We retrospectively reviewed the data of 190 adults (206 ears) with acquired cholesteatoma who had undergone tympanoplasty at our department between July 2010 and December 2021. The cholesteatoma stages, surgical strategies adopted, recurrence rate, and hearing improvement success rate were analyzed. The extent of cholesteatoma was classified into stages according to the Classification and Staging of cholesteatoma proposed by the Japan Otological Society in 2010. Stage II was the most common in both patients with pars flaccida cholesteatoma and pars tensa cholesteatoma. A canal wall-down mastoidectomy with canal reconstruction using auricular cartilage was performed for ears with stage II/III disease. Staged tympanoplasty was selected for 22.0% of patients with pars flaccida cholesteatoma and 9.1% of patients with pars tensa cholesteatoma. Residual cholesteatoma was observed in 30.0% of patients with pars flaccida cholesteatoma and 50.0% of patients with pars tensa cholesteatoma treated by staged tympanoplasty at the second operation. Three patients (1.6%) with pars flaccida cholesteatoma developed recurrence; all of them were diagnosed as having retraction cholesteatoma. One patient (4.5%) with pars tensa cholesteatoma had a residual cholesteatoma. The hearing improvement success rate was 75.1% in patients with pars flaccida cholesteatoma and 71.4% in patients with pars tensa cholesteatoma. These results indicate the usefulness of canal wall-down mastoidectomy with canal reconstruction using auricular cartilage for minimizing the risk of residual cholesteatoma and retraction cholesteatoma, without compromising on hearing.

Acquired cholesteatoma is often advanced even at diagnosis in children and recurs more frequently than in adults. Complete removal of a cholesteatoma without compromising on hearing improvement is important. We retrospectively evaluated the data of 25 children (26 ears, 2–15 years) with acquired cholesteatoma who had undergone tympanoplasty at our department between July 2010 and November 2021. The extent of cholesteatoma, surgical strategies adopted, residual cholesteatoma rate, recurrence rate, and hearing improvement success rate were analyzed. The extent of cholesteatoma was classified into stages according to the Classification and Staging of cholesteatoma proposed by the Japan Otological Society in 2010. One ear was classified as stage I, and the remaining 25 as stage II or III. A canal wall-down mastoidectomy with canal reconstruction using auricular cartilage was performed for ears with stage II/III disease. Staged tympanoplasty was selected for 23 of the 26 ears. Residual cholesteatoma was observed in 10 of the 23 ears treated by staged tympanoplasty at the second operation. The recurrence rate was 15.4% (4/26), including three cases of residual cholesteatoma and one case of retraction cholesteatoma. The overall hearing improvement success rate was 70% (14/20), according to the criteria of the Otological Society of Japan (2010). These results indicate the usefulness of staged tympanoplasty and auricular cartilage reconstruction for minimizing the risk of residual cholesteatoma and retraction cholesteatoma.

Introduction: This retrospective study was aimed at evaluating the surgical outcomes of 23 ears of patients with middle ear malformations who had undergone primary surgery at the Department of Otorhinolaryngology-Head and Neck Surgery, Shiga University of Medical Science hospital, between December 2004 and August 2022.

Methods: Pure tone audiometry using three frequency averages (0.5, 1, and 2 kHz) was performed pre-and post-surgery. The postoperative audiometric data were obtained at least six months after the surgery. The types of malformations were classified by the surgical findings according to Funasaka’s classification. We evaluated the surgical outcomes according to the guideline for reporting hearing results in middle ear and mastoid surgery (2010) proposed by the Japan Otological Society.

Results: The patients consisted of 11 men and 12 women, with a mean age of 22.0 years (range 6–67). The malformations were as follows: absence of the incudo-stapedial joint (10 ears, 43.5%); fixation of the malleus or incus (6 ears, 26.1%); fixation of the stapes footplate (2 ears, 8.7%); multiple malformations (2 ears, 8.7%); and other unclassified malformations (3 ears, 13.0%). We performed tympanoplasty type I in 7 ears, type IIi in 2 ears, type IIc in 1 ear, type IIIi in 3 ears, type IIIc in 2 ears, type IVi-M in 3 ears, type IVi-I in 3 ears, and stapedotomy in 2 ears. The overall success rate was 82.6%; a postoperative air-bone gap of 15 dB or less was achieved in 56.5% cases, improvement of the hearing level by 15 dB or more was achieved in 73.9% cases, and a postoperative hearing level of 30 dB or less was achieved in 73.9% cases.

Conclusion: The appropriate choice of surgery is essential to achieve a good hearing outcome in patients with middle ear malformations.

Introduction: This retrospective study was aimed at evaluating the surgical outcomes of 31 ears of patients with otosclerosis who had undergone primary stapedial surgery at the Department of Otorhinolaryngology-Head and Neck Surgery, Shiga University of Medical Science hospital, between October 2004 and September 2022.

Methods: Pure tone audiometry using three frequency averages (0.5, 1, and 2 kHz) was performed pre-and post-surgery. The postoperative audiometric data were obtained at least six months after the surgery. We evaluated the surgical outcomes according to the guideline for reporting hearing results in middle ear and mastoid surgery (2010) proposed by the Japan Otological Society. We compared the surgical outcomes and incidence of perioperative adverse events between the Skeeter drill use group and KTP laser use group.

Results: The patients consisted of 10 men and 18 women, with an average age of 49.0 years (41.5–55.5). We performed stapedotomy in 27 ears, total stapedectomy in 2 ears, partial stapedectomy in 1 ear, and stapedial mobilization in 1 ear. The overall success rate was 90.3%; a postoperative air-bone gap of 15 dB or less was obtained in 83.9% of cases, improvement of the hearing level by 15 dB or more was achieved in 87.1% of cases, and a postoperative hearing level of 30 dB or less was achieved in 35.5% of cases. There were no significant differences in either the surgical outcomes or the incidence rates perioperative adverse events between the Skeeter drill group and KTP laser group.

Conclusion: The overall surgical outcomes and incidence of perioperative adverse events in the Skeeter drill group and KTP laser group were comparable, with no significant differences. We could perform safe and effective surgery with both devices.

We retrospectively evaluated the data of 10 patients (10 ears) with congenital aural stenosis who had undergone meatoplasty and tympanoplasty at our department between November 2005 and December 2019. The symptoms, presence/absence of cholesteatoma, type of middle ear malformations, surgical strategies, and hearing improvement rate were analyzed. Hearing loss was the most common symptom. Eight patients had external auditory canal cholesteatoma. Middle ear malformations were observed in 8 patients; all 8 patients had ossicular anomalies and 2 patients had facial nerve displacement. A canal wall-down mastoidectomy with canal reconstruction using auricular cartilage was performed for ears in which the cholesteatoma invaded the middle ear cavity. Ossicular reconstruction could not be performed in 1 ear because of displacement of the facial nerve and bony closure of the oval window. The overall hearing improvement rate was 75.0%. The success rate in patients without cholesteatoma was 100% and in patients with cholesteatoma was 66.7%. No recurrence of aural stenosis has been noted in any cases after the surgery. We should evaluate middle ear anomalies carefully to avoid complications and achieve hearing improvement in patients with congenital aural stenosis.

External auditory exostoses, also referred to as “surfer’s ears,” primarily occur in cold-water surfers, and are associated with long-term exposure to cold water. There are few reports of external auditory exostoses developing in patients without any history of aquatic activities.

We report two cases of external auditory exostoses caused by repetitive cold-water stimulation. A 56-year-old man presented to us with otorrhea and hearing loss on the right side. He gave a history of being in the habit, for several years, of soaking in a cold bath up to his head after a sauna bath. The external auditory exostoses were observed bilaterally, and the patient was also diagnosed as having chronic otitis media in the right ear. We performed canaloplasty and tympanoplasty on the right side. At 10 months after the right ear surgery, we performed canaloplasty on the left side. After the surgery, the patient’s hearing was restored and the external auditory exostoses have not recurred. A 70-year-old woman presented with a 4-year history of ear fullness on the right side. She had been in the habit, for more than 15 years, of often spraying cold water into the right ear canal when she felt itchy in the ear. The external auditory exostoses were observed on the right side and the right external auditory canal was almost completely obstructed. We performed canaloplasty and removed an external auditory canal cholesteatoma. After the surgery, her symptoms were improved and the exostoses have not recurred.

External auditory exostoses are induced by repetitive exposure to cold water. Avoiding exposure to cold water is important to prevent exacerbation and recurrence of external auditory exostoses.

Sinonasal inverted papilloma (IP) is a benign tumor with the potential for recurrence and malignant transformation. The aim of this study was to investigate age, gender, postoperative follow-up duration, Krouse classification, surgical approaches adopted, preoperative diagnoses, rate of recurrence, and presence/absence of malignancy in patients with sinonasal IP. A retrospective study was performed in 58 patients with sinonasal IP who had undergone surgery at Shiga University of Medical Science Hospital between April 2000 and March 2020, and the patients were divided into two groups; those operated in the 2000s (group I) and those operated in the 2010s (group II).

There were 23 patients (17 males, 6 females; average age, 60 years) in group I and 35 patients (27 males, 8 females; average age, 59 years) in group II. The postoperative follow-up duration was 57 months in group I and 46 months in group II. In regard to the Krouse classification, there were 7 cases of T1, 8 cases of T2, 3 cases of T3, and 5 cases of T4 in group I, and 6 cases of T1, 11 cases of T2, 17 cases of T3, and 1 case of T4 in group II. From 2010 onward, due to thorough biopsies for sinonasal masses, including nasal polyps, the preoperative diagnosis rate of IP has increased from 42% to 83% in the cases treated initially at our hospital. Although the traditional external surgical approaches were used in 4 cases (e.g., lateral rhinotomy) in the 2000s, all operations were performed by the endoscopic approach using minimally invasive techniques, such as endoscopic modified medial maxillectomy and Draf type III, or by combined approaches (endoscopic approach with gingivectomy) in the 2010s. The postoperative recurrence rate in the cases treated initially at our hospital decreased from 16% in the 2000s to 3% in the 2010s. The postoperative recurrence rate in cases with recurrence after surgery reported from other hospitals is 13%, which was comparable to that in the cases treated initially at our hospital. Recurrence developed in both the cases in which the postoperative serum test for SCC antigen was positive.

We conducted this study to evaluate the outcomes of patients with squamous cell carcinoma of the maxillary sinus treated primarily in our department. The subjects included 17 cases of squamous cell carcinoma without distant metastasis out of the 29 cases of malignant maxillary sinus tumors treated at our hospital between January 2010 and March 2022. We examined the patient characteristics, the TNM classification of the tumors, the clinical stage and treatment adopted, the survival rate, using Kaplan-Meier analysis, the time to recurrence, and the results of histopathological evaluation after concurrent chemoradiotherapy with intra-arterial cisplatin (RADPLAT) or intravenous cisplatin (CCRT).

The median age of the patients, consisting of 14 male and 3 female patients, was 65 years; the median observation period in this study was one year 11 months. The T stage distribution of the tumors was as follows: T1, 1 case; T2, 2 cases; T3, 2 cases; T4a, 10; cases and T4b, 2 cases. The N stage distribution was as follows: N1, 2 cases: and N2b, 2 cases. Of the 12 cases with stage III or IVA, disease, 9 received RADPLAT. For all 17 cases, the 5-year overall survival rate was 74.6%, and the 5-year disease-specific survival rate was 81.5%. The disease-specific survival rates were 100% at 28 months for patients with stage I to III disease, 85.7% at 60 months for stage IVA disease, and 50% at 15 months for stage IVB disease. The 5-year disease-specific survival rate in cases with lymph node metastasis was 33.3%, and lymph node metastasis was identified as a significantly poor prognostic factor. Recurrence was observed in 2 stage IVA cases, and 2 stage IVB cases failed to be cured by RADPLAT or CCRT. Among the cases that underwent curative resection or sinonasal endoscopic biopsy after RADPLAT or CCRT, tumor cells were not detected in 86% of cases. A sinonasal endoscopic biopsy should be performed when residual tumor is suspected after concurrent chemoradiotherapy. Radical resection can be avoided if there is no pathologically evident residual tumor.

The endoscopic modified Lothrop procedure is a surgical technique used for the treatment of refractory frontal sinusitis. Herein, we present the case of a 61-year-old man who was referred to our hospital with refractory frontal sinusitis and an upper eyelid fistula. CT revealed diffuse bony thickening of the frontal sinuses bilaterally, and bony closure of the left nasofrontal duct. The endoscopic modified Lothrop procedure was performed by an outside-in approach using a CT-guided navigation system. Because of the massive hemorrhage from the drilled bone, the opening of the left frontal sinus was insufficient, and the bone surface was partially covered with a pedicled mucosal flap. The operation time was over 7 hours, and the intraoperative blood loss was 1225 mL. One month after the surgery, the patient presented with recurrent acute frontal sinusitis, and by 6 months after the surgery, the orifice of the left frontal sinus was blocked. The obstruction of the frontal sinus orifice was presumably attributable to osteitis and subsequent osteogenesis. Control of infection, adequate opening of the frontal sinus, and covering of the exposed bone with a pedicled mucosal flap are important to minimize the risk of stenosis and obstruction of the frontal sinus orifice.

Invasive fungal rhinosinusitis is a disease that tends to occur more frequently in immunosuppressed patients. Herein, we present a case of chronic invasive fungal rhinosinusitis that developed after chemoradiotherapy (CRT) for frontal sinus cancer.

A 69-year-old man diagnosed as having squamous cell carcinoma of the right frontal sinus extending into the cranium and orbit (cT4bN0M0) underwent concomitant CRT with cisplatin at a total radiation dose of 70 Gy administered in 35 fr). Although marked shrinkage of the tumor was observed in response to this therapy, contrast-enhanced MRI indicated the possibility of residual disease in the right ethmoid sinus and frontal sinus. Four months after the CRT, endoscopic sinus surgery (ESS) was performed, which failed to reveal any residual cancer. Five weeks after the ESS, we detected a fungal mass (Aspergillus) in the posterior wall of the right frontal sinus. Despite regular nasal cleaning on an outpatient basis and daily sinonasal irrigation, the fungal mass grew gradually in size. Sixteen weeks after the ESS, the patient presented with gait disorder. When the patient visited our hospital at 19 weeks after the ESS, we found paresis of the left leg and a mildly decreased level of consciousness. An emergency MRI showed mass extending from the right frontal sinus to the frontal lobe. Serum β-D glucan was within normal range. A neurosurgical craniotomy revealed necrotic tissue without cancer in the frontal lobe, and debridement was performed. Culture of the intracranial lesion yielded growth of Aspergillus fumigatus. Two days after the neurosurgery, the patient became fully conscious, and the physical symptoms improved by 20 days after the surgery. The patient received voriconazole for 7 months and until now, 3 years since the surgery, the patient has shown no evidence of recurrence.

We speculate that the barrier dysfunction in the frontal sinus mucosa and dura mater caused by the cancer and CRT promoted the adherence and growth of Aspergillus on the sinus wall, which led to the development of chronic invasive fungal rhinosinusitis in the patient.

Human papillomavirus (HPV)-related multiphenotypic carcinoma (HMSC) is a newly described rare sinonasal tumor with histological features resembling those of adenoid cystic carcinoma. Herein, we report a case of HMSC in a 62-year old man. The mass was located around the right agger nasi and middle meatus. A tumor biopsy revealed HPV-positive poorly differentiated squamous cell carcinoma. Contrast-enhanced CT showed a 16 × 12 mm tumor with mild contrast enhancement in the right agger nasi without bone destruction. Contrast-enhanced MRI showed low signal intensity on T1-weighted sequences, high signal intensity on T2-weighted sequences, and mild contrast enhancement with gadolinium. PET-CT showed FDG accumulation in the area of the tumor, with no distant metastases. Based on the imaging findings, we diagnosed the tumor as a localized clinical stage I nasal carcinoma in the right nasal cavity (cT1N0M0). Endoscopic en-bloc resection was performed with a 6- to 7-mm safety margin. The operation time was 2 hours and 54 minutes, and the operative blood loss was 174 mL. Histopathological examination showed a cribriform architectures of the tumor typically seen in adenoid cystic carcinoma, with focal expressions of p63 and diffuse expressions of p16. Based on the findings, the patient was diagnosed as a case of HMSC (pT1N0M0). The postoperative course was uneventful, and until now, 16 months since the surgery, no recurrence has been noted.

Tumors in the pterygopalatine fossa (PPF) are rare, and the most commonly encountered ones are benign neurogenic tumors, such as schwannomas. We report a rare case of schwannoma arising from the extracranial trigeminal nerve (the greater palatine nerve) in the left PPF. The endoscopic medial maxillectomy (EMM) has been used as an endoscopic surgical approach for tumors in the maxillary sinus. However, this procedure sacrifices the inferior turbinate and nasolacrimal duct. Recently, an endoscopic modified medial maxillectomy (EMMM) approach was newly developed to preserve the inferior turbinate and nasolacrimal duct. We applied the EMMM approach for resection of the schwannoma in the PPR. Preoperative transcatheter embolization of the left sphenopalatine artery and an intraoperative CT-guided navigation system were useful for safe and complete tumor resection. Besides postoperative hypoesthesia around his left hard palate, the patient developed no other complications. No local recurrence has been observed until now, one-year after the surgery. The EMMM approach using a CT-guided navigation system is useful for surgical resection of benign tumors of the PPF.

Renal cell carcinoma (RCC) is a malignant tumor associated with a high rate of metastasis, although metastases are rarely found in the nasal cavity and paranasal sinuses. Sinonasal metastasis from of RCC shows a propensity for intractable recurrent epistaxis. If complete resection can be performed, radical cure and relief of symptoms can be expected. We present a case of metastatic RCC of the nasal cavity that was resected by endoscopic surgery.

A 75-year-old man with a history of recurrent epistaxis presented to our hospital. Clinical examination revealed a tumor in the left nasal cavity, and a tumor biopsy revealed malignancy secondary to a primary tumor originating at another site. The patient had previously undergone surgical treatment for RCC and lung metastasis, and the present lesion was suspected as a nasal metastasis from RCC. FDG-PET/CT revealed no other sites of metastasis or recurrence. Endoscopic surgery was performed to remove the tumor, along with mucosal excision of the nasal floor and nasal septum. The total bleeding volume was 200 ml. Histopathological findings of the excised mass were consistent with metastasis from RCC. The postoperative course was uneventful, and no recurrence was found at the 6-month follow-up.

RCC is a hematogenous tumor with a hemorrhagic tendency. A literature review of 58 cases with sinonasal RCC metastasis showed that epistaxis is the most common presenting symptom. A high risk of intraoperative bleeding has been reported, and according to a previous report, in cases with multiple sinonasal metastases, the average blood loss during the surgery is 1656 ml. In 25.9% of the cases, sinonasal metastases are discovered more than six years after the diagnosis of RCC, and 67.2% of cases either have a history of metastasis to other sites or have metastases at new sites.

Sinonasal organized hematomas are hemorrhagic and non-neoplastic lesions, but have locally aggressive characteristics, with the ability to destroy the surrounding bone tissue. These clinical characteristics often lead to these lesions being misdiagnosed as malignancy. Organized hematomas often occur in the maxillary sinus, but the same lesions in the sphenoid sinus are extremely rare. Organized hematomas in the sphenoid sinus are often accompanied by bone destruction of the internal carotid artery wall and cranial base, which may lead to cranial base injury and massive bleeding.

We report a case of an organized hematoma arising in the sphenoid sinus. A 64-year-old woman visited our hospital with a 2-month history of headache and diplopia. CT and MRI revealed a mass lesion in the sphenoid sinus with destruction of the surrounding bone tissue, bilateral internal carotid artery wall, optic canals, and cranial base. Endoscopic sinus surgery was performed for biopsy and partial resection. The supply vessel, a branch of the left sphenopalatine artery, was cauterized at the level of the anterior wall of the left sphenoid sinus. Histopathological examination revealed the diagnosis of organized hematoma. The patient’s headache and diplopia resolved within a month after the surgery. The mass lesion gradually shrank postoperatively, but was still present. CT angiography determined that the supply vessels were mainly from the right sphenopalatine artery without blood flow from the internal carotid arteries. Six months after the first surgery, second-stage radical resection of the residual mass was performed endoscopically. The sphenopalatine arteries were ligated bilaterally near the sphenopalatine foramen. The mass in the sphenoid sinus was largely scarred, with poor blood flow, and was resected along with the desquamated necrotic tissues. Until now, 2 years after the second surgery, the patient has remained asymptomatic and shown no evidence of recurrence.

Japanese cedar pollinosis (JCP) is one of the most common diseases in Japan. The prevalence of JCP in Japan was 38.8% in 2019, and approximately 70% of patients with JCP also have Japanese cypress pollinosis. Avoiding exposure to pollen is important for managing the symptoms of pollinosis. We examined Japanese cedar pollen and Japanese cypress pollen dispersals from 1995 to 2023 in Otsu City, Shiga, Japan. Large amounts of pollen dispersal were observed every other year. High average temperatures and long hours of sunshine in the month of July of the previous year were associated with a large amount of pollen dispersal. Cedar pollen dispersal began in early February and ended in the middle of April, while cypress pollen dispersal began in late March and ended in early May. The duration of cedar pollen dispersal was longer than that of cypress pollen dispersal. The amount of pollen dispersal is affected by many factors, including the climate and the age of trees in Japan.

Lymphoepithelial carcinoma is a common malignant tumor of the nasopharynx, that rarely occurs in the salivary glands. Lymphoepithelial carcinoma accounts for 0.4% of all salivary gland tumors, and has been reported to be associated with Epstein-Barr virus (EBV) infection, similar to nasopharyngeal lymphoepithelial carcinoma.

An 85-year-old woman presented to us with a swelling in the right parotid region. Physical examination revealed a tumor in the parotid gland measuring 6 cm in diameter, with erythema of the overlying skin. There was no evidence of facial nerve palsy. A needle biopsy revealed cells suspicious for malignancy. Contrast-enhanced CT revealed a 6-cm mass with ring enhancement in the right parotid gland. Extended parotidectomy, including the skin and facial nerve, was performed. Histopathological examination revealed atypical tumor cells with lymphocytic infiltration. Immunohistochemistry showed positive staining of the tumor cells for cytokeratin AE1/AE3 and EBER-ISH. The patient was diagnosed as a case of EBV-associated lymphoepithelial carcinoma of the parotid gland. The postoperative course was uneventful, and no tumor recurrence has been noted during the 2 years since the surgery.

Salivary gland lymphoepithelial carcinoma is rare. Case reports have shown favorable outcomes of surgery and radiotherapy.

Post-tonsillectomy hemorrhage (PTH) is a serious complication of tonsillectomy. We conducted a retrospective analysis of the data of 170 patients who had undergone tonsillectomy at Shiga University of Medical Science hospital between April 2012 and March 2017. PTH occurred in 36 patients (21%), and 5 patients (3%) required hemostatic surgery under general anesthesia.

Multiple logistic regression analysis identified current smoking (odds ratio 8.8; 95% confidence interval, 3.2–24.6 vs. nonsmokers) and use of both bipolar and ligation for hemostasis (odds ratio 6.1; 95% confidence interval, 2.1–17.7, vs. only bipolar tissue hemostasis) as significant clinical risk factors for PTH. However, the proportion of patients in whom hemostasis under general anesthesia became necessary was 2.5% (1/40) among patients in whom bipolar and ligation hemostasis were used, versus 3.1% (4/130) in those in whom bipolar tissue hemostasis alone.

In adult patients undergoing tonsillectomy, it is important to provide preoperative smoking cessation counseling and postoperative lifestyle guidance, and the tonsillar portal should be ligated during the tonsillectomy.

Background: Tongue cancer most frequently occurs at the tongue edge, and accounts for about 30% of all cases of head and neck cancer.

Methods: This retrospective study was aimed at evaluating the clinical outcomes in 45 patients with oral tongue cancer who had undergone primary surgery at the Department of Otorhinolaryngology-Head and Neck Surgery, Shiga University of Medical Science hospital, between January 2010 and March 2022. The overall survival rate (OS) and disease-specific survival rate (DSS) were evaluated by the Kaplan-Meier method.

Results: The mean age of the patients, consisting of 38 men and 7 women, was 65.1 years (range 29–89 years). The median follow-up period after the primary surgery was 36 months. The tumor stages according to the UICC eighth edition 2017 were distributed as follows: stage 0, 5 cases; stage I, 11 cases; stage II, 8 cases; stage III, 8 cases; and stage IVa, 13 cases. The 5-year OS rates were as follows; all cases, 63.1%; stage 0, 80.0%; stage I, 74.1%; stage II, 85.7%; stage III, 50.0%; and stage IVa, 46.2%. The 5-year DSS rates were as follows; all cases, 72.0%; stage 0, 100%; stage I, 100%; stage II, 85.7%; stage III, 58.3%; and stage IVa, 46.2%. Recurrence of the tumor after the primary surgery was observed in 15 out of the 45 cases (33.3%). Only 1 out of the 6 cases of recurrence in patients with stage 0-II disease died, whereas all 9 of the 9 cases of recurrence in patients with stage III-IVa disease died of disease progression.

Conclusion: The prognosis of recurrent disease in patients with advanced oral tongue cancer is extremely poor and initial treatment is important.

Distant metastases in cases of head and neck cancer are commonly detected in the lungs, bones and liver. Metastasis in skeletal muscle is rare, because the tumor cells cannot survive the mechanical stimuli associated with muscle contractions. We report a case of skeletal muscle metastasis secondary to an oropharyngeal carcinoma. An 80-year-old man presented to our hospital with a hard mass lesion in his left neck. An ulcerative tumor of the tongue base and left cervical lymphadenopathy were found, and biopsy revealed oropharyngeal squamous cell carcinoma (cT2N2bM0). Upfront neck dissection on the left side was performed and radiotherapy (2 Gy/fraction, total 70 Gy) was administered, followed by palliative therapy for the residual oropharyngeal carcinoma. Three months later, the patient presented with walking difficulty and a 4-cm mass lesion in the left thigh. Contrast-enhanced magnetic resonance imaging (MRI) revealed an enhancing mass lesion with a low apparent diffusion coefficient in the left thigh. A needle biopsy revealed skeletal muscle metastasis from the oropharyngeal squamous cell carcinoma. At 7 months after the diagnosis of the skeletal muscle metastasis, the patient died from progression of the oropharyngeal carcinoma. Skeletal muscle metastasis is rare, and sometimes, it is difficult to differentiate this condition from soft tissue sarcomas. Needle biopsy and contrast enhanced MRI are useful for the diagnosis of skeletal muscle metastasis.

Lipomas are common benign tumors, and sometimes contain cartilage, bone and fibrous connective tissue. Chondrolipoma is a type of lipoma that contains mature cartilage tissue, and rarely occurs in the head and neck region. We report a case of chondrolipoma arising from the underside of the tongue. A 43-year-old man visited our hospital after he noticed a mass on the tongue. A physical examination revealed a hard white mass measuring 10 mm in diameter on the underside of the tongue. The mass lesion was surgically resected completely, and histopathological examination confirmed the diagnosis of chondrolipoma. No recurrence has been noted during the 4 months of follow-up since the surgery.

We conducted this retrospective study to investigate the treatment outcomes of 107 patients with hypopharyngeal cancer who received their primary treatment at the Department of Otorhinolaryngology-Head and Neck Surgery, Shiga University of Medical Science Hospital, between January 2010 and March 2022. The 5-year overall survival (OS) and disease-specific survival (DSS) rates were 57.1% and 72.5%, respectively. The 5-year OS rates in patients with stage 0, I, II, III, IVA and IVB disease were 100%, 76.9%, 27.8%, 57.1%, 42.1%, and 40.0%, respectively. The 5-year DSS rates in patients with stage 0, I, II, III, IVA and IVB disease were 100%, 92.9%, 83.3%, 85.7%, 55.7%, and 40.0%, respectively. Then, the treatment outcomes of the patients with early-stage cancer (Stage I–II) were examined in 19 patients treated by transoral surgery and 11 patients treated by radiation therapy. The 5-year OS rates and 5-year DSS rates in the transoral surgery group and radiation therapy group were 77.1% and 72.9%, and 90.9% and 87.5%, respectively. The 5-year local control rates (LCRs) in the transoral surgery group and radiation therapy group were 27.2% and 63.5%, respectively, being lower in the transoral surgery group than that in the radiation therapy group. The rate of positive resection margins in the transoral surgery group was 21.9% in cases with Tis-T2 disease, but positive resection margins recurred in only 28.6% of cases. In the transoral surgery group, even some cases with negative resection margins developed local recurrence. With the provision of appropriate treatment after local recurrence, the 5-year OS and 5-year DSS rates in the transoral surgery group were comparable to those in the radiation therapy group. Appropriate evaluation of the resection margins in these patients during transoral surgery is important and the our method of evaluation needs to be improved.

Transoral surgery is a minimally invasive treatment procedure for superficial laryngo-pharyngeal cancer. We retrospectively evaluated the data of 42 patients with superficial laryngo-pharyngeal cancer who underwent transoral surgery at our department between January 2012 and December 2021. We performed 61 transoral surgeries, including transoral videolaryngoscopic surgery (TOVS) (47 cases) and endoscopic laryngopharyngeal surgery (ELPS) (14 cases) in 42 patients with hypopharyngeal cancer (46 cases), oropharyngeal cancer (8 cases), supraglottic cancer (5 cases), hypopharyngeal and esophageal cancer (1 case), and pharyngeal cancer after laryngectomy (1 case). In most of the cases (50 cases, 82%), the diagnosis was made by upper gastrointestinal endoscopy. The pathological T stage was Tis, T1, and T2 in 31 cases, 26 cases, and 4 cases respectively, and 11 patients developed metachronous multiple laryngo-pharyngeal cancers. Simultaneous double cancer was found in 29 patients; 21 patients (50%) had esophageal cancer and 8 patients (19%) had head and neck cancer. Locoregional recurrence occurred in 7 (16.7%) patients. Three patients developed aspiration pneumonia and 2 patients developed pharyngeal stenosis after surgery. Transoral surgery is a useful and developing procedure for superficial laryngo-pharyngeal cancer and should be applied in carefully selected cases.

We retrospectively analyzed the data of 9 patients with bilateral vocal cord fixation who underwent Ejnell’s operation for laterofixation of the vocal folds at our department between January 2012 and December 2021. The bilateral vocal cord fixation was caused by cardiovascular surgery in 3 cases, total thyroidectomy in 2 cases, long-term tracheal intubation in 2 cases, thymectomy in 1 case, and radiotherapy for laryngeal cancer in 1 case. We used a 2-0 nylon suture for laterofixation of the vocal folds; two sutures were used in 5 patients, and one suture in 4 patients. In all the patients, tracheotomy was performed prior to Ejnell’s operation to prevent dyspnea. The tracheostoma could be closed in 8 of the 9 patients (89%) after Ejnell’s operation. In the remaining 1 patient, the tracheostoma could not be closed, because the patient developed pyogenic spondylodiscitis and became bedridden after the operation. Repeat operation was needed in 3 patients because of recurrence of the glottal stenosis. During the repeat operation, we confirmed the disruption of the nylon thread in all 3 patients. We used silicon spacers to fix the nylon thread in 7 of the 9 patients, and the remaining 2 patients needed repeat Ejnell’s operation. Use of a silicon spacer during Ejnell’s operation may be of value to minimize the risk of repeat operation.

We conducted a retrospective study of 90 cases of laryngeal cancer treated at our department between 2012 and 2021: the patients included 59 cases with the glottic type of cancer (stage I: 39 cases; stage II: 13 cases; stage III: 6 cases; stage IV: 1 case), 28 cases with the supraglottic type of cancer (stage I: 4 cases; stage II: 4 cases; stage III: 4 cases; stage IV: 16 cases), and 3 cases with the subglottic type of cancer (stage II: 1 case; stage IV: 2 cases). The 5-year overall survival rate was 90.2% in the patients with stage I–II disease (61 cases) and 61.3% in the patients with stage III–IV disease (29 cases). In the patients with stage III–IV disease, the poor prognostic factors were: serum albumin level less than 3.6 g/dL at initial diagnosis, neutrophil-to-lymphocyte ratio greater than 3.4, and body mass index less than 20.

Lemierre’s syndrome is a potentially fatal disease that is characterized by jugular vein thrombosis and abscess in various organs. It often develops as a complication of head and neck infections, such as tonsilitis. Recently, the incidence of Lemierre’s syndrome has been increasing. We report the case of a 58-year-old man who was diagnosed as having Lemierre’s syndrome with bacterial meningitis and subdural abscess after treatment of the deep neck abscess.

The patient presented with a 5-day history of sore throat with trismus. CT showed a deep neck abscess, which was treated by drainage and intravenous antibiotic therapy (TAZ/PIPC). On Day 7 after the surgery, the patient developed seizures, with loss of consciousness. Cerebrospinal fluid examination and CT revealed evidence of bacterial meningitis, subdural abscess and left internal jugular vein thrombosis, and we diagnosed the patient as having Lemierre’s syndrome. There were no abscesses in any other organs besides the subdural abscess. The patient recovered without any residual symptoms after the drainage of the subdural abscess and intravenous antibiotic (MEPM) therapy for 8 weeks.

Otolaryngologists should consider the possibility of Lemierre’s syndrome in cases with prolonged inflammation after head and neck infection; contrast-enhanced CT scan is useful for the diagnosis of Lemierre’s syndrome.

The cribriform-morular variant is a rare type of thyroid papillary carcinoma that primarily affects young women under the age of 30 years. This type of cancer accounts for less than 0.5% of all cases of thyroid papillary carcinoma. It could show sporadic or familial occurrence, and familial cases often exhibit APC gene mutations and are linked to familial polyposis coli.

A 27-year-old female patient was referred to our hospital with a mass lesion on her left neck. Ultrasound examination revealed a tumor measuring 35 mm in diameter in the left lobe of the thyroid gland, and the results of an aspiration needle biopsy suggested the possibility of papillary thyroid carcinoma. CT and MRI showed compression of the trachea and invasion of the esophagus by the thyroid tumor. The patient was diagnosed as having papillary thyroid cancer (cT4aN0M0, stage I) and treated by total thyroidectomy and neck dissection (D2b). Colonoscopy excluded associated with polyposis coli. Histopathological examination of the resected tumor revealed the cribriform-morular variant of papillary thyroid carcinoma with the risk of progression to poorly differentiated carcinoma (pT3N0M0, stage I). The postoperative course of the patient was uneventful, and no recurrence has been seen until date, 18 months after the surgery.