Skull base osteomyelitis is a condition characterized by osteomyelitis of the base of the skull and the temporal bone. This disease occurs under the direct influence of inflammation that has occurred in the external auditory meatus and middle ear, the paranasal sinuses or by hematogenous influence from some remote organs. We report herein on a case of skull base osteomyelitis which presented difficulty in differentiation from a nasopharyngeal carcinoma. The patient was a 66-year-old man who presented with left earache. At a neighborhood medical clinic, he was treated as having acute otitis media but his symptoms were getting worse. Several examinations that included computed tomography and magnetic resonance imaging were performed at the clinic. As a result, a nasopharyngeal tumor was suspected based on some of the examinations, and he was referred to our hospital. We performed a biopsy on several occasions. There were no malignant views. However, the patient started to complain of a headache in addition to the earache, and those symptoms showed a tendency to worsen. Accordingly, we performed a biopsy under general anesthesia. At this biopsy, we gathered many specimens from considerably deep sites, following which a discharge of much pus occurred from the deep biopsy sites. We therefore subjected the biopsies to culture and gram staining. No malignant views were seen at all. After the biopsy, the patient's earache and headache were improved significantly. We were unable to identify the causative agent, but we diagnosed the condition as skull base osteomyelitis based on some of the results of our examination, and we started him on appropriate therapy. Following a 6-week antibiotic treatment, he currently does not have any recurrence of the illness.

　Skull base osteomyelitis is a disease associated with a poor convalescence, so we must diagnose this disease early. Therefore, there are some cases which might suffer from a misdiagnosis, for example a case with difficulty in differentiation from nasopharyngeal carcinoma, or a case which is culture negative. We should thus perform a biopsy under general anesthesia to arrive at a positive diagnosis.

　The “SONAVIA” and “SONAVIA Lock-on System” as assistive devices for fine needle aspiration biopsy cytology for thyroid nodular lesions and cervical lymph nodes Ultrasound-guided fine needle aspiration cytology (FNAC) for lesions such as thyroid nodules and enlarged cervical lymph nodes is presently an essential medical procedure that is frequently performed in clinical practice. Accidental puncturing of important organs may lead to serious consequences such as hemorrhaging. We report an FNAC assistive device that we developed to safely collect samples without the need to completely rely upon the surgeon's skill and expertise.

　The most favorable advantage of robotic surgery is the markedly free movement of joint-equipped robotic forceps under 3-dimensional high-vision. Accurate operation makes complex procedures straightforward and may overcome weak points of previous thoracoscopic surgery. The efficiency and safety improves with acquiring skills. However, the spread of robotic surgery in the general thoracic surgery field has been delayed compared to those in other fields. The surgical indications include primary lung cancer, thymic diseases, and mediastinal tumors, but it is unclear whether technical advantages felt by operators are directly connected to merits for patients. Moreover, problems concerning the cost and education have not been solved. Although evidence is insufficient for robotic thoracic surgery, it may be an extension of thoracoscopic surgery, and reports showing its usefulness for primary lung cancer, myasthenia gravis, and thymoma have been accumulating. However, the spread in the robot-assisted thoracic surgery does not progress as expected at present. Because target area is wide in the thoracic cavity, it is necessary for safe and effective utilization of da Vinci by devising it. There are many problems including education, training, cost, advanced medical care, the insurance publication for the future development.

　Endoscopic sinus surgery (ESS) has become widespread as a standard surgical method for chronic rhinosinisitis (CRS). By the development of various surgical devices such as microdebridder and navigation system, ESS became safer and more adequate compared with conventional sinus operations such as Caldwell-Luc procedure. Especially, microdebridder enables rapid resection and smooth mucosal healing.

　Radical and thorough as well as appropriate removal of the sinus pathology leads the patient recovery from the diseases. On the other hand, inappropriate and rough manipulation during the surgery may cause major complications such as orbital injury and CSF leakage. Above all, prevalence of orbital injury with the use of microdebridder, which resulted in permanent orbital dysfunction, has been increasing.
　Key points for safer and effective usage of microdebrider are as follows,

1. Understand anatomy, especially anatomical relations of basal lamellas and ethmoidal air
　 cells.

2. Examine pre-op CT.
3. Keep a clear and proper field of endoscopic view.
4. Always, watch blade endoscopically.

5. Crush ethmoidal cells with conventional forceps, then debride them with microdebridder.
6. Use debridder not only as blade but also as suction tube.
7. Never press orbital wall and skull base directly with blade.
8. Know about the complications which actually occurred, and then learn how to prevent it.
9. Try to do “mucosal preservation” with microdebridder.

　Microdebridder is very useful tools for smooth mucosal healing. OR time becomes shorter, and the stress for the patients are less. However, this "powered instrument" always have some risk of orbital and cranial complications, which tend to progress rapid. surgeon should first understand such features of this device, then carefully and effectively use it for the better outcomes.

　Three-dimensional imaging (3D-CT) and virtual reality temporal bone simulator would provide accurate anatomical information to perform skull base surgery and useful for preoperative surgical planning and simulation operation.

　We presented a case of trigeminal neurinoma of the parapharyngeal space that involved the middle of the skull base.
　The tumor was resected by the Combination of Orbito-zygomatic approach with transcervical approach, which preserves the facial nerves. This is a useful procedure for accessing to infratemporal fossa or parapharygeal space.

　There have been many techniques described for inferior turbinate reduction, including submucosal turbinoplasty, turbinectomy, and diathermy. Submucosal tissue resection preserving mucosal surface has been recommended against the risk losing the physiologic function of the nose. Here, we described a new technique, submucosal inferior turbinoplasty and neurectomy with the coblater 2 wand ICW. The current surgical technique would be an easy and effective method for the inferior turbinate tissue reduction for the treatment of allergic rhinitis and inferior turbinate hypertrophy.