We analyzed the data of 39 patients who had undergone endoscopic sinus surgery for sinonasal inverted papilloma (IP) over the past 8 years and were followed up for half a year or more after the surgery. For this retrospective study performed in the 39 patients, we collected data from the medical records about the background characteristics of the patients, the follow-up period, about whether these patients had undergone the first operation or reoperation, the extent of the IP, the operative procedure, the recurrence rate, the interval to recurrence, and the site of recurrence.

　There were 26 men and 13 women with an average age of 54.9 years, and the mean follow-up period was 30.44 months. The surgery was the first operation in 36 cases, and reoperation in 3 cases. The Krouse stage was 1 patient in stage T1, 11 in stage T2, 27 in stage T3 and 0 in stage T4. Of the 39 cases, 18 were treated by ESS with an additional endoscopic approach, and 1 patient was treated not only by ESS, but also by the Caldwell-Luc procedure. There were 2 cases with recurrence (5.13%). In one case, the recurrence occurred in the maxillary sinus 18 months after the operation, and in the other, the recurrence occurred in the ethmoid and frontal sinus at 12 months after the operation and at 30 months after the reoperation.

　In order to further reduce the risk of recurrence, I think it would be useful to not only evaluate the origin of the IP before the operation, to remove the origin of the IP completely under clear endoscopic view by segmental resection, and scratch the bone thickening area, but also ensure a study of the margin, and not hesitate to perform expanded surgery in reoperation cases.

　Facial nerve decompression is often indicated in cases of traumatic immediate facial palsy, because of the low cure rate of traumatic immediate facial palsy. Although there is no clear standard regarding the timing of treatment, it has been reported that for treating immediate paralysis, it is desirable to perform facial nerve decompression within 2 weeks. However, traumatic facial palsy is often accompanied by disturbance of consciousness and delayed diagnosis of paralysis or otologic examinations, and it is often difficult to actually perform surgery within two weeks.

　We encountered 2 cases of traumatic immediate facial paralysis. Both cases showed complete paralysis of the nerve, and because of early consultation with the otolaryngologist, surgery could be performed within two weeks after the injury. As a result, the facial nerve score in the first case improved from 8 to 36, meeting the healing criteria, and that in the second improved from 6 to 28.

　In facial nerve decompression, it is common to consider the indications for surgery after conducting prediction tests, such as ENoG, within 1 week to 10 days of onset. However, in order to further improve the cure rate, in the case of complete paralysis in cases of immediate paralysis, correspondence that is different from that for late paralysis and other causes of facial nerve paralysis is required. Also, in order to perform surgery early, collaboration with other departments and regional collaboration are also important.

　Bilateral internal jugular vein ligation is associated with increased intracranial pressure and is a dangerous procedure that can sometimes lead to death. Therefore, cases requiring bilateral internal jugular vein ligation are, in principle, considered as unsuitable candidates for surgery. Herein, we report a patient with cervical lymph node metastasis from an unknown primary tumor. The Patient have previously undergone contralateral radical neck dissection. Findings of imaging suggested the presence of a metastatic cervical lymph node suspected to be partially infiltrating the internal jugular vein on the contralateral side. Therefore, internal jugular vein reconstruction using the great saphenous vein was planned in advance, and an autologous patch of the great saphenous vein was prepared for the internal jugular vein defect site. The internal jugular vein was blocked for 45 minutes. Neck dissection could be performed safely without any serious intraoperative complications. After the surgery, good perfusion of the preserved internal jugular vein was also observed. In the future, if there is a compelling need for bilateral internal jugular vein ligation, it is necessary to actively consider revascularization in order to avoid the serious complications associated with the potential increase of the intracranial pressure associated with ligation.