Objectives: To study the natural history of intratemporal facial nerve schwannomas not associated with facial nerve paralysis.
Patients & Methods: Eleven patients were diagnosed as having facial nerve schwannoma without facial nerve paralysis in the past decade. We examined the clinical and demographic characteristics of these patients, including the gender, tumor site, presence of tumor growth, facial nerve scores from the initial until the last visit, and the initial symptoms.
Results: Two patients developed facial paralysis during the observation period, which improved with steroid therapy, and two other cases gave a history of facial paralysis. In both the cases that showed tumor growth, facial nerve paralysis did not occur.
Conclusions: No correlations were observed between facial nerve paralysis and age or tumor growth. We suggest that the location of the tumor, whether in the anterior or posterior genu, may determine the presence/absence of facial paralysis.

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We perform concurrent S-1, nedaplatin/radiation therapy (SN therapy) for the treatment of patients with head and neck squamous cell carcinoma with concomitant esophageal carcinoma. We report here a case of a patient with hypopharyngeal carcinoma complicated by esophageal carcinoma who achieved significant tumor reduction but subsequently developed rapidly progressing interstitial pneumonia, which had been observed on pretreatment computed tomography (CT), resulting in an unfortunate outcome. A 72-year-old man presented with pharyngeal pain. Laryngeal fiberoscopy revealed a tumor arising from the posterior wall of the hypopharynx and occupying the larynx. Upper gastrointestinal endoscopy revealed a second tumor 35 cm from the incisor teeth. Both tumors were biopsied and diagnosed as well-differentiated squamous cell carcinoma. As metastasis to the left cervical lymph node was detected on CT, a diagnosis of hypopharyngeal carcinoma (T4aN2bM0) with esophageal carcinoma (T1bN0M0) was made and SN therapy started. Although the tumors responded to treatment, achieving complete response on visual examination, the patient developed acute exacerbation of the interstitial pneumonia at the end of the second course of treatment, immediately followed by respiratory failure. Despite the treatment given, the patient showed no response and died.

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We report a case of internal carotid artery rupture caused by acute invasive fungal sinusitis. A 70-year-old man with macroglobulinemia who was on daily treatment with an oral steroid presented with decreased vision of sudden onset in his right eye. CT and MRI showed filling of the right Onodi's cell and sphenoid sinus, with erosion of the lateral wall. Endoscopic sinus surgery was performed immediately, and histopathological examination of the resected material revealed the diagnosis of acute invasive fungal sinusitis. Intensive antifungal therapy was administered. However, 79 days after the surgery, the patient presented with severe bleeding from the nose of sudden onset. Although we could stop the bleeding with a gauze tampon, we could not find the bleeding point. MRA revealed an aneurysm in the right internal carotid artery, so, we embolized the aneurysm with coils. After the embolization, the patient developed neither bleeding nor brain dysfunction.
This case emphasizes the importance of rapid diagnosis by MRA of acute invasive fungal sinusitis of the sphenoid sinus.

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Myxoma in the head and neck region is a relatively rare neoplasm. We encountered a case of myxoma in the submandibular region.
The patient was a 60-year-old man who visited our hospital with a slow growing mass in the neck. MRI showed a well-circumscribed mass under the platysma in the right submandibular region, visualized as a low intensity on T1-weighted images and high intensity on T2-weighted images. Liposarcoma was suspected based on the findings of fine-needle aspiration cytology. The mass was removed carefully with the surrounding fat, to avoid dissemination, under local anesthesia. Histopathological examination confirmed the diagnosis of myxoma.
Preoperative diagnosis of myxoma is difficult, and some myxomas lack a capsule and show infiltration; therefore, a high recurrence rate has been previously reported. When myxoma or mucus production is suspected, the tumor should be treated by complete excision of the tumor with a clear margin.

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[in Japanese]

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