In the treatment of intratemporal bone facial nerve schwannoma, those with a mild paralysis score are often considered for observation, while those with a score of 20 or less are often considered for total excision, including nerve reconstruction. Also, if the paralysis progresses during follow-up, facial nerve decompression surgery is recommended. At our institution, we have obtained good results with transmastoid and transmidcranial fossa facial nerve decompression surgeries. Nerve decompression surgery is associated with a low risk of functional impairment and is less likely to interfere with any additional treatment that may be required afterwards, so that it seems appropriate to widen the range of surgical indications.

We report a rare case of traumatic facial palsy and ossicular disruption induced by earpick injury.

A 5-year-old female child was brought to our hospital with right facial palsy that had developed after right ear trauma caused by an ear pick. Otoscopic examination showed perforation of the right tympanic membrane and pure-tone audiometry revealed mixed moderate hearing loss in the right ear. The Yanagihara facial nerve grading score was 12/40. Computed tomography showed malleus-incus joint disruption. Since traumatic immediate facial palsy and ossicular disruption were suspected, exploratory tympanotomy was performed by transcanal endoscopic ear surgery (TEES) on the first visit day. TEES revealed facial bone fracture in the horizontal portion and disruption of the incus. The bone fragment around the facial canal was removed, followed by placement of sponzel with a steroid. A type III tympanoplasty was performed with the columella of the auricular cartilage, and the patient showed almost complete recovery of the facial palsy as well as hearing after the surgery.

TEES was effective for treating traumatic facial palsy and ossicular disruption caused by earpick injury.

Dialysis and radiation have been reported as possible causes of external auditory canal cholesteatoma, and in recent years, there have been some reports also of these lesions caused by bisphosphonates and denosumab (antiresorptive agents: ARAs). We report cases of ARA-associated external auditory canal cholesteatoma encountered at our department.

Of the total of 74 cases of external auditory canal cholesteatoma treated at our department between October 2009 and October 2022, a history of ARA use was identified in 7 cases (12 ears). The indication for the ARAs was osteoporosis in all the 7 patients, and many of the patients also had overlapping risk factors for cholesteatoma. With the exception of one case, conservative treatment with ear treatment every few months and application of ointment at home was effective to arrest significant progress of the lesions.

Suppression of bone remodeling and inhibition of angiogenesis are considered as the main mechanisms underlying the development of ARA-associated external auditory canal cholesteatoma. Progression of the condition is slow and in many cases, disease progression can be controlled by conservative treatment, although long-term follow-up is necessary due to the long half-life of bisphosphonates and overlap with other risk factors. However, there is no consensus yet on the prophylaxis or post-onset drug withdrawal in cause of ARA-associated external auditory canal cholesteatoma.

In today’s aging society, the incidence of ARA-related external auditory canal cholesteatoma is expected to increase, and it is important for otorhinolaryngologists to accumulate cases and conduct studies in collaboration with other departments.

Introduction: Sarcoidosis is a systemic granulomatous disease of unknown cause that most commonly affects the lungs and eyes. While nasal sarcoidosis is relatively rare, it should be noted that nasal sarcoidosis often complicates pulmonary sarcoidosis.

Case: We encountered a patient who presented with nasal obstruction developing during follow-up for pulmonary sarcoidosis. CT of the sinuses revealed thickening of the nasal septum, and conservative treatment with a nasal steroid spray failed to improve the condition. Histopathological examination of a biopsy specimen obtained from the inferior nasal dorsum showed thickening of the mucosa and findings consistent with the diagnosis of nasal sarcoidosis. After a brief period of improvement following surgery, the patient’s nasal obstruction worsened again several years later, and local treatment with nasal steroids and other drugs failed to elicit a response.

Summary: Although careful patient selection for oral steroid therapy is required among patients with sarcoidosis, oral steroids may be a treatment option in patients such as the present case, in whom the quality of life is significantly impaired by the symptoms of nasal obstruction and it is difficult to treat the disease by local treatment alone.

Secretory carcinoma is a tumor for which the disease concept has only recently been established. Secretory carcinomas occur most frequently in the parotid gland (50%–70% of cases). They have a predilection for subjects in their 40s, and the incidence tends to be slightly higher in males. It is estimated that 10% of all salivary gland carcinomas are secretory carcinomas. The histology is similar to that of acinic cell carcinoma, and the diagnosis is often difficult to make by preoperative cytology. Detection of the ETV6-NTRK3 fusion gene plays an important role in the definitive diagnosis of secretory carcinoma. We report a case in which the fusion gene ETV6-NTRK3 was detected by preoperative cytological diagnosis.

The patient was a 51-year-old man who visited our hospital with the chief complaint of a gradually enlarging mass in the right parotid region. Examination revealed a mass in the right parotid region measuring 20 mm in diameter, and fine-needle aspiration was performed. Cytological examination revealed a papillary cystic arrangement of cells that were thought to be of epithelial origin, and immunohistochemical study showed positive staining for S-100 (+), mammaglobin (focal+), CK19 (+); the ETV6 split signal was observed by FISH. Based on these findings, a preoperative diagnosis of secretory carcinoma was made, and the parotid gland lesion was treated by excision. Postoperative histopathology confirmed the diagnosis of secretory carcinoma.

The detection of the fusion gene ETV6-NTRK3 by RT-PCR or FISH plays an important role as a genetic marker for diagnosing this tumor, and FISH analysis of cell block specimens, in addition to HE staining, PAS staining, and immunostaining, enabled confirmation of the diagnosis.

We analyzed the data of 63 patients with untreated parotid cancer diagnosed at our institution between 2006 and 2021. The patients consisted of 39 men and 24 women, with a median age of 64 years (age range, 6 to 92 years). Of the 63 patients, the disease stage was I, II, III, IVA, IVB and IVC in 8 patients, 14 patients, 12 patients, 24 patients, 1 patient, and 4 patients, respectively. The most common histopathological type was salivary duct carcinoma (n = 25), followed by carcinoma ex pleomorphic adenoma (n = 11). The 5-year overall survival rate was 76.9%, and the 5-year recurrence-free survival rate was 75.1%. Factors associated with a poor outcome were advanced clinical stage of the disease, advanced T stage, N+, and high-grade malignancy. We conclude that prophylactic neck dissection and postoperative radiotherapy are important to improve the therapeutic outcomes.

Introduction/Purpose: Vocal cord paralysis causes hoarseness of the voice and greatly reduces the QOL. Therefore, it is essential for otorhinolaryngologists to fully understand the causes and prognosis of vocal cord paralysis. In this study, we investigated the proportion of cases of vocal cord paralysis by cause and prognosis.

Subjects/Methods: The study was conducted in a total of 183 patients who were diagnosed as having vocal cord paralysis by laryngeal endscopy at our hospital between April 1, 2004, and March 31, 2021. The patients were classified by the cause of the vocal cord paralysis, age, sex, and the paralyzed side. In addition, in 167 patients with vocal cord paralysis who could be followed up, we investigated the period from the onset of vocal cord paralysis to recovery.

Results: Of the 183 patients, the cause of the paralysis was idiopathic in 62 cases, neoplastic in 42 cases, postoperative in 40 cases, post-intubation in 21 cases, infection in 7 cases, arterial in 6 cases, trauma in 2 cases, and central in 1 case. Of the 167 patients who could be followed up, 46 (27.5%) recovered completely, with complete resolution of the vocal cord paralysis and subjective symptoms. 80 cases (47.9%) improved subjective symptoms (including 46 cured cases). There were 87 cases (52.1%) in whom neither the vocal cord paralysis nor the subjective symptoms improved.

Conclusion: In all the 46 cases with complete resolution of the paralysis and subjective symptoms, the time from onset of symptoms to recovery was less than 1 year. Therefore, we consider that patients with vocal cord paralysis should be followed up for at least 1 year after onset of the paralysis.

Laryngeal chondrosarcoma is a very rare malignancy, accounting for approximately 0.2% of all laryngeal cancers. Despite its generally favorable prognosis, the local recurrence rate of laryngeal chondrosarcoma can reach 40%. Surgical management is challenging owing to the need to balance preservation of laryngeal function with oncological control. Herein, we present a case of laryngeal chondrosarcoma in which total laryngectomy was necessitated due to rapid progression during the wait-and-watch period.

A 78-year-old man presented to our hospital with a tumor located on the right side of the cricoid cartilage. Open biopsy confirmed the diagnosis of grade I chondrosarcoma. Although surgical intervention was recommended, the patient opted for a wait-and-watch approach. Two years later, tumor progression led to breathing difficulties, necessitating a tracheostomy. Five years after the initial presentation, the tumor showed rapid progression accompanied by infection, resulting in significant laryngeal dysfunction and necessitating total laryngectomy. Six years post-initial visit, total laryngectomy and bilateral neck dissection were performed. Histopathology revealed a grade II/III chondrosarcoma. Despite effective local control, lung metastases were detected five months following the total laryngectomy. Comprehensive genomic profiling identified several mutations, but no effective targeted therapies were available, and the patient subsequently succumbed to the disease.

This case illustrates the potential for rapid progression of laryngeal chondrosarcoma during an extended wait-and-watch period. While chondrosarcoma is typically considered a slow-growing tumor, our findings suggest that early surgical intervention may be crucial to prevent rapid disease progression.

In patients with papillary thyroid carcinoma, metastasis to Rouviere’s lymph node is considered to be relatively rare. Surgical excision is the first-line treatment, and although various approaches to Rouviere’s lymph node have been reported, transcervical approach is the most commonly adopted. Dysphagia is a major postoperative complication of surgery via the transcervical approach, and while there have been reports of this complication, there are few reports describing the postoperative course in detail.

A 31-year-old man diagnosed as having papillary thyroid carcinoma with lymph node metastasis was treated by total thyroidectomy and lymph node dissection (including dissection of Rouviere’s lymph node). He developed postoperative dysphagia and was managed by swallowing rehabilitation, including balloon dilatation. He was discharged on the 49th postoperative day and resumed intake of a regular diet. No recurrence or metastasis was observed after one year.

The cervical approach to dissection of Rouviere’s lymph node resulted in transient injury of the pharyngeal branch of the vagus nerve and the pharyngeal nerve plexus, causing postoperative dysphagia. Balloon dilatation was found to be effective for opening the upper esophageal sphincter (UES) in this patient with UES-related dysphagia.

Stellate ganglion block improves the blood flow and controls the pain in patients with peripheral facial paralysis and postherpetic neuralgia. Despite its proven safety, however, there are reports of development of a serious complication known as posterior interpharyngeal space hematoma in rare cases. Herein, we present the case of a patient who developed posterior interpharyngeal hematoma following a stellate ganglion block and was treated by airway clearance followed by hematoma removal. The patient, a 49-year-old man, underwent stellate ganglion block for cervical skin hypersensitivity that developed following COVID vaccination with an RNA vaccine. Following the 13th session of the block, the patient experienced pharyngeal discomfort, respiratory distress, hoarseness, and neck pain, and visited our emergency department 8 hours postblock. Laryngoscopy revealed significant swelling of the posterior pharyngeal wall, with partial visibility of the glottis. A contrast-enhanced CT confirmed the presence of a hematoma extending from the level of the first cervical vertebra to the superior mediastinum. Given his clinical course, we suspected a posterior interpharyngeal hematoma, and the need for a tracheostomy. Although interventional radiology was performed to identify the source of bleeding, the source vessel could not be identified. As the hematoma was deemed too large for spontaneous resorption, we aspirated the hematoma on post block day 2. Following this procedure, the swelling of the posterior pharyngeal wall immediately improved, and subsequent CT examinations indicated hematoma shrinkage. The patient was discharged on day 12. Treatment options for posterior interpharyngeal hematomas include hematoma removal or conservative management. However, there are no clear indications for either approach. Nevertheless, for cases with large hematomas, aggressive removal is often considered as the optimal strategy for achieving rapid recovery.

In this retrospective clinical study of peritonsillar abscesses, we reviewed the data of 162 patients with peritosillar abscess, including 116 men and 46 women in the age range of 8 to 86 years old (mean age, 37.0 years), who had been diagnosed by contrast-enhanced CT, hospitalized, and treated for the abscess between January 2017 and December 2022. The abscess was on the left side in 72 (44.4%) cases, on the right side in 80 (49.4%) cases, and bilateral in 10 (6.2%) cases. The abscess was of the superior oval type in 85 (49.4%) sides, of the superior cap type in 41 (23.8%) sides, of the inferior oval type in 25 (14.5%) sides, and of the inferior cap type in 21 (12.2%) sides. Bacteriological examination of the abscess fluid for the causative bacteria in 111 cases yielded 78 causative strains, including 24 strains of aerobic bacteria, predominantly S.pyogenes (51.6%) and 47 strains of anaerobic bacteria; the remainder were mixed bacterial strains. Bacterial resistance rates to antibiotics were as follows: 5.8% for PIPC, 3.4% for CTRX, 2.6% for MEPM, 11.5% for CLDM, 28.6% for LVFX, and 15.4% for MINO. Of the 162 patients, 83 (48.3%) were treated by incision, 25 (14.5%) by puncture, 62 (36.0%) with antibiotics, and 2 (1.2%) by abscess tonsillectomy. The most frequently used antibiotics (87.2% cases) were SBT/ABPC combined with CLDM and/or DEX. The peritonsillar abscess recurred in 14 (8.6%) patients, with the relapse occurring within 3 months of the initial onset in 8 (57.1%) of these cases.

In conclusion, contrast-enhanced CT should be performed to accurately diagnose the location, size, and shape of peritonsillar abscess, and to select the optimal treatment.