In this study, we examined the clinical outcomes of 13 cases （24％） with parotid and cervical lymph node metastases out of 54 cases of periocular sebaceous carcinoma treated at our hospital between 2010 and 2023. Parotid node metastases were found in 10 cases, a high proportion （77％）, suggesting the need for concurrent parotid node dissection when cervical lymph node metastases are found. Of the four cases with recurrence in the dissection field after surgery, three were in the group without postoperative radiotherapy, while one was in the group with postoperative radiotherapy. This finding suggests that postoperative radiotherapy to the parotid and cervical regions should be actively considered to improve regional control rates. Currently, there is no established standard treatment for distant metastasis, and the development of new therapeutic strategies remains a challenge for the future.

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We introduced video-assisted neck surgery （VANS method）, an endoscopic thyroid surgery, in August 2018. Treatment outcomes were compared between 69 patients who underwent hemithyroidectomy using the VANS method and 62 patients with a cervical collar incision from August 2018 to July 2023. The VANS group was significantly younger than the collar incision group, with a median age of 48 years, and a significantly high proportion were women （95.7％）. While operative time was significantly longer in the VANS group, blood loss was significantly less in the VANS group. There was no significant difference in the frequency of recurrent nerve palsy in the two groups. No other serious complications were observed, and we believe that the surgeries were performed safely.

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Odontogenic inflammation tends to spill over into the intermuscular space of mastication and may form abscesses. The patient was an 89-year-old woman who presented with a chief complaint of swelling in the right lower ear and lower jaw. There was a fistula in the mucosa of the right posterior molar triangle of the oral cavity, which was draining. A denture was in contact with the location of the fistula. Contrast- enhanced CT showed an abscess and emphysema in the intermuscular space of the masticatory muscle. It was thought to be a masticatory muscle gap abscess caused by chronic irritation by the denture that perforated the buccal mucosa and triggered infection. In this case, the masticatory muscle pore abscess developed into the submandibular space and the anterior neck. The pathway of the abscess varied, and the patient’s general condition was well maintained due to the anterior extension of the abscess. It is important to understand the pathophysiology based on clinical symptoms and imaging findings.

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Epithelial-myoepithelial carcinoma （EMC） is a rare, low-grade tumor that accounts for 1％ of salivary gland tumors. Its preoperative diagnosis can be challenging. We present three EMC cases, all with a favorable prognosis, and discuss their clinical features. The first case was an 84-year-old woman with a benign cyst. Surgical results confirmed clear margins, and there has been no recurrence for postoperative 2 years. The second case was a 72-year-old woman initially suspected of having a malignant tumor. Surgical results revealed positive margins where the tumor adhered to the facial nerve; however, postoperative irradiation was discontinued by the patient. The third case was an 84-year-old woman with malignant cytology. Surgical results confirmed clear margins, and there has been no recurrence for postoperative 1 year. It is crucial to be aware that EMC can undergo high-grade malignant transformation, and prognoses can vary significantly, even among cases with identical histological types.

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The patient was a 55-year-old male. He had a submucosal tumor of the left hypopharynx. The tumor had compressed the larynx, making it difficult to observe the vocal cords using a laryngeal fiberscope. After tracheotomy, biopsy was performed under general anesthesia, and a diagnosis of schwannoma was made. Although it was a benign tumor, we decided to remove it because it might cause airway constriction and dysphagia in the future. A modified thyrotomy approach was used to remove the tumor. Schwannomas in the head and neck region are often found in the parapharyngeal space or around the carotid sheath, and rarely in the hypopharynx. Since the tumor is benign and it is important to preserve voice and swallowing functions when removing it, the modified thyrotomy approach is useful for relatively large tumors that are close to the vocal cords, as in this case.

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The patient was a 66-year-old woman on maintenance hemodialysis. One month after a hemodialysis shunt infection, a deep neck abscess was found in the right carotid sheath, and an incisional drainage of the abscess was performed. The local findings were relieved by daily treatment, but pulsatile bleeding was observed from the wound on the 14th postoperative day. Contrast-enhanced CT revealed an aneurysm at the right carotid bifurcation, and endovascular treatment was performed on the same day. Postoperatively, the abscess cavity disappeared with antimicrobial therapy, and the patient did not relapse. Since there was no evidence of infection in the oral cavity or pharynx, and the patient had a history of hemodialysis shunt infection prior to the onset of the abscess, a prior hematogenous infection was considered to be the cause of the deep neck abscess. We report this case in which endovascular treatment was effective in treating an infected carotid artery aneurysm associated with a deep neck abscess.

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Surgery is one of the important treatment modalities for Graves’ disease （Basedow’s disease）. Clinical situations that favor surgery as treatment for Graves’ disease include symptomatic compression or large goiter. Here, we report three cases of Graves’ disease with huge goiter for which we performed total thyroidectomy as a definitive treatment.
Case 1：A 48-year-old-female who complained of dyspnea. Operative duration was 335 minutes. Blood loss was 1,020ml. Thyroid weight was 840g.
Case 2：A 71-year-old-male who complained of tightness of the neck. Operative duration was 244 minutes. Blood loss was 450ml. Thyroid weight was 815g.
Case 3：A 18-year-old-female who complained of tightness of the neck. Operative duration was 352 minutes. Blood loss was 620ml. Thyroid weight was 620g.
In case 1, extracorporeal membrane oxygenation （ECMO） was introduced at the induction of general anesthesia because difficult tracheal intubation was predicted. However, tracheal intubation was achieved after ECMO was introduced, and general anesthesia was performed through a tracheal tube during operation. In the other two cases, tracheal intubation was achieved without ECMO. In all cases, we ligated the superior thyroid artery at the proximal part, which is close to the external carotid artery, because it was difficult to distinguish the superior laryngeal artery due to the huge goiter. In case 2, we evaluated blood vessels by medical virtual reality （VR） technology before surgery to reduce blood loss, which resulted in the least blood loss of the three cases. In case 1, unilateral laryngeal nerve injury and dysphagia was observed. In the other two cases, no major postoperative complication was observed. In all three cases, no fatal complication such as thyrotoxic crisis was observed.
We could safely perform operations for cases of Graves’ disease by utilizing the techniques described above.

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Odontogenic cysts originating in the maxilla may spread to the nasal cavity or maxillary sinus. Endoscopic removal has been widely reported as an effective treatment. The present case was a 61-year-old female. She had developed pain in the left cheek after a cold, and an imaging study revealed a lesion in the posterior maxillary sinus, which led to her referral to our department. Suspecting an odontogenic cyst, we planned surgical removal. Due to lateral extension beyond the infraorbital nerve, we decided to combine endoscopic modified medial maxillectomy （EMMM） with the direct anterior lateral maxillectomy approach （DALMA）. The cyst was successfully excised as a single mass and the postoperative diagnosis confirmed an odontogenic cyst. One year postoperatively, the patient continues to do well.
While the combined use of EMMM and DALMA for lesions in the posterior maxillary sinus remains a topic of debate, it provided a good outcome in this case.

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Adenomatous goiter and follicular tumor can be differentially diagnosed by ultrasonography and cytology, but the diagnosis can be difficult because of the great histopathologic similarities. The patient was a 51-year-old male. A slowly increasing tumor was found in both lobes of the thyroid gland, and a total thyroidectomy was performed. Pathological examination revealed multiple follicular tumors in the glands, and a final diagnosis of multiple adenomatous goiter with mixed follicular tumors was made. The opinions of several pathologists differed in their interpretations of the diagnosis, depending on which of the findings they considered most important. Since cases of follicular carcinoma with no local recurrence or distant metastasis for more than 10 years have often been reported, careful follow-up is necessary.

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Photoimmunotherapy （PIT） is a treatment for unresectable locally advanced head and neck cancer or locally recurrent head and neck cancer that has become difficult to treat after standard therapies. PIT was approved in Japan in January 2021. PIT enhances the immune response and, when combined with immune checkpoint inhibitors （ICIs）, its effectiveness is amplified. This study presents two cases where PIT was highly effective after ICI treatment. The first case was a 69-year-old male with oropharyngeal squamous cell carcinoma and the second case was a 66-year-old male with recurrent anterior neck cancer. In both cases, complete response （CR） was maintained after one course of PIT for the residual disease following ICI. The combination of PIT and ICIs showed a synergistic effect. Although there is no consensus on the optimal timing for conducting PIT, these results suggest that PIT following ICI treatment may be a highly effective option.

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Clear cell chondrosarcoma （CCCS） is a rare, low-grade chondroplastic bone tumor classified as a distinct subtype of chondrosarcoma. CCCS rarely occurs in the head and neck region. This report presents a case of CCCS involving the hyoid bone, along with a literature review. A 77-year-old Japanese woman presented with a left cervical mass. Imaging via computed tomography and magnetic resonance imaging identified a primary tumor in the hyoid bone. Puncture aspiration cytology indicated a Class Ⅲ diagnosis, raising suspicion of malignancy. The tumor, along with the surrounding connective tissue and adjacent hyoid muscles on the cephalocaudal side of the tumor, were excised. Histopathological analysis revealed clear cells with abundant cytoplasm, either clear or slightly acidophilic. Immunohistochemistry showed S-100 positivity, with cytokeratin （CK） 7, CK18, and CK AE1/AE3 negative. Periodic acid-Schiff-positive granules were also observed in the cytoplasm. Based on these findings, a diagnosis of CCCS was established, with clear resection margins. Long-term follow-up is essential, as CCCS often recurs locally or metastasizes distantly after 5 years.

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Adenosquamous （AdSC） carcinoma of the head and neck is considered a rare variant of squamous cell carcinoma. AdSC is a highly aggressive entity, typically presenting at advanced stages due to its proclivity for local invasion and distant metastasis. The objective of this case report is to highlight the course of treatment in this case in which chemotherapy was effective.
An 81-year-old man presented to the hospital with hoarseness and pharyngeal discomfort. Laryngoscopy revealed a tumor on the right glottis with right vocal cord fixation. Biopsy of the larynx led to a diagnosis of squamous cell carcinoma. A simple CT scan revealed neoplastic lesions in broad contact with the medial cortex of thyroid cartilage, and multiple enlarged right cervical lymph nodes. He was clinically diagnosed with laryngeal squamous cell carcinoma, T3N2bM0, stage Ⅳb. We performed a total laryngectomy and dissection of the right neck as an initial treatment. Postoperative pathological examination showed that he had adenosquamous cell carcinoma and multiple lymph node metastases with extranodal invasion. Since there was a high probability of recurrence, chemoradiotherapy was administered as a postoperative treatment.
During outpatient follow-up, recurrence of multiple lung metastases was observed, so immune checkpoint inhibitors were administered as second-line treatment. However, these were not effective and the tumors grew, so chemotherapy with paclitaxel and carboplatin was administered. There were no adverse events, and distant metastases disappeared.
Adenosquamous cell carcinoma of the larynx has been reported to be refractory to chemotherapy, but chemotherapy after administration of immune checkpoint inhibitors was effective in this case.

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Open partial laryngectomy is an option for function-sparing treatment of early-stage laryngeal cancer, along with radiation therapy and endoscopic resection. However, it is recommended that salvage surgery for recurrent cases after radiotherapy be performed only at centers with more experience, in part because of the small margin of safety for resection.
Vertical partial laryngectomy allows direct visual resection of the tumor with subglottic extension once the laryngeal lumen is opened. However, when the vocal folds on the unaffected side are incised from the subglottis to the supraglottis, it is not possible to do so under direct vision. The thin endoscope assisted resection while confirming the tumor extension in the subglottic region, suggesting that this technique may be performed more widely because it guarantees a reliable resection even though it has a small margin of safety for resection.

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