A 3-year 8-month-old girl visited our clinic complaining of a feeling of fullness in the right ear. She had passed the newborn hearing screening (NHS) with the automated auditory brainstem response (automated ABR) test. CT imaging of the right temporal bone revealed internal auditory canal stenosis. MRI showed that the right cochlear nerve was thin, but continuous. No ABR was evoked even by 90 dB nHL of click stimuli to the right ear. Distortion product otoacoustic emission (DPOAE) response from the right ear was not clear. These results indicate that hearing impairment might appear after birth in patients with congenital unilateral internal auditory canal stenosis.

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Bilateral hearing loss in a 44-year-old mother and her 17-year-old daughter was thought to be related to osteogenesis imperfecta (OI), although the other typical clinical signs and symptoms were scarce. Both showed a normal stature and no bone deformities. The mother has been followed up for 7 years as a case of sensorineural hearing loss, with one episode of acute deterioration in the lower frequencies about one year ago. She gave a history of suffering from bone fractures four times. The daughter showed bilateral mixed hearing loss and a blue sclera, but no history of bone fractures. CT images of the daughter showed extensive decalcified foci, suggestive of otosclerotic changes, in the otic capsule, however, no such changes were confirmed in the mother’s CT.
In diagnosing the cause of sensorineural hearing loss, careful checkup of the family and past history and physical signs of OI, such as bone deformities and blue sclera, and CT should be considered. We should be aware that sensorineural hearing disorders in cases of OI may occur in the absence of the characteristic physical features.

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One hundred two inpatients with idiopathic sudden sensorineural hearing loss (ISSHL) treated primarily in our hospital between January 2008 and March 2014 were studied clinico-statistically. Our principal therapy adopted for ISSHL included a series of glucocorticoids, methylprednisolone sodium succinate, or prednisolone sodium succinate.
The treatment results were as follows; the cure, improvement, and effective ratios were 32.4%, 54.9%, and 76.5%, respectively. According to the grades for initial hearing levels, the cure ratios were not statistically different. The ratios differed based on the types of audiogram, especially for the deaf or completely deaf types; however, no cured cases were identified. Patients >64 years of age at the first presentation had significantly lower ratios than patients <64 years of age. In addition, patients complaining of vertigo had significantly lower ratios than those without vertigo. Amongst the patients with diabetes mellitus (DM), the cure ratio was not significantly different from patients without DM because insulin was administered immediately after admission. There were no significant differences in the efficacies of the different types of glucocorticoids in the treatment of ISSHL, thus we decided to administer prednisolone sodium succinate because of the lower cost, as analyzed with a clinical pathway. Stellate ganglion block (SGB) therapy did not contribute to the therapy for ISSHL, but in patients with less than grade 3 ISSHL, the, effectiveness was significant.

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The incidence of syphilis has decreased remarkably after the appearance of penicillin.
On the other hand sometimes we still see syphilis cases that were infected via sexual behavior. Very few of them manifest hearing impairment and vertigo like Meniere’s disease. We report herein on the case of an otosyphilis patient.
A 29-year-old man was referred to our department in order to evaluate bilateral progressive hearing impairment. Hearing loss in his right ear and left ear occurred suddenly 2 weeks previously and 1 week previously, respectively. On pure tone audiometry the patient showed mild and sensorineural hearing loss in the left and right ear, respectively. No rash was seen anywhere on his body. The serological and spinal fluid examinations were syphilis positive and the patient was diagnosed as having neurosyphilis. He was prescribed a 9-day course of betamethasone disodium phosphate and 14-day course of doxycycline. The hearing impairments in both of his ear improved partially. This case suggests that we must think of otosyphilis in patients with progressive bilateral hearing impairment.

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Care must be taken to identify cochleovestibular malformations and facial nerve anomalies in the patients undergoing cochlear implantation (CI). Canal wall down mastoidectomy gives excellent visibility and access during surgery in difficult temporal bone anatomy. We present herein on a case of CI surgery where cochleovestibular malformations existed, and adequate surgical access for implantation was obtained using canal wall down mastoidectomy with blind sac closure of the external ear canal. Indications for performing canal wall down mastoidectomy+CI surgery are as follows: chronic otitis media with persistent otorrhea, presence of a radical cavity/canal wall down open mastoid technique, cochlear ossification/obliteration, inner ear malformations and/or facial nerve anomaly, fracture of temporal bone with inner ear involvement and unfavorable anatomic conditions for posterior tympanotomy. In cases with chronic otitis media and persistent inflammation, canal wall down and complete mastoidectomy are mandatory to eradicate infected middle ear mucosa. Contraindications are as follows: Only one absolute contraindication is when electroacoustic stimulation with EAS-CI system is to be used. A relative contraindication is cases with active infection of the middle ear or cavity. The procedure can be staged. At the first stage, complete mastoidectomy with total eradication of the infection has to be performed. Canal wall down mastoidectomy with blind sac closure of the external ear canal combined with CI is a good procedure required in specific situations as mentioned above.

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Superficial siderosis of the central nervous system (CNS) is a progressive disease of the CNS associated with persistent or chronic subarachnoid hemorrhage. The classic symptoms are bilateral sensorineural hearing loss, cerebellar ataxia and myelopathy. Sensorineural hearing loss is a particularly important symptom which occurs early in the disease and ultimately affects 95% of cases. The failure site associated with hearing loss due to the disease is retrocochlear, and peripheral or both of them coexist. However, the detailed mechanism is not known. We describe herein a 57-year-old woman with superficial siderosis who underwent cochlear implantation for bilateral profound hearing loss. The performance score on the word recognition test was 72%. However, the speech perception started to worsen at 18 months after the operation. Prolonged follow-up may be therefore required to evaluate the benefit of cochlear implantation for profound hearing loss associated with superficial siderosis.

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We report herein on two cases of otogenic complications caused by a cholesteatoma.
Case 1: The patient was a 33-year-old male who was hospitalized because of confusion, fever, and anorexia. Computed tomography (CT) scan and magnetic resonance imaging (MRI) showed that he had an ear cholesteatoma with bone destruction of the cranial base, an abscess in the left temporal lobe of brain abscess and subperiosteal abscess. After drainage of the brain abscess, he underwent a radical mastoidectomy with meatoplasty. We finished the operation leaving some remnant cholesteatoma on the dura because of very strong dural adhesion by the cholesteatoma. The patient was transferred to a convalescent hospital without any side effects.
Case 2: The patient was a 65-year-old female who was hospitalized because of left otitis media, meningitis and hydrocephalus. CT scan and MRI showed that she had a left side cholesteatoma with bone destruction of the cranial base and a fistula in the lateral semicircular canal. She underwent radical mastoidectomy with meatoplasty. We finished the operation leaving some remnant cholesteatoma on the dura for similar reasons as with case 1. The patient was transferred to a convalescent hospital without any side effects.

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Secondary cholesteatoma is relatively rare, but can develop by extension of the tympanic epithelium into the tympanic cavity through perforation of the marginal membrane. The subject reported herein was a 68-year-old male patient with a history of persistent bilateral otorrhea since childhood. Examination revealed a large perforation in the tympanic membrane on both sides, with debris observed on the promontory of the right tympanic cavity. The hearing level was 66.7 dB in the right ear, and 65 dB in the left ear. Subsequently, a secondary cholesteatoma, with the cholesteatoma matrix extending continuously from the upper edge of the tympanic membrane perforation was observed, a tympanoplasty was attempted under general anesthesia on the right side. Among the ossicles, only the stapedial footplate and the handle of the malleus were found to remain, and the horizontal portion of the facial nerve canal was also broadly destroyed. While the antrum mastoideum was filled by the cholesteatoma extending from the tympanic cavity, the cholesteatoma matrix and the dura mater of the middle cranial fossa were tightly adherent and very difficult to separate. Therefore, the plasty method, referred to as the “open method tympanoplasty”, was employed, allowing the cholesteatoma matrix in the mastoid antrum to remain. Until now, five years after the surgery, no recurrence has been observed. Thus, in patients with chronic otitis media associated with tympanic perforation and pesistent otorrhea in whom the perforation is found to extend to the handle of the malleus, the possibility of a secondary cholesteatoma should be borne in mind. In such cases, rather than continuing with conservative treatment, it is important to examine the patient carefully, bearing in mind the possibility of secondary cholesteatoma.

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A 69-year-old female patient visited our clinic with the complaints of dizziness, recurrent otorrhea from the left ear, and worsening tinnitus. She had undergone Bondy’s operation on the left ear in her childhood. A granulomatous lesion was detected in the left mastoid antrum 7 years and 9 months after her first visit to our clinic. The first biopsy showed mild dysplasia with dyskeratosis. A second biopsy repeated 8 months later revealed well-differentiated squamous cell carcinoma. Temporal bone CT and MRI showed the temporal bone tumor almost invading the intracranial region. Superselective intra-arterial chemoradiotherapy was administered. However, two months after this therapy, partial resection of the temporal bone was performed because of suspected residual tumor. However, histopathology revealed no viable carcinoma cells within the resected specimen. The patient has shown no signs of recurrence until now, a year after the operation. Retrospective CT evaluation showed that the CT performed 2 years and 9 months before the appearance of the granulomatous lesion showed a slight thickening of the soft tissue in the mastoid antrum. In conclusion, it must be borne in mind that carcinoma can arise from chronic otitis media, and repeated biopsy should be performed in patients with suspected carcinoma. Temporal bone CT and otoscopy at regular intervals are recommended, so that the early signs of carcinoma development are not missed. In addition, our experience suggests that superselective intra-arterial chemoradiotherapy might possibly control advanced squamous cell carcinoma of the middle ear without surgery.

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Fracture of the stapes following head injury is thought to be clinically less common than displacement of the incus or disarticulation of the incudostapedial joint. We present a case of traumatic fracture of the stapes due to an indirect force without dislocation of the incudostapedial joint.
A 52-year-old male was referred to our hospital complaining of hearing loss on the left side four weeks after a traffic accident that had led to the patient sustaining multiple intracranial injuries with disturbance of consciousness. He recovered with conservative treatment and subsequently became aware of hearing loss in the left ear. A pure-tone audiogram showed a 70-dBHL conductive hearing loss with a 40-dB air-bone gap. Temporal bone computed tomography (CT) revealed disarticulation of the incudomalleolar joint and displacement of the stapes. After exploratory tympanotomy, we found disarticulation of the incudomalleolar joint, and fracture of both the stapedial crura, however, the incudostapedial joint and the footplate of the stapes were intact. Six months after type IV tympanoplasty, the patient achieved air-bone gap closure to within 15 dB.
In the present case, the incudostapedial joint was preserved, while the patient had sustained considerably forceful head injury that caused multiple intracranial injuries and dislocation of the ossicles, which is a rare form in indirect trauma of the ossicular chain. In addition, multiplanar reconstruction images of temporal bone CT allowed us to accurately diagnose the pathology of the ossicular chain in the patient.

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Carcinoma of the external auditory canal are a relatively uncommon entity, accounting for only 1% of all head and neck carcinomas, and the management of this tumor type is not fully established. The aim of this study was to analyze clinical outcomes following lateral temporal bone resection (LTBR) for external auditory canal carcinomas.
Between 1994 and 2012, we performed LTBR for 10 patients. The histopathological types were squamous cell carcinoma in 5 cases, adenoid cystic carcinoma in 3 cases and basal cell carcinoma in 2 cases. The clinical stages were T1 in 8 cases, T2 in a case and T3 in a case.
In the T3 case the temporo-mandibular joint (TMJ) was surgically resected via a transcranial approach because of tumor invasion of the TMJ. The resected tumor in all cases demonstrated a pathologically tumor-free margin. Two patients underwent post-operative radiotherapy because of the risk of recurrence: in one case because of a histologically diagnosed closed-surgical margin and in the case for an intraoperative cut-in into the tumor. The disease-specific 5-year survival rate was 100% using the Kaplan-Meier method.
This study revealed that LTBR is a good indication for the initial treatment of external auditory canal carcinomas in the early stages. Furthermore, it showed that postoperative radiotherapy is recommended for the cases with high risk of recurrence.

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Pleomorphic adenomas occurring in the external auditory canal are very rare benign tumors, accounting for only 2–3% of benign tumors in this canal. A 29-year-old male visited our hospital with left ear fullness as the chief complaint. The left external auditory canal was filled with a tumor arising from the posterosuperior wall. Temporal bone CT showed a mass obstructing the left external auditory canal but no bone destruction or tumor extension to the middle ear cavity. Biopsy suggested a ceruminous or pleomorphic adenoma. The tumor was excised under local anesthesia using an endaural approach. The skin defect of the external auditory canal after the excision was covered with fibrin glue and a polyglycolic acid (PGA) sheet. The tumor (13×10 mm) was pathologically diagnosed as a pleomorphic adenoma originating from the ceruminous (apocrine) gland, and the surgical margin was negative. His postoperative course was favorable, showing epithelialization of the skin defect of the external auditory canal at about 1 month.
There are two theories concerning the origin of pleomorphic adenomas of the external auditory canal: they originate from myoepithelial cells of the ceruminous (apocrine) gland or from aberrant parotid gland tissue. Since this patient showed ceruminous glands around tumor cells but no parotid gland structures, the tumor was considered to be of ceruminous gland origin. The first treatment choice is surgery. In this patient, the tumor could be excised using an endaural approach that is minimally invasive. A PGA sheet was useful for wound healing in the external auditory canal and the prevention of scar contracture after tumor excision.

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Fibrous dysplasia of the temporal bone (FDTB) is a rare clinical entity, the most common clinical manifestations of which are conductive hearing loss and secondary ear canal cholesteatoma caused by stenosis of the external auditory canal (EAC). Surgical intervention is appropriate in cases with functional deficits (such as conductive hearing loss) or complications (such as secondary cholesteatoma formation), however, postoperative re-stenosis of the EAC is observed at a high frequency. We present the case of a patient with FDTM in whom, despite canalplasty being performed four times during childhood, the lesion was slowly progressive and re-stenosis occureed 20 years after the last surgery. The female patient presented to our hospital with conductive hearing loss and canal cholesteatoma caused by stenosis of the EAC at the age of 40 years. Canal wall down tympanomastoidectomy and canalplasty were performed, and the extended ear canal was covered with normal bone paste and the temporalis fascia. Because FDTB is a slowly progressive benign bone lesion, complete resection is not necessary, however, a canal wall down approach with tympanomastoidectomy is recommended in cases in which the lesion extends into the middle ear and mastoid cavity.

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To reveal the clinical characteristics of pediatric acute rhinosinusitis in the intermountain region, we performed nasal culture bacteriological tests and examined the background factors and the efficacy of treatments.
We collected retrospectively the bacteriological test results, patient background factors, and histories of antibiotic use for 106 pediatric outpatients with acute rhinosinusitis who had undergone nasal culture tests at the Shobara Red Cross Hospital between April 2011 and January 2012. We analyzed the relationship among these factors, the risk of emergence of resistant bacteria, and the therapeutic outcome (cure group/resistant group).
There were 67 males and 39 females and the median age was 33.5 months. There were 23 mild cases, 77 moderate cases, and 6 severe cases. We obtained 55 Moraxella catarrhalis strains, 54 Haemophilus influenzae strains, and 29 Streptococcus pneumoniae strains in all 157 strains. These three bacterial species accounted for 88% of all. There were 21 strains of β-lactamase non-producing ampicillin resistant (BLNAR) and 13 strains of penicillin intermediate S. pneumoniae (PISP). Earlier age (5 years and under) was a significant risk factor for the emergence of resistant bacteria unlike in the case of group nursing. The therapeutic outcomes of each severity level were 21/2 (mild), 51/26 (moderate), and 2/4 (severe), respectively. The moderate and severe cases were significantly more resistant to treatment than mild cases. With regard to the moderate cases, both the group of administration of penicillin antibiotic by mouth and non-administration antibiotic group were significantly more resistant to treatment than the group of administration of cephem antibiotic by mouth. Earlier age, group nursing, and presence or absence of resistant bacteria did not affect the severity level and therapeutic outcome unlike in the case of administration of antibiotics.
It is important for antimicrobial treatment of pediatric acute rhinosinusitis to use antimicrobials properly according to the scoring system along with an understanding of the clinical background.

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Among adults with obstructive sleep apnea (OSA) who required nasal continuous positive airway pressure (n-CPAP) ventilation treatment, we performed cauterization of the inferior turbinate by an argon plasma coagulation system^® in 27 patients with hypertrophic rhinitis who complained of nasal obstruction. After the surgery, the nasal resistance decreased significantly from 0.42±0.28 to 0.22±0.13 Pa/cm³/sec (P <0.001). The score for sleepiness in the Japanese version of the Epworth Sleepiness Scale (JESS) decreased significantly from 10.6±4.2 to 6.0±3.0 (P <0.001). Furthermore, the nasal surgery improved the adherence to the n-CPAP treatment. Cauterization of the inferior turbinate is a minimally invasive surgery and effective as an adjuvant therapy for n-CPAP.

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Beclometasone (product name: Salcoat^®) for oral spray is a powder formulation containing a large amount of a mucosal-adhesive base material (hydroxypropyl cellulose: HPC), which allows the drug to be retained longer at the local site. When the product is sprayed on the affected site with a dedicated small sprayer (pubriser^®), the HPC gelates by absorbing moisture on the mucosal surface and adheres to the mucosa. As a result, it remains at the affected site for a prolonged period of time and thereby also releases the active ingredient (steroid) locally for a prolonged period of time.
Treatment with Salcoat^® nasal spray (one puff in each nostril, twice daily) was given to 10 patients with nasal polyps associated with allergic rhinitis who showed no improvement with conservative treatment for one year or longer. Subjective improvement in the feeling of nasal congestion was observed in 7 cases and the nasal polyps shrank in 5 cases.
Treatment with Salcoat^® was prematurely discontinued in one patient because nasal congestion occurred immediately after the formulation was sprayed, due to gelation of the drug. None of the patients showed any signs of mycosis.

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We retrospectively evaluated 13 cases of orbital fracture in children younger than 15-year-old treated at Hiroshima City Asa Hospital from 2006 to 2012. Seven cases (53.8%) had nausea and vomiting immediately after the injury due to activation of the oculo-vagal reflex. Coronal-view computed tomographic images showed that the inferior wall was fractured in 10 cases. Among them, two cases (20%) had the punched-out type of fracture, three cases (30%) had open-door type fracture, and five cases (50%) had linear-type fracture. All of the five cases with linear-type fracture required urgent surgical intervention. In all cases, gaze impairment was relieved after the operation, however, minor residual diplopia persisted in the three cases who showed the “missing rectus sign” on the preoperative CT. Pediatric orbital fracture is a true surgical emergency. Early diagnosis and surgical repair are crucial.

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Multiple fractures of the facial bones occasionally cause nasolacrimal duct obstruction, resulting in epiphora and dacryocystitis. Herein, we report the case of a 25-year-old man who developed nasolacrimal duct obstruction secondary to facial fractures sustained in a motorcycle traffic accident. He was operated upon by plastic surgeons for his facial injuries. However, epiphora in the right eye persisted, for which endoscopic dacryocystorhinostomy was performed after 11 months. We used a dacryoendoscope to establish the orientation. A 2.5-mm diamond bur was used for the dacryocystorhinostomy. A Nunchaku-type silicon tube was inserted successfully, which was removed 3 months after the surgery. The epiphora disappeared within one year of this procedure.

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Endoscopic sinus surgery (ESS) has now become the standard treatment for medically refractory chronic sinusitis. The most frequently occurring complication is lateralization of the middle turbinate and synechia formation in the middle meatus, which increases the risk of recurrence of the sinusitis and may necessitate a revision surgery. Several methods have been reported so far to prevent synechia formation, and we used the septum stitch, which is a semiautomatic suturing device for suturing the nasal septum. At the end of the surgery, the middle turbinate was sutured to the nasal septum, thereafter, post operative lateralization of the middle turbinate and synechia formation were assessed 3 months after the surgery. No synechia formation was seen in 64.9% of the cases and 91% of the cases needed no extra treatment. The synechia formation was mostly seen in the upper part of the middle meatus. Middle turbinate-septal suturing medialization is effective for preventing lateralization of the middle turbinate and synechia formation after ESS.

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Mixed connective tissue disease (MCTD) is a collagen disease of unknown origin characterized by the combination of the symptoms similar to systemic lupus erythematosus, systemic sclerosis, dermatomyositis, and positive anti-U1-RNP antibody. We herein report on the case of a 62-year-old female who first presented with left dysgeusia, together with numbness of the left cheek. After an otorhinolaryngological examination she was examined in the neurological department. The neurological examination clearly showed left trigeminal sensory neuropathy in the maxillary and mandibular nerves. Additionally, in this examination Raynaud’s phenomenon, swollen hands, and sclerosis of the fingers were also found. The laboratory examination showed leucopenia and positive anti-U1-RNP antibody. These clinical manifestations and laboratory findings are consistent with a diagnosis of MCTD. The trigeminal sensory neuropathy is also associated with MCTD. We suggested that the left dysgeusia and numbness of the left cheek were due to trigeminal sensory neuropathy. The above symptoms were treated, but failed to improve. We suggested that MCTD should be considered in the differential diagnosis when a patient complains of unilateral dysgeusia and numbness of the cheek. To the best our knowledge, in Japan, our case is the first otorhinolaryngological report on dysgeusia due to MCTD.

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Pyriform sinus fistula is a rare disease that is associated with recurrent suppurative thyroiditis and neck abscess. However, it is difficult to remove the fistula radically. Furthermore, patients, especially children, need to tolerate the burden of emotional and physical stress. Recently, chemocauterization of the internal opening of the fistula using trichloroacetic acid (TCA) was reported as a safe and reliable treatment procedure for this disease.
Here, we report the case of a 13-year-old girl who was diagnosed as having a right pyriform sinus fistula and was treated by chemocauterization with TCA. The internal opening of the fistula could be easily observed under a laryngoscope, which allowed the chemocauterization to be performed without any difficulty. No complications were observed during or after the procedure.
Until date, 15 month since the treatment, the patient remains free of recurrence. Based on our experience, we suggest that chemocauterization with TCA is a useful and safe treatment for pyriform sinus fistula.

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Cervical lymphangioma usually occurs in children as a soft tumor, but lymphangioma of the palatine tonsil is an extremely rare lesion that presents as a tonsillar outgrowth. We report herein on our rare experience with a 30 years old female patient with lymphangioma of the palatine tonsil. She presented with a foreign body sensation and a nonproductive cough from two years previously. Her tonsillar lymphangioma was treated by wide surgical excision with a tonsillectomy. Recurrence of tonsillar lymphangioma has not been detected to date at 8 months after surgery. We present herein the course of this case with several references to previous literature.

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Ligature of the external carotid artery (LECA) is a very effective and final method of choice in patients with excessive post-tonsillectomy hemorrhage. I report herein on the case of a 26-year-old woman who underwent LECA for an excessive post-tonsillectomy hemorrhage. Her tonsillectomy had been performed under general anesthesia for habitual angina eight days previously. In the early morning of the 8th postoperative day sudden and excessive bleeding occurred and the patient went into shock. Immediate LECA was performed under general anesthesia. The bleeding was stopped promptly and completely. Subsequently, a tracheostomy and a blood transfusion were performed. The patient was discharged 21 days after the LECA without any severe complications.

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We describe herein a case of bilateral arytenoid dislocation caused by self-extubation in a 17-year-old man. He was injured in a motor vehicle accident. He had convulsions, and the emergency medical technician performed intubation. By the time he arrived at our hospital, self-extubation had occurred, and we intubated again.
Four days after the extubation incident, the patient complained of hoarseness and coughing. A fiberoscopic examination revealed immobile bilateral vocal cords in the dilated position and the vocal cords were under tension. Bilateral arytenoid dislocation was suspected from the fiberoscopic and CT findings.
Using a laryngo-microsurgery approach, we raised his bilateral arytenoids using a balloon catheter filled with 2 ml water. After the operation, his vocal cords regained mobility and his voice recovered completely.

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In East Asians, a strong association has been reported to exist between a past or current history of facial flushing after a small dose of alcohol (flushers) and heterozygosity for inactive aldehyde dehydrogenase-2 (ALDH2); furthermore, individuals with the latter have been shown to have a higher relative risk of alcohol-related oral and esophageal cancers as compared to individuals with wild-type ALDH2 alleles.
The purpose of this study was to examine whether flushers with oral or/and pharyngeal squamous cell carcinoma might also at a higher risk of synchronous or metachronous cancers of the upper gastrointestinal (UGI), and to clarify the relationship between the risks associated with flushing and those associated with alcohol and smoking.
This is a retrospective study conducted using a questionnaire and medical chart review. We sent a questionnaire to 240 patients or families of patients treated for head and neck squamous cell carcinomas (HNSCCs) from 2004 to 2011, to determine if the patients had a past or current history of flushing after a small dose of alcohol, and also whether they were habitual smoker or drinkers; the 121 patients or their families who replied were enrolled in this study. In addition to being classified as flushers or non-flushers, the patients were dichotomized into heavy smokers (≧10 pack-years) and non-heavy smokers, and into heavy drinkers (consumption of ≧20 g of alcohol per day) and non-heavy drinkers. We evaluated the relationships among these factors and the occurrence of second primary cancers in the UGI tract.
Flushers showed a higher incidence of second primary cancers (22% v.s. 11% in 5 years), although the difference was not significant. Univariate analysis showed a higher hazard ratio in heavy drinkers than in flushers or smokers, however, this was also not statistically significant. Multivariate analyses showed that a history of flushing was associated with a higher hazard ratio than drinking or smoking habit, however, the difference were not significant.
A simple interview about the drinking habit and history of facial flushing after a small dose of alcohol may be useful for identifying patients at high risk for HNSCC.

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An 85-year-old woman was referred with a left-side pre- and infra-auricular mass. She had no complaints such as pain and facial paresis with the exception of the large mass. In the past history, she had undergone four operations for a parotid gland tumor. The CT scan showed a 110×80 mm mass arising from the parotid gland. MRI imaging indicated a smooth and encapsulated mass. The pre-operative diagnosis was a large pleomorphic adenoma of the parotid gland. In the intraoperative findings, the tumor was located in the deep lobe and some branches of the facial nerve were sacrificed to remove the tumor. The extirpated tumor was 12 cm in diameter and weighed 570 g. Based on the histopathological findings, the tumor was diagnosed as pleomorphic adenoma without malignant change. Early operative removal of the tumor should be performed as much as possible in case of pleomorphic adenoma of the parotid gland due to the possibility of malignant change and the increasing size of the tumor.

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Apocrine carcinomas are a rare condition. In this report, a case of an apocrine carcinoma (AC) of the inferior eyelid is described.
A 55-year-old male patient was examined for right exophthalmos without diplopia, oculomotor dysfunction, or vision and visual field disorders. A tumor was identified in the right nasal cavity, and on palpation, the right inferior eyelid was indurated, and there was no palpable lymphadenopathy in the cervical region. AC was diagnosed by biopsy and immunostaining for GCDFP-15. A tumorectomy and reconstructive surgery were performed. No additional treatment was performed because the tumor margin was pathologically negative. We initially followed the patient postoperatively, but the patient on his own accord declined further examination. After three years of absence, the patient returned to our facility with the chief complaint of right cervical swelling. A fine-needle aspirate of the cervical swelling showed an adenocarcinoma. Because this tumor was a recurrence, the patient underwent a right modified radical neck dissection (m-RND). After two years of follow-up, a left cervical swelling was identified. He underwent a left m-RND and received titanium silicate chemotherapy for 6 months. However, brain metastasis was diagnosed on contrast-computed tomography. Chemotherapy was planned, but he died before receiving treatment.

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We report herein on a rare case of a solitary fibrous tumor in the anterior neck. A 45-year-old man visited our hospital with the chief complaint of a mass of the anterior neck. CT scan and MRI revealed that the inside of the tumor had a solid pattern. Fine needle aspiration cytology showed no malignant cells. Because the tumor had increased in size compared to the CT findings of 7 years previously, we removed the tumor. Based on the pathological examination, the tumor was diagnosed as a solitary fibrous tumor. Immunohistochemical staining was positive for CD34, vimentin, and the NAB2-stat6 fusion gene. Solitary fibrous tumors originated from the anterior neck have been relatively rare.

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Hypopharyngeal cancer is the second most common of the head and neck cancers in Japan. We retrospectively analyzed 77 fresh cases of hypopharyngeal cancer who were treated in our department between 2005 and 2013. They were 69 males and 8 females, aged 49 to 81 years with an average of 65.3 years.
Our treatment protocol was as follows: For T1/2 cancers, hyperfractionated radiotherapy with concurrent daily carboplatin (25 mg/m²) was performed. Responders at 30–40 Gy continued receiving chemoradiotherapy to a total of 72 Gy whereas nonresponders underwent surgery. For T3/4 cancers, 1–2 courses of induction chemotherapy (docetaxel 60 mg/m² [day 1], cisplatin 60 mg/m² [day 1], and 5-fluorouracil 600 mg/m² [days 1–5]) were performed. Responders of T3 patients and good responders of T4 patients were then given chemoradiotherapy whereas the other T3/4 patients underwent surgery after induction chemotherapy.
The overall 5-year crude and disease-specific survival rates determined by the Kaplan-Meier method were 58.0% and 68.1%, respectively. The survival rates were significantly higher in patients at stage II/III than in those at stage IV. The overall laryngeal preservation rate after primary treatment was 58.4%. The laryngeal preservation rate was significantly higher in patients of T1/2 than in those of T3/4 (T1: 100%, T2: 93.3%, T3: 53.3%, T4: 25.8%). The survival rate of T3/4 patients did not differ between the laryngeal preservation and removal groups.
The overall survival and laryngeal preservation rates could be improved by the early detection of hypopharyngeal cancers and by altering the treatment protocol for advanced cancers.

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We encountered a patient with a cystic neck metastasis from oropharyngeal carcinoma, which was detected after extraction of a cystic neck mass under the diagnosis of a lateral cervical cyst. The patient was a 64-year-old woman with a one-month history of swelling in the left side of the neck. The swelling was diagnosed preoperatively as a lateral cervical cyst, however, histopathological examination of the resected specimen revealed the diagnosis of squamous cell carcinoma (SCC). One year and ten months later, when the patient presented with a new swelling in the left-upper-neck region, she was referred to another medical institution for further examination and treatment. Transoral endoscopic examination with NBI revealed the primary lesion in the left palatine tonsil; biopsy revealed SCC and the specimen was positive for p16. Reexamination of the previous cystic specimen suggested that it might have been a p16-positive lymph node metastasis from the overlooked tonsillar cancer.
Lymph node metastases from HPV-positive oropharyngeal cancer tend to show cystic degeneration, and sometimes appear as neck metastases from cancer of unknown primary origin. Care must be taken when examining the cystic mass, with the possibility of oropharyngeal cancer borne in mind.

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Accordiry to previous reports, lymph node metastasis from primary-unknown melanoma usually involved the axillary or inguinal lymph nodes, and more rarely, the head and neck lymph nodes. We report a case of metastatic melanoma in a parotid lymph node from the unknown primary site.
A 28-year-old woman was detected to have a left parotid tumor by a neighborhood doctor and referred to our hospital. Aspiration biopsy revealed parotid lymph node metastasis from a malignant melanoma, however, the primary site could not be identified. We resected the lymph node, followed by administration of chemotherapy (DAC-Tam; DITC, ACNU, CDDP, and Tamoxifen). However, the patient presented with metastasis to the lungs, brain, breast, femoral muscle, cervical lymph nodes, axillary lymph nodes, and intraabdominal lymph nodes, and died two years three months after she was first medically examined.

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Metastatic laryngeal tumors are very rare. We encountered a rare case of laryngeal metastasis from a lung adenocarcinoma. A 74-year-old female had been treated for lung cancer four years earlier. She presented to us with a 3-week history of persistent hoarseness of the voice. Fiberoptic laryngoscopy and computed tomography of the neck showed a subglottic tumor. Although the patient did not complain of breathlessness, because of the tumor size, tracheotomy and laryngomicrosurgery were performed, and the tumor was resected. Histological examination revealed the diagnosis of metastatic adenocarcinoma from the lung. Later, recurrence of the lung cancer was also found, and the patient was started on chemotherapy for lung cancer. At one year two months after the surgery, the laryngeal tumor could no longer be detected.

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Renal cell carcinoma can metastasize to any part of the body, and recurrences and/or metastases of this tumor have been reported even after a long interval from the initial therapy. We report two cases of renal cell carcinoma with metastasis to the head and neck region.
The patient was a 51-year-old male who had undergone left nephrectomy for renal cell carcinoma. Five years later, he presented with nasal obstruction and epistaxis. A solitary tumor in the epipharynx was surgically removed; histopathology of the resected specimen revealed the diagnosis of metastatic renal cell carcinoma.
The other patient was a 61-year-old male who had undergone left nephrectomy for a renal cell carcinoma. Twenty years later, he noticed a swelling in the right parotid gland region that was surgically removed; histopathological examination of the resected specimen revealed the diagnosis of metastatic renal cell carcinoma.
Until date, 18 cases of parotid gland metastasis have been reported in the literature, however, there have been no reports yet of epipharyngeal metastasis. Metastasis from renal cell carcinoma should be included in the differential diagnosis of head and neck tumors, even if a long time has elapsed after treatment of the primary lesion.

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The purpose of this study was to clarify the usefulness of the MCFP (mucosal defect covered with fibrin glue and polyglycolic acid sheet) technique in elderly patients undergoing partial glossectomy. The subjects were patients aged over 70 years old with tongue cancer who underwent partial glossectomy at our hospital between 2007 and 2014. The patients were divided into the simple suture group, consisting of patients who underwent partial glossectomy before 2010, and the MCFP group, consisting of patients who underwent partial glossectomy after 2010. We compared the length of hospital stay, duration of analgesic use and the interval until resumption of oral intake after the surgery. The interval until resumption of oral intake and the length of hospital stay were similar in the two groups. However, the duration of analgesic use was significantly shorter in the MCFP group than in the simple suture group. It is possible that the postoperative pain was less severe in the MCFP group, since the surgical wound surface was coated with glue and there was no added tension as in the simple suture group. Physiological functions, including renal function, are knowns to be deteriorated in elderly patients, therefore, the shorter duration of analgesic use after surgery in the MCFP group may be of relevance to avoid drug-induced renal dysfunction in patients undergoing glossectomy.

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Background:
Concurrent chemoradiotherapy is one of the standard treatment for locally advanced head and neck cancer. Cisplatin is the most feasible regimen of concurrent chemoradiotherapy. However the clinical response has been less satisfactory favorable.
The favorable efficacy of chemotherapy with cisplatin and docetaxel, 5-FU (TPF) as induction chemotherapy for head and neck cancer have been reported. However the feasibility of concurrent chemoradiotherapy with TPF has been sparsely reported and has had many limitations. The purpose of this study was to identify the feasibility of TPF concurrent chemoradiotherapy.
Materials & Methods:
We retrospectively analyzed 60 head and neck cancer patients treated with definitive concurrent TPF chemoradiotherapy. We investigated the treatment completion rate, adverse events, average relative dose intensity, and causes of dose reduction.
Results:
The treatment completion rate was 98.3% and ARDI was 70%. Hematological adverse events over Grade 3 were observed as leukopenia 60.9%, neutropenia 60%, anemia 11.8%, and thrombocytopenia 6.4%. Febrile neutropenia was observed as 16.4% patients however no treatment related death was observed.
Conclusion:
Concurrent chemoradiotherapy with TPF was a feasible treatment for head neck cancer. We should continuously investigate the efficacy of this treatment.

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Myoepitheliomas are an uncommon tumor of the salivary gland. In this study, we report on a case of myoepithelioma of the larynx, which was extremely rare.
The patient, a 49-year-old female, presented initially with hoarseness. A submucosal tumor of the right false vocal cord was revealed. She was diagnosed as having myoepithelioma of the larynx based on the biopsy findings. She underwent surgery, a laryngofissure under temporary tracheostomy, with fat reconstruction for the deficit of the right vocal cord. Eighteen months follow-up showed no recurrence and a good functional result.
To our knowledge, this paper described the fourth reported case. We identified the surgical points and suggest the usefulness of fat reconstruction for a laryngofissure.

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There are few reports of small cell carcinoma originating in the nasal and paranasal cavity, but in this paper, we report on a case we experienced, in which small cell carcinoma developed around the ethmoidal sinus.
A 57-year-old male with the major complaint of a left nasal obstruction and epistaxis consulted with his local doctor, and because a hemorrhagic mass filling the nasal cavity was observed, he was referred to our department. CT imaging showed a tumorous lesion was seen accompanying a contrast effect from within the anterior cranium to the nasal cavity. As a result of the biopsy, small cell carcinoma of the nasal cavity (T4bN0M0) was diagnosed, and treatment commenced.
We believed that it was impossible to avoid bilateral visual organ disorder, and after chemotherapy using irinotecan and cisplatin radiotherapy was concomitantly administered only after the tumor had shrunk.
In the imaging after treatment, because there was a possibility of there being some residual tumor, a PR (partial response) was determined, and for the purpose of evaluation, navigation accompanying an endoscopic biopsy was performed. For the right calcified portion, there were findings only of growth of fragmentary bone tissue, granulation tissue and blood vessels, and there were no obvious malignant findings, so from the above, the treatment results were judged to be pathological CR (complete response).

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In head and neck cancer, almost all patients treated with chemoradiotherapy suffer from oral mucositis. But, a standard treatment for chemoradiotherapy-induced oral mucositis has not been established. It is considered that the creation of reactive oxygen species (ROS) caused by radiation and anticancer drugs is related to the mechanism that causes oral mucositis. Recently, it was reported that glutamine, an antioxidant, can reduce oral mucositis induced by chemoradiotherapy. Therefore, in the present study we examined the effects of glutamine supplementation on oral mucositis in head and neck cancer patients receiving chemoradiotherapy. Of the patients with head and neck cancer who received chemoradiotherapy or radiotherapy, we compared 6 patients receiving glutamine supplementation and 7 patients not receiving it. The patients receiving glutamine supplementation showed a reduction in the grade of oral mucositis with grade 4 never being reached, and both intake and the type of food were maintained. There was a significant elevation of the C-reactive protein (CRP) score in patients not receiving glutamine supplementation compared with those who received it (2.43 vs. 0.77, P <0.05). This result suggested that glutamine supplementation had therapeutic effects on oral mucositis induced by chemoradiotherapy.

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Adult T-cell leukemia (ATL) is leukemia whose symptoms are shown owing to an adult-T-cell-leukemia virus (human T-cell leukemia virus type I: HTLV-1).
A 74-year-old woman presented to the ENT service with a two-month history of a starange feeling in her face. On endoscopic examination, a tumorous lesion was observed in the nasopharynx. CT and MRI showed the inversional region in the pterygopalatine fossa to the sphenoid sinus. A positron emission tomography/computed tomography (PET/CT) scan showed accumulation in the same area with a 10.8 standardized uptake value (SUV). Histological analysis showed variant cell, which stained positivity for CD3, CD4, and CD25, and negatively CD8, CD20 and CD79a.
Taking those findings together, we diagnosed the patient as having the acute type of ATL.

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Thyroid fine-needle aspiration biopsy (FNAB) is a simple, cost-effective and minimally traumatic technique for the diagnosis of thyroid nodules. We report on two cases of acute thyroid swelling after FNAB. In both cases, within two hours after completion of the procedure, the entire thyroid gland enlarged rapidly. Ultrasound showed diffuse swelling of the entire thyroid gland with a heterogeneous appearance. There were no signs of bleeding or airway obstruction. The next morning a repeat US showed that the thyroid had returned to its normal size.
It has been demonstrated that nerve fibers storing neuropeptides such as vasoactive intestinal peptide, substance P, cholecystokinin, neuropeptide Y, peptide histidine isoleucine, galanin, and calcitonin gene-related peptide (CGRP) exist in the thyroid.
The clinical and ultrasound data support the hypothesis of capillary leakage as the underlying mechanism, possibly evoked by neuropeptide release.

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Mediastinal goiter means the presence of a goiter within the mediastinum or the thoracic cavity and is also called intrathoracic or substernal goiter. However, its terminology and definition have not been standardized. Katlic et al. defined mediastinal goiter as a thyroid tumor existing continuously or discontinuously in the mediastinum, with not less than 50% of the tumor always being within the mediastinum. This condition is treated with surgery. The tumor can often be removed when it is approached via a collar incision in the cervical region, but sternotomy is sometimes needed. The present study investigated patients who underwent thyroid surgery during the recent 10-year period, and those who were treated surgically after being diagnosed as having mediastinal goiter based on the above definition were reviewed.

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In the present study, we analyzed the impact of concurrent chemoradiotherapy (CCRT) statistically and reappraised the necessity of neck dissection (ND) in 32 cases of head and neck squamous cell carcinoma with N1 nodal disease.
At our hospital, between 1989 and 2005, we encountered 21 cases of N1 nodal disease in which the N-stage was not defined using PET-CT; the 3-year neck control ratio in these patients who were primarily treated by induction chemotherapy (ICT) followed by irradiation with ND or definitive irradiation alone, was 71%. On the other hand, between 2006 and 2014, we encountered 11 cases of N1 disease in which the N-stage was strictly defined using PET-CT; the 3-year neck control ratio in these patients treated by pre-operative CCRT followed by ND or definitive CCRT, was 100%. The difference between the two groups was statistically significant.
Furthermore, histopathological examination of the dissected lymph nodes from the patients treated by pre-operative CCRT revealed no evidence of residual disease.
Consequently, definitive CCRT without ND, if feasible, is a promising therapeutic strategy for N1 neck nodal disease, and although close follow-up with a “watch-and-see policy” and frequent examinations by FDG-PET are necessary.

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Spindle cell carcinoma is a rare tumor that contains both a conventional epithelial squamous component and a sarcomatous spindle cell component. Here, we report a rare case of spindle cell carcinoma of the hypopharynx. The patient was a 49-year-old woman who visited our hospital complaining of discomfort in the throat. A pedunculated tumor originating from the left piriform sinus was observed. Contrast-enhanced CT and T1-weighted MR images showed a well-demarcated mass with heterogeneous enhancement and a pedunculated mass adjacent to the left piriform sinus. A biopsy led to the diagnosis of an undifferentiated pleomorphic sarcoma. A partial pharyngectomy and left neck dissection were performed. The pathologic diagnosis was consistent with spindle cell carcinoma. Pathologically, the surgical margins were negative, and cervical lymph node metastasis was not observed. No signs of recurrence were observed at a 26-month follow-up examination.

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Desmoid tumor are benign fibrous tumors that can occur in the connective tissue of skeletal muscles, fascia, and tendon membranes. These tumors tend to recur locally despite being pathologically benign, and are regarded as being “clinically malignant”.
We report a case with a desmoid tumor that occurred in the anterior scalene muscles. A 39-year-old man visited our ENT facility complaining of a left neck pain and swelling of the neck appearing 4–5 years earlier. Computed tomography (CT) and magnetic resonance imaging (MRI) showed an inversional region in the anterior scalene muscles. A positron emission tomography/computed tomography (PET/CT) scan showed an accumulation in the same area with a standardized uptake value (SUV) of 3.3. A histological analysis revealed spindle cells, which stained positive for β-catenin and α-SMA in the nuclei and negativity for desmin, CD34, bcl-2 and S-100.
Accordingly, the patient was diagnosed as having a desmoid tumor.
Here, we describe the clinical course of this case and provide a review of the literature.

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Papillary cystadenocarcinoma is a salivary gland tumor that was classified as a subtype of adenocarcinoma by the World Health Organization (WHO) in 1991. It is histologically characterized by papillary growth with a cyst-like structure. The incidence is extremely low, with this tumor accounting for less than 0.2% of all salivary gland tumors. We report our experience of two patients with papillary cystadenocarcinoma, the tumor originating from a small salivary gland in the first case and from the sublingual gland in the second, with a review of the literature.
Patient 1 was a 73-year-old woman who presented with a cyst-like tumor at the base of the tongue. Biopsy led to the diagnosis of papillary cystadenocarcinoma, and tumor resection was performed by the suprahyoid approach under general anesthesia. Histopathology of the resected specimen revealed the diagnosis of papillary cystadenocarcinoma of low-grade malignancy originating from a small salivary gland. Until now, 4 years since treatment by surgery, the patient has shown no evidence of relapse. Patient 2 was a 67-year-old woman who was diagnosed as having papillary cystadenocarcinoma and underwent tumorectomy by the suprahyoid approach and manipulation from the oral cavity. The pathological diagnosis was papillary cystadenocarcinoma of high-grade malignancy originating from the sublingual gland. Because the resection line allowed for only a close margin, postoperative radiation therapy (60 Gy/30 Fr) was administered. Thereafter, the patient developed repeated recurrences, and despite salvage surgery, she died 4 years and 3 months after the initial surgery.
Although papillary cystadenocarcinoma shows slow growth and benign tumor-like features, in some cases, the tumor is classified as being of high-grade malignancy relapses occur, therefore, treatment should be selected with due consideration given to the possibility of relapse and metastasis.

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Metastatic hepatocellular carcinoma in the sinonasal region is rare. We report the case of an 85-year-old man who presented to us with a history of recurrent nasal bleeding. A reddish and hemorrhagic tumor was found in the right nasal septum. Histopathological examination of a biopsy specimen of the tumor revealed metastatic hepatocellular carcinoma. The patient had been diagnosed as having hepatocellular carcinoma many years ago and received multiple sessions of transcatheter arterial chemoembolization. Computed tomography and magnetic resonance imaging showed a slightly enhancing soft-tissue mass measuring 10 mm in diameter in the right nasal septum. We resected the metastatic hepatocellular carcinoma in the right nasal septum by endoscopic surgery under local anesthesia to control the recurrent nasal bleeding, and this treatment improved the quality of life of the patient. The postoperative course was uneventful, and until now, eight months since the surgery, the patient has shown no evidence of recurrence.

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Solitary fibrous tumor (SFT) is a benign tumor originating from the mesenchyme. While many cases of SFT arising from the serosa, such as the pleura and peritoneum, have been reported, this tumor is relatively rare in the field of otorhinolaryngology. In this article, we report the case of a SFT arising in the nasal vestibule in a female patient.
The patient was a 61-year-old female in whom a SFT was discovered inside the left nasal cavity. Contrast-enhanced CT imaging revealed a heterogeneously enhancing tumor lesion in the nasal cavity. MRI showed a tumor with a uniformity of internal anatomy measuring 3 cm in diameter. On T2-weighted images, the tumor was visualized as a hyperintensity, showing uniformly strong enhancement with gadolinium. Under general anesthesia, the tumor was removed via a gingival incision. On histopathology, the tumor was partially lined by ciliated epithelium and was composed of spindle cells lacking atypia within a subepithelial fibrous framework. Some vitrifications of vasodilatation were also noted. Immunohistochemistry revealed positive staining of the tumor for CD34 and bcl-2, along with positive staining of the tumor margin for SMA and desmin. Based on the above findings, the tumor was diagnosed as SFT. After the operation, the patient has been under outpatient follow-up, and until now, 12 months since the operation, there has been no evidence of recurrence or transfer of the tumor.
Recurrence or transfer of nose/paranasal sinus SFT has not been reported to date in Japan. Complete removal of the tumor by surgery was successfully accomplished in both the previously reported cases. The first surgical removal was considered to be an important indicator to assure a favorable prognosis.

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INTRODUCTION
The purpose of this study was to investigate the postoperative complications of thyroid surgery.
METHODS
The medical records of 206 consecutive patients who underwent thyroid surgery between April 2008 and February 2015 at our hospital were reviewed. The data of 166 patients with thyroid carcinoma (162 papillary, 1 follicular, 2 poorly differentiated, 1 anaplastic), 27 patients with benign follicular nodule, 7 patients with hyperthyroidism (6 Graves’ disease, 1 Plummer’s disease), and 3 patients with chronic thyroiditis were analyzed. Mainly, the incidences of recurrent laryngeal nerve (RLN) palsy, postoperative hemorrhage and hypoparathyroidism were evaluated.
RESULTS
Permanent RLN palsy occurred in 3 patients (1.5%); one of these 3 patients had a prior history of thyroid surgery, and the operator failed to identify the RLN in the severely scarred tissues. In another, with an extra-laryngeal RLN branch, the surgeon mistook the posterior branch as the main trunk of the RLN. Transient RLN palsy occurred in 7 patients (3.4%). No patient developed RLN palsy after the introduction at our facility of non-continuous laryngeal nerve monitoring during the operation.
Four patients (1.9%) developed postoperative hemorrhage necessitating reoperation; of these 4 patients, 3 had large follicular nodules.
Permanent hypoparathyroidism occurred in 3 of the 47 patients (6.4%) who underwent total thyroidectomy.
CONCLUSIONS
We reconfirmed the frequency of postoperative complications following thyroid surgery at our facility, and found them comparable to the results reported from other facilities.

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Parathyroid cysts are comparatively rare, and are often difficult to differentiate from thyroid cysts preoperatively. Therefore, a definitive diagnosis of parathyroid cysts can be made only after surgery in most patients. We report two cases of parathyroid cysts. Parathyroid cysts are classified as functional or non-functional, depending on whether the patient exhibits features of hyperparathyroidism or not. Both of our cases reported here were classified as having non-functional cysts. It is difficult to distinguish parathyroid cysts from thyroid cysts based on the clinical and radiological findings alone. It has been reported that analysis of the cyst contents obtained by cyst puncture under ultrasonographic guidance may be a useful technique for accurate diagnosis of parathyroid cysts. Puncture and ethanol injection are good treatment alternatives for this benign disease.

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We report a patient with metachronous bilateral malignant melanomas in the nasal cavity and paranasal sinuses that were attributed to submandibular lymph node metastasis.
A 65-year-old female visited our hospital with a left submandibular mass. She was diagnosed as having a left submandibular gland tumor, and surgery was performed. The histological diagnosis was lymph node metastasis from a malignant melanoma. Neither the primary lesion nor other metastatic lesions were detectable by CT, MRI, or FDG-PET. However, visual examination confirmed the presence of a black mass (approximately 1 mm in diameter) at the anterior edge of the left inferior nasal concha and blackish brown pigmentation of the mucosa of the left common nasal meatus tectorium. The primary origin was considered to be the nasal cavity. Endoscopic tumor resection and left neck dissection were performed through a left lateral rhinotomy incision. Histopathological examination revealed multicentric melanoma at the anterior edge of the left inferior nasal concha and mucosal interstitium of the maxillary sinus. No metastasis was detected in the dissected lymph nodes. The patient was diagnosed as having malignant melanoma, pT3pN1M0, stage IVA. Three cycles of adjuvant chemotherapy (DAV therapy: DTIC, ACNU, VCR) were administered. Sixty-two months after the surgery, a black lesion appeared in the right olfactory cleft. Biopsy was performed, and recurrence of malignant melanoma was confirmed. The tumor was endoscopically resected through a right lateral rhinotomy incision. Melanoma lesions were observed in the right anterior ethmoid and right sphenoid sinuses. Three cycles of adjuvant chemotherapy (DAC-Tam therapy: DTIC, ACNU, CDDP, TAM) were again administered. At present, 89 months after the surgery, the patient remains free of recurrence or metastasis.
Malignant melanomas, even small ones, can metastasize early to the lymph nodes. Since they are sometimes multicentric, an examination of the entire body and extensive resection with an adequate safety margin, such as total resection of the sinonasal mucosa, are necessary.

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