The rationale for use of the translabyrinthine approach (TLA) is to obtain lateral access to the internal auditory canal and the cerebellopontine angle (CPA), which would allow removal of lesions at CPA, including vestibular schwannomas (acoustic neuromas), without cerebellar retraction. The enlarged field provided by the TLA overcomes the anatomical limits represented by the middle cranial fossa dura, the sigmoid sinus, and the jugular bulb. Extensive bone removal over these structures allows them to be retracted during surgery, and together with the subsequent wider incision of the posterior fossa dura, use of the TLA enables surgeons to remove vestibular schwannomas irrespective of the tumor size. In addition, sufficient bone removal surrounding the internal auditory canal (transapical extension of TLA) makes access to the petrous apex easier for removal of more anteriorly extending tumors. This approach also offers the advantage of allowing the facial nerve to be identified at the fundus of the internal auditory canal, which could lead to preservation of the facial nerve function. Moreover, the TLA prevents cerebrospinal fluid leakage resulting from deep insertion of strips of abdominal fat into the cerebellopontine cistern. Most importantly, TLA is considered to be an extension of complete mastoidectomy or subtotal petrosectomy, with which otologic surgeons are much more familiar, and this advantage could encourage otologists to take up the challenge of using the TLA for vestibular schwannoma removal.

In this study, I selected cases with the first episode of definite Ménière’s disease (MD) among vertigo patients who visited my clinic over the past three years and retrospectively reviewed their age at the first visit, gender, affected side, and the transition rate to persistent postural-perceptual dizziness (PPPD).

Eligible subjects were new first-ever cases of MD who visited my clinic during the three-year period between June 1, 2020, and May 31, 2023, who met the diagnostic criteria for MD established by the Japan Society for Equilibrium Research, revised in 2017.

There were a total of 111 cases, including 27 male and 84 female patients. The male-to-female ratio was 1:3.1, indicating that most of the patients were female. The mean age ± standard deviation was 45.4 ± 16.2 years.

The period from the initial episode until the initial consultation was 3 days in 49 cases, under 7 days in 29 cases, under 14 days in 13 cases, under 21 days in 5 cases, under 28 days in 2 cases, and 29 days or longer in 13 cases, indicating that 70.3% of the patients sought diagnosis within 7 days of symptom onset.

In regard to the affected side, the right side was affected in 52 cases and the left side in 56 cases. There were only 3 cases with bilateral involvement.

The most common subjective symptom was aural fullness in 95 cases (85.6%), followed by vertigo in 68 cases (61.2%), hearing loss in 76 cases (68.5%), tinnitus in 59 cases (53.2%), hyperacusis in 28 cases (25.2%), and autophony in 22 cases (19.8%).

In regard to the underlying diseases, there were 16 cases with hypertension, 10 cases with hyperlipidemia, 9 cases with heart disease, including arrhythmia, 6 cases with diabetes mellitus, and 23 cases with insomnia. Four patients had a current or past history of psychiatric disorder. There were 37 cases with concurrent migraine and 39 cases with concurrent tension headache.

As for the time to remission, remission concurrent within 3 months in 20 cases, and took 3 months or longer in 91 cases. A total of 19 patients decided to stop coming to the clinic, and their status is unknown.

In this study, there were 4 cases of MD, and 1 case MD with vestibular migraine (VM) that transitioned to PPPD.

The transition rate only for cases that transitioned from MD to PPPD was 3.6％, and that for cases that transitioned from MD with VM to PPPD was 4.5％. After excluding cases whose status was unknown, the transition rate only for cases that transitioned from MD to PPPD was 4.3％, and that for cases including those that transitioned from MD with VM to PPPD was 5.4％.

As compared to the transition rate to PPPD of cases with definite benign paroxysmal positional vertigo examined previously, the transition rate to PPPD of cases with definite MD was higher.

Selection of the appropriate surgical approach may pose a challenge in cases of cholesteatoma where the disease extends in an atypical direction, such as into the petrous portion. We encountered a case of cholesteatoma extending from the medial side of the mandibular fossa to the foramen spinosum. We utilized the transmandibular fossa approach and successfully removed the lesions completely, without major complications. The patient was an 80-year-old man who had undergone right-sided tympanoplasty and canal wall-down mastoidectomy in his childhood and presented to us with a history of right-sided otorrhea and sensorineural hearing loss. The tympanic membrane was adherent, primarily in the posterosuperior quadrant. The anterior wall from the mesotympanum to the epitympanum was retracted. Keratin debris discharge was observed. Computed tomography (CT) of the temporal bone showed soft tissue density areas extending from the medial side of the mandibular fossa to the foramen spinosum, associated with a bone defect in the medial wall of the mandibular fossa, tegmen and jugular fossa. We diagnosed the lesion as a recurrent cholesteatoma and scheduled surgical treatment. To secure a sufficiently wide area to remove the lesion completely, we dislocated the head of the mandible and drilled out the mandibular fossa. The postoperative course was uneventful, and no recurrence was observed until the last follow-up 8 months later. Adoption of the transmandibular fossa approach may enable a surgeon to remove middle ear lesions that extend ventrally to the foramen spinosum without sacrificing critical structures.

Fibrous dysplasia is one of the idiopathic benign bone diseases. It is known to sometimes occur in the craniofacial region, but cases of the condition arising in the temporal bone are rare. We report a case of temporal bone and parietal bone fibrous dysplasia with stenosis of the external ear canal.

The patient was a 57-year-old female who reported feeling that her temporal area had gotten bigger and bigger after a head trauma sustained 25 years earlier and that her external ear canal was becoming progressively narrower. She was referred to our hospital. Her temporal and parietal areas were markedly swollen, and CT showed hyperostosis of the temporal and parietal bone. We made the diagnosis of fibrous dysplasia after hyperostosis excision surgery of the cranial bones performed twice, but her external ear canal failed to become wider. Therefore, we resected the postauricular bone lesion and covered it with temporal fascia, which resulted in widening of the external ear canal and visualization of her eardrum.

In addition to sinusitis, other causes of unilateral sinus disease include odontogenic maxillary sinusitis, mycosis, and tumors. In many cases, it is difficult to distinguish among these causes by sinus CT alone, which is widely used for preoperative diagnosis in patients undergoing endoscopic sinus surgery (ESS), and the usefulness of MRI to improve the accuracy of diagnosis has been reported. To improve the accuracy of preoperative diagnosis, we investigated the disease distribution, patient backgrounds, and preoperative positive diagnosis rate in patients who underwent unilateral ESS.

The subjects were 192 patients who underwent unilateral ESS between 2016 and 2023. The etiologies were classified into four groups: chronic sinusitis (CRS; n = 66), mycosis (n = 48), odontogenic maxillary sinusitis (n = 39), or tumor (n = 36); there were two cases of combined mycosis and odontogenic maxillary sinusitis and one case of tumor with odontogenic maxillary sinusitis. The mean age was the highest, and the proportion of female patients was higher, in the patient group with mycosis. The CT showed calcification, heterogeneous density, and microbubbles in the cases with mycosis. There was no significant difference in the percentage of cases with a convex and normal nasal septal curvature across all four disease groups. MRI was significantly more useful for the diagnosis of mycosis and tumors than CT.

Preoperative MRI should be performed in many patients with unilateral sinonasal disease, especially in those with mycosis and tumors, because CT alone is often not sufficient for a diagnosis.

Nasogastric tube syndrome (NGTS), first reported in 1990 by Sofferman, is characterized by the development of sore throat and bilateral vocal cord paralysis after insertion of a nasogastric tube. It can sometimes lead to life-threatening upper airway obstruction, necessitating tracheotomy. We reviewed the data of 11 cases of NGTS encountered at our department over the past 10 years and examined the risk factors and appropriate therapy. Being bedridden (p = 0.044) was identified as a possible risk factor. The data also suggested that immediate removal of the nasogastric tube and steroid administration could lead to improved vocal cord abduction. Since nasogastric tube insertion is a commonly needed procedure in daily clinical practice, especially as it serves as a useful alternative to oral feeding, and it can occasionally be complicated by life-threatening conditions such as NGTS, it is important for the treating physician to be aware of how to manage NGTS in a timely manner.

Deep vein thrombosis (DVT)/pulmonary thromboembolism (PTE) is a serious condition that requires prompt and appropriate diagnosis and treatment. We report a case of head and neck surgery for a tumor in a patient with idiopathic thrombocytopenic purpura (ITP) who developed DVT/PTE and postoperative hemorrhage that were difficult to manage. The patient was a 60-year-old woman with ITP who was diagnosed as having desmoid-type fibromatosis in the head and neck region. Two days after the surgery, a decrease in blood oxygen level was detected and a chest CT was performed, which confirmed the onset of DVT/PTE, and we started the patient on anticoagulant therapy. Due to the use of anticoagulants, she developed recurrent postoperative hemorrhage which proved difficult to control. We stopped the anticoagulants and controlled the hemorrhage by applying a hemostatic agent and applying pressure to the wound. The DVT/PTE resolved, and the patient was discharged from the hospital on the 19th day after surgery.

It is necessary to consider the high risk of development of DVT/PTE in cases with ITP undergoing surgery. In such cases, early diagnosis and prompt treatment are crucial. The treatment for DVT/PTE is anticoagulation, but there is a possibility that this will result in difficult-to-control postoperative hemorrhage. When postoperative hemorrhage complicates DVT/PTE treatment, careful airway management is necessary, especially in patients undergoing head and neck surgery. In patients at a high risk of developing DVT/PTE, it is important to prevent the onset of the disease, but in cases where there is a risk of hemorrhage, such as in patients with ITP, this could prove challenging. Selection of anticoagulant therapy for preventing DVT/PTE should be considered on an individual-case basis, taking into consideration the risk of hemorrhage.

Although the number of cases of tuberculosis (TB) in Japan has been decreasing and the country was declared as “low endemic” for TB for the first time in 2021, cervical tuberculous lymphadenitis should always be considered in the differential diagnosis of patients presenting with cervical lymphadenopathy. Between 2014 and 2023, we encountered 15 cases of cervical tuberculous lymphadenitis. The patients included 6 males and 9 females, ranging in age from 24 to 88 years (mean age, 57.7 years). Pulmonary tuberculosis was present in only one of the 15 patients, and one patient also had a past history of tuberculous lymphadenitis. Two patients had coexisting diseases that could potentially cause cervical lymph node metastasis.

None of the cases were suspected as cases of tuberculosis based on fine-needle aspiration cytology (FNAC), and inflammatory cells were observed in all of the 14 cases in which aspiration was performed. Atypical cells were found in one case. The diagnostic sensitivities of smear, culture, and PCR testing for acid-fast bacilli were 20%, 66.7%, and 53.3%, respectively. Histopathological examination of lymph node biopsy specimens obtained in 12 cases showed epithelioid granulomas with (11 cases) or without caseous necrosis (1 case). Presence of acid-fast bacilli was confirmed by Ziehl-Neelsen staining of the tissue specimens in 33.3% of cases, and immunological testing by T-SPOT revealed a positive result in 92.3% of cases.

The differential diagnosis of cervical tuberculous lymphadenitis is broad, and the low sensitivities of individual tests often makes definitive diagnosis challenging. When performing lymph node biopsies, it is important to consider tuberculous lymphadenitis and to evaluate the findings comprehensively by combining various diagnostic tests.

Surgical site infection (SSI) remains a significant concern in the field of head and neck surgery. We conducted this study to investigate the characteristics, clinical course, and risk factors associated with SSI. Data of a total of 263 patients who underwent head and neck cancer surgery at the University of Fukui Hospital between 2017 and 2023 were retrospectively analyzed. Patient-related and surgery-related factors were assessed separately to explore the risk factors. The cohort included 187 men and 76 women, with a median age of 66.2 years (range, 23–97 years).

SSI occurred in 30 patients (11.4%), including superficial infection in 9 patients, abscess in 9 patients, pharyngocutaneous fistula in 7 patients, flap infection in 3 patients, and orocutaneous fistula in 2 patients. The most frequent primary site was the oropharynx, and the most common surgical procedures that were complicated by SSI were oropharyngectomy and total laryngectomy. In most cases, SSI developed during the second postoperative week. Streptococcal species and other oral bacteria were the most frequently isolated pathogens. The mean hospital stay was significantly longer in the SSI group as compared with the non-SSI group (p < 0.01).

Univariate analysis identified male sex, underlying diabetes mellitus, preoperative chemoradiotherapy, clean-contaminated surgery, prolonged operative time, greater blood loss, and flap reconstruction as significant risk factors for SSI. Multivariate analysis identified underlying diabetes mellitus [p = 0.04, odds ratio (OR) = 2.66] and prolonged operative time [p < 0.01, OR = 10.1] as independent risk factors.

These findings highlight the importance of strict perioperative glycemic control and efforts to shorten the operative time to reduce the incidence of SSI in patients undergoing head and neck cancer surgery.