Orbital surgery is quiet difficult surgery because the orbit contains a number of important and vulnerable structures, including the optic nerve, the ophthalmic artery and vein, the ocular muscles and their motor nerves. The endoscopic endonasal approach is a form of minimum invasive surgery for orbital retrobulbar lesions. I examined adaptations and the limit of the operation from 21 cases. Many patients visited for neurosurgery and ophthalmology. About 70 percent of the patients had a severe visual impairment. On the other hand, there were no visual impairments in 29 percent of the patients.
Medial or lateral orbital subperiosteal lesions can be removed by this procedure with low risk of operative damage to the orbital structures. This procedure is not impossible in upper subperiosteal liquid lesions. The endoscopic endonasal approach is a very useful procedure for orbital subperiosteal lesions. However, the orbital tumor inside the muscle cone is accompanied by serious complications. It is necessary for us to think about adapting the operation.

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[in Japanese]

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Auricular hematoma is not a rare disease, and its prognosis is usually good. This disease results from trauma producing a soft, smooth, doughy, rounded swelling of the auricle that is tender and shows size changes, often obliterating the anatomic contours of the auricle. Auricular hematoma is considered to occur between the perichondrium and cartilage, or within the cartilage. Various techniques have been applied to treat auricular hematoma without auricular cartilage fracture, such as fine needle aspiration, incision and drainage, pressure dressing with a splinting mold, mattress suture, or injection of OK-432 and continuous portable vacuum drainage.
A 20-year-old male was admitted to our hospital complaining of swelling and severe pain in his left auricle. Based on ENT examination, he was diagnosed as having auricle hematoma and perichondritis with auricular cartilage fracture. Following emergency hospitalization, we incised the auricular skin and drained it, then treated it with antibiotic therapy. After suppressing the inflammation, he received auricular plasty. This is a good course after an operation, and he was discharged after 15 postoperative days.

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The operation for cholesteatoma with labyrinthine fistula requires care to prevent loss of hearing especially in cases with only one hearing ear. A 52-year-old woman presented with cholesteatomas and labyrinthine fistula. She had suffered from profound sensorineural hearing loss in the opposite ear from her childhood. Although the fistula was not detected in the preoperative CT, we predicted the existence of labyrinthine fistula due to dizziness and symptoms of fistula. We performed canal-wall-down tympanoplasty type III. The fistula existed from the lateral semicircular canal to the vestibule. Her hearing level was remarkably improved after surgery, and vestibular symptoms were also improved.
We operated on 115 ears with cholesteatomas in the past five years, five of which had labyrinthine fistula. Referring to these five cases, we investigated the factors that affect bone conduction levels and indications for surgery for those cases with only one hearing ear.

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A glomus tumor is a benign tumor that originates from glomus bodies in peripheral arteriovenous anastomosis sites and is usually found in the skin of the extremities. We report here on a patient with a glomus tumor in the left nasal ala.
A 58-year-old female visited our hospital complaining of spasmodic pain in the left nasal ala. Local findings showed tumor formation in her left nasal ala and a hypervascular tumor was detected by enhanced computed tomography (CT).
We resected the tumor with a safety margin and used the nasolabial flap for reconstruction of the defect. Pathological examination of the resected tumor showed the features of a glomus tumor.
There were no complications and the post-operative result was acceptable. It is a good course without severe narrowing of the nostril, and tumor recurrence has not been detected three months after surgery.

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Skull base osteoradionecrosis is one of the most serious post-irradiation complications. In spite of localized lesions, patients have symptoms of foul odor and headache, which are very uncomfortable. What is even worse, without appropriate management, is that a mortal complication such as a rupture of the internal carotid artery may occur. We must recognize this disease and take a positive attitude toward this problem.
We report on a 61-year-old man with skull base osteoradionecrosis after re-irradiation for a recurrence of nasopharyngeal carcinoma. Based on a few literature reviews, endoscopic sequestrectomy is very effective for relief of symptoms and prevention of the rupture of the internal carotid artery. But, if we accidentally expose the internal carotid artery during surgery, we may induce rupture of said artery. So, we must choose the method of treatment carefully. Furthermore, we should understand the structure of the skull base in detail and work cautiously during surgery.

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Tumors in the lacrimal sac are relatively rare, and 70% of them are malignant. The patient often visits the department of ophthalmology because symptoms are similar to chronic dacryocystitis. We report a case of a 79-year-old female with a malignant tumor in the lacrimal sac. She received tumor resection with orbital exenteration, removal of a part of the maxilla, parotidectomy and neck dissection. The pathological study revealed that the tumor is primary adenocarcinoma of the lacrimal sac, which has the same characteristics as salivary duct carcinoma. Otolaryngologists should treat patients with tumors of the lacrimal sac because an extended operation is required in case of advanced cancer.

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Retropharyngeal hematoma is considered a relatively rare condition. If this disease is suspected, appropriate measures should be taken immediately because it can cause dyspnea due to upper airway obstruction. Here, we report on the management of 2 patients with retropharyngeal hematoma.
Case 1: A 74-year-old woman was referred to our department with cervical swelling and dyspnea, which occurred after she fell out of bed. Case 2: A 44-year-old man was referred to our department with dyspnea and pharyngeal pain, which occurred after he received a stellate ganglion block at a pain clinic. In both patients, the airway was initially secured by tracheotomy, after which the retropharyngeal hematoma was removed surgically. The outcome of treatment was favorable in both cases. The clinical course of these patients is reported here together with discussion of the relevant literature.

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Osteosarcoma is, overall, the most common primary bone malignancy, but is rarely observed in the head and neck region, with <10% of all cases of osteosarcoma occurring in this region. Osteosarcomas of the head and neck exhibit clinical behavior and natural history that are distinct from those of the extremities. In this report, we describe six cases of osteosarcoma of the mandible and review the relevant literature. All six patients underwent surgical resection. Four patients underwent surgery alone, with the two remaining patients treated with a combination of surgery and neoadjuvant chemotherapy. Neoadjuvant chemotherapy was not effective in the treatment of these two patients. Patients with negative surgical margins at initial surgery showed good long-term survival, which was similar to the results of other studies. Complete surgical excision to achieve negative surgical margins is crucial to successful therapy for patients with head and neck osteosarcoma. The role of chemotherapy is not well defined, so the indication of neoadjuvant chemotherapy needs to be considered carefully without delaying surgery.

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Forty-three patients with oropharyngeal cancer treated at our hospital were reviewed retrospectively. In total, 74% were stage IV, the 2-year overall survival rate for all patients was 77%, and 31% were HPV-positive. HPV-positive patients had a significant number of advanced cancers, and a lower probability of double cancers than HPV-negative patients. The 2-year overall survival rate was 70% in HPV-positive patients and 79% in HPV-negative patients. There was no significant difference between HPV positive and negative patients.

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Pyriform sinus fistula can be a potential infection route for suppurative thyroiditis, which, in cases with repetitive abscess formation, need therapy. We experienced a case in which both abscess drainage and fistula excision were successfully performed simultaneously. In this case, which was for a 26-year-old patient, the first attempt to remove the fistula was done two months after abscess formation. But a scar tissue mimicking a fistula tract was mistakenly excised at the first operation; then, abscess formations were repeated 2.5 and 5 years after the operation. As an early resolution was required by the patient, we performed the second operation to excise the fistula and abscess drainage simultaneously. Because the abscess naturally separated the larynx from adjacent scar tissue, a good visualization of the pyriform sinus was easily obtained with an excision of the upper pole of the left thyroid gland, so that the fistula excision was made successfully. We will discuss the optimal timing of a fistula excision and abscess formation with our other cases.

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Two cases with verrucous carcinoma of the larynx (T1aN0M0), which were successfully treated by argon plasma coagulation, are presented. Although accurate diagnoses of this disease are essential for using this technique, this procedure will be effective as a relatively non-invasive means of treating early-stage-verrucous carcinoma of the larynx.

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Of the patients seen for cervical neurinoma at our department between April 2005 and June 2013, 25 underwent intercapsular resection. Of them, we investigated 7 in whom the condition originated in the brachial plexus. Only 1 patient was presented with a postoperative neurological deficit and improved within 3 months, indicating that intercapsular resection is effective. Sensory or motor dysfunction of the upper extremities may be caused in cases of neurinoma originating in the brachial plexus, which may greatly affect a patient's work and quality of life. Before operation, informed consent must be obtained, and relevant surgical experience should be acquired in addition to taking disadvantages into account.

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It is often difficult to accomplish a standard therapeutic course in cases of head and neck cancer associated with psychiatric disorders. We reviewed 27 cases of patients with head and neck cancer associated with psychiatric disorders who received hospital treatment between January 2008 and June 2013. Their treatment courses and treatment complications were investigated.
Six cases could not start treatment for cancer because of severe dementia. In cases of radiotherapy, most patients made their psychiatric disorder worse to a greater or lesser extent because of a prolonged therapeutic period. Some of them also developed additional physical complications that led to cessation of the radiotherapy. In cases of surgical therapy, half of them revealed postoperative deliria, and the incidence rate of complications related to surgical reconstruction was relatively high.
Comprehensive evaluation of cancer staging, physical condition and psychosocial background is required for determination of treatment strategy in case of head and neck cancer associated with psychiatric disorders.

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Some of the tumors in the buccal region arise from Stensen's duct or the accessory parotid gland. Both of them, especially Stensen's duct, are rare. However, it is often difficult to distinguish the origin; we think that there is a histopathologic tendency in each origin. According to previous reports, the most frequent types of the tumor arising from Stensen's duct and the accessory parotid gland are squamous cell carcinoma and mucoepidermoid carcinoma, respectively.
We report another case of primary squamous cell carcinoma arising from Stensen's duct. A 71-year-old man suffering from swelling in his right cheek was referred to our hospital. We located the tumor arising from the accessory parotid gland and performed local resection penetrating the buccal region from the skin of the cheek to the buccal mucosa and total neck dissection. Following histopathological examination, we generally diagnosed the tumor as primary squamous cell carcinoma originating from Stensen's duct.

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We report herein ten cases of primary hyperparathyroidism (pHPT) caused by intrathyroid parathyroid adenoma (IPA). Of the 319 patients who underwent parathyroidectomy for pHPT between April 2006 and December 2013, ten patients (3.1%) were found to have IPAs (eight in the right lobe and two in the left lobe) by pathological examination. Six patients were found to have IPAs in the lower pole of the thyroid. Under ultrasonography, IPA showed a hypoechoic mass in seven patients, an isoechoic mass in two, and a mixed pattern mass in one. Six patients showed hypervascularity in IPA under color Doppler ultrasonography. MIBI scintigraphy showed accumulation of the isotope in ITA in five of the seven patients examined. CT was able to point out an intrathyroid nodule, but the qualitative diagnosis was difficult. We could confirm preoperatively the intrathyroid nodule to be a pathological parathyroid tumor in five of the six patients, by measuring PTH concentration of the aspirate obtained from the nodule under ultrasonography. Preoperative jugular venous sampling with PTH analysis was also useful to localize the laterality of pathological ITA in one patient.

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Carotid body tumor(CBT)is a paraganglioma arising in a carotid body, which is located at the bifurcation of the common carotid artery and works as a chemoreceptor. CBTs easily infiltrate neighboring blood vessels and nerves, leading to Horner's syndrome or lower cranial nerve symptoms such as aspiration, dysphagia or hoarseness. The choice for radical cure of CBT is a surgical extirpation, while surgery has the great risk of surgical complications such as bleeding or postoperative lower cranial nerve damage. We examined the clinical features and the oncological and functional outcomes of the treatment of CBT. We experienced 9 patients with 11 tumors at the department of Otolaryngology-Head and Neck Surgery, Kobe University Hospital from 2001 to 2013. There were 6 women and 3 men with an average age of 44.6 years old (17 to 78). The mean follow-up period was 41 months(4 to 116 months). Bilateral CBTs were seen in 2 patients. Five were surgically resected, 2 were treated by irradiation and 2 were under clinical observation. One patient had a family history. One patient with malignant CBT died of distant metastases. The other 8 patients had favorable courses. A treatment plan should be determined with careful consideration of age, size, location, neurologic symptoms and family history.

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Generally, small cell carcinoma occurs in the lungs. An extrapulmonary small cell carcinoma of the head and neck is a comparatively rare disease and has high-potential malignancy. It has poor prognosis because of distant metastasis at a high rate. The treatment is mainly concurrent chemoradiotherapy except in the case of localized and early stage. We reported two cases of small cell carcinoma of the head and neck.

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Thymic cyst occurs along the embryologic pathway of migration of the thymus and does not usually appear in the neck. We herein report a case of a 71-year-old female with a thymic cyst as well as thyroid adenomatous goiter. CT and MRI indicated that the cyst expanded from the upper mediastinum to the lower neck in the left side. During surgery the cyst was removed from the upper mediastinum cavity using the cervical approach. Thymic cyst generally produces few symptoms, but can sometimes cause airway obstruction or change to a malignant tumor. Therefore, early diagnosis and excision of the thymic cyst seems important.

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In 2010, the Ministry of Health, Labour and Welfare of Japan permitted radioiodine (I-131) therapy to be performed at outpatient departments for high-risk patients with differentiated thyroid cancer after total thyroidectomy. Accordingly, we started such therapy in 2011, and herein report the therapeutic problems and value of the therapy.
Three of 22 patients were not able to undergo the therapy because of difficulty of self-restriction of iodine uptake before the therapy, recurrence of additional cancer, or the possibility of radiation exposure to caregivers. Although the remaining 19 patients underwent the therapy, two of them became nervous about quickly starting the therapy in view of the radioactive contamination caused by the Fukushima nuclear power plant disaster after the Great East Japan Earthquake on March 11, 2011. Comparing the method of thyroid hormone suspension, the recombinant human thyroid stimulation hormone (rhTSH) method was acceptable to all patients in terms of complications. Tumor recurrence (3 cases) or distant metastasis (1 case) appeared in 19 cases, all of which had previously experienced cervical recurrence and some surgical operations. Therefore, the current radioiodine therapy may not be completely effective to prevent re-recurrence, although the present study had a short duration and a small number of patients.

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