Various conditions have been proposed to cause sudden deafness, one of them being cochlear circulatory disturbance. In diabetics, sudden deafness is often thought to be caused by vascular disorders. In this report, the authors describe a case of a 70-year-old male who presented with left-sided tinnitus of sudden onset with hearing loss for middle to high tones. He was already receiving treatment for cardiovascular risk factors, such as diabetes mellitus, high blood pressure, and angina pectoris. He was started on treatment with a steroid and hyperbaric oxygen for his otologic symptoms. However, the hearing loss aggravated, resulting in complete deafness from day 5 of treatment. The authors thought that this was caused by the vasoconstrictive effect of the steroid and highly concentrated oxygen.

Based on a series of studies including brain function tests, we reinforced and improved treatment for tinnitus by developing a tinnitus retraining therapy (TRT) that incorporates the “tinnitus pain model”; our laboratory subsequently introduced this therapy in 2013. This model provides a clinical explanation that tinnitus manifests and worsens through nerve synchronization of the auditory path and the non-auditory path with the pain network. Therefore, the target of tinnitus therapy based on this model is the auditory path generating the tinnitus and the pain network that worsens the tinnitus. The therapy mainly uses “acoustic therapy” and “directive counseling”, which are the same as the original TRT. What characterizes this method is the central use of a hearing aid in the “acoustic therapy” targeting tinnitus patients with hearing loss. TRT incorporating the “tinnitus pain model” would be ideal for the establishment of an outpatient department dedicated to hearing loss and tinnitus. In actual practices, however, many hospitals avoid offering “directive counseling”, as it is often difficult to provide sufficient counseling in a general outpatient setting.

This report examined the tinnitus treatment practice of a municipal hospital with two otolaryngologists. The hospital administered TRT incorporating the “tinnitus pain model” to 62 cases (average age: 68.7 years, prevalence period: 16 months [median]). All the cases were treated with “directive counseling”, while 32 cases used hearing aids as a part of “acoustic therapy”. The tinnitus handicap inventory (THI) score showed a statistically significant reduction after treatment from 49.3±23.0 to 24.8±21.1. The improvement rate, based on an “improvement of 20 THI points or above” and “16 or lower final THI points” as the statistical criteria, was 62.9%. The proactive involvement of municipal hospitals in tinnitus treatment may reduce the frequency of doctor shopping by tinnitus patients and could help to break the “vicious circle” of tinnitus treatment practices.

We report a case of acute sensorineural hearing loss caused by multiple cavernous hemangiomas. The patient was a 38-year-old woman who presented to us with a history of sudden loss of hearing on the left side and left-sided tinnitus. After two weeks, both the symptoms improved, but a pure-tone audiometry revealed sensorineural hearing loss in the zone of scale-out on the left side. Initially, we suspected functional deafness, however, the patient was finally diagnosed as having retrocochlear deafness based on evaluation of the auditory brainstem response (ABR) following that of the distortion product optoacoustic emission (DPOAE). Furthermore, MRI revealed multiple cavernous hemangiomas, one of which was at the left cerebellopontine angle.

We conclude that objective auditory testing is very useful for evaluation of the hearing ability in patients with sensorineural hearing loss, but it is necessary to understand the characteristics of each test for an accurate interpretation of the results.

Herein, we report two cases of cerebrospinal fluid leakage in children that we encountered at our hospital. Both presented with hearing loss.

Case 1 also suffered from blurred vision and photophobia. He exhibited a series of problem behaviors at school and violent behavior at home. These behaviors had become pronounced after a traffic accident. Ophthalmological testing using an autorefractor revealed the presence of hypertonia of the ciliary muscle and unstable refraction in both eyes. After 4 sessions of treatment with an epidural autologous blood patch (BP), the symptoms improved. The findings in this case suggest that hypertonia of the ciliary muscle and unstable refraction causing visual impairment can occur in cases of cerebrospinal fluid leakage. His abnormal behavior was the result of the abnormalities of the eyes and ears.

Case 2 had chronic dizziness in addition to the hearing loss. The dizziness and abnormalities in the stabilometer test improved a long time after BP treatment. However, the hearing impairment never complately improved.

The interval from the traffic accident to the correct diagnosis was 3 years 9 months in Case 1, and from the initial examination to the correct diagnosis was 3 years 10 months in Case 2. Patients often consult the ENT clinic due to such symptoms as headache, dizziness, hearing loss, tinnitus, and/or visual impairment. We should always bear in mind the possibility of cerebrospinal fluid leakage in such cases. Especially, children with this condition may not be able to precisely express their mental and physical distress, and may exhibit problem behaviors or strange behaviors. Therefore, it is important to obtain a careful history.

A previous retrospective study reported that the sympathetic hypersensitivity caused by chronic stress might induce orthostatic blood pressure elevation (OBPE) and dizziness. This prospective study was planned to endorse that suggestion. Tofisopam, which is effective for normalizing sympathetic hypersensitivity, was administered to 13 dizzy patients with OBPE with no other abnormal findings. The patients were asked about whether they were aware of their exposure to stress or not. After the start of administration of tofisopam, a significant decrease of the OBPE and improvement of dizziness were observed in 12 (92.3%) of the 13 patients. Eleven (84.6%) of the 13 patients were considered to be exposed to chronic stress from their living environment, however, only 8 (61.5%) were aware of their exposure to chronic stress. These results validate the findings of the previous aforementioned study. OBPE may be a promising biomarker in the objective evaluation of chronic stress, because it was observed even in those patients who did not recognize their exposure to chronic stress.

Cochlear implant is an established auditory prosthesis for children and adults with severe to profound sensorineural hearing loss. With the expansion of the use of cochlear implants, the number of cochlear implant users needing magnetic resonance imaging (MRI) is also increasing.

We report a case of magnet displacement after 1.5 T MRI in a 68-year-old female patient who was using the Hi-Res 90K^TM cochlear implant. The patient complained of severe pain during the MRI. On physical examination, the skin over the internal magnet was found to be swollen. Because of severe tenderness in the region, the patient could not wear the receiver-stimulator. A CT scan showed that the lower end of the internal magnet in the implant had become dislodged from the silicone sheath. In this case, the magnet was repositioned by a non-invasive approach via a percutaneous closed reduction maneuver. Immediately after the repositioning procedure, the tenderness and the bulging of the skin disappeared. At present, 6 months since the procedure, the cochlear implant continues to function well.

We report the case of 39-year-old female patient who was diagnosed as having bacterial meningitis (BM) complicating acute otitis media. The patient presented with 5-day history of acute otitis media and a 4-day history of headache, vomiting, and high fever. We diagnosed her as having BM based on clinical evidence of meningeal involvement and the result of a cerebrospinal fluid analysis. The patient was started on intravenous prednisolone and meropenem for empiric treatment of both the BM and sensorineural hearing loss. These treatments led to rapid relief of the patient’s symptoms without any sequela. Temporal-bone CT showed the suggestion of a partial bone defect in the temporal tegmen. Exploratory tympanotomy of the right ear confirmed the presence of the bone defect in the temporal tegmen and the attic was obliterated with a bone plate.

BM is considered as a neurological emergency. The possibility of BM should be borne in mind in patients with otitis media presenting with persistent meningeal symptoms.

Congenital cholesteatoma within the tympanic membrane is very rare and is mainly treated with the removal of the lesion, including all of the cholesteatoma matrix and keratin debris. We report the case of a 14-month-old boy who was diagnosed as having congenital cholesteatoma in his right tympanic membrane. The patient presented with a white mass in the inferior portion of the right tympanic membrane. A computed tomography scan of the temporal bone revealed that the mass was located within the tympanic membrane but had not invaded the ossicular chain. Since the mass appeared to have increased at the time of a 1-year-follow up, we surgically removed the congenital cholesteatoma within the tympanic membrane. During the surgery, we removed the matrix under the epithelial layer of the tympanic membrane and thoroughly removed all of the keratin debris. After the surgery, the matrix on the fibrous layer of the tympanic membrane was used to cover the tympanic membrane and external auditory canal as an epithelium. To date, there have been any signs of recurrence. These findings indicate that the removal of the matrix under the epithelial layer as well as keratin debris in the cholesteatoma can lead to the complete healing of a congenital cholesteatoma within the tympanic membrane.

We report a rare case of a patient with a cholesterol granuloma located in the infratemporal fossa. A 65-year-old male patient was referred to our department because of the findings on CT at another hospital of right ear opacification and bone defect of the anterior wall of the tympanum. He had undergone right ear surgery at the age of 33 years. He had suffered from hearing loss on the right side for many years and experienced right-sided otorrhea since two months before presentation. In addition, a lesion in the anterior wall of the right maxillary sinus associated with a bone defect was also recognized on the CT. MRI demonstrated a large cystic lesion extending to the infratemporal fossa and tympanum. Cholesterol granuloma, cholesteatoma, and tumor invasion from the maxillary sinus were considered in the differential diagnosis; OMAAV, or Otitis Media with Anti-neutrophil Cytoplasmic Antibody (ANCA)-associated vasculitis, was also suspected because blood examination revealed an elevated myeloperoxidase-ANCA titer. Tympanoplasty was planned for biopsy and drainage of the cyst, followed by endoscopic sinus surgery for biopsy. Canal wall-down mastoidectomy was performed, the granulation tissue occupying the tympanum and attic was removed, and the bone defect was found above the orifice of the right Eustachian tube. After fenestration, abundant brown fluid flowed out of the cavity in the infratemporal fossa. A drainage tube was then inserted into the tympanic membrane and a silicone sheet into the cavity of the infratemporal fossa. Histological examination demonstrated no evidence of malignant tumor or OMAAV, whereas the finding of a granuloma containing cholesterol crystals in the middle ear mucosa indicated the diagnosis of cholesterol granuloma. After the surgery, the otorrhea resolved. The patient is under follow-up at our hospital and has shown no evidence of recurrence since the surgery.

Langerhans cell histiocytosis is a disease of unknown cause, characterized by abnormal proliferation of Langerhans cells. It may manifest as functional disorders of the liver and spleen, and/or as osteolytic lesions. The temporal bone is occasionally affected by Langerhans cell histiocytosis. Lateralized tympanic membrane usually occurs after operations on the external auditory canal or middle ear, or in association with injury and inflammation of the external ear. It may sometimes cause medial meatal fibrosis (MMF). A case of transcanal endoscopic ear surgery for lateralized tympanic membrane that arose as a complication after treatment of Langerhans cell histiocytosis is reported.

A patient was a 6-year-old boy who was brought to our hospital 4 years ago with intractable otorrhea on both sides. Biopsy of the tumor detected in the external auditory canal revealed the diagnosis of Langerhans cell histiocytosis. Ahead CT revealed several mass lesions with bone destruction of the skull and soft-tissue shadows in the external auditory canals of both sides. The patient received chemotherapy at the Department of Pediatrics and enterd remission after four years of treatment. Subsequently, he suffered from binaural conductive hearing loss caused by a lateralized tympanic membrane. A repeat CT showed soft-tissue shadows within both external auditory canals. We made the diagnosis of MMF developing after treatment for Langerhans cell histiocytosis. Transcanal endoscopic ear surgery was performed for the MMF on both sides, step-by step. An endoscope offers several advantages over a microscope: a wide field of view, higher magnification on close approach of the object, and clear visualization of structures that are hidden when a microscope is used. Thus, transcanal endoscopic ear surgery appears to be very useful for the treatment of the lateralized tympanic membrane, specifically for management around the tympanic annulus.

Herein, we report three cases diagnosed as having facial palsy concomitantly with herpes zoster in the head and neck region. Case 1 presented with Ramsay Hunt syndrome, and was concomitantly diagnosed as having herpes zoster in the neck skin innervated by the ipsilateral C3 nerve. Case 2 showed facial palsy and herpes zoster in the cheek skin innervated by the ipsilateral 2nd and 3rd branches of the trigeminal nerve. Case 3 showed facial palsy and herpes zoster in the cheek skin innervated by the contralateral 2nd branch of the trigeminal nerve. We treated all three cases using methylprednisolone and aciclovir (or valaciclovir), and both the facial palsy and herpes zoster resolved within four months.

We speculated that in cases 1 and 2, the varicella zoster virus (VZV) that was reactivated in the geniculate ganglion or the trigeminal ganglion was transmitted to other ipsilateral nerves via neural anastomosis. In case 3, we propose two possible mechanisms. The first is that VZV was reactivated in the geniculate ganglion and contralateral trigeminal ganglion simultaneously, although this patient developed neither herpes zoster in the auricle nor complained of hearing loss or vertigo. The second is that herpes simplex virus (HSV) was reactivated in the geniculate ganglion and VZV was reactivated in the contralateral trigeminal ganglion simultaneously.

An 8-year-old girl was brought to the emergency room of our hospital with a right temporal bone fracture sustained when she received a strong blow to the right side of her head in a traffic accident.

She was found to have total right facial palsy on the following day, and was referred to the otolaryngological department 3 days after the injury. Decompression surgery of the right facial nerve was attempted 5 days after the injury, however, at surgery, the patient was found to have developed complete neurotmesis of the facial nerve in the horizontal portion, with a defect about 20 mm in length, caused by the impact of the temporal bone fragments. This was a very rare case of traumatic facial palsy caused by a temporal bone fracture.

The great auricular nerve was used to reconstruct the facial nerve. The nerves were not sutured to each other, but stuck to each other with fibrin glue.

Approximately a year after the operation, the paralysis grade had improved from grade IV to grade III (House-Brackmann grade), and the Yanagihara score from 0 to incision 24.

In a case presenting with severe temporal bone fracture, it is necessary to recognize the possibility of neurotmesis of the facial nerve and prepare to reconstruct the facial nerve. Various methods of reconstruction of the facial nerve have been discussed in the literature.

Transplantation of the great auricular nerve in the present case was very simple and resulted in a good outcome.

We propose a novel nasal symptom questionnaire (NSQ) for easy evaluation of patients suffering from sinonasal diseases. Between June 2015 and April 2016, the NSQ was completed by 70 healthy people without any nasal diseases, 79 patients who had undergone sinonasal surgery, and 44 patients with olfactory disorder who were treated at the Department of Otolaryngology, Hyogo College of Medicine. The NSQ is a self-administered survey questionnaire consisting of a total of 10 items divided into two parts (I–II): (I) nasal symptom-related items (8 items): 1) sneezing and/or itching of nose, 2) nasal discharge, 3) nasal obstruction, 4) post nasal drip and/or sputum, 5) olfactory loss, 6) pain (buccal, tooth, facial pain and/or headache), 7) eye itching and/or epiphora, and 8) cough; and (II) quality of life (QOL)-related items (2 items): 1) reduced productivity at school/work, limitation of outdoor life and/or social functioning, and 2) sleep problem, general physical problems and/or emotional problems. The subjects are asked to score their responses to each item of the NSQ on a 4-grade scale, as follows: no symptoms at all (0 points); mild symptoms (1 point); severe symptoms (2 points), and extremely severe symptoms (3 points). The total (0–30 points) score on the NSQ and also the scores for individual (0–3 points) items of the NSQ were analyzed. In addition, a visual analogue scale (VAS) for determining the severity of the nasal symptoms was also applied in the third part (III) of the NSQ. The mean total score on the NSQ (9.97 points, n=79) was significantly higher in the patients with sinonasal diseases (3.14 points, n=70) than in the healthy subjects (p<0.001). The scores for nasal discharge, obstruction, postnasal drip, and QOL-related items were also significantly higher in the patient group higher than in the group of healthy subjects. In particular, patients with eosinophilic chronic rhinosinusitis (ECRS) showed high scores on the items of olfaction loss and cough. In the receiver operating characteristic (ROC) analysis, the area under the curve (AUC) of 0.847 could be considered as “good”. According to these statistical data, the cutoff value of the NSQ score for patients with sinonasal diseases was clinically determined to be 4 or more. The NSQ score showed a statistically significant correlation with the scores on other previously reported questionnaires for nasal symptoms. Our results suggested the NSQ as a useful questionnaire for easy evaluation of the condition of patients suffering from nasal symptoms.

Nasal foreign bodies are commonly encountered in ENT outpatient clinics. They are more frequently seen in young children, therefore, they tend to be long-standing, unless the children themselves confess or the families happen to catch sight during the insertion. Inorganic foreign bodies such as metal are associated with few symptoms. Multiple magnetic foreign bodies are unique in nature because of their attractive forces. We report a case with long-standing bilateral intranasal foreign bodies which had been inserted more than 15 years earlier. A 23-year-old female presented to us with the complaint of slight pain in the left cheek. Nasal endoscopy and CT revealed a small part of a metallic foreign body on the nasal septum on the right side. We removed the foreign body endoscopically from inside the nasal septum under general anesthesia. The foreign body consisted of two small magnets attracted to each other. They sandwiched the nasal septum and had been buried in the nasal septum for a long time without any infection. Nasal septal perforation had not occurred, presumably because one side of the foreign bodies was covered by mucosa. Some cases of multiple magnetic foreign bodies in the nasal septum have been reported with the complication of perforation of the nasal septum. It is also dangerous to perform MRI in cases with magnetic foreign bodies. Such foreign bodies must be removed without delay.

Hypohidrotic ectodermal dysplasia is a hereditary syndrome characterized mainly by the triad of less hair, less sweat and less teeth. It is associated with hypoplasia of the ectoderm caused by a genetic abnormality, and treatment remains mainly symptomatic. I encountered a case in a boy who presented with rhinostenosis at one month after birth. There were no anatomic abnormalities of the nasal cavity, however, the entire nasal cavity was filled with crust associated with atrophic nasal inflammation. Nose breathing was disturbed because of the pervasive crust and the child developed recurrent episodes of upper respiratory tract infection with a bad odor of the nasal mucus. Provision of care to prevent nasal crust formation for 4 years 6 months at the outpatient department led to improvement of the nose breathing and the bad odor of the nasal mucus. Herein, I report the method and the outcome.

We report a rare case of neurofibroma of the nasal cavity, which is the 24th reported case in Japan. The patient was a 46-year-old man who presented to our hospital with nasal hemorrhage. Nasal endoscopy revealed a white mass in the nasal cavity. Computed tomography showed a tumor occupying the middle nasal meatus. We attempted biopsy multiple times, but could not confirm the diagnosis in the outpatient setting. We then performed endoscopic surgery and completely removed the tumor. Histopathology of the resected specimen revealed the diagnosis of neurofibroma of the nasal cavity. Because there are reports of recurrence and malignant change, careful follow-up is necessary.

We encountered a patient who developed an infection and eye complications after the use of Gore-Tex^® to treat an orbital floor fracture.

The patient was a 38-year-old man who had undergone plastic surgery for a left orbital floor fracture at another hospital about 20 years earlier. The patient recently experienced the development of left exophthalmos and diplopia and visited an ophthalmologist. A computed tomography examination revealed a calcification shadow in the left maxillary sinus, and the patient was referred to our department. He was diagnosed as having left maxillary sinusitis-induced eye complications, and left nasal endoscopic surgery was performed under general anesthesia. A material assumed to be Gore-Tex^® was present in the maxillary sinus, and this material was considered to have been the cause of the infection. An incision of the canine fossa was performed, and the Gore-Tex^® in the maxillary sinus was removed endoscopically. The postoperative course was favorable, with a reduction in the exophthalmos and an improvement in the diplopia. The possibility of late-onset complications caused by the use of artificial materials to reduce orbital floor fractures should be considered in cases that present with exophthalmos and diplopia.

A 56-year-old man presented with left-sided exophthalmos. The patient gave a history of having sustained an orbital blow-out fracture 25 years previously, and the orbital floor had been reconstructed with a silicone implant. CT and MRI showed a mass surrounding the orbital floor implant on the left side. We removed the hemorrhagic cyst arising from the silicone implant by endoscopic surgery. Endoscopic sinus surgery is an effective approach for removing an orbital foreign body.

Inverted papilloma (IP) of the sinonasal cavity occurs most commonly in the fifth to seventh decades of life, and accounts for 0.5–4% of all primary nasal tumors.

We report the case of a 60-year-old man who was diagnosed as having benign IP with intracranial extension. The patient was treated by sinonasal IP resection several times, however, each time, the tumor recurred. Eventually, as the tumor extended to the nasal cavity, right maxillary sinus and bilateral ethmoidal sinuses, we performed endoscopic sinus surgery and skull base resection. However, the tumor recurred again and extended into the skull. Finally, we performed skull base operation with craniotomy and administered postoperative radiation therapy to achieve complete control of the tumor. Until now, 12 months since completion of the last treatment, there has been no evidence of recurrence, and no evidence of brain dysfunction.

IP with intracranial extension without malignant transformation is uncommon. However, according to some reports, once it occurs, the mortality rate is 30–40%. Aggressive treatments, such as skull base operation with craniotomy and/or radiotherapy, are needed to achieve complete recovery.

Chondromyxoid fibroma is a rare cartilaginous tumor, accounting for only 1% of all bone tumors. In most cases, these tumors arise from the tubular bones, and cases of the tumor arising from the skull base are extremely rare.

In this paper, we report a case of chondromyxoid fibroma of the sphenoidal sinus. The patient was a 65-year-old woman who presented to us with a 1-year history of double vision. At first, based on the imaging findings, we suspected sinusitis with fungal infection of the sinus. Biopsy revealed chondromyxoid fibroma, and the patient was treated by radiotherapy. However, at present, 7 months after the treatment, the tumor remains unchanged, indicating the need for careful follow-up of the patient.

Cough, one of the most common pediatric respiratory symptoms, could be caused by a variety of conditions. Rhinosinusitis is an important cause of chough in children. We analyzed the prevalence and characteristics of cough in 91 children (age 1–12 of years, 65 boys and 26 girls) clinically diagnosed as having rhinosinusitis. The chief complaint was rhinorrhea in 35%, cough in 13%, and nasal congestion in 12% of the subjects. The prevalence of cough was 64%, with the cough being productive in 95% of the casas. The average age was significantly lower and the proportion of cases with stridor significantly higher in the children with cough. Of all the subjects with rhinosinusitis, 13% reported postnasal drip as a subjective symptom; all of these children were five years or older. None of the children presented with postnasal drip as the chief complaint. There was no significant correlation between the presence of cough and the presence of subjective or objective postnasal drip. The mechanisms by which rhinosinusitis causes cough have not yet been precisely elucidated. Productive cough is a frequent and important symptom in children with rhinosinusitis. Accurate diagnosis and immediate treatment are necessary, especially for rhinosinusitis associated with cough.

Oral Allergy Syndrome (OAS) is caused by ingestion of trigger foods, including several fruits and vegetables. Many patients with OAS also suffer from hay fever, a condition that is called Pollen-Associated Food Allergy Syndrome (PFS).

In this study, we focused on patients who tested positive for antibodies against the antigen of the genus Alnus of the birch family, which is one of the causative pollen antigens.

Among the subjects who visited our department between May 2012 and October 2015 with nasal symptoms and underwent determination of antigen-specific IgE antibody (Immuno CAP), we investigated the antigen-positive rate, the age-specific sensitization rate for the antigen of the genus Alnus, and the age, sex and the presence OAS in patients showing a positive reaction to the antigen of the genus Alnus.

Positive reaction to the antigen of the genus Alnus was found in 19% of the patients with nasal symptoms, which represented one in about five people tested. The total IgE was high in many of the Alnus-positive cases, and there were no cases that showed sensitization to the Alnus antigen alone.

The patients with OAS had a tendency to show significantly elevated levels of Alnus-specific IgE.

The pollen scattering season, namely, early spring, of the genus Alnus overlaps with that of Japanese cedar and cypress, therefore, Alnus hay fever hardly attracts attention.

However, sensitization to the genus Alunus may cause OAS and may even leads to anaphylaxis. Therefore, the antigen of the genus Alnus should also be tested for to determine the causative antigens for hay fever in the early spring.

Stevens-Johnson syndrome (SJS) is a hypersensitivity reaction of the skin and mucosa to medications or infection. Herein, we report the case of a 15-year-old boy with SJS who presented with mucous membrane lesions, but without skin lesions. He was admitted with fever, extensively ulcerated and swollen lips, sore throat, and conjunctivitis. He had a one-week history of high fever prior to admission, and had been prescribed an antibiotic with an antipyretic-analgesic by his family doctor. His fever resolved, however, he presented soon thereafter with a 2-day history of mucosal erosions and conjunctivitis. He complained of a sore throat and was unable to swallow. His mouth and pharynx were covered with pseudomembranous lesions. There were no remarkable lesions on the skin. Although skin lesions were absent, the mucosal erosions and conjunctivitis were suggestive of SJS. He was begun on steroid therapy, which led to prompt resolution of the mucosal erosions and conjunctivitis.

Atypical SJS with an absence of skin lesions, but with strongly evident mucosal erosions can occur. The mucosal erosions in the oral cavity rarely are caused by SJS. Therefore, in cases with mucosal erosions, it is always necessary to take into consideration the possibility of SJS.

In children and adolescents under 20 years of age, tumors of the parotid gland are relatively rare. A total of 14 patients with benign parotid tumors and 7 patients with malignant parotid tumors were treated at Osaka Medical College Hospital between 1999 and 2016. Pleomorphic adenoma was the most frequent benign neoplasm, while the most frequently encountered malignant neoplasm was mucoepidermoid carcinoma, followed by acinic cell carcinoma. Fine-needle aspiration cytology is useful and important for making a preoperative histological diagnosis, especially for benign tumors. Perioperative frozen section diagnosis is useful when there is doubt about whether the tumor is benign or malignant. Treatment is mainly surgery, with radiation therapy reserved for advanced-stage and/or histologically high-grade tumors. Parotid carcinoma in the pediatric age group is more often localized to the primary site and of low-grade histology than that in the adult population. Low- and intermediate-grade parotid carcinoma in the pediatric population may have favorable outcomes as compared to high-grade parotid carcinoma and adult parotid carcinoma.

Injuries of the oral cavity and pharynx are fairly frequent in children, because they often play with foreign objects in their mouths. In most cases, the injury is superficial and heals without any complications. However, objects penetrating into deeper tissues may need to be surgically removed.

We report a pediatric case of an intraoral penetration injury caused by a long piece of a chopstick embedded in the epipharynx after piercing the soft palate. A 1-year-old male child was referred to our hospital emergency unit due to oral bleeding. By the time of the examination, the bleeding from injured soft palate had stopped, and his general condition was good. The chopstick piece was not visible in his mouth or epipharynx. However, computed tomography (CT) revealed the chopstick piece embedded in the epipharynx after piercing the soft palate. We removed the foreign body under general anesthesia on the same day. After the operation, there were no problems, and the child was discharged four days later.

In the case of a child, it is difficult to assess the subjective condition of the patient, identify the site of pain or determine the circumstances of the accident. Even if the foreign body is not identified, it is important to carry out a quick and thorough examination and provied appropriate treatment. In the present case, CT was useful for the diagnosis of the foreign body embedden in the epipharynx, which was not visible from the mouth.

Compensatory hypertrophy of the lingual tonsil can develop after extraction of the palatine tonsil, causing dyspnea and a feeling of suffocation. Sometimes, such patients present with physical airway obstruction, and in some cases, surgical treatment is warranted for the enlarged lingual tonsil. Our patient reported herein presented with inspiratory dyspnea caused by compensatory hypertrophy of the lingual tonsil 20 years after she had undergone enucleation of the palatine tonsil passed after palatine tonsil. We performed extraction of the lingual tonsil using an FK-WO retractor and obtained good results. We present the case herein.

The patient was a 54-year-old woman who presented to our department with the chief complaint of dysphagia, mild dyspnea and dysphonia. The patient had undergone bilateral palatine tonsil enucleation as treatment for sleep apnea syndrome 20 years earlier. The endoscopic findings at the initial diagnosis consisted of a markedly enlarged lingual tonsil with constriction of the pharyngeal cavity at the site. Moreover, a portion of the enlarged tonsil hung down like a pendulum and invaginated into the glottis during inspiration. The patient was diagnosed as having airway stenosis due to compensatory hypertrophy of the lingual tonsil. Because of the difficulty in intubation caused by the enlarged lingual tonsil, we undertook airway maintenance by tracheotomy and induced general anesthesia of the patient. Then, we carried out resection of the enlarged tonsil by Transoral Video-Laryngoscopic Surgery (TOVS) using the FK-WO retractor. We also resected a portion of the epiglottis, because the transformed epiglottis has already become useless. At present, one year since the surgery, there has been no recurrence of the symptoms and the airway continues to be maintained well too.

There have been no other case reports of inspiratory airway obstruction caused by hanging down into the airway, like a pendulum, of a part of an enlarged lingual tonsil.

In this case report, we present two cases in which migrating foreign bodies, a partial denture and a fish bone, were successfully removed from the hypopharynx and esophagus by transcervical incision. The first patient was a 55-year-old male who presented with the feeling of a lump in the throat after accidental swallowing of a partial denture. Although the endoscopist could visualize the foreign body and tried to remove it with the flexible endoscope, the ingested foreign body failed to come within the grasp of the endoscopic forceps. Therefore, the migrating foreign body was removed by transcervical incision. The second patient was a 62-year-old male who presented with odynophagia after accidentally swallowing a fish bone. The fish bone could not be visualized by endoscopic examination, but was clearly detected by three-dimensional-CT imaging. The fish bone was then successfully removed surgically by a transcervical incision. Recently, in most cases, foreign bodies in the hypopharynx and esophagus have been removed using a flexible endoscope. However, in the management of ingested foreign bodies, removal by transcervical incision should be considered in case of any difficulties in endoscopic removal.

We performed a retrospective statistical analysis to evaluate the safety, efficacy and effectiveness of a tonsillectomy for the treatment of immunoglobulin A nephropathy (IgAN).

Forty-four patients were included in the study. The safety and efficacy of the surgical techniques were confirmed by the frequency of postoperative bleeding and the mean operative time, which were equal to those observed after tonsillectomies in patients with diseases other than IgAN. The median duration of hospitalization was 7 days. For comparison, patients were divided into three groups: a non-operative group, a tonsillectomy alone group, and a group with a tonsillectomy followed by the pulse administration of a glucocorticoid (TSP). Statistical analyses were performed to determine changes in the following indices between the pretreatment levels and the levels at one year after the completion of treatment: (1) daily urine protein level, (2) urine red blood cell count, (3) clinical remission rate of urine, and (4) urine clinical remission rates of histopathological prognostic categories at the point of diagnosis. The results showed that the latter two groups that had undergone a tonsillectomy both had significantly better improvements, compared with the non-operative group. However, no statistical difference in the clinical remission rates was seen between the latter two groups, although the rate for the tonsillectomy alone group was higher. The remission rates for the three prognostic categories were 53%–78%, and no significant difference were observed among the categories. In conclusion, surgical therapy for IgAN tonsillectomy was performed safely and with no increase in the hospitalization time. A tonsillectomy alone and TSP were both effective for the treatment of IgAN, although a significant difference between the two treatments was not observed. The accumulation of a larger number of cases treated with a tonsillectomy alone is needed to determine the indications for a tonsillectomy in patients with IgAN.

PFAPA syndrome is characterized by five features: Periodic Fever, Aphthous stomatitis, Pharyngitis and cervical Adenitis, occurring in children under 5 years of age. Periodic fever, the main symptom, persists for about 3–6 days, accompanied by aphthous stomatitis, pharyngitis, neck lymphadenitis. We reviewed the data of two patients with PFAPA syndrome treated by tonsillectomy. In one patient, no improvement of the symptonms was obtained in response to treatment with a steroid and H2 blocker prescribed by a pediatrician, and tonsillectomy was performed; the patient has had no symptoms since this treatment.

The other patient wished to undergo tonsillectomy even before being initiated on any medications such as a steroid or H2 blocker. Both the patients who underwent tonsillectomy have shown a good course since the tonsillectomy.

We believe the tonsillectomy is feasible and effective in patients with the PFAPA syndrome.

Herein, we report a case of recurrent localized laryngeal amyloidosis in a patient who had been followed up for 15 years after the first treatment. A 63-year-old male was referred to our department with the chief complaints of hoarseness and dyspnea. Several examinations showed submucosal swelling of the subglottic area bilaterally. A biopsy specimen obtained by laryngomicrosurgery showed submucosal deposition of amyloid. Debulking surgery was performed via an opening of the trachea. However, 9 months after the first surgery, the patient presented to us again complaining of dyspnea. We performed revision surgery for a repeat debulking of the lesion via a laryngofissure. His postoperative course was good and his dyspnea improved. However, 13 years after the revision surgery, the patient presented yet again with dyspnea. Therefore, we performed a third surgery using the same procedure as in the previous operation. Despite the repeated recurrences, we performed debulking of the lesion, and not total resection. Since amyloidosis is a benign disorder, and the larynx has important functions, organ-preserving surgery is recommended in cases of laryngeal amyloidosis.

Unilateral vocal cord paralysis appears to be a frequently encountered condition by otorhinolaryngologists, that often manifests as hoarseness or dysphagia. We encountered some cases that had recovered from unilateral vocal cord paralysis.

We studied the clinical features of patients who had recovered from unilateral vocal cord paralysis, by retrospectively analyzing the data of 135 patients who had been diagnosed as having unilateral vocal cord paralysis at our hospital between December 2010 and October 2015.

In the 135 patients enrolled in the study, the causes of the unilateral vocal cord paralysis were distributed as follows: idiopathic, 38 cases; postoperative, 42 cases; endotracheal intubation, 11 cases; tumor, 30 cases; others, 14 cases. A total of 41 of the 135 cases showed recovery from the paralysis, including 13 of the 38 cases with idiopathic paralysis (34.2%), 17 of the 42 with postoperative paralysis (40.5%), 10 of the 11 in whom the paralysis developed following endotracheal intubation (90.9%), and one of the 30 in which the paralysis was caused by a tumor (3.3%); none of the 14 cases with vocal cord paralysis of other causes showed recovery from the paralysis.

In the cases with idiopathic unilateral vocal cord paralysis, almost complete recovery was noted within 9 months of the appearance of the first symptoms and within 6 months of the diagnosis. In cases with the vocal cord paralysis developing after surgery or endotracheal intubation, near-complete recovery was observed within 4 months of the diagnosis. In patients with postoperative unilateral vocal cord paralysis after thyroid surgery, the intraoperative hemorrhage tended to be less and the operative duration was shorter in the patients who recovered than in those who had permanent paralysis.

Our findings revealed that unilateral vocal cord paralysis developing as a result of endotracheal intubation has a good prognosis, whereas that caused by tumors has a poor prognosis. Surgical procedure for paralysis should be considered on the merits of each case, such as in cases with idiopathic paralysis not improving within 9 months of the appearance of the first symptoms and cases with postoperative paralysis not resolving within 4 months. In cases of paralysis developing after thyroid surgery, the volume of hemorrhage, operative duration and type of operative procedure were found to exert an influence on the likelihood of recovery from the postoperative vocal cord paralysis.

Herein, we report a case of retropharyngeal hemorrhage. A 48-year-old woman was referred to our hospital with sore throat. At first, retropharyngeal abscess was suspected, and the patient was referred to our department. Treatment with antibiotics was ineffective. MRI was performed, which suggested retropharyngeal hemorrhage caused by a parathyroid. We drained the hematoma and performed parathyroidectomy. Histological examination of the resected specimen showed the hemorrhage from parathyroid cyst. Hemorrhage from a parathyroid cyst is rare and there have been no reports of cases diagnosed before surgery. In cases of sore throat, careful diagnosis and prompt treatment are needed. Parathyroid can be a origin of retropharyngeal hemorrhage. Moreover, cases of hemorrhage from a parathyroid cyst should be treated taking into consideration the functional status of the cyst.

A 51-year-old male was referred to us with a tumor in the left neck that had been found incidentally on MRI of the cervical spine. Physical examination revealed Horner syndrome on the left side. We considered the possible diagnosis of cervical sympathetic chain schwannoma; however, fine needle aspiration and PET-CT findings led to the suspicion of malignancy. We resected the tumor under general anesthesia. After the operation, the patient developed transient left vagus nerve palsy. Histopathology revealed the diagnosis of malignant paraganglioma with lymph node metastasis.

Sympathetic paragangliomas are exceedingly rare tumors of the head and neck and should be considered in the differential diagnosis of tumors suspected to arise from the sympathetic chain. Malignant paragangliomas are extremely rare, and there is as yet no established treatment.

The optimal method for parotidectomy in patients with non-melanoma cutaneous carcinoma of the head and face region has still not been clarified. To clarify the optimal procedure for therapeutic parotidectomy, we reviewed the medical records of patients with non-melanoma cutaneous carcinoma. Between 2006 and 2010, we treated four cases of cutaneous carcinoma with metastasis to the parotid area. The site of origin of the cutaneous carcinoma was the temporal region of the head in three of these patients and the eyelid in the fourth patient. All four patients had metastatic lymph nodes in the parotid area. Two of the four patients had lymph node metastasis in both the parotid and cervical areas. None of the patients had facial palsy before the surgery. Facial nerve-preserving total parotidectomy (FNP-TP) with or without neck dissection was performed in all patients. Postoperative histopathological examination revealed occult metastasis of the lymph nodes in the deep and superficial lobes of the parotid gland in two of the patients. None of the patients received postoperative adjuvant radiation therapy or chemotherapy and all survived for more than five years without recurrence. From these results, it is considered that FNP-TP (elective dissection of the deep lobe of the parotid gland) may be the appropriate choice of procedure for therapeutic parotidectomy in patients with cutaneous carcinoma of the temporal area of the face and neck with metastatic lymph nodes in the parotid area. Furthermore, this procedure may allow avoidance of postoperative adjuvant radiotherapy in some cases.

Hodgkin lymphoma accounts for about 10% of all cases of malignant lymphoma, and laryngeal malignant lymphoma accounts for less than 1% of all laryngeal malignancies in Japan. We report the very rare case of an 85-year-old woman with Hodgkin lymphoma of the larynx. The patient presented with the chief complaints of difficulty in breathing, hoarseness of the voice and difficulty in swallowing. Laryngoscopic examination revealed immobility of the vocal folds and mucosal swelling of the pyriform sinus and subglottis bilaterally. Repeated biopsies from the pyriform sinus and subglottic tissue failed to reveral a definitive diagnosis. However, histopathological examination of a cervical lymph node specimen obtained by excision biopsy revealed the diagnosis of Hodgkin lymphoma. The disease stage was classified as clinical stage II AE and the patient was administered radiotherapy at a total radiation dose of 39.6 Gy. Fortunately, complete remission was achieved, and no recurrence has been observed until now, 20 months after the irradiation.

Malignant tumor originating from the nasal septum accounts for a relatively small number of cases of head and neck cancer. In the early stages, as in cases of other head and neck squamous cancer, resection of the tumor by nasal surgery is the treatment of choice, although some cases with early carcinoma of the nasal septum have been treated by endoscopic surgery. We encountered a case of nasal septum cancer, in which we conducted nasal surgery and reconstructed the nasal bone using a graft from the ilium. The patient was a 63-year-old man who visited our hospital with the chief compliant of recurrent nosebleeds. Examination revealed a tumor of the nasal septum in the left nasal cavity. Contrast-enhanced CT and MRI revealed a mass measuring about 30 mm in diameter showing heterogeneous contrast enhancement. The lesion was found to have invaded the nasal septum cartilage. However, there was no spread to the mucosa lining on the opposite side of the nasal septum. The head side of the lesion was very close to the nasal bone. Therefore, we could not rule out invasion of the nasal bone. On biopsy, the lesion was diagnosed as a squamous cell carcinoma. There was no swelling of the cervical lymph nodes. PET-CT revealed accumulation only in the nasal cavity. There was no evidence of cervical lymph node metastasis or distant metastasis. We scheduled surgery under the diagnosis of nasal cavity cancer, cT2N0M0. By using a nasal endoscope, it was disconnected nostril side and the nasal cavity the bottom side of the tumor. The nasal cavity was accesed by the midfacial degloving method. We excised a part of the nasal bone, the outer nose cartilage and a part of the nasal septal mucousa with a sufficient safety margin. We reconstructed the nasal bone and the outer nose cartilage with a graft obtained from the ilium. The patient has shown no evidence of postoperative recurrence. We selected surgical therapy without radiation therapy/chemotherapy. As a result, we were able to avoid disabling systemic chemotherapy and radiation, and reserve these treatments for any recurrences.

We report the case of a 69-year-old man with NK/T cell lymphoma who developed a recurrent lesion in the larynx after radiotherapy. He presented with the chief complaint of hoarseness, and endoscopic examination revealed inflammation with plaques in the right subglottic area. The diagnosis of extranodal NK/T cell lymphoma was confirmed by biopsy of the laryngeal lesion, and the tumor was treated by radiotherapy. At the 1-year follow-up, endoscopic examination of the larynx revealed that it was tumor-free, and FDG-PET showed no evidence of recurrence. Laryngeal NK/T cell lymphoma is very rare, and a definitive histopathological diagnosis is often difficult due to the location of the tumor and the perilesional inflammation and necrosis.

First branchial cleft fistula is a rare disease among branchial anomalies and is often diagnosed as an inflammatory lesion in submandibular or pinna region. The disease can be difficult to distinguish from an atheroma or epidermoid tumor because the occurrence of multiple infections can obscure the fistula.

Here, we report the case of a first branchial cleft fistula that was diagnosed after two biopsies, and was then surgically treated.

Initially, a computed tomography examination with enhancement was performed to confirm the location and size of the fistula. As a result, the fistula was found to be located close to the mandibular branch of the facial nerve. The tissue surrounding the fistula showed marked scarring, so a nerve stimulator was applied.

The marginal branch could not be confirmed durling the surgery, but postoperative inferior lip paralysis was avoided.

When a total maxillectomy is performed in patients with maxillary cancer, it is important to preserve visual function and maintain the patient’s facial features, since both orbital floors are removed. Various reconstruction methods have been reported. We have performed reconstructions of the orbital floor using a dynamic titanium mesh. The results have been satisfactory in terms of function and cosmetic appearance, since neither diplopia nor infectious symptoms have been observed and minimal post-surgical cheek deformation has occurred. The prosthesis were prepared so as to cover the resected area of the hard palate. The removal of the prosthesis facilitated observations of the cavity. Also, the presence or absence of recurrences and the condition of the reconstruction site could be assessed visually. The titanium mesh that was employed was useful for preserving postoperative visual function, since it has a high biological affinity and can be easily used to replicate the 3D structure of the orbital floors. Compared with a vascularized composite-free tissue transfer, surgery using this mesh requires only a short operative time and the sacrifice of fewer autografts. In contrast to bone grafting, the restoration of ocular alignment is possible, since the mesh can easily replicate the 3D structure of the orbital floors. The mesh, however, may be exposed on the surface of the skin or cause infection if used over a wide area extending to the zygomatic bones, since it is an artificial material. It is important to take the area of reconstruction into consideration when using this mesh, as in the present cases. Here, we report three postoperative cases with follow-up periods of more than 5 years. A lengthy and meticulous follow-up period is necessary for such cases.

Vascular malformation rarely arises in the submandibular gland. Here, we describe two cases of multiple phleboliths in the submandibular glands.

The first case was a 70-year-old woman who presented with a mass in her left submandibular gland. A plain computed tomography (CT) examination showed calcification indicative of sialolithiasis in the submandibular gland.

The second case was a 40-year-old woman who presented with a mass that had repeatedly appeared and disappeared. A plain CT examination showed a sialolith in the right Warton duct and calcification of the submandibular gland.

In both cases, the tumors were removed surgically under general anesthesia. The pathological diagnosis was vascular malformation with phleboliths. The differentiation of phleboliths from sialolithiasis was difficult especially in the second case, which was complicated by the presence of a sialolith in the Warton duct. In this case, additional examinations using ultrasonography or contrast enhanced CT were required.

In cases with sialolithiasis of the submandibular gland with calcification in a submandibular lesion, otolaryngologists should consider vascular malformation in the differential diagnosis.

We report a case of dedifferentiated carcinoma of the parotid gland. A 48-year-old woman presented to us with a mass in the right parotid region. Computed tomography revealed a peripherally enhancing mass in the right parotid gland. The patient was treated by superficial parotidectomy. The tumor was found to be adherent to the marginal mandibular branch of the facial nerve. Intraoperative frozen section analysis revealed a malignant tumor. Thus, resection of the tumor with the affected nerve and the surrounding parotid gland tissue and lymph node dissection were performed. Postoperative histopathological examination revealed the diagnosis of dedifferentiated carcinoma of the parotid gland. There has been no recurrence or metastasis until now, one and a half years since the surgery. Dedifferentiated carcinoma of the parotid gland is a rarely encountered disease, therefore, additional case studies are needed to clarify the characteristic clinicopathological features of this disease entity.

We report a case of dumbbell-shaped Warthin’s tumor extending from the parotid gland to the parapharyngeal space. A 64-year-old man was referred because of a left neck tumor and a feeling of dysphagia. CT scanning and an MRI examination revealed a tumor with clear boundaries extending from the deep lobe of the parotid gland into the parapharyngeal space. Warthin’s tumor was diagnosed based on a biopsy from the oral cavity, and a transcervical-parotid approach was chosen. The tumor size was approximately 9 cm, but the tumor was relatively soft with minimal adhesion; thus, we were able to remove it en bloc without any major complications. The patient exhibited first bite syndrome on the eighth day after surgery, but the pain gradually disappeared.

We examined four patients who underwent reoperations for recurrent parotid pleomorphic adenoma in our department. All four patients had multi-focal recurrent nodules following one or three prior surgical procedures. The surgical procedures included a total parotidectomy in two patients and a superficial parotidectomy in two patients; an antegrade technique was used for two patients and a retrograde technique was used for the other two patients. There were two incidents of transient facial nerve palsy after the operations, but both patients recovered within six months. None of the patients experienced further recurrence after the reoperations. Retrograde nerve dissection is useful, and possibly essential, for the treatment of recurrent pleomorphic adenoma of the parotid gland. However, long-term follow up for these tumors is needed because of the high rate of recurrence for recurrent parotid pleomorphic adenoma.

The TPF protocol composed of docetaxel, cisplatine and 5-fluorouracil, is the most commonly used chemotherapy regimen for the treatment of head and neck cancer. Recently, the importance of maintaining a relative dose-intensity (RDI) has been shown. Therefore, the treatment and prevention of febrile neutropenia, which can reduce the RDI of the TPF protocol, are important. Here, we compare patient outcomes before and after the introduction of pegfilgrastim for primary prophylaxis. The first group is consisted of 60 patients (88 chemotherapy courses) treated between January 2011 and October 2014 who did not receive prophylaxis. The second group consisted of 14 patients (20 chemotherapy courses) treated between November 2014 and July 2016 using pegfilgrastim. We examined the frequency of neutropenia (grade 3 and 4), febrile neutropenia (FN) and treatment-related death, the amount of granulocyte-colony stimulating factor (G-CSF) used, the cost for FN treatment and the hospitalization period. In the first group, there were 74 neutropenia events, 34 cases of FN and 2 treatment-related deaths; the average hospitalization period was 18.5 days. In the second group, there were 7 neutropenia events, 1 case of FN, and 0 treatment-related death; the average hospitalization period was 12.6 days. The frequency of adverse events, the amount of G-CSF used, the cost for FN and the hospitalization period were all significantly reduced by the introduction of pegfilgrastim. In conclusion, the administration of pegfilgrastim for the primary prophylaxis of FN was effective when included in the TPF protocol for the treatment of head and neck cancer.

We reviewed 78 cases of parotid gland tumors treated at our hospital over the past 2 years and 5 months. Benign tumors were observed in 65 patients (36 males and 29 females), and malignant tumors were observed in 13 patients (4 males and 9 females). The average patient age was 50 years old for the cases with benign tumors and 65 years old for the cases with malignant tumors. The most common benign tumor was pleomorphic adenoma, followed by Warthin’s tumor. The most common malignant tumor was mucoepidermoid carcinoma. The sensitivity/specificity/accuracy of preoperative fine-needle aspiration cytology (FNA) were 27.3%, 96.8%, and 86.5%, respectively, while those of MRI were 84.6%, 86.2%, and 85.9% when an unsharp margin or a low signal intensity on T2-weighed MRI were regarded as malignant findings. As surgical treatments, extirpation or a partial lobectomy were mainly applied for benign tumors. On the other hand, a partial lobectomy or total parotidectomy with facial nerve resection were selected for malignant tumors, except in 3 cases that only underwent an open biopsy. Postoperative facial nerve palsy was observed in 6 (9.2%) out of 65 benign tumor cases and 5 (50%) out of 10 malignant tumor cases treated with radical surgery, but all the patients except for one case with parotid cancer recovered in 1 to 5 months. Postoperative first bite syndrome was seen in 3 cases requiring deep lobe tumor removal. When the patient group with Warthin’s tumor was compared with that of pleomorphic adenoma, a significantly higher age, a male predominance, and a higher smoking rate were observed, similar to the findings of previous reports. Not only imaging findings and FNA results, but also patient age, sex, and smoking habits are thought to be important for discriminating between Warthin’s tumor and pleomorphic adenoma.

Salivary gland carcinoma was originally classified as acinic cell carcinoma because of its histological similarity to secretory breast carcinoma. However, in 2010, Skalove et al. characterized this tumor as mammary-analogue secretory carcinoma, because like secretory breast carcinoma, it often expresses the ETV6-NTRK3 fusion oncogene. We encountered a case of mammary-analogue secretory carcinoma arising from the parotid gland. This specific diagnosis was made because (1) a follicular variant was present, (2) physaliphorous cells were observed, (3) no zymogen granules were observed, (4) the mucoid discharge in the follicular lumen was D-PAS-positive, and (5) the tumor showed immunostaining characteristics consistent with those of mammary-analogue secretory carcinoma (e.g., positive for S-100 and adipophilin). No additional treatment was administered to the patient after the resection, as the tumor is known to show a low malignancy potential and the surgical margins were negative. Tumor recurrence or metastasis has not been observed until date.

Solitary fibrous tumor (SFT) is a relatively rare myofibroblastic tumor involving the pleura and peritoneum in most cases. Recently, SFTs arising various sites of the body have been described. The 2013 WHO classification of tumors of soft tissue and bone defines SFT an intermediate-grade tumor that is benign. However, distant metastases have been reported in about 10% of cases.

We report a rare case of SFT of the neck. The patient was a 75-year-old female who presented with the complaint of swelling of the right neck. Her previous doctor suspected schwannoma and referred her to our center for operation. However, the findings of fine-needle aspiration biopsy, computed tomography and magnetic resonance imaging were atypical. Therefore, we performed resection of the tumor to obtain a final diagnosis. Histopathology of the resected tumor revealed the diagnosis of SFT. This case serves to emphasize that in the differential diagnosis of tumors of the neck, it is important to bear in mind the possibility of SFT.

Adenoid cystic carcinoma (ACC) is a rare malignant tumor of the head and neck. Although ACCs are usually slow-growing, local recurrences and distant metastases often occur, resulting in a poorer long-term prognosis. We examined the prognostic factors in patients with ACC. Data of 23 patients with ACC who were treated at our hospital between 1996 and 2015 were reviewed retrospectively. The patients consisted of 10 males and 13 females, with a mean age of 59 years. The primary tumor site was the major salivary gland in 18 patients, oropharynx in 2 patients, nasal cavity in 2 patients, and oral mucosa in 1 patient. There were some cases in which it was difficult to diagnose ACC preoperatively. The overall survival rate was 82% at 5 years, and 47% at 10 years. The disease-specific survival rate was 82% at 5 years, and 65% at 10 years. Metastasis to the cervical lymph nodes and distant metastases were identified as poor prognostic factors. Since ACC shows diverse clinical manifestations, it is necessary to accumulate a greater number of cases to establish appropriate treatment modalities.

The subjects of this study were 38 patients with esophageal carcinoma who had undergone esophagectomy at our hospital between 2010 and 2014. All the patients had undergone 3-field lymph node dissection. FEES was performed on postoperative day 8, before starting oral alimentation, to assess the laryngeal functions and aspiration status.

The incidence of aspiration pneumonia in this case series was 18% (7 patients), and the 30-day mortality after esophagectomy was 3% (1 patient). The FEES revealed insufficient whiteout in 43% of patients (6 patients) who were thereby judged as being at high risk of aspiration. Tracheostomy was needed in only 8% of patients (2 patients) from the low risk group.

In conclusion, comprehensive FEES after esophagectomy is recommended before oral feeding challenge, and may be useful to reduce the pulmonary complication.

A 74-year-old man presented with fever, sore throat and neck pain 11 days after extraction of his tooth. At presentation, his neck was swollen along the left sternocleidomastoid muscle. Contrast-enhanced CT showed thrombosis of the left internal jugular vein and multiple septic emboli in the lungs. Contrast-enhanced MRI and CT showed cavernous sinus thrombosis. On the basis of these findings, we made the diagnosis of Lemierre’s syndrome. The patient was successfully treated with intravenous antibiotics, heparin and warfarin. A rapid diagnosis of Lemierre’s syndrome is essential, because this syndrome can prove fatal in case of a diagnostic delay.