Herein, we report the case of a 75-year-old woman diagnosed as having the neurovascular compression syndrome associated with intermittent hemifacial spasm and simultaneous tinnitus.

Magnetic resonance imaging of the head revealed compression of the left seventh and eighth cranial nerves by an expanded vertebral artery, and based on these findings, the diagnosis of neurovascular compression syndrome was made. The left hemifacial spasm was induced by compression of the seventh cranial nerve. The patient did not complain of vertigo or hearing loss, but exhibited intermittent tinnitus on the left side, suggesting that the tinnitus was induced by abnormal contraction of the stapedial muscle as a result of stimulation of the stapedius nerve, a branch of the seventh cranial nerve.

We retrospectively analyzed the data of 387 patients who had no previous experience of using hearing aids, seen between 2009 and 2013 (164 males and 223 females). The average age of the overall subject population was 77.3 years (range 34 to 96 years); gender-wise, the average age of the males was 76.5 years (range 49 to 96), while that of the females was 77.9 (range 34 to 94). Of the 387 patients, 289 purchased hearing aids, representing a purchase rate of 74.7% during the five-year period, with the rate increasing year on year. The average hearing level of the ear for which the hearing aid was used was 61.5 dBHL ((500 Hz+1000 Hz+1000 Hz+2000 Hz)/4). The average hearing level of the patients who purchased a hearing aid was 64.2 dBHL, while that of the patient who didn’t purchase a hearing aid was 52.9 dBHL, with the hearing level in the former group being significantly higher than that in the latter group (p<0.05). In all, 37 patients wore hearing aids for both ears, representing a rate of use of bilateral hearing aids of 12.8%. We had aimed at providing hearing aids on rent for approximately two months. However, the mean rental period in patients who purchased hearing aids was 88.5 days.

We encountered a case of sudden hearing loss in a 4-year old boy. The patient was brought to the hospital with a history of having developed tinnitus and vertigo simultaneously. He could not walk due to the severe vertigo. We detected acute sensorineural hearing loss of his right ear, and horizontal and rotatory nystagmus. Hematological examination, CT of the temporal bone and MRI of the brain revealed no abnormalities. Consequently, we diagnosed the case as a case of idiopathic sudden hearing loss. We administered prednisolone for seven days, which led to improvement of the vertigo, but not of the hearing loss.

Sudden hearing loss in childhood is often accompanied by vertigo, as compared to sudden hearing loss in adulthood. However, the prognosis of sudden hearing loss is similar in adults and in children.

We report false-negative magnetic resonance imaging (MRI) results in a case of cerebellar infarction presenting with horizontal direction-changing ageotropic positional nystagmus. A 69-year-old male presented to us with the complaints of vertigo and nausea. Physical examination revealed direction-changing positional nystagmus and gait disorder. The finger-to-nose test was normal. MRI of the brain revealed no abnormalities at 16 hours after the onset. With a diagnosis of benign paroxysmal positional vertigo, he was admitted to our department. Because of the prolonged gait disorder, MRI was performed again, which revealed a high-intensity area in the inferior cerebellar peduncle.

MRI is useful for diagnosing acute ischemic stroke. However, some patients with acute stroke show no abnormal findings on MRI in the early stage. It has been reported that 31% of patients with vertebrobasilar ischemic stroke show false-negative MRI results during the first 24 hours. Thus, the possibility of cerebellar and brainstem infarction cannot be ruled out in patients with vertigo, even if the initial MRI shows no abnormal findings.

This retrospective study was performed to clarify the relation between orthostatic blood pressure elevation (OBPE) and dizziness. Data of 188 outpatients who visited Kure Medical Center in 2013 for dizziness were analyzed. OBPE was defined as a greater than 5 mmHg increase of the systolic blood pressure just after and/or 10 minutes after the patient stood up in the Schellong test. OBPE without any other significant findings on routine examination was diagnosed in 24 patients. Tofisopam, which is known to normalize sympathetic nerve hypersensitivity, was administered to 4 of the 24 patients. In 3 of these 4 patients, the Schellong test was repeated after two weeks of treatment with tofisopam. Both the dizziness and OBPE had resolved completely by this time in all of the 3 patients. All of these 3 patients reported being exposed to some kind of chronic stress. Our findings suggest that sympathetic nerve hypersensitivity might cause both OBPE and dizziness, and that chronic stress might induce sympathetic nerve hypersensitivity.

More than 100 years have passed since the establishment of caloric testing, and it remains an important examination for the evaluation of vestibular function, especially the functioning of the lateral semicircular canal. There are now two new tools to evaluate vestibular function. One is the test for vestibular evoked myogenic potentials (VEMP) and the other is the video head impulse test (vHIT). The former can evaluate the functions of the otolith organs and their afferents, and the latter the functions of each of the semicircular canals and their afferents. New disease concepts have been established by means of these new examinations: inferior vestibular neuritis is one such, and we report a case herein.

A 62-year-old female presented with a history of sudden-onset vertigo that had lasted for a day. She also complained of longstanding dizziness. The audiogram showed no abnormalities. No gaze, spontaneous or positional nystagmus was noted. The caloric test yielded normal results. Cervical VEMP were absent in the left ear, thus, dysfunction of the saccule was inferred. vHIT indicated low gain with catch-up saccade in the left posterior semicircular canal. Afferents from the posterior semicircular canal are carried by the inferior vestibular nerve, therefore, we diagnosed the patient as having inferior vestibular neuritis. She was followed up under treatment with an ATP administration and vitamin B12 supplementation. cVEMP and vHIT are necessary to diagnose inferior vestibular neuritis. These examinations may be indicated in patients presenting with sudden-onset vertigo in whom caloric testing yields normal results.

The large vestibular aqueduct syndrome is a congenital disease characterized by inner ear malformation. The major symptom of this disease is difficulty in hearing and dizziness. According to a previous study, the hearing level gradually became worse with head trauma or strenuous exercise. However, several cases, hearing deterioration was not associated with any obvious events. There are few reports of long-term observation of cases of large vestibular aqueduct syndrome. We diagnosed 10 cases of this disease at our hospital and were able to follow up 3 of these cases for over ten years. The aim of this study was to investigate the clinical symptoms, especially by healing study and to discuss the characteristics of this disease by long-term observation.

As results, the cases with repeated and acute decreas in hearing level were not induced head trauma. The hearing level in most cases decreased gradually during the long-term observation, even though it recovered each time with acute medications.

Herein, we report the results of clinical evaluation and surgical treatment of a case of glomus tympanicum tumor. The patient was a 63-year-old woman who presented with a 2-year history of pulsatile tinnitus. Otoscopic examination revealed a reddish and pulsatile mass in the tympanic cavity, and the tumor was diagnosed as a glomus tympanicum tumor based on the otoscopic, CT and MRI findings. Preoperative embolization was performed, followed by complete resection of the tumor via a transcanal approach. On preoperative angiography, the inferior tympanic artery was identified as the lone feeding artery, and this artery was occluded with PVA embolization material. There were no complications after the preoperative embolization procedure, and the pulsatile tinnitus disappeared immediately after the embolization. The amount of bleeding was slight.

Electron-microscopic examination of the resected specimen revealed the presence of neuroendocrine vesicles in the tumor tissue suggestive of catecholamine production by the tumor.

We have encountered four cases of infantile otitis media caused by multidrug-resistant Haemophilus influenzae, including to the newer quinolones. The antimicrobial sensitivity of each bacterial isolate was tested on the basis of the minimum inhibitory concentration (MIC). Each isolate was then tested using the polymerase chain reaction (PCR) to investigate whether the TEM β-lactamase production gene was present, and to detect mutations in the penicillin-binding protein (PBP) genes and mutations leading to amino acid substitutions in the quinolone resistance-determining region (QRDR). The isolates were found to be classifiable into two types according to the amino acid-substitution mutations. Molecular epidemiological analysis by pulsed field gel electrophoresis (PFGE) revealed different electrophoretic patterns in all the H. influenzae isolates, suggesting that the four patients were infected by different strains.

A clinical study was performed on 109 patients with facial palsy who were treated at the Department of Otolaryngology of Kohsei Chuo General Hospital between January 2008 and December 2013. There were 77 cases of Bell’s palsy and 32 cases of Ramsay Hunt syndrome. A significant difference was seen in the healing at the final examination depending on the time of the first visit and the paralysis score in both the cases of Bell’s palsy and Ramsay Hunt syndrome. The cure rate was significantly higher in the Ramsay Hunt syndrome patients who had received steroid pulse therapy as compared to those who had not. Our findings suggested that neuropathy was more severe in Ramsay Hunt syndrome, and that those with advanced facial paralysis were more resistant to treatment. Our results suggested that an aggressive steroid therapy could be recommended for Ramsay Hunt syndrome patients who show advanced paralysis, and also that oral steroid administration could be recommended for Bell’s palsy patients who have milder paralysis. We concluded that, rather than considering administration of high doses of steroids in all cases of facial paralysis, the steroid dose should be selected according to the severity of the paralysis and its cause, in order to reduce the side effects and complications.

The occurrence of benign tumors in the external auditory canal is relatively rare. Whereas reports concerning tumors such as nevus cell nevus, osteomas, papillomas, hemangiomas and adenomas can be noted, there are few reports on pleomorphic adenomas of the external auditory canal in Japan.

We have experienced one case of pleomorphic adenoma of the external auditory canal. A 42-year-old male visited our hospital with a two-year history of left ear hearing loss. We identified a mass occupying the left external auditory canal consisting of an elastic tumor. Following excision of the tumor under general anesthesia, it was pathologically diagnosed as a ceruminal gland pleomorphic adenoma.

Pleomorphic adenomas of the external auditory canal have a better prognosis than those of parotid origin, but the possibility also exists that a malignant tumor from the parotid has developed in the external auditory canal. We considered that the first treatment of choice should be an operation.

A 64-year-old Japanese man presented with a 2-year-history of an itchy skin swelling of the right ear helix. Ultrasonography revealed no abnormalities of the salivary glands or lymphadenopathy. Although the swelling was solitary and small, blood examination revealed eosinophilia and a high serum IgE level. Surgical resection of the ill-defined lesion measuring 3 cm in diameter was performed. Histopathological examination of the resected lesion revealed the characteristic findings of Kimura’s disease, namely, numerous lymph follicles with germinal centers and profuse eosinophilic infiltration of the thickened dermal tissue. IgE staining revealed reticular reaction in the germinal centers. Because of the similarity of the histopathological findings and site of predilection around the ear, this condition should be differentiated from angiolymphoid hyperplasia with eosinophilia (ALHE).

Neoplasms arising from the external ear present with diverse histological features. Papillomas are seldom found in the external ear canal. Herein, we report two cases diagnosed as having external ear canal papilloma.

The first case was a 77-year-old female patient, in whom a papillomatous lesion was found filling the left ear canal. The tumor was treated by CO₂ laser ablation. The second case was a 60-year-old female patient. An exophytic papillomatous lesion was found on the anterior wall of the left ear canal. In this case, the root of the exophytic lesion was ablated with CO₂ laser. No recurrence has been detected in either case. CO₂ laser ablation is an effective treatment modality for papilloma.

HPV is presumed as being the cause of papillomas. We analyzed the subtypes of HPV by PCR, however, no HPV DNA was detected in the specimens obtained from either case.

Pleomorphic adenomas most commonly arise in the major salivary glands, and only rarely in the nasal cavity. We reported herein on a case of a pleomorphic adenoma originating from the nasal septum.

A 49-year-old female complained of left nasal obstruction. A tumor had arisen from the left nasal septum, and it was covered with smooth mucosa and showed vasodilation. The CT scan showed a 20×20 mm soft tissue mass in the posterior left nasal cavity. MRI imaging showed that the mass was a well-defined and hyperintense in T2-weighted images, and isointense in T1-weighted images. The tumor was removed with endoscopic surgery, and the pathological diagnosis was a pleomorphic adenoma.

Including the present cases, 99 cases of pleomorphic adenoma arising from the nasal cavity have been reported in Japan. Of these 79 (79.8%) arose from nasal septum and 18 (18.2%) arose from lateral nasal wall. Four cases (4.3%) have been reported as demonstrating malignancy and 4 (4.3%) as recurrent tumors. Cases of pleomorphic adenoma of nasal cavity have characteristics unlike those of the major salivary gland adenomas in that symptoms such as nasal obstruction and epistaxis appear early, and sufficient resection is possible. The treatment of choice for pleomorphic adenomas is resection. Careful follow-up for a longer period is necessary.

Angiofibroma is a benign tumor and mostly occurs in the nasopharynx among the otorhinolaryngological region. The tumor has a predilection for adolescent boys. In addition, angiofibromas are highly vascular tumors and surgery for these tumors is associated with a massive risk of hemorrhage.

A 61-year-old male patient presented to us with the chief complaint of epistaxis from the left nostril, and was diagnosed as having an extremely rare type of angiofibroma arising from the nasal septum. The CT and MRI imaging showed an enhancing mass in the nasal septum, with no evidence of infiltration of the surrounding tissues. The tumor was fully resected endoscopically after preoperative vascular embolization.

In this report, we discuss the differences in the clinical features between angiofibroma of the nasal cavity and angiofibroma of the nasal septum, and the significance of preoperative embolization of angiofibromas.

Monotherapy with intranasal corticosteroids results in some improvement of the nasal congestion in patients with allergic rhinitis. However, the improvement after oral administration of the combination tablet of fexofenadine hydrochloride/pseudoephedrine hydrochloride (FH/PH) is more rapid. In this study, we evaluated the possibility of expediting the induction effect of monotherapy with intranasal corticosteroids by using these combination tablets at the start of therapy.

For this evaluation, 29 patients presenting with the chief complaints of nasal allergy and nasal congestion were divided into two groups: one group (n=17) was treated with the FH/PH tablets in combination with intranasal corticosteroids (combination group), while the other (n=12) was treated with an intranasal corticosteroid spray alone (intranasal corticosteroid monotherapy group).

The combination group was treated with the FH/PH tablets for two weeks. One week after the start of treatment, concurrent administration of an intranasal corticosteroid spray (mometasone furoate hydrate) was started to initiate the shift toward intranasal corticosteroid therapy. Two weeks after the first dose, the treatment was switched to intranasal corticosteroid monotherapy, which was then used as the sole regimen for the subsequent two weeks. The overall treatment efficacy was evaluated four weeks after the first dose.

One, two and four weeks after the first dose, the Visual Analogue Scale (VAS) for symptoms showed significant improvement in both groups. The degree of swelling of the inferior nasal turbinate mucosa showed steady improvement each week after the start of treatment in the combination group; on the other hand, no significant improvement of the mucosal swelling was observed at one week after the start of treatment in the intranasal corticosteroid monotherapy group.

Our findings suggest that improvement of nasal congestion with FH/PH is more rapid than that with intranasal corticosteroids, and it is advantageous to administer FH/PH prior to the start of intranasal corticosteroid monotherapy.

Our study further suggests that fast-acting FH/PH may perform a key role as an effective induction agent at the start of monotherapy with intranasal corticosteroids in patients with allergic rhinitis presenting with nasal congestion.

Recently, the mortality rate from intracranial complications secondary to bacterial infection of the paranasal sinuses has decreased, because of the availability of effective antibiotic treatment. However, the complications of acute bacterial rhinosinusitis still pose a potentially life-threatening problem. Long-term antibiotic therapy together with prompt endoscopic surgery is considered suitable for the treatment of this disease. Herein, we report the case of a patient who developed intracranial complications secondary to acute rhinosinusitis.

An 18-year-old male complained of nasal obstruction and purulent nasal discharge. About one month later, he presented at the neurological department with severe frontal headache, high fever and nausea, and was suspected as having acute meningitis. He was immediately hospitalized and treated with antibiotics. Nine days later, the patient developed paresis and sensory disturbance of the left lower extremity. Because computed tomography (CT) and magnetic resonance imaging (MRI) revealed the presence of paranasal sinus opacification and a subdural soft-density lesion, the patient was referred to the Department of Otolaryngology of our hospital. Endoscopic sinus surgery with surgical drainage of the subdural abscess was performed.

After the surgical procedure, the headache, paresis and sensory disturbance of the left lower extremity resolved completely. However, 43 days later, lower right quadrantanopsia was observed, and CT revealed recurrence of the abscess in the occipital region. Surgical drainage of the subdural abscess was performed again. After administration of a long course of antibiotics again, the patient was discharged 55 days postoperatively.

We encountered a case of subdural abscess complicating sinusitis. Both the subdural abscess and sinusitis improved with aggressive antibiotic and surgical treatment, while the neurosurgery department confirmed that there were no signs of neurologic deficits.

We verified the usefulness of the RAPIRUN^® S. pneumoniae HS (Otitis media and Rhinosinusitis) kit (RAPIRUN HS) as a screening test during the initial examination for acute rhinosinusitis (ARS).

The study subjects consisted of 100 pediatric patients with ARS examined at our clinic between January and June 2014. Of the 100 cases, 50 were treated based on the results of the RAPIRUN HS rapid test (RAPIRUN HS group), while the remaining 50 were treated in accordance with clinical guidelines for the management of ARS (control group). The selected antimicrobial agents, recovery period, and other factors were compared between the groups and evaluated.

The RAPIRUN HS group comprised 50 patients with a median age of 5.0 years and a male-to-female ratio of 1:1; of the 50, 21 patients were diagnosed as having moderate rhinosinusitis, and 29 as having severe rhinosinusitis. The control group comprised 50 patients with a median age of 4.5 years and a male-to-female ratio of 27:23; 20 patients of this group were diagnosed as having moderate rhinosinusitis, and 30 as having severe rhinosinusitis.

In terms of the overall performance, the RAPIRUN HS showed a sensitivity of 73.3% and specificity of 100% for the diagnosis of rhinosinusitis, when culture results were used as the reference. The sensitivity of RAPIRUN HS tended to decrease in cases with a shorter interval between the onset of ARS and the date of examination in cases with small bacterial counts. The recovery period in the RAPIRUN HS group was <7 days in 25 patients and ≥7 days in 25 patients, while that in the control group was <7 days in 13 patients and ≥7 days in 36 patients (one patient did not re-visit). The percentage of patients who healed within 7 days was thus significantly higher in the RAPIRUN HS group.

The results of this study suggest that selection of antimicrobial agents on the basis of the results of the RAPIRUN HS rapid test allows shortening of the treatment period and reduction of the burden on the patients and their guardians.

Ameloblastoma is one of the most common odontogenic tumors that arise most commonly from the mandible, but rarely arise from the maxilla. We report the case of a 32 year-old male patient with ameloblastoma of the maxilla. The patient visited our hospital complaining of a swelling in the left cheek. Computed tomography revealed a solid bony tumor measuring about 4 cm in diameter in the left maxillary sinus. Gallium-67 scintigraphy showed a hot spot in the region of the tumor. We performed resection of the tumor, and histopathologic examination of the resected tumor revealed the diagnosis of ameloblastoma, desmoplastic type. As at time of writing, the patient remains alive, with no recurrence.

Desmoplastic ameloblastoma is an unusual type of ameloblastoma that was first reported at 1984. Ameloblastoma is considered as a benign tumor, however, as numerous casea of recurrence have been reported prompt and effective treatment is very important. Complete tumorectomy is desirable as resection of the mandible would be associated with cosmetic disfigurement.

Ours was a case of desmoplastic ameloblastoma, which is rarely known to recure; we propose to follow up the patient carefully.

Chronic invasive fungal sinusitis is recognized as one type of fungal sinusitis, however, there are few case reports of this disease and patients with this disease are rare. We report herein on a 60-years-old male patient with chronic invasive fungal sinusitis treated by surgery and an antifungal drug. The patient had been suffering from lacrimation and slight pain of the right eye for three years. Right maxillary sinusitis was detected on brain magnetic resonance imaging (MRI) and he was referred to our hospital. Computed tomography (CT) detected opacity of the right maxillary area with calcification. Both T1-weighted and T2-weighted MRI showed a low signal lesion of the right maxillary sinus with invasion of the right nasolacrimal duct. Blood chemistry revealed that β-D glucan levels were high (42.1 pg/ml). Because the time course of the disease had been very long and the nasolacrimal duct was invaded, chronic invasive fungal sinusitis in the right maxillary sinus was the final diagnosis. A lateral rhinotomy was performed with reconstruction of right nasolacrimal duct and voriconazole was administered for 8 days after the operation. The pathological sample revealed major fungal invasion of the sinus mucosa shown to be Aspergillus with immunostaining. The patient has now been without recurrence for 21 months. A standard treatment of chronic invasive fungal sinusitis has not been established and has varied in the few case reports available; one of them reported treatment with only an operation and the other reported treatment with an operation and an antifungal drug. Our results showed that the combination of an operation and an antifungal drug was effective in the treatment of chronic invasive fungal sinusitis.

Orbital cellulitis and abscess formation in pediatric patients usually arises as a complication of acute rhinosinusitis, and if untreated, may cause visual loss or life-threatening intracranial complications.

We report a pediatric case of orbital subperiosteal abscess secondary to acute rhinosinusitis.

An 11-year-old boy presented with purulent nasal discharge, periorbital swelling and proptosis on the right side. A head computed tomography (CT) showed a medial subperiosteal orbital abscess and destruction of part of the medial wall of the orbital bone. The patient was treated with intravenous antibiotics for four days, however, the periorbital swelling and proptosis persisted. Therefore, we performed endoscopic sinus surgery and drained the subperiosteal abscess through the bony dehiscence. The swelling and proptosis resolved, and the patient was discharged on postoperative day 6. A repeat CT performed during the postoperative follow-up period showed complete resolution of the orbital and nasal lesions.

This case demonstrated that surgical treatment is effective and necessary in patients with an orbital subperiosteal abscess in whom conservative therapy proves ineffective.

Extramedullary plasmacytomas are rare plasma cell tumors that occur mainly in the head and neck region. We report a case of extramedullary plasmacytoma of the parotid gland. A 32-year-old woman presented to us with the chief complaint of swelling of the right mandibular region. Physical examination and MRI revealed a mass lesion measuring 25×15 mm in the right parotid gland and an enlarged right retropharyngeal node. Fine needle aspiration cytology of the main mass showed the presence of some severely atypical, plasma cell-like cells. For the purpose of definitive diagnosis, a right superficial parotidectomy with preservation of the facial nerve was performed. Histopathological examination of the resected specimen revealed the diagnosis of extramedullary plasmacytoma. Immunohistological studies revealed positive staining of the tumor cells for IgG and the kappa chain of immunoglobulin. There were no abnormalities of the serum immunoglobulin level or serum and urinary protein levels, and no abnormal findings on bone marrow biopsy. Postoperative radiation therapy (intensity modulated radiation therapy: IMRT) was administered at a total dose of 50 Gy to the right parotid gland and retropharyngeal lymph node. According to the literature, extramedullary plasmacytoma often transforms to multiple myeloma after several years or even several decades. Therefore, long-term strict observation after treatment is needed.

We report four patients with intractable recurrent oropharyngeal ulcers, including two with idiopathic oropharyngeal ulcers, one with intestinal Behcet’s disease, and one with mucous membrane pemphigoid. The diagnosis of intestinal Behcet’s disease was confirmed by gastrointestinal endoscopy, and the diagnosis of mucous membrane pemphigoid was confirmed by skin biopsy. However, no causative disease could be identified in the two cases with idiopathic oropharyngeal ulcers on the basis of any of the clinical findings, blood examinations or histological analysis. The patients with idiopathic oropharyngeal ulcers were treated by steroids combined or not combined with colchicine. The patient with intestinal Behcet’s disease was treated with infliximab. The patient with mucous membrane pemphigoid was treated using a combination of steroids with diaminodiphenyl sulfone and rituximab. During clinical observation over an average period of 7 years, all the patients have maintained a good course without a recurrence of severe ulcers.

The patient was a 41-year-old man who presented with an approximately 1-month history of sore throat. Examination revealed several ulcers on both sides of the tonsillar bed and root of the tongue. Blood, microbiological and histopathological examinations failed to reveal a clear cause of the ulcers. Viral infection, syphilis and tuberculosis were ruled out. An incomplete type of Behcet’s disease was diagnosed by the internal medicine and connective tissue disorders. Treatment with prednisolone and colchicine led to steady improvement of the pharyngeal ulcers. Approximately five months later, the patient visited our hospital again with a history of exertional dyspnea, and he was diagnosed as having pneumocystis pneumonia. Finally, his pharyngeal ulcers were diagnosed as having been caused by HIV (human immunodeficiency virus) infection. Oral manifestations such as intractable pharyngeal ulcers are sometimes the presenting symptom in patients with HIV infection. Therefore, every otolaryngologist should be aware of the possibility of the diagnosis of HIV infection in patients with oral/pharyngeal ulcers.

Recurrence occurred in a 56-year-old female with a history of surgery for Basedow’s disease, and she was on oral drugs continuously. From 1 month earlier, she had experienced repeated episodes of hematemesis. In the present episode, she lost a large volume of blood, resulting in shock, and was transported to our hospital by ambulance. Contrast-enhanced CT of the neck showed a lesion in the left piriform sinus, which was considered to be the cause of the bleeding. Laryngoscopy and ultrasonography were performed, and a diagnosis of a hypopharyngeal varix was made. A thick vein entering the varix from a swollen thyroid gland was observed. Due to the recurrence of Basedow’s disease, blood flow to the thyroid gland may have become abundant, and the vessel may have coursed into the hypopharynx, forming a varix. To stop blood flow to the hypopharynx, a total thyroidectomy was performed. The hypopharyngeal varix disappeared, and the patient’s postoperative course was favorable without episodes of hematemesis.

Varices in the superior portion of the esophagus in patients with recurrence after surgery for goiters have been reported. Our case suggests that varices can also form in the hypopharynx.

Tonsillectomy is one of the most common surgeries performed by otolaryngologists, and is, therefore, unfortunately, sometimes performed by inexperienced otolaryngologists. Post-tonsillectomy hemorrhage is occasionally encountered even now as a complication of tonsillectomy. Herein, we studied the risk factors for post-tonsillectomy hemorrhage by analyzing the data of 429 patients who underwent tonsillectomy at our hospital between April 2009 and December 2015. Two patterns of post-tonsillectomy hemorrhage were identified; hemorrhage that required hemostasis under general anesthesia (7 patients), and hemorrhage that necessitated delay in discharge of the patient from the hospital (51 patients). On the basis of the results of statistical analysis, we identified use of epinephrine as a risk factor in the hemostasis surgery group, and sex, BMI, and surgery performed without the guidance of an experienced otolaryngologist as risk factors in the delayed discharge group. Considering these risk factors for post-tonsillectomy hemorrhage, it is necessary to customarily operate a better surgery under various opinions.

There have been reports of cases in which a clicking sound is produced in the neck region upon swallowing. It could occur because of elongation and thickening of the hyoid bone, resulting in its coming in contact with the cervical vertebrae during swallowing, or because of abutting of the thyroid cartilage against the hyoid bone, or even because of ossification of the space between the thyroid cartilage and the greater cornu of the hyoid bone. However, in all of these cases, the causes are different and also very rare. Herein, we report a case that we encountered in which a clicking sound was produced in the neck region because of both the thyroid bone and the hyoid bone coming in contact with the cervical vertebrae. The patient was a 57-year-old man. He visited our clinic, because one-year earlier, he had started to hear a sound when swallowing, which had progressively worsened. The abnormal sound was a click coming from the left neck region, and on CT, we observed elongation and hypertrophy of the left greater cornu of the hyoid bone. It was thought that the overgrowth of the hyoid bone was the principal cause, however, this could not be confirmed prior to the surgery. Surgery was performed under local anesthesia. First, the hypertrophic omohyoid muscle and sternohyoid muscle were cut, but the symptoms did not change. Upon cutting of the left greater cornu of the hyoid bone, which was thickened and slightly elongated, and came in contact the cervical vertebrae upon swallowing, the symptoms resolved somewhat. After cutting the superior cornu of the thyroid cartilage, which interfered with the cervical vertebrae upon swallowing, the symptoms disappeared altogether. This was an extremely rare case where the symptoms were caused by both the thyroid cartilage and the hyoid bone, however, appropriate treatment was given through surgery done under local anesthesia while the symptoms were concurrently assessed.

Herein, we report a case of Lemierre’s syndrome with thrombosis of the anterior jugular vein. A 21-year-old man without any significant previous medical history presented to us with a history of fever and sore throat. While he complained of a severe sore throat, examination of the pharynx showed no clinically significant signs. However, we noticed a palpable induration on his right neck. Computed tomography (CT) showed anterior jugular vein thrombosis and multiple subpleural tumors. On the basis of these findings, we diagnosed the patient as having Lemierre’s syndrome. He was initiated on treatment with intravenous SBT/ABPC and oral warfarin. His symptoms rapidly improved in response to the treatment. When he initially presented to the hospital, his chest radiograph showed some nodules; post-treatment, these nodules had completely resolved. Anticoagulant therapy with warfarin was continued even after the patient was discharged. Lemierre’s syndrome is a disease that follows laryngopharyngeal infection and is characterized by thrombophlebitis of the internal jugular vein.

In this case, while the patient’s symptoms were very severe, examination of the pharynx scarcely revealed any clinically significant findings. However, we were able to diagnose Lemierre’s syndrome by CT based on the detection of the induration on his neck.

We reviewed the clinical records of 42 outpatients who visited the Ear, Nose and Throat outpatient clinic at Saitama Medical University Hospital with hoarseness or dysphagia between January 2009 and December 2014, and were initially diagnosed as having laryngeal paralysis. These patients underwent further careful examination of the recurrent laryngeal nerve to determine the causes of the paralysis. Patients with laryngeal cancer or vagal nerve paralysis without involvement of the recurrent laryngeal nerve or in whom the cause of the recurrent laryngeal nerve palsy (RLNP) had been diagnosed previously were excluded from this study. We recorded the age, sex, etiology of the RNLP, side of the RLNP, position of the vocal cords, and the clinical course for each patient. We further reported the clinical details of four patients with rare causes of RLNP.

There were 34 men (81.0%) and eight women (19.0%), with a median age of 67 years (range, 42–87 years). The causes of the RLNP identified were hypopharyngeal cancer or esophageal cancer in 26.2%, lung cancer in 23.8%, aortic aneurysm in 11.9%, and thyroid cancer in 9.5% of the patients. In addition, some patients had rare causes of RLNP: a cyst under the arch of the aorta in 2.4%, pulmonary aspergillosis in 2.4%, benign thyroid tumor in 9.5%, and Ortner’s syndrome in 4.8% of the patients. The vocal cord paralysis was left-sided in 71.4%, right-sided in 26.2%, and bilateral in 2.4% of the patients. The position of the vocal cords was paramedian in 28.6%, partial paralysis in 11.9%, median in 11.9%, intermediate in 11.9%, and dilated in 2.4%, with that in the other cases not recorded. Diagnosis of RLNP took about 10 days in most cases.

This study highlights the need to be aware of the potential causes in patients presenting with laryngeal paralysis at the outpatient clinic. It is important to make a prompt diagnosis in these patients, in consultation with other specialists, such as pulmonologists and cardiologists.

We analyzed 10 patients with laryngeal injuries who had been treated in our hospital between May 2005 and April 2014. All patients had consulted our hospital within one week following the injury and so were acute patients. The most common etiologies were sports-related injuries in the young, suicide attempts in the middle-aged, and falls in the elderly. Six patients (60%) had received conservative therapy as out-patients. Three patients (30%) had been admitted to the hospital and were treated conservatively. The remaining one patient (10%) underwent surgical treatment. The purpose of treatment in the acute phase should be to secure the respiratory tract. For those patients who complained of dyspnea, admission and closer observation were mandatory and the need for an emergency tracheostomy should be considered. The patient who underwent surgery had an open injury due to their attempted suicide.

Pneumothorax may occasionally occur because of damage to the pulmonary apex during urgent tracheotomy. The reported frequency of unilateral pneumothorax after tracheotomy is 0.92–1.4%, while that of bilateral pneumothorax is much lower, at 0.4%.

Herein, we report a case of bilateral pneumothorax that occurred during tracheotomy performed for a huge polypoid vocal cord.

Respiratory tract obstruction occurred during the urgent tracheostomy, necessitating provision of breathing assistance. This led to the development of extreme negative pressure in the thoracic cavity and caused the alveolar and mediastinal pleurae to be sucked into the thoracic cavity, resulting in pneumothorax. A respiratory surgeon promptly performed tube thoracostomy on both sides, and the patient’s breathing improved.

Postoperative chest radiography helped in early diagnosis of the pneumothorax. The patient underwent laryngeal microsurgery for bilateral polypoid vocal cord resection under general anesthesia, with bilateral tube thoracostomy.

Histopathology revealed an inflammatory lesion arising from the right vocal cord, with no evidence of malignancy.

When a patient develops symptoms such as pain, dyspnea, decrease in oxygen saturation on pulse oxymetry, or tachycardia after tracheotomy, bilateral pneumothorax should be considered, and chest radiography should be performed for definitive diagnosis.

When pneumothorax occurs, it is necessary to take quick measures, such as drainage of the air by tube thoracostomy.

Nasopharyngeal cancer is generally difficult to diagnose at an early stage because it is anatomically hard to access, often asymptomatic, and apt to metastasize. We retrospectively analyzed the date of 19 freshly diagnosed cases of nasopharyngeal cancer who were treated at our department between 2001 and 2013. The patients consisted of 15 males and 4 females, and ranged in age from 17 to 77 years, with an average of 62.6 years.

Our treatment protocol was as follows: For stage I/II cancers: hyperfractionated radiotherapy (1.2 Gy×2/day) to a total of 72 Gy, with concurrent daily carboplatin (25 mg/m²); for stage III/IV 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)), followed by concurrent chemoradiotherapy as for the stage I/II cancers. Patients with remnant primary tumor received additional radiotherapy with a cyberknife. Patients with remnant disease in the cervical lymph nodes underwent neck dissection if/when they showed complete response of the primary tumor without distant metastasis.

The subdivision of the primary tumor was the posterosuperior wall in 11 patients (58%) and lateral wall in 8 patients (42%). Two patients had stage I disease, 3 patients had stage II disease, 6 patients had stage III disease, and 8 had stage IV disease. The overall 5-year crude and disease-specific survival rates determined by the Kaplan-Meier method were 49.8% and 69.2%, respectively. The 5-year crude and disease-specific survival rates in each stage were 100%/100% (crude/disease-specific) in patients with stage I disease, 33.3%/50.0% in patients with stage II disease, 50.0%/100% in patients with stage III disease, and 31.3%/46.9% in patients with stage IV disease.

The survival rate could be improved by early detection of cancers and altering the treatment protocol for advanced cancers.

A 52-day-old infant with bilateral cervical fistulae originating from the second branchial apparatus was admitted because of left cervical swelling and fever. Computed tomography revealed findings suggestive of infection of the left cervical fistula, and the patient was treated by incision and drainage and administration of intravenous antibiotics. The swelling of the neck subsided by 7 days after the start of treatment and the patient was discharged from the hospital. However, the infection recurred repeatedly, and incision and drainage was performed a total of three times. Frequent incision and drainage to treat cervical fistula infections in infants has been rarely reported. Although general anesthesia in infancy should ideally be avoided, surgery should be considered in infants with frequent infection of cervical fistulae.

Cetuximab plus radiotherapy has been shown to be a useful treatment for locoregionally advanced squamous cell carcinoma of the head and neck (LA-SCCHN). At our institute, we have begun to use cetuximab plus radiotherapy for LA-SCCHN in August 2013. In this paper, we report the adverse events of cetuximab plus radiotherapy and the countermeasures adopted by us at our institute. We applied this treatment regimen for 15 patients. The site of the primary lesion were as follows; oropharynx (3 cases), hypopharynx (8 cases), larynx (3 cases), and unknown (1 case). The distribution of the disease stage was as follows; Stage II (5 cases), Stage IVA (8 cases), and Stage IVB (1 case). The treatment was administered in accordance with the protocol in the Bonner trial. The treatment completion rate in the initial period of observation was 66.7%, while the rate improved in the latter part of the observation period. Presumably, the rate improved in the latter part of the treatment period because we adopted measures for management of the adverse effects of radiation dermatitis and oral mucositis. No serious infusion reactions were observed. We observed grade 3 radiation dermatitis in 6 cases, oral mucositis in 5 cases and grade 4 interstitial pneumonia in 1 case. The patients with interstitial pneumonia recovered with steroid pulse therapy, however, the radiation therapy had to be discontinued. Cetuximab plus radiotherapy is a very useful treatment method for squamous cell carcinoma of the head and neck, however, it is associated with a high risk of serious adverse events. Thus, patients should be carefully selected for cetuximab plus radiotherapy.

A retrospective study was performed of the data of 72 patients of adenoid cystic carcinoma who underwent treatment at Kyushu Cancer Center. In the 62 patients treated by surgery, there was no significant difference in the loco-regional control rate between the group that received postoperative radiotherapy and the group which did not receive postoperative radiotherapy. In the 25 patients who developed distant metastasis post initial treatment, the prognosis was significantly better in the group that received chemotherapy as compared to that in the group that did not receive chemotherapy (p = 0.0003). These results clearly indicate the importance of complete resection of adenoid cystic carcinoma at surgery. Furthermore, the patient group with successful loco-regional control showed a significantly lower frequency of distant metastasis as compared to the patient group with failure of loco-regional control (p = 0.01). We reconfirmed that success of loco-regional control was of the greatest importance in relation to the prognosis in patients with adenoid cystic carcinoma.

Follicular dendritic cell sarcoma (FDCS) is a rare malignancy arising from the follicular dendritic cells, which are antigen-presenting cells in the lymphoid follicles. We report the case of a 71-year-old male patient who was diagnosed as having FDCS of the tonsil. The patient presented with a 1-month history of throat pain and swelling of the right tonsil. An incisional biopsy of the tumor in the right tonsil was performed, and the diagnosis of FDCS was made on the basis of the histopathological and immunohistochemical findings. The tumor was surgically resected with the right pharyngeal wall by the pull-through method. A tensor fascia lata flap was used for reconstruction of the pharyngeal wall. No postoperative therapy was adopted. The swallowing function and articulation were preserved as prior to the surgery. At present, one year after the surgery, the patient has shown no evidence of either local recurrence or distant metastasis.

We report herein on a case of undifferentiated carcinoma of the thyroid with a high serum G-CSF level. A 78-year-old woman was referred to hospital in respiratory discomfort that caused by large neck mass. A cytological examination from an aspiration biopsy disclosed papillary carcinoma of the thyroid. CT and MRI examinations revealed thyroid carcinoma with laryngeal infiltration and lung metastasis. We diagnosed it as papillary carcinoma of the thyroid (T4aN1aM1 Stage IVc) and suggested surgery with radiation therapy. However, she and her family were not expecting treatment, so we performed only a tracheostomy. Four years later, she was admitted to our hospital because of a rapidly enlarging tumor, anorexia and general malaise. She died a month later after admission. Marked elevation of the number of leukocytes to 178,900/mm³ was observed during the clinical course, and an increase in the G-CSF level (139 pg/dl) was demonstrated in the serum. We discuss the clinical course and prognosis of this tumor based on our case with reference to the literature.

S-1 consists of tegafur and two biochemical modulators and reduces adverse effects such as neuro- and cardiac toxicity, hand-foot syndrome and gastrointestinal (GI) toxicity. It can be used as a relatively safe anti-cancer agent for various types of cancers in not only the head and neck region but also the GI, breasts, lungs and so forth.

At our center, we have used concurrent chemoradiotherapy with S-1 in combination with nedaplatin in patients with head and neck squamous cell cancer and obtained favorable feasibility; recently, however, three GI-related serious adverse events that were considered to be due to S-1 occurred in series. One case was a lower GI hemorrhage accompanied with hemorrhagic shock. The remaining two cases were GI perforations, including one fatal outcome.

We have been evaluating various factors that could contribute to GI adverse events including medication, patient and healthcare personnel factors to establish a more appropriate therapeutic plan and supportive care.

Congenital factor XI deficiency is a rare hereditary coagulation disorder which was first reported by Rosenthal and his coworkers in 1953. It is transmitted as an autosomal recessive trait and occurs with equal frequency in males and females. Only thirty-seven patients have been reported in Japan in the national survey of 2014, but operated cases in such patients were very few. In this paper a successful operation for tongue cancer in a patient with this hereditary disease is described.

A 67-year old male with factor XI deficiency (factor XI activity: less than 3%), who had a history of cerebral hemorrhage, underwent partial resection of the tongue and supraomohyoidal neck dissection for tongue cancer (cT2N0M0 Stage II). Also, in preparation for the bleeding and airway obstruction after surgery, a tracheotomy was performed prophylactically. The histopathological diagnosis was well-differentiated squamous cell carcinoma pT1pN0, tumor thickness of 5 mm, surgical resection margins were negative. Fresh frozen plasma was supplied before and after surgery while monitoring to keep the activated partial thromboplastin time (APTT) value in the normal range and to maintain intraoperative factor XI activity at more than 10%.

This replacement therapy saved the patient from any tendency towards intra-and postoperative bleeding and helped avoid postoperative complications. In addition, in the surgery of the head and neck, there is a need for perioperative management in preparation for bleeding and airway obstruction after surgery.

We report herein on a case of methotrexate-associated lymphoproliferative disorder (MTX-LPD) presenting with a right parotid swelling and facial nerve palsy. A 69-year-old woman with 4-year rheumatoid arthritis (RA) history with MTX medication and Sjögren’s syndrome presented with a right parotid swelling. Although she was treated on occasions with antibiotics and oral steroids for 4 months, the swelling grew bigger and more painful, then facial nerve palsy appeared. She underwent a biopsy of the right parotid gland, revealing a diffuse large B-cell lymphoma. After MTX withdrawal, the parotid swelling shrank and the facial nerve palsy resolved almost simultaneously within several weeks. She had no evidence of recurrence for 6 months.

Advanced maxillary cancer involving the eye or tissues surrounding the orbit necessitates removal of the eyeball or intensive radiotherapy with the radiation field including the eyeball. Thus, the treatment often results in severe visual impairment in the patient. Herein, we report a case of extended total maxillectomy combined with autokeratoplasty performed for a patient with maxillary sinus cancer involving the orbit. A 55-year-old man visited our hospital with a suspected maxillary sinus tumor. Endoscopic nasal biopsy revealed the diagnosis of squamous cell carcinoma and we diagnosed the patient as a case of maxillary sinus carcinoma (T4aN1M0) invading the right orbit on the basis of the MRI findings. The patient also suffered from left corneal opacity because of keratoconus. It was predicted that the treatment of the maxillary sinus cancer would leave the patient with severe left visual impairment and a significant deterioration in the quality of life (QOL). To provide the patient with best possible QOL, we performed extended total maxillectomy combined with autokeratoplasty. At a follow-up examination conducted 3 years 11 months after the surgery, the patient was found to show no signs of recurrence and his eyesight on the left side was maintained.

A 73-year-old male was referred to our hospital complaining of swelling of his right neck, and was diagnosed as having oropharyngeal squamous cell carcinoma, clinical stage T2N2bM0. He had received concurrent radiotherapy with cetuximab treatment and achieved complete remission by the time he had received a total of 70 Gy of radiation to the neck and 7 courses of intravenous cetuximab treatment. However, he developed perforation of the sigmoid colon 1 month after completion of the cetuximab treatment.

Cetuximab is a monoclonal antibody directed against epidermal growth factor receptor (EGFR), which binds to EGFR and inhibits cell proliferation. We searched PubMed and the Japan Medical Abstracts Society for cases of bowel perforation associated with cetuximab treatment, and identified 3 other cases of bowel perforation. All developed bowel perforation a couple of months after the completion of cetuximab treatment and had a history of gastrointestinal diseases like colon cancer, stoma creation and colonic diverticular disease. Only a few cases of severe gastrointestinal complications related to cetuximab treatment for head and neck cancer have been reported until now, and this is the first case of a patient with oropharyngeal carcinoma developing bowel perforation requiring urgent surgery. However, we suspect that EGFR inhibitors could exert toxic effects on the bowel mucosa in the same way as VEGF receptor inhibitors, the toxicity of which to the bowel mucosa came to be widely recognized during the post-marketing surveillance.

Close observation with an index of suspicion for bowel perforation is thought to be necessary when treating head and neck cancer patients with cetuximab, especially in patients with a history of gastrointestinal diseases like diverticular disease.

The mandible is significantly involved in oropharyngeal functions. Dysphagia and dysarthria occur in patients undergoing segmental resection of the mandible for malignant tumors. In some cases, en bloc resection of the skull base and temporomandibular joint is required on account of extensive spread of the tumor and involvement of the joint capsule. In such cases, hard reconstruction of the mandible is difficult and a free flap consisting of soft tissue alone is used for the reconstruction. In this study, we evaluated the deglutition and articulatory functions patients undergoing resection of the middle cranial fossa and segmental resection of the mandible for en bloc resection of the joint capsule, followed by reconstruction using a soft tissue free graft. We examined the data of four of six subjects who underwent the aforementioned surgery between 2010 and 2014 at the Department of Otorhinolaryngology, Head and Neck Surgery, Hachioji Medical Center and answered our questionnaire. There were three males and one female, ranging in age from 14 to 69 years (mean age: 49.2 years). The primary tumor was located in the parotid gland in three cases, and in the ear canal in one case. Referring to the Clinical Practice Guidelines in Oncology, Head and Neck Cancers (2013), articulation was assessed based on the conversational function evaluation criteria, while feeding disorder was evaluated based on the MTF scores, functional oral intake scale (FOIS) and food style at hospital discharge. The mean score on the conversational function evaluation criteria was 9.25. The mean MTF and FOIS scores were 11 and 5.75, respectively, both of which indicate relatively well-conserved function. As for the type of food that the patients could eat at hospital discharge, all of the patients were able to ingest a bite-sized soft foods. Thus, the feeding and articulatory functions were conserved in subjects who underwent mandibular reconstruction using soft tissue alone.

Cetuximab is one of the effective chemotherapeutic agents used for the treatment of head and neck squamous cell carcinoma (HNSCC). It was approved for use and began to be used in Japan in the year 2012. The most frequent adverse effect of cetuximab is skin rash, such as acneiform papules, which results from skin fragility developing as a result of inhibition of EGFR, and occurs in over 95% of patients treated with cetuximab. It commonly arises in seborrheic areas such as the face, scalp, precordium and back, while also rarely occurring on the buttocks and trochanteric areas, which are exposed to minor pressure and shear. These papules or pustules frequently develop into pressure sore-like ulcers due to the excessively fragile skin. These adverse events have been reported only in a few cases of non-small cell lung carcinoma treated with gefitinib and erlotinib, but never in association with the use of cetuximab.

Herein, we report two cases of HNSCC with pressure sore-like ulcers on acneiform papules caused by cetuximab.

Both the patients were elderly males with metastatic HNSCC who were receiving cetuximab-based chemotherapy. The patients presented with acneiform papules occurred on the buttocks and trochanteric areas, which had developed pressure-sore like ulcers, causing pain. The pain decreased the quality of life (QOL) of the patients, causing the patients to become intolerant to the treatment.

Pressure-sore like ulcers not only cause annoying pain and deterioration of the QOL of patients, but also lead to treatment failure and a poor prognosis. To prevent treatment failure caused by the adverse effects of cancer chemotherapy, it is important to adopt a multidisciplinary approach to the treatment.

Chromium is a heavy metal that shows superior corrosion resistance, rigidity and luster, and has been used in various industries as a plating material, oxidizer, catalyzer and pigment. Long-term exposure to hexavalent chromium (Cr (VI)) can cause dermatitis, skin ulcers, conjunctivitis, keratitis, nasal mucositis, and/or nasal septal perforation. In addition, exposure to Cr (VI) has also been reported to increase the risk for lung cancer among workers in the chromate-producing industry. Cr (VI) has been designated as a carcinogen for lung cancer by the International Agency for Research on Cancer. Cr (VI) has also been shown to be capable of inducing stomach and colon cancers, and less often, nasal and paranasal sinus malignancies.

Herein, we report a rare case of synchronous double cancer of the lung and nasopharynx arising in a chrome-plating worker. A 60-year-old man who had been working in the chrome-plating industry for 32 years was referred to our institute with a 5-month history of neck swellings and a nodular shadow on chest X-ray. Physical, rhinoscopic and endoscopic examinations showed enlarged walnut-sized cervical lymph nodes on both sides, a large nasal septal perforation, and an ulcerative tumor in the posterosuperior nasopharyngeal wall. Computed tomography and magnetic resonance imaging revealed multiple lymph nodes measuring 30 mm in maximum diameter on both sides of the neck, a weakly enhancing protuberance in the nasopharynx, and a 30-mm nodule with spicula and vascular convergence in the lower lobe of the left lung. Endoscopic biopsies were performed, and the nasopharyngeal and lung lesions were diagnosed histopathologically as nonkeratinizing carcinoma and squamous cell carcinoma, respectively. Thoracoscopic left lower lobectomy with hilar and mediastinal dissection was performed for the lung tumor, and the nasopharyngeal cancer was treated subsequently by induction chemotherapy followed by concurrent chemoradiotherapy. The posttreatment course was uneventful, and the patient has remained free of recurrence during the 6-month follow-up period since.

There are certain physical findings that help to distinguish benign from malignant parotid tumors. It is well known that pain/tenderness, fixation to surrounding structures, and facial weakness/paralysis are important symptoms and signs associated with parotid cancer. Among 149 cases of parotid cancer, pain/tenderness was present in 79 cases, and fixation to the surrounding structures was noted in 98 cases. Some degree of facial nerve dysfunction was noted in 27 cases, while, on the other hand, none of the 668 patients with benign parotid tumors showed any evidence of facial nerve dysfunction. All of these symptoms/signs associated with malignant parotid tumors were found at higher frequencies in histologically high malignancy grade tumors than in intermediate/low malignancy grade tumors. Adenoid cystic carcinoma is well known to be characterized histologically by perineural spread, and accounts for about 80% of all parotid tumors. Pain/tenderness has been noted in 88% of patients with adenoid cystic carcinoma, a higher rate as compared to that in parotid cancer patients as a whole. Awareness of the symptoms and signs associated with malignancy is the first step towards early diagnosis of malignant parotid tumors.

We retrospectively analyzed the treatment outcomes in patients with tongue cancer at our department. The patients were 50 newly diagnosed cases of tongue cancer who were treated at our department between 2005 and 2015. There were 40 males and 10 females, aged 34 to 88 years old (average age 63.0 years). Our treatment protocol was as follows: the first-line treatment was surgery in all except the M1 cases. The resection area of the tongue was determined by the size of the tumor; i.e., partial glossectomy for T1 lesions, partial glossectomy or hemiglossectomy for small T2 (<30 mm) lesions, hemiglossectomy for large T2 (≥30 mm) lesions, hemiglossectomy or subtotal glossectomy for T3 lesions, and (sub)total glossectomy for T4 lesions. Intra-arterial chemoradiotherapy was indicated for patients with unresectable T4 and those who were unsuitable for or refused surgery. Neck dissection was performed in patients with N(+) and/or ≥large T2 lesions. Patients with a positive surgical margin, extranodal spread of the tumor and/or ≥4 metastatic lymph nodes received postoperative chemoradiotherapy (61.2 Gy with daily carboplatin (25 mg/m²)).

The overall 3-year crude and disease-specific survival rates determined by the Kaplan-Meier method were both 72.1%. The overall 5-year crude and disease-specific survival rates were 63.1% and 68.8%, respectively. The 5-year disease-specific survival rates in the stage I, II, III and IV patients were 100%, 82.5%, 57.1% and 34.1%, respectively. The disease-specific survival rates were significantly higher in the stage I than in the stage III/IV patients, and significantly lower in the stage IV than in the stage II patients. In all, 15 patients died, 11 of them from local recurrence.

These results indicate that early detection and local control are important to achieve a better survival rate in patients with tongue cancer. To improve the local control rate, the resection area of the tongue, indications for neck dissection and postoperative chemoradiotherapy, and the regimen for concurrent chemotherapy should be reconsidered, all of which must be investigated in a future study.

Synovial sarcoma is a relatively rare soft tissue sarcoma, most commonly occurring in the para-articular regions of the extremities and also in the head and neck region. To the best of our knowledge, there have been only six reports of thyroid synovial sarcoma in the medical literature. We report the case of a 49-year-old man who presented to us with the chief complaint of a cervical mass and hoarseness of the voice. Total thyroidectomy was performed, and anaplastic thyroid carcinoma was suspected on the basis of the histopathological findings. The patient received adjuvant concurrent chemoradiotherapy and adjuvant chemotherapy. One year 10 months after the surgery, the patient was diagnosed as having lung metastases, however, because of the atypically slow progression of these lesions, we reexamined the pathological diagnosis. Finally, the histopathological diagnosis of synovial sarcoma was confirmed by TLE1 immunohistochemistry. It was thought that the diagnosis was difficult, because synovial sarcoma of the thyroid gland is extremely rare, and histopathologically, poorly differentiated synovial sarcoma shows less specific features.

Introduction: Individualized maximum repeatable dose (iMRD) is the maximum dose at which a drug can be repeated in an individual to maintain the toxicity grade at 1 or lower. In this phase I study, the starting dose to estimate the iMRD in weekly paclitaxel treatment for recurrent and/or head and neck cancer patients was determined.

Patients and Methods: Patients were enrolled according to the modified Fibonacci method. Six patients were enrolled at the starting dose of level 0 (60 mg/m²). Weekly dose adjustments were made to maintain the toxicity at grade 1 or lower. The iMRD was estimated after the 6th infusion.

Results: One patient developed grade 3 neutropenia, while another developed grade 2 neutropenia that did not resolve within 2 weeks. The iMRD could be estimated in four of the six enrolled patients. The starting dose was determined to be level −1 (50 mg/m²).

Conclusion: A phase II study of weekly paclitaxel at the aforementioned starting dose to detect iMRD has been planned. In patients for whom the iMRD can be detected, tumor dormancy therapy with weekly paclitaxel can be continued without compromising the quality of life.

In general, stable respiratory management after tracheostomy is difficult in patients with a thick short neck. A longer length of the tracheal tube is needed for patients with a thick short neck as compared to patients with a normal size of the neck. The unstable condition associated with the use of a longer tracheal tube in patients with a thick neck results in many complications and difficulty in respiratory management. We report the case of a patient weighing over 200 kg with a very thick neck in whom we performed tracheostomy because of acute respiratory failure. Prior to the tracheostomy, the fatty tissue between the skin and trachea was removed to the minimum extent needed to avoid the production of dead space after the tracheostomy. We discuss the problems related to tracheostomy and management of the tracheal tube in overweight patients. From our experience with this case, we recommend selection of a tracheal tube with a movable neck flange for patients with a thick neck. The BMI based on the body weight after the tracheostomy (such as 14 days later, 21 days later) has been suggested as a novel predictor of the development of postoperative complications in these patients.