Introduction: The EXTREME regimen has been reported to result in significant prolongation of survival for unresectable recurrent and metastatic head and neck cancers.
Method: We performed a retrospective analysis of prognostic factors in 28 patients who underwent the EXTREME regimen between 2015 and 2019 based on patient background factors and treatment content.
Results: One-year PFS was 16％ and one-year OS was 60％. One-year OS was 79％ in patients with total cisplatin accumulation of more than 300mg/m2, and those with chemoradiotherapy before recurrence tended to have total cisplatin accumulation of more than 300mg/m2.
Discussion: Patients who received chemoradiotherapy before recurrence tended to be able to receive cisplatin at 300mg/m2 or more, and those who received a sufficient amount of cisplatin resulted in long-term survival.

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Some patients in poor general condition are unable to tolerate reconstructive surgery. For such patients, less invasive surgery such as segmental mandibulectomy without reconstruction is necessary to reduce the operation time and blood loss. However, there have been few reports describing the details of this procedure. We conducted a retrospective study to evaluate the efficacy of this technique. The median age of the patients was 78 years, they had some complications and PS1, and all of them had cT4a. The mandibular area defect was mainly lateral and extended to the midline. Postoperatively, all patients progressed without serious complications, and feeding function was maintained. Local recurrence was observed in four cases, but two cases were salvageable. It is suggested that this technique is safe and preserves feeding function.

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To evaluate the efficacy of multimodality therapy including radical surgery, radiation therapy, and chemotherapy for maxillary sinus cancer, we analyzed 59 patients in our institute between 2002 and 2019. We reviewed the 3-year overall survival rate to assess the efficacy of the therapy. The 3-year overall survival rate was 64.4％ for all patients, 100％ for patients in stage Ⅰ, 100％ in stage Ⅲ, 59.3％ in stage ⅣA, and 18.2％ in stage ⅣB. The 3-year overall survival rate was 90.0％ in the surgery with preoperative radiotherapy group, 74.1％ in the surgery with or without postoperative radiotherapy group, and 41.0％ in the radiotherapy or chemoradiotherapy group. Our results indicate the necessity of multimodal therapy for maxillary sinus cancer.

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The case records of a consecutive series of 266 patients with laryngeal carcinoma who were given primary radical treatment between 2005 and 2018 were retrospectively reviewed. With a median follow-up of 44 months, 5- and 10-year overall survival rates were 77％ and 60％, while 5- and 10-year disease-specific survival rates were 89％ and 88％, respectively. There were 60 deaths in total, comprising 25 from cancer under study （including 7 from complications of treatment）, 30 from intercurrent diseases, and 5 from unknown causes. Twenty-five cases died of second malignancy, accounting for more than 40％ of total deaths. Multiple primary malignancies were observed in 41％ of all cases. Among the primary sites of secondary malignancy causing death, lung and upper digestive tract were the most and the second most common. Control of multiple primary malignancies and late toxicity of treatments may be important for improving survival rates.

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The combination of endoscopic laryngo-pharyngeal surgery （ELPS） and open surgery would enable preservation of the larynx in cases with hypopharyngeal cancer invading the cervical esophagus. This report describes the case of a 65-year-old female with basaloid squamous cell carcinoma who underwent prior ELPS to determine the superior excision line and subsequent open surgery, resulting in complete cure without losing her own voice. We evaluated her tumor under general anesthesia and noticed it was not invading the larynx but was infiltrating the cervical esophagus.
Measures to prevent aspiration were done at the end of the operation, and she overcame aspiration pneumonia several times and became able to ingest necessary nutrients orally. Two years and 11 months have passed since the operation, and she has no trouble with vocalization and there is no recurrence or metastasis in her whole body.

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Foreign bodies of fish bones are often visually confirmed, but if they have strayed into the submucosa of the oral cavity or pharynx, they are often difficult to diagnose and remove. We report fish bone foreign matter that had strayed into the tongue.
An 87-year-old man complaining of discomfort in the tongue visited an otolaryngologist one month after accidentally swallowing fish bones. Although no foreign body could be confirmed by visual inspection, a foreign body that had entered the tongue was confirmed by computed tomography （CT） and ultrasonography （US） examinations. The foreign body was removed using US under general anesthesia.
This case showed that preoperative CT and intraoperative US are clinically useful for the detection and removal of foreign bodies of fish bones that have strayed into the tongue.

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Papillary carcinoma rarely arises from ectopic thyroid tissue in a thyroglossal duct cyst. We report a case of thyroglossal duct carcinoma. The present case was an 18-year-old woman who had a painless solid mass in the neck. The tumor was suspected to involve the anterior cervical muscle and thyroid cartilage on computed tomography and magnetic resonance imaging. Papillary carcinoma was suspected on fine needle aspiration cytology. The tumor was resected with sterno-hyoid muscle, sterno-thyroid muscle, a part of the hyoid bone, a part of thyroid cartilage and the pyramidal lobe of the thyroid isthmus. Thyroglossal duct carcinoma is a rare condition, accounting for only 1% of thyroglossal duct cysts, however, it should be considered in patients presenting with a middle neck mass, and the possibility of malignant tumor should be explained to the patient before surgery.

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We report on a case of cervical penetration injury caused by glass fragments. A 47-year-old man had been injured by penetration of his neck after falling from a stepladder and his head breaking a glass door. CT scanning showed glass fragments near the common carotid artery and internal jugular vein of both sides. The vascular injury was not clear on imaging examination. We performed foreign body enucleation with skin incision under general anesthesia. Active bleeding at an internal jugular vein damaged by a foreign body occurred during surgery, so we sewed up the lesion with a non-absorbable suture. In case of a penetrating neck injury, deep injuries may be more serious than is suggested by the appearance. As the neck is an anatomically important region containing a great many vessels, cranial nerves and aerodigestive tract, it is necessary to identify the locations of foreign bodies and neighboring organ injury by imaging examination.

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A 48-year-old man who was diagnosed with p16 positive oropharyngeal squamous cell carcinoma （T1N1M0） underwent chemoradiotherapy （CRT） with cisplatin. Two months after the treatment, he started to have pharyngeal pain and progressive mucosal ulcer and was diagnosed with radionecrosis in the oropharynx. Six months after the treatment, he was hospitalized and received systemic administration of corticosteroids, antibiotics and prostaglandin, and nutritional support including HMB/Arg/Gln. He also underwent hyperbaric oxygen therapy （HBO）, and debridement of necrotic tissue in the pharyngeal necrotic lesion was performed. The combined treatment was successful and the radionecrosis healed in 2 months.
Radionecrosis in the oropharynx after CRT is extremely rare; however, it could be a life-threatening complication unless appropriate treatment is conducted. We experienced a rare case of oropharyngeal radionecrosis treated according to the treatment protocol for laryngeal radionecrosis. In this case, oral administration of antibiotics, steroids and prostaglandin was ineffective. Multidisciplinary treatment including local debridement, nutritional support and HBO should be conducted for such cases at the appropriate timing to avoid severe complications.

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We report a case of inner ear malformation presenting with adult-onset recurrent meningitis. The patient was a 68-year-old man who had congenital deafness of the left ear. He had suffered recurrent meningitis and continuous watery rhinorrhea from the left nasal cavity after a head injury four years ago. We found a colorless serous discharge from his pharyngeal orifice of the Eustachian tube on the left side, and it was considered cerebrospinal fluid leakage. Temporal bone CT showed left cochlear and semicircular ducts hypoplasia （Mondini dysplasia）. Under general anesthesia with spinal drainage, he underwent middle ear multiple obliteration and inner ear window closure to control the perilymph gusher. Cerebrospinal fluid leakage stopped and no meningitis was suffered thereafter. We need to be aware that inner ear malformation can be a cause of recurrent meningitis even in adult-onset cases.

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We report a rare case of persistent thyrotoxicosis with destructive thyroiditis with a huge adenomatous goiter cured by thyroidectomy. A 56-year-old male patient with acute heart failure and thyrotoxicosis was referred to our hospital for a detailed examination of thyrotoxicosis. The examination revealed destructive thyroiditis with a huge adenomatous goiter. Because his serum FT3 and FT4 levels had not decreased for three months after conservative treatment, a thyroidectomy was performed. Thereafter, his serum FT3 and FT4 levels normalized, and the thyrotoxicosis improved. A thyroidectomy should be considered for persistent thyrotoxicosis that is refractory to conservative treatment.

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The prognosis for carcinoma of the external auditory canal is good when the tumor can be removed en bloc, and the surgical procedure is often uniformly selected based on the T grade according to the Pittsburgh classification. However, since tumor localization differs despite the same T grade, uniformity in surgical procedures can cause excessive complications. In the case reported here, the tumor in a patient with left external auditory canal carcinoma extended from within the external auditory canal to the lateral wall of the attic, and was classified as T3 （Pittsburgh classification）. After neoadjuvant chemotherapy, we planned an atypical surgery to remove the attic lateral to the malleus head in a lump, as well as a lateral bone resection. The lesion was removed en bloc while confirming the margin intraoperatively using a navigation system, and no recurrence has been observed for nearly 4years after surgery. We believe that advances in diagnostic imaging have made it possible to avoid relying on a single standard procedure and have helped us accurately determine tumor margins and use navigation systems to effectively resect tumors.

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Nasal hemangioma, particularly giant hemangioma, has a rich blood supply, and surgical treatment requires particular care due to the high risk of massive bleeding and obstructed field of view.
The case was a 78-year-old male who presented with recurrent left nasal bleeding, with hemangioma filling the left nasal cavity. As preoperative embolization was not possible, the sphenopalatine artery, which is a feeder, needed to be clamped at the beginning of the surgery.
For en bloc resection, the endonasal endoscopic approach was selected combined with transseptal access with crossing multiple incisions （TACMI） and endoscopic Denker’s approach for coagulation of the sphenopalatine artery.
This case study shows that the sphenopalatine artery of a large nasal tumor, which is difficult to approach by the standard middle meatal antrostomy or endoscopic medial maxillectomy, can be approached endonasally by TACMI and endoscopic Denker’s approach.

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Biliary infections occur when bile drainage is obstructed due to the formation of gallstones or bile mud. Prolonged fasting or inadequate oral intake can cause stagnation of bile, resulting in the formation of gallstones or bile sludge. In addition, opioids may cause sphincter of Oddi dysfunction. Abdominal symptoms during chemoradiation therapy require attention. We experienced a case of biliary tract infection during cetuximab-based bioradiotherapy for carcinoma of the external auditory canal. Biliary tract infection may require laparotomy if diagnosis and treatment are delayed. Biliary tract infection is one of the complications of chemoradiotherapy that otolaryngologists should be aware of.

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