We reviewed 256 cases of deep cervical abscess in our hospital. Otorhinolaryngology-head and neck surgery （ORL-HNS） was responsible for 45％ of the cases, and oral and maxillofacial surgery for 36％. Airway management was performed in 36 cases （14％） by endotracheal intubation alone （23 cases） or tracheostomy （13 cases）, which were treated in the Department of Trauma, Critical Care and Emergency Medicine and ORL-HNS. The cases requiring airway management were older than those without, and often encompassing multiple cervical fascial spaces, and Streptococcus anginosus species were more frequently detected in pus. Regarding the method of airway management, a non-parametric comparison found no difference in days of intubation or hospitalization between tracheal intubation and tracheostomy. Comparing percutaneous drainage and incisional drainage, no difference in length of stay was found. Regardless of modality, it is important to perform airway management and drainage as needed without delay.

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This study investigated patients with local recurrence of hypopharyngeal squamous cell carcinoma after definitive radiation therapy. Of 222 patients treated with （chemo） radiation therapy, local recurrence was observed in 49 patients, 18 of whom underwent salvage surgery. Salvage surgery included 4 patients who underwent transoral surgery and 14 who underwent total or partial pharyngectomy with total laryngectomy. The median timeframe for detecting local recurrence after completing the initial treatment was 6.3 months, and 38 of 49 patients with local recurrence were detected within 12 months. Additionally, the 5-year local control, overall survival, and disease-free survival rates of patients who underwent salvage surgery were 59.6％, 44.4％, and 38.9％, respectively. Regional recurrence, positive surgical margin, including close to margin, and pathological T4a are the worst prognostic factors. Therefore, detecting local recurrence at a low T stage and negative surgical margin in salvage surgery are considered important.

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The treatment for benign parotid tumors is surgical resection, in principle. It is important to avoid complications in parotidectomy for benign tumors, including facial nerve palsy, Frey syndrome, salivary fistulas, postoperative bleeding and infection. Facial nerve palsy is a complication that requires more attention. We evaluated the postoperative complications of 273 patients with benign parotid tumors who received parotidectomy between April 2012 and June 2020. The mean age was 53±14 years; 120 were male and 153 were female. One hundred sixty-three patients had tumors in superficial lobes, 79 in lower pole lobes, and 31 in deep lobes, with a mean maximum diameter of 27±13mm. Histopathological diagnosis showed pleomorphic adenoma in 175 patients and Warthin’s tumor in 67 cases, accounting for about 90％ of all cases. Regarding postoperative complications, facial nerve palsy occurred in 18 patients （7％）, salivary fistulas in 13 （5％）, Frey syndrome in 3 （1％）, postoperative infection in 2 （1％）, and postoperative bleeding in no patients. Regarding facial nerve palsy, temporary palsy occurred in 17 patients （6％） and permanent palsy in 1 （0.4％）. The tumor locations in the patients with postoperative facial nerve palsy were superficial lobe, lower pole lobe, and deep lobe in 8, 4, and 6 cases, respectively. On univariate analysis, the incidence of facial nerve palsy was significantly higher in patients with deep lobe tumors （p＝0.009）. We should especially pay attention to facial nerve palsy for patients with deep lobe tumors.

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Tonsillectomy is a frequent operation in otolaryngology, and the most serious complication is post-tonsillectomy hemorrhage. This time, we reviewed 246 patients who underwent tonsillectomy performed by the same surgeon. Postoperative hemorrhage occurred in 17.8％ of patients; the hemorrhage group was older, and the indication was more common for patients with chronic tonsillitis. The most common time of occurrence was after discharge, and the longest was 8 days after surgery. In addition, hemorrhage was more frequent among specialists than general doctors. Since hemorrhage was particularly common on the third day after discharge, we consider that it is important to give the patient sufficient guidance on diet and lifestyle. In addition, the reason why hemorrhage was common among specialists may have been that the surgery was performed independently and that careful procedures and hemostasis could not be confirmed, so we consider that self-checking during surgery is necessary.

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Pyriform sinus fistula （PSF） is a rare congenital abnormality that causes acute suppurative thyroiditis. Complete removal of the fistula with thyroid tissue has previously been used. Recently, endoscopic electrocauterization has been reported as a less-invasive treatment for PSF. The present study retrospectively reviewed fourteen patients with PSF treated at our institution. The post-operative course was uneventful in all cases, with no cases of recurrent laryngeal nerve paralysis. The success rate of the initial electrocauterization was 93％ （13/14 cases）. Endoscopic electrocauterization appears to be a less-invasive, safe, and effective method for the treatment of PSF.

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We experience complications and non-home discharges after surgery for various reasons in elderly patients. We evaluated the characteristics of patients by geriatric assessment （GA） and examined what kind of support is necessary. A retrospective study was performed on 117 elderly patients scheduled for reconstructive surgery for head and neck cancer who underwent GA from August 2019 to February 2022. There was no association between GA and complications, but non-home discharge was associated with IADL and MOS （p＝0.04/0.03）, all of which occurred in non-single residents. Patients who were discharged to non-home settings were thought to have decreased independence and decision-making ability and to need support for making decisions on their own as much as possible with their limited abilities.

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Yolk sac tumor （YST） originating in the head and neck region is a rare tumor. We report a case of YST arising in the paranasal sinus.
An 82-year-old man presented with left nasal congestion and bloody rhinorrhea. Endoscopic examination revealed a big tumor filling the left nasal cavity, and computed tomography revealed a 5-cm mass in the left ethmoid sinus and nasal cavity. Two consecutive biopsies could not confirm any histopathological diagnosis. Therefore, a bigger sample was taken under general anesthesia. The immunohistochemical features indicated YST. The patient was placed on radiation therapy and showed a good response. However, the tumor grew rapidly and 16 months later he died of the YST.
Herein, we discuss the histological features and treatment of this tumor, with reference to other cases of YST in the nasal cavity.

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Head and neck tumors that progress from the superior mediastinum to the subclavian region may require resection of the clavicle or sternum to secure the operative field. However, this manipulation results in postoperative shoulder joint motion disorders. One method to overcome this issue is the transmanubrial osteomuscular sparing approach （TMOSA）, which preserves the sternum and clavicle, as well as the muscles that adhere to them. The present case involved a 79-year-old female patient diagnosed with papillary thyroid cancer, and TMOSA was selected due to lymph node metastases that had progressed from the upper left mediastinum to the subclavian region. The sternum was dissected in an L-shape between the first intercostal space and the first rib was cut at the sternum attachment. A good field of view near the subclavian arteriovenous vein was secured by lateral translation of the clavicle, to which the sternum was partially attached. No postoperative functional impairment was observed. TMOSA is a safe approach with good functional preservation.

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The patient was a 57-year-old male with maxillary sinus carcinoma cT4aN0M0. We administered chemotherapy （DCS; docetaxel 60mg/m², cisplatin 60mg/m², TS-1 20mg/body）. On day 7, he developed febrile neutropenia and received antibacterial treatment. On day 25, he developed melena and colonoscopy revealed multiple ulcerative colitis in the large intestine. Biopsy of the same site revealed amebic colitis. Hepatic abscess due to amebic infection also occurred. Although we treated him with metronidazole and puncture of the liver abscess, he died due to septic shock and hemorrhagic shock for melena. Amebiasis sometimes progresses to a fatal fulminant type. If abdominal symptoms are observed during chemotherapy, it is necessary to treat with amebic infection in mind.

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Inflammatory myofibroblastic tumor （IMT） is a rare intermediate malignant tumor characterized by inflammatory cell infiltration and proliferation of myofibroblastic and fibroblastic spindle cells. In the present study, we experienced three cases of laryngeal IMT. The first case was a 60-year-old man. He underwent laryngomicrosurgery for a right vocal cord tumor, 7mm in size. One year after the surgery, no evidence of recurrence was seen. The second case was a 53-year-old man with a left vocal cord polyp-like lesion 15mm in diameter with a tendency to enlarge. He underwent laryngomicrosurgery. One year after the surgery, no evidence of recurrence was seen. The third case was a 40-year-old man with IMT diagnosed by a biopsy of a subglottic mass. The case was placed on observation and has remained unaffected for four years. Anaplastic lymphoma kinase （ALK） gene rearrangement was confirmed by fluorescence in situ hybridization in all cases. Preoperative diagnosis of IMT is usually difficult because of the lack of characteristic findings. Surgical resection is the first-line treatment. Although it can cause asphyxia, the increase is generally slow and the choice of timing of treatment needs to be tailored to the pathology. IMT usually has a benign course, but cases with local recurrence or distant metastasis have been reported. In laryngeal IMT, local recurrence was reported in about 20％ of cases, and no metastasis was reported. Surgical treatment should be considered in the presence of a hard, enlarging laryngeal mass, with the possibility of IMT.

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Nodular fasciitis （NF） is a rare benign tumor consisting of reactive proliferation of fibroblasts. The pathogenic mechanism of NF is unclear, and NF may have both neoplastic progression and reactive proliferation of fibroblasts. In previous reports, most NF was idiopathic, but some were postoperative cases. There are no specific findings of the examination of NF, and the preoperative diagnosis is difficult. The problem in the treatment for NF is that NF is misdiagnosed as a malignant tumor because of its rapid-growing feature and potential for invasion into the surrounding tissues. Here, we report a case of nodular fasciitis occurring after surgery for a parotid gland tumor. A 21-year-old female underwent partial parotidectomy for preauricular pleomorphic adenoma. Seven months after surgery, a retroarticular mass grew near the surgical wound. MRI, US, and fine needle aspiration cytology were performed. It was difficult to determine whether the tumor was in the parotid gland or the sternocleidomastoid muscle. Recurrent pleomorphic adenoma or soft tissue tumors were suspected, but a definitive diagnosis was difficult. The lesion was growing gradually, so we performed extirpation of the lesion. The lesion existed in the sternocleidomastoid muscle. The margin of the tumor was unclear, so the surrounding sternocleidomastoid muscles were resected together. After surgery, the resected mass was diagnosed as nodular fasciitis by histopathological examination. There was no recurrence for 1.5 years after the operation.

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We report a case in which oral ingestion was possible by an indwelling voice prosthesis （Provox^Ⓡ, PV） for a pharyngeal cutaneous fistula near the permanent tracheal foramen. The case was a 73-year-old man. Radiation monotherapy 67.5Gy was performed for laryngeal glottic cancer T2N0M0. A simple total laryngectomy was performed due to recurrence, but a fistula was found near the tracheal foramen. On the 85th day after the first operation, the fistula was closed with a pectoralis major myocutaneous flap, but the fistula was found again from the tracheal hole side. Thereafter, by using a T-tube or a retina cannula for the fistula and finally an indwelling PV, sufficient oral intake became possible without obstructing the tracheal foramen.
We believe that PV may be an option for pharyngeal cutaneous fistulas near the tracheal foramen.

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Nodular fasciitis is a benign neoplastic lesion caused by reactive proliferation of myofibroblasts, but it must be differentiated from malignant tumors. We report a case of nodular fasciitis of the buccal region in which USP6 gene rearrangement was detected for the first time in a cytological specimen. The patient was a 37-year-old woman who presented to our department for a close examination of a buccal mass that had been increasing in size for about a year. The mass was suspected to be adherent to the surrounding skin. Cytological examination revealed a spindle cell tumor （Papanicolaou Class Ⅲ）. Since the possibility of malignancy was considered, surgery was performed for a definitive diagnosis as well as treatment. The resected specimen contained an irregular-shaped mass, measuring 35×30×13mm, histopathologically composed of fascicular proliferation of spindle cells with a storiform pattern, and fluorescence in situ hybridization （FISH） analysis showed ubiquitin specific peptidase 6 （USP6） gene rearrangement, leading to a diagnosis of nodular fasciitis. FISH analysis of the cytological specimen also showed USP6 gene rearrangement. It is worth considering FISH analysis in preoperative cytological specimens in cases where nodular fasciitis is considered.

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Sympathetic schwannomas arising in the cervical region are often perceived as asymptomatic masses, and it has been reported that symptoms often do not improve even after surgery when Horner’s syndrome is present. In this report, we describe a case of cervical sympathetic schwannoma with preoperative Horner’s syndrome that improved within 2 months after intracapsular excision. A 46-year-old male patient reported to our hospital with a chief complaint of a left cervical mass that had been increasing in size for 2 years. During the initial examination, a 50×30mm elastic tumor was palpated in the left lower ear. There were no symptoms of nerve dropout, and magnetic resonance imaging findings suggested a schwannoma of sympathetic origin. Approximately 3 weeks before surgery, the patient developed Horner’s syndrome characterized by left eyelid ptosis and constriction of the pupil, and the tumor was subsequently removed by intercapsular resection. The neurological symptoms did not resolve immediately after surgery. Previous reports have shown that patients with neurological symptoms long after the onset of symptoms are unlikely to improve even if surgery is performed. However, symptoms may improve if surgery is performed within 3 weeks after the onset of neurological symptoms.

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Liposarcoma accounts for 11.5％ of malignant tumors arising in soft tissues and is one of the most frequent types, but its occurrence in the head and neck region is rare. Dedifferentiated liposarcoma is one of the histological subtypes of liposarcoma, consisting of a mixture of an adipocyte-rich well differentiated component and a spindle cell-rich dedifferentiated component. Herein, we present a rare case of dedifferentiated liposarcoma arising in the neck. A 79-year-old man with a lump in his right neck was referred to our hospital after a biopsy at the previous hospital revealed a suspected spindle cell tumor. He underwent resection of the malignant tumor in the right neck and was diagnosed with a dedifferentiated liposarcoma. Postoperative radiation therapy of 70Gy was administered. No local recurrence or metastatic disease has been detected during a 16-month follow-up. This disease should be considered as one of the differential diagnoses when a soft tissue tumor is suspected.

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Sclerosing rhabdomyosarcoma is a rare soft tissue tumor, and the subtype accounts for only about 10％ of all rhabdomyosarcomas. We herein report a case of sclerosing rhabdomyosarcoma originating from the nasal wing, which responded well to chemotherapy. A 26-year-old man received therapy for sclerosing rhabdomyosarcoma of the left nasal wing. The tumor size was extremely reduced after three courses of neoadjuvant chemotherapy which made tumor excision easier during the subsequent surgery. After the surgery, four courses of chemotherapy were performed as adjuvant therapy. The patient has remained recurrence-free for thirteen months after the therapy. This case suggests that chemotherapy may be a practical choice for the treatment of sclerosing rhabdomyosarcoma in head and neck sites, whose prognosis is commonly considered poor.

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We present the case of a patient with low-grade non-intestinal-type adenocarcinoma （non-ITAC） of the nasal cavity, which is a very rare tumor. A 62-year-old female visited another hospital due to nasal obstruction on the left side. Adenocarcinoma of the nasal cavity was suspected, and she visited our department for detailed examination and treatment. A tumor was observed from the left inferior meatus to the common nasal meatus. Contrast-enhanced CT/MRI showed a neoplastic lesion with a mild contrast-enhancing effect localized in the nasal cavity. Under the diagnosis of left nasal adenocarcinoma cT1N0M0, we performed endoscopic tumor resection under general anesthesia. Histopathologic examination of the tumor showed low-grade non-ITAC. The margins were negative and no additional treatment was performed. No local recurrence or metastasis was observed 12 months postoperatively.

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