Laryngeal cancer surgery is divided into laryngeal-sparing surgery and total laryngectomy. In early-stage laryngeal cancer, laryngeal conservation treatment is recommended as grade A in the Japanese Clinical Practice Guidelines for Head and Neck Cancer 2018. Although total laryngectomy is the standard treatment for cT4a laryngeal cancers, many patients desire laryngeal conservation. For this reason, doctors often have to offer patients chemoradiotherapy; as a result, total laryngectomy is frequently used to treat recurrent laryngeal cancer. On the other hand, one of the typical complications after total laryngectomy is mucosal suture failure. When this failure occurs, patients experience delays in resuming oral intake. Mucosal suture failure is therefore a high-impact complication not only for patients but also medical staff. At our center, laryngectomy with hyoid bone preservation has been performed since 2018 for cases of total laryngectomy following irradiation where the risk of mucosal suture failure is high. When we performed laryngectomy with hyoid bone preservation on five patients, none of them experienced such failure. To examine if this surgery is valuable in preventing mucosal suture failure, we compared outcomes between total laryngectomies with and without hyoid bone preservation.

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There have been no reports of long-term follow-up of vertical partial laryngectomy for elderly patients. We investigated the long-term survival rate and laryngeal dysfunction-free survival of such patients. Twenty cases aged 70 years or older who underwent surgery from January 1992 to December 2007 were examined retrospectively from their medical records. The median age was 73 years and the median follow-up period was 87 months. The overall survival rate was 73/55％ at 5 years / 10 years, and the laryngeal dysfunction-free survival was 69/44％ at 5 years / 10 years. There were no cases in which laryngeal functions of speaking and eating could not be preserved. No cases required hospitalization for aspiration pneumonia, laryngectomy, or tracheostomy.

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With population aging in Japan, more older adults are being diagnosed with head and neck cancers. The choice of treatment for these patients should be based on their age and individual conditions. In this study, we retrospectively analyzed the data of 61 patients with head and neck cancers aged ≥75 years who underwent surgery as a primary treatment in our department between April 2016 and September 2020. We investigated the postoperative complications, cases of functional decline resulting in hospital transfer, and risk factors for these situations. Eleven patients experienced postoperative medical complications, including pneumonia and arrhythmia. Of these, six patients were unable to return to their original place of residence and required hospital transfer. The risk factors for postoperative medical complications included dementia, comorbidity, prolonged surgery, and tracheostomy. Dementia was also indicated as a risk factor for requiring hospital transfer. On the other hand, an increase in age was not correlated with an increase in the risk of postoperative complications of hospital transfer.
When treating older patients with head and neck cancers, it is necessary to consider their physical conditions and social backgrounds. Preoperative dementia is a risk factor for postoperative complications and hospital transfer; therefore, a preoperative evaluation of cognitive function should be performed and taken into account when considering treatment strategies.

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Early-stage laryngopharyngeal cancers have been detected frequently with the widespread use of narrow-band imaging （NBI） by magnifying endoscopy. Transoral surgery （TOS） has been widely used to treat laryngopharyngeal cancers. It is not uncommon to encounter simultaneous or heterogeneous multiple cancerous lesions in the laryngopharyngeal region. In this study, we investigated the risk factors for multiple laryngopharyngeal cancers in patients who underwent transoral surgery and the risk factors for simultaneous multiple lesion resection. In univariate analysis, a history of head and neck cancer and a history of esophageal cancer were significant risk factors for the development of multiple lesions. There were no obvious risk factors for simultaneous resection of multiple lesions or multiple resections of multiple lesions.

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Parotid gland cancer is a rare disease, having various histological types and malignancy, and may be difficult to diagnose and treat. We investigated 41 cases of parotid gland cancer who underwent surgery as the first-line treatment in our department. The 5-year crude survival rate was 90.2%, the 5-year recurrence-free survival rate was 84.6%, and the prognostic factors that showed a significant difference in multivariate analysis were the presence or absence of cervical lymph node metastasis. Since cervical lymph node metastasis was observed in 5 of 9 cases who underwent prophylactic neck dissection, such dissection should be considered in cases of suspected locally advanced cancer or high-grade cancer. Trastuzumab therapy has been effective in cases of recurrence of lung metastasis. Further knowledge of chemotherapy for inoperable cases and distant metastasis cases needs to be accumulated.

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We report two cases of giant soft tissue tumor of the hypopharynx.
Patient 1：A 61-year-old man presented with a smooth-surfaced pedunculated soft tissue tumor in the postcricoid of the hypopharynx but had no incarceration in the larynx and underwent surgical treatment on an elective basis. Postoperative pathological examination revealed a giant vascular fiber polyp.
Patient 2：A 60-year-old woman was transported to our hospital due to nausea and vomiting. A tumor protruded out of the oral cavity. She had two smooth-surfaced pedunculated soft tissue tumors on the posterior wall of the hypopharynx and underwent emergency surgery due to the risk of airway stenosis. Postoperative pathological examination revealed well-differentiated liposarcoma, but the course was good without recurrence.
Giant soft tissue sarcoma of the hypopharynx, a very rare disease, may require emergency surgery due to the potential for choking associated with incarceration in the larynx.

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We report a case of hypopharyngeal lipoma in a 58-year-old man who was referred to our hospital due to discomfort while swallowing. Laryngeal videoscopy revealed a submucosal tumor arising from the posterior wall of the hypopharynx. This tumor was detected at approximately the same signal as that of fat on magnetic resonance imaging. Due to the small tumor size of 12mm and no malignancy, the patient was kept under observation by a practitioner. Approximately 3 years later, the tumor increased in size and covered the larynx. Therefore, the tumor was resected under general anesthesia. Transoral videolaryngoscopic surgery （TOVS） was performed rather than lateral pharyngotomy, as it was less invasive. We removed the tumor using an FK-WO retractor and a rigid endoscope with flexible tip. A hypopharyngeal lipoma is very soft and easily deformable, making it usually asymptomatic for a long time, but its growth may lead to increased risk of serious symptoms, such as airway obstruction. Lipoma is difficult to distinguish from liposarcoma preoperatively. Thus, we recommend removal of the tumor for diagnosis and treatment.

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Secretory carcinoma （SC） is a type of salivary gland malignant tumor and has been reported to be a mammary analogue secretory carcinoma due to its morphological resemblance to secretory carcinoma of the breast. SC is newly listed in the WHO Classification of Head and Neck Tumors （4th edition） as a slow-growing and low-grade malignant tumor of the salivary gland. SC may have been diagnosed as acinic cell carcinoma or adenocarcinoma not otherwise specified. Herein, we present four cases of SC regarding histopathological and immunochemical findings and an expression of specific ETV6-NTRK3 fusion genes. Of the four cases, the submandibular and parotid glands were involved in one and three cases, respectively. All patients were male, and the age ranged from 46 years to 63 years. There were no cases of facial palsy before treatment and no specific findings on the sonogram or magnetic resonance imaging scan. SC was suspected in Case 1 from preoperative fine-needle aspiration cytology with immunochemical staining by Pan-Trk and NOR-1. Malignancy was suspected in Case 4 although the histological type was inconclusive. Surgery was performed in all cases. In two patients （Cases 1 and 4）, postoperative radiation was performed due to the close surgical margin. The diagnosis of SC was made based on histopathological findings, immunochemical staining （mammaglobin, S-100, Pan-Trk, and NOR-1）, and the presence of ETV6-NTRK3 fusion genes. In three cases （Cases 2, 3, and 4）, the ETV6-NTRK fusion gene was detected by the RT-PCR or FISH method. In Case 1, detection of fusion gene was not performed because of the immunochemical positivity of Pan-Trk which has a high specificity for NTRK3 fusion, and negativity of NOR-1 for acinic cell carcinoma. The post-treatment course was uneventful, and Case 4 was well without recurrence or metastasis for 5 years.

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Amebiasis is an infectious disease caused by oral ingestion of cysts of the protozoan parasite Entamoeba histolytica. This disease is classified into extraintestinal amebiasis and intestinal amebiasis （amebic colitis）. Amebic colitis is a diarrheal disease, but is rarely predicted as an adverse event during cancer treatment because Japan is not considered to be an endemic country. We report a case of amebic colitis in a 60-year-old man who developed diarrhea during chemoradiotherapy for oropharyngeal cancer. Initially, we considered that he had cytotoxic agent-related intestinal mucositis or an enteral feeding-related diarrhea. However, treatments such as bowel rest and administration of antibiotics did not result in improvement. We conducted further examinations to investigate the cause of the intractable diarrhea. Computed tomography showed inflammation of the entire colon, and a colonoscopy enabled a correct diagnosis to be made. Only conservative management, which comprised administration of metronidazole and paromomycin, rapidly improved his symptoms. Finally, the patient was able to achieve the planned cancer treatment.
Amebiasis is an infectious disease in Japan that requires a thorough survey to be conducted for its diagnosis. The number of cases of amebiasis rapidly increased after 2000, and there are more than 10,000 asymptomatic carriers. Furthermore, the route of infection was not identified in approximately half of the cases reported in the past 5 years. The disease can result in manifestations, such as liver abscess, brain abscess and intestinal perforation, and death may occur if the diagnosis of amebiasis is delayed. Therefore, even if there is no obvious risk of infection but diarrhea is more severe than usual during chemotherapy, physicians should consider the possibility that patients may be infected with this disease. Prompt collaboration with a gastroenterologist for a detailed examination should then be carried out.

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The number of foreign body cases in the outpatient clinic of otolaryngology department is about 0.5-2％ of the total number of new patients.
We report a case of an intracranial foreign body through the nasal cavity, which is extremely rare among such cases.
The patient was a 39-year-old man. After cleaning the nasal cavity with a self-made cotton swab on a resin stick, he noticed the loss of the tip of the swab and visited his previous doctor. A foreign body was found in the left olfactory fissure, but it was difficult to remove and the patient was referred to our department. No foreign body was found in the nasal cavity at the time of initial examination and so CT was performed. A foreign body was found to have perforated the olfactory fissure and penetrated the cranium, so a craniotomy was performed to remove the foreign body. The patient was discharged 10 days after surgery without complications.
Since intracranial perforation is frequently associated with spinal fluid leakage and infection, it is dangerous to remove a foreign body before evaluating the damage by imaging diagnosis.
Early surgical removal is necessary, but close cooperation with neurosurgery is important.

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Clear cell carcinoma is a low-grade salivary gland tumor that is indolent and rare. We report a case of clear cell carcinoma arising from the base of the tongue. The patient was a 64-year-old man with a tumor at the base of the tongue incidentally detected during an upper gastroendoscopy. Computed tomography and magnetic resonance imaging revealed a 17-mm tumor arising from the base of the tongue. A biopsy indicated either a clear cell carcinoma arising from a minor salivary gland or metastasis from renal carcinoma; the latter was ruled out by abdominal examination. The tumor was successfully removed by intraoral median glossotomy. After the surgery, fluorescence in situ hybridization analysis revealed that the tumor cells were positive for EWSR1-ATF1 rearrangement, establishing the definitive diagnosis of clear cell carcinoma. No local recurrence or distant metastasis was observed 9 months post-surgery. Esthetics were maintained by the minimally invasive procedure, and the patient’s recovery progressed without any functional impairment such as dysphagia or dysarthria.

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Intravascular papillary endothelial hyperplasia （IPEH） is a benign lesion caused by the proliferation of vascular endothelial cells. We report an extremely rare case of IPEH derived from the maxillary sinus.
A 52-year-old man visited our department with repeated right epistaxes from a month ago. Nasal endoscopy revealed discharge of blood from the right maxillary sinus ostium. CT and MRI showed a unilateral maxillary sinus mass with irregular edges on the maxillary sinus floor. It was difficult to determine preoperatively whether the mass was malignant or benign because of the lack of accessibility to the lesion for a biopsy.
The maxillary sinus mass was resected by the Caldwell-Luc operation for diagnostic treatment. The histopathological diagnosis was IPEH.
When IPEH occurs in the maxillary sinus, it may be difficult to distinguish from malignant tumors clinically and radiologically. Thus, it is worth knowing that IPEH is one of the differential diseases of maxillary sinus masses.

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We report a surgical case of acquired choanal stenosis. The patient was a 78-year-old woman with a chief complaint of nasal obstruction. Membrane choanal stenosis was found using fiberscopy and computed tomography. She was diagnosed with acquired membrane choanal stenosis due to syphilis and underwent endoscopic surgery. Postoperatively, however, the choana gradually developed stenosis. We performed endoscopic surgery again and placed a silicone stent and mucosa of the inferior turbinate on the choana. Recurrence has not been observed for 13 months after the surgery.

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We experienced two cases of tracheostomy for a new coronavirus positive patient （COVID-19）. Case 1 was a man in his 80s. Long-term tracheal intubation management was required, so a tracheostomy was performed with full PPE using an N95 mask. Case 2 was a man in his 60s. Given that it was difficult to secure a visual field in the first tracheostomy, a surgical tracheotomy was performed under a powered air-purifying respirator （PAPR）. By using the PAPR, we were able to solve the problem of securing the visual field when performing surgical tracheostomy with full PPE, and it was considered to be useful for surgical tracheostomy under safe infection control.

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In cases of advanced head and neck cancer with skin infiltration or skin metastasis, the patient’s quality of life declines because of symptoms such as bleeding, foul odor, severe pain, and exudation. Effective treatments are not yet available. Some studies have reported that Mohs’ ointment, containing zinc chloride, can potentially chemically fix the tumor and suppress such harsh symptoms. In the present study, bleeding was controlled in patients with skin metastasis of oropharyngeal cancer by devising a procedure using Mohs’ ointment and gauze, as it was difficult to achieve by the usual method of applying ointment directly to the tumor. We report some specific precautions and improved procedures for the use of Mohs’ ointment on the head and neck.

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Patients who need total laryngo-pharyngo-esophagectomy after previous chemoradiotherapy in the cervical region sometimes develop failure of wound healing, ruptured sutures, or necrosis around the tracheostoma. Though some reports described surgical management to prevent these failures, there have been few reports on how to handle tracheostoma problems in such cases. We experienced three cases of wound healing failure in tracheostoma and describe their clinical courses. Adequate local treatment and selection of tracheal tube are necessary to achieve reform of the tracheostoma canal.

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