arises from remnants of the thyroglossal duct during fetal life, but it rarely shows malignant transformation. In most reported cases, thyroglossal duct carcinoma was diagnosed by postoperative histopathology after surgery for thyroglossal duct cysts that were considered benign prior to the surgery. The rate of correct diagnosis by preoperative puncture aspiration cytology is also only about 50%–55%. We report a case in which we were able to diagnose carcinoma of the thyroglossal duct by preoperative aspiration cytology.

A 55-year-old man visited our hospital with the chief complaint of a painless anterior cervical mass that had been present for six months. Ultrasonography revealed an irregularly shaped hypoechoic tumor with a mixture of cysts and solid components, and calcification around the hyoid bone. The tumor was located close to the tip of the pyramidal lobe. Aspiration cytology suggested the diagnosis of papillary carcinoma.

We performed Sistrunk surgery with additional neck dissection of the submental area and prelaryngeal area. There was no recurrence of the tumor until the end of 5-year follow-up period.

The postoperative histopathology showed papillary carcinoma with cysts lined by striated columnar epithelium and squamous epithelium, which are components of the thyroglossal duct cyst, based on which we made the diagnosis of thyroglossal duct carcinoma. Extracystic infiltration was noted, and lymph node metastasis was found in the submental area and prelaryngeal area.

When planning surgery for a thyroglossal duct cyst, the possibility of thyroglossal duct carcinoma should be considered. Malignancy should be suspected in the presence of thickening or irregularity of the cyst wall, solid lesions within the cyst, and/or calcified lesions. If extension outside the cyst wall is suspected, it is necessary to select a surgical procedure considering the possibility of lymph node metastasis.

The pterygopalatine fossa is a narrow space surrounded by multiple bones and is a corridor connecting the middle cranial fossa, orbit, nasal cavity, and so on. Removal of tumors in the pterygopalatine fossa is challenging, because of the anatomical complexity of this region. Various methods have been devised for safe performance of surgical procedures in the pterygopalatine fossa, including the maxillary swing approach.

We report a modified maxillary swing approach adopted by us to remove a hard palatal carcinoma while preserving the anterior maxilla. The patient was a 77-year-old man with a palatal tumor. Biopsy revealed the diagnosis of adenoid cystic carcinoma, and computed tomography (CT) showed enlargement of the greater palatine canal, suggesting tumor extension into the pterygopalatine fossa along the greater palatine nerve. Because there was no evidence of tumor invasion of the anterior wall of the maxillary sinus, we chose the maxillary swing approach. An osteotomy was performed along the Weber-Ferguson skin incision and the lateral maxilla, and the anterior wall of the maxillary sinus and part of the alveolar ridge were then swung laterally with the buccal skin. The posterior wall of the maxillary sinus was excised to obtain a clear view of the pterygopalatine fossa. After resection of the tumor, the inverted tissue was restored and fixed with titanium plates. Postoperative histopathology revealed clear cell carcinoma, which is a low-grade carcinoma. The postoperative facial appearance of the patient was successfully maintained, even though he underwent surgery for high-grade carcinoma.

Postoperative discomfort, such as autophony or hyperacusis, is sometimes reported following surgery in which the posterior fossa dura membrane becomes exposed to the mastoid cavity. We report two patients with postoperative hearing discomfort who were successfully treated by mastoid cavity obliteration.

Case 1: A 35-year-old man who had undergone endolymphatic sac decompression surgery on the left side for Meniere’s disease 3 years prior to his first visit to our department. While the patient had obtained relief from the vertigo, he developed postoperative hyperacusis caused by pressure on the posterior left ear and autophony. Communication between the posterior cranial fossa and the mastoid cavity was delineated on a computed tomographic (CT) image. Mastoid cavity obliteration was performed under general anesthesia. The mastoid cavity was obliterated with sliced auricular cartilage and granular hydroxyapatite. The hearing discomfort improved within 1 month after the operation, and no exacerbation has been noted after the surgery.

Case 2: A 59-year-old woman who had undergone the Jannetta surgery for left hemifacial spasm 1 month prior to her first visit to our department. She was referred to our department because of postoperative hyperacusis caused by postauricular pressure and autophony in the left ear. Since CT revealed a communication between the posterior fossa and the mastoid cavity, the mastoid cavity was obliterated with sliced auricular cartilage and granular hydroxyapatite. The left ear discomfort disappeared within 1 month after the operation, and no exacerbation has been observed until now, 1year after the surgery.

Mobility of the dura membrane of the posterior fossa that had become exposed to the middle ear cavity during the previous surgery may explain the uncomfortable sensation reported by the patients. If the posterior fossa dura membrane becomes exposed to the mastoid cavity due to surgical procedures and the resulting ear discomfort is severe, mastoid cavity obliteration may be recommended to resolve the symptoms.