Concurrent chemoradiotherapy （CRT） with high-dose cisplatin is the standard non-surgical treatment for advanced head and neck cancer. However, treatment-related complications such as weight loss and muscle wasting are known prognostic factors that can negatively affect clinical outcomes. This retrospective study evaluated the effectiveness of supportive interventions, including in-hospital physical rehabilitation and the use of Kampo medicines （Rikkunshito and Ninjinyoeito）, administered during CRT.
The introduction of rehabilitation led to a statistically significant reduction in weight loss compared to no intervention （p＜0.05）. While the change in skeletal muscle index （SMI） did not differ significantly among the groups, there was a trend toward reduced SMI loss in patients who received rehabilitation and Kampo medicines.
Importantly, the incidence of grade ≥3 infectious complications during CRT was significantly lower in the Ninjinyoeito group compared to the other groups （p＝0.007）. Neither rehabilitation nor Kampo medicine administration was associated with an increase in other CRT-related adverse events, suggesting that these interventions are safe.
These findings suggest that physical rehabilitation and Kampo medicines may serve as safe and effective supportive therapies during CRT. They appear to help preserve body weight and muscle mass, and may reduce the risk of severe infectious complications, thereby improving treatment tolerance and clinical outcomes in patients undergoing CRT for head and neck cancer.

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Thyroid surgery is commonly performed; however, when severe postoperative complications such as hemorrhage or airway obstruction occur, prompt intervention is required. In this retrospective study, we analyzed 471 cases of thyroid surgery performed at our institution between 2017 and 2024 to investigate risk factors for postoperative complications requiring emergency management. Postoperative complications occurred in 9 cases （1.9%）, including 7 cases of hemorrhage and 3 cases of airway obstruction （with overlap）. Multivariate analysis identified operative time ≥130 minutes, blood loss ≥80mL, total thyroidectomy, and Graves’ disease as independent risk factors. In high-risk cases, the use of intraoperative nerve monitoring and consideration of staged surgery may contribute to improved safety. This study highlights the importance of early detection and preventive management of postoperative complications.

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Recurrent laryngeal nerve （RLN） injury after thyroid surgery can cause severe voice dysfunction. While autologous nerve grafting has been the standard, it presents challenges such as donor site morbidity. This study retrospectively analyzed 11 cases （4 males, 7 females, median age 60 years） of RLN reconstruction using artificial nerve conduits. Nerbridge® was used in 6 cases and ReNerve® in 5, with nerve anastomosis or nerve transfer performed based on the nerve defect length.
Postoperatively, recovery of voluntary vocal cord movement was not observed in any patient. However, some cases showed improvements in voice function, such as extended maximum phonation time and better GRBAS scores, suggesting the potential utility of artificial nerves. No wound complications or foreign body reactions attributable to the artificial nerves were noted, indicating their safe applicability.
This study demonstrates that artificial nerve conduits can be technically applied to reconstruct the motor RLN and potentially contribute to voice function preservation or improvement under specific conditions. This offers a safe and feasible option, especially when autologous nerve procurement is difficult. Nevertheless, further evidence is crucial, requiring increased case numbers, objective functional assessments including electrophysiological analyses, and long-term follow-up studies.

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Objective: The purpose of this study was to examine factors associated with local recurrence and neck metastasis in transoral endoscopic surgery.
Patients and Methods: Ninety-two lesions in 87 cases of transoral surgery for malignant pharyngeal or laryngeal tumors were included in the study. The following items were examined: occasion of discovery, other multiple cancers, treatment details, relationship between final pathology recurrence/metastasis, and treatment outcomes.
Results: 59.8％ of cases were detected during upper gastrointestinal endoscopy. Metachronous multiple primary cancers were observed in 78.2％. Tracheostomy was performed concurrently in 9.4％, and postoperative dysphagia occurred in 5.7％. The negative margin rate in permanent pathology was 75.0％. Local recurrence occurred in 7.8％, and distant metastasis was present in 4.8％ of cN0 cases.
Summary: In transoral endoscopic surgery for pharyngeal or laryngeal carcinoma, the local recurrence rate was higher in cases with positive margins/close margins and prior radiation therapy. The neck metastasis rate was higher in cases with cT2 or higher tumor stage, positive margins/close margins, and tumor thickness of 1mm or greater.

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A retrospective study was conducted to evaluate risk factors for postoperative hypocalcemia in primary hyperparathyroidism （PHPT）, using the need for calcium supplementation as a surrogate marker. Among 74 patients who underwent initial surgery for PHPT, 70 patients with surgical success were included in the analysis, and 13 patients （18.6%） required calcium supplementation within one month postoperatively. Multivariate analysis identified preoperative intact parathyroid hormone levels ≥195pg/mL as an independent risk factor （odds ratio＝8.02, 95%CI: 1.47-43.80, p＝0.016）. Only 4 patients （5.7%） required calcium supplementation beyond one month, with no significant predictors identified.

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In cases of thyroid cancer with mediastinal extension or mediastinal lymph node metastasis, surgery is recommended not only for tumor control but also airway preservation and protection of the great vessels, but there are no clear guidelines on surgical methods. In this study, we reviewed eight cases of thyroid cancer that underwent osteotomy at our department between January 2016 and December 2023. Surgical procedures included L-shaped osteotomy in two cases, partial resection of the manubrium and clavicle in two cases, and the transmanubrial osteomuscular sparing approach in three cases. The surgical method was selected based on the localization of the lesion, and all surgeries were performed solely by our department. Of the eight cases, five were differentiated carcinoma and three were non-differentiated carcinoma. Complete resection was achieved in all five cases of differentiated carcinoma. Surgical complications associated with osteotomy included major vessel injury in two cases and wound infection in one case. We conclude that the choice of surgical approach based on tumor localization is critical, and that osteotomy is a safe and effective surgical approach.

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We retrospectively investigated the treatment outcomes of salvage surgery for locoregional recurrence after definitive （chemo）radiotherapy in patients with hypopharyngeal cancer. A total of 179 patients with hypopharyngeal cancer treated at Kobe University Hospital between 2012 and 2020 were included in this study. We analyzed the recurrence rate, salvage surgery rate, postoperative complications, and survival outcomes. Salvage surgery was performed in 81％ of recurrent cases, and the 3-year overall survival rate in the salvage surgery group was 74％, demonstrating favorable outcomes. On the other hand, postoperative complications, including pharyngocutaneous fistula, were frequent, and salvage surgery was associated with a significantly higher risk of complications compared to primary surgery. With the increasing demand for salvage surgery in the management of hypopharyngeal cancer, strategies to detect recurrence at an early stage through strict follow-up protocols, enhancement of postoperative care, and intraoperative techniques to reduce complications have become essential issues. Further efforts are required to improve treatment outcomes and to develop new strategies that can reduce the morbidity associated with salvage procedures while maintaining oncologic control. Our findings highlight the critical role of timely salvage surgery and meticulous perioperative management in improving prognosis for patients with recurrent hypopharyngeal cancer after （chemo）radiotherapy.

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Intraductal carcinoma （IDC） of the salivary gland is a disease entity newly defined in the 4th edition of the WHO Classification of Head and Neck Tumors in 2017. Previously, it had been referred to as low-grade salivary duct carcinoma or low-grade cribriform cystadenocarcinoma. Here, we report a case of parotid gland carcinoma diagnosed as IDC. The patient was a 70-year-old man who presented to our department with a gradually enlarging mass in the right preauricular region for five months. Suspecting parotid carcinoma, we performed a superficial parotidectomy of the right parotid gland for both diagnostic and therapeutic purposes. The tumor was adherent to the communicating branches between the zygomatic and buccal branches of the facial nerve, necessitating partial resection of the nerve. Histopathologically, the tumor was composed of mainly intraductal cribriform or papillary proliferation of tumor cells with apocrine differentiation and low- to high-grade atypia, leading to a diagnosis of intraductal carcinoma, apocrine type. This subtype requires careful differentiation from salivary duct carcinoma （SDC）, given their overlapping immunohistochemical features. Moreover, the apocrine type of IDC may represent a precursor lesion to SDC, and thus close long-term follow-up is warranted.

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Traditional maxillectomy is often difficult to manipulate in the posterior region, which is located deep in the face. Recently, the usefulness of endoscopic assistance has been reported as a method to ensure the posterior margin. In this study, we describe a case of endoscopic-assisted partial maxillectomy.
The patient was a 22-year-old male who underwent endoscopic-assisted partial maxillectomy for a stemmed mass of the right hard palate. The tumor was resected en bloc with the posterior margin under clear view with endoscopic modified medial maxillectomy （EMMM）, and transoral corridor.
In traditional maxillectomy, it is difficult to resect the posterior margin under clear view and it is sometimes difficult to secure an accurate surgical margin. The addition of endoscopic assistance to maxillectomy allows the posterior margin to be manipulated under clear view for more accurate resection, which may contribute to a reduction in recurrence.

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Pregnancy-associated malignant tumors have been reported to occur in approximately 0.1％ of pregnancies in Japan, with thyroid cancer accounting for 3.8％ of these cases. We report two cases of pregnancy-associated advanced thyroid cancer diagnosed during the first trimester of pregnancy. In both cases, disease progression during pregnancy was suspected based on ultrasound and contrast-enhanced CT findings, and surgical intervention was performed during the second trimester prior to delivery.
Although thyroid cancer is generally considered a slow-growing malignancy with a favorable prognosis, some cases may demonstrate rapid growth or invasion into adjacent organs, potentially compromising survival and quality of life. Therefore, in cases of pregnancy-associated thyroid cancer, it is essential to determine the optimal treatment approach and timing by considering the biological behavior of the tumor, as well as the health and safety of both the mother and fetus. This report also discusses current trends in domestic and international clinical guidelines.

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Concurrent chemoradiotherapy （CCRT） is the standard treatment for unresectable, locally advanced head and neck squamous cell carcinoma （HNSCC）. Among the available radiotherapy techniques, intensity-modulated radiation therapy （IMRT） enables precise and selective irradiation of tumors while sparing surrounding healthy tissues. However, the accuracy of IMRT requires the use of immobilization devices, such as thermoplastic masks, which can induce significant psychological distress in patients with claustrophobia, potentially hindering treatment initiation or completion.
Both pharmacological treatment and cognitive behavioral therapy （CBT） have been reported as effective interventions for claustrophobia. We report a case of a patient with unresectable, locally advanced HNSCC who initially could not undergo radiotherapy due to severe claustrophobia triggered by the fixation mask. Induction chemotherapy was initiated as a bridging strategy, during which CBT was concurrently implemented. The patient gradually overcame her fear through structured psychological interventions, including education about the treatment process, mask desensitization, and coping strategies. As a result, she was ultimately able to undergo and complete IMRT successfully.
This case highlights the importance of integrating CBT into the multidisciplinary management of patients with claustrophobia undergoing radiotherapy for head and neck cancer. Early identification of psychological barriers and the provision of targeted psychological support during the pretreatment phase, such as the period of induction chemotherapy, may improve adherence to curative-intent therapy. This case underscores the value of CBT as an integral component in supporting patients with psychological barriers, facilitating the successful completion of standard oncologic therapy.

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Parathyroid carcinoma is a rare disease; however, due to the risk of tumor seeding during surgical manipulation, it is crucial to suspect malignancy preoperatively and plan surgery accordingly. We report three cases of parathyroid carcinoma encountered between January and July 2023, in which preoperative neck ultrasonography raised suspicion of malignancy, allowing appropriate surgical intervention.
In all three cases, neck ultrasonography revealed irregularly shaped and poorly defined masses located at the lower pole of the thyroid gland, leading to a preoperative suspicion of parathyroid carcinoma. Surgery was subsequently performed. Postoperative pathological examination confirmed the diagnosis of parathyroid carcinoma, revealing invasion into the right recurrent laryngeal nerve, the thyroid gland, and the surrounding adipose tissue.
These findings suggest that irregular shape and poorly defined margins on neck ultrasonography are important features suggestive of parathyroid carcinoma.

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Pharyngeal fish bone foreign bodies are commonly encountered. They are usually located in the tonsils or at the base of the tongue and can be removed easily. However, in some cases, the foreign body migrates outside the pharynx and cannot be identified by fiberscope, making removal difficult. We report a case of an extra-pharyngeal foreign body that was successfully removed under laryngoscopy without the need for an external cervical approach.
A 75-year-old woman with Parkinson’s disease presented with sore throat after swallowing yellowtail. She first visited a local otolaryngologist, but the bone could not be identified under fiberscope. She was then referred to the gastroenterology department for removal. A foreign body was detected in the right piriform sinus, however retrieval was unsuccessful. The patient was subsequently referred to our department for further management. Computed tomography （CT） revealed the bone embedded in the wall of the hypopharynx. As her symptoms had subsided, she was initially managed conservatively with close observation.
Two weeks later, CT showed that the bone was still in the hypopharyngeal wall, and so we decided to proceed with removal under general anesthesia. Using a Weerda laryngoscope, we incised the posterior wall of the hypopharynx with a needle-shaped electrosurgical knife and successfully extracted the bone. The patient was discharged the following day without pharyngeal bleeding or other complications.

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