Surgical treatment of orbital wall fractures includes transnasal, transmaxillary sinus, and transorbital methods, and the transnasal method has been the main method performed in our department. We report a case of L-shaped fracture of the inferior orbital wall in which the fracture extended from medial to lateral along the anterior wall, and then from the anterior wall to the lateral part of the posterior wall. We used a combined transorbital and intranasal approach to treat the fracture. The transnasal approach consisted of endoscopic modified medial maxillectomy, and the transorbital approach was by means of a transconjunctival incision. Traditionally, the intranasal approach has been effective in treating fractures of the posterior infraorbital wall, but it has been difficult to repair anterior fractures, while the transorbital approach is effective for treating fractures of the anterior infraorbital wall, but it has been difficult to repair posterior fractures. The fracture in our patient extended from the anterior to the posterior infraorbital wall. We believe that the combined approach is useful in the treatment of extensive orbital wall fractures and that it is important to select the most appropriate procedure in each case.

Although olfactory dysfunction in children is said to be associated with QOL and higher brain function, it has not been researched in Japan. In this study, we investigated the olfactory identification ability of children with adenoid hypertrophy and compared it with the olfactory identification ability of normal children, and we assessed the effect of adenoidectomy on it. Ten children (nine boys and one girl, mean age 8.30±1.68 years, range 5–12 years), who underwent adenoidectomy at our hospital were the subjects of this study. Scores, i.e., the numbers of correct responses to the Open Essence (OE) test, a card-type odor identification test, were recorded before, 6 weeks after, and 6 months after surgery, and the OE scores were compared with the scores of 168 normal children of the same age. The mean OE score was 6.60±1.20 before surgery, 7.0±1.87 at 6 weeks after surgery, and 8.00±1.48 at 6 months after surgery. The preoperative mean OE score was significantly lower than the score of the normal children (8.03±2.20; p=0.016), but it had improved to be the same as the score of the normal children at 6 months after adenoidectomy (p=0.846). The results showed that children with adenoid hypertrophy had poorer olfactory identification ability compared to normal children, but that surgical intervention may improve it.

Proliferating trichilemmal tumor (PTT) is a rare skin tumor and is more common in women than in men. More than 90% of PTT lesions arise on the scalp, but here we report a case of PTT on the right lower ear.

The patient was a 40-year-old man who had been aware of the tumor for about 10 years. He came to our hospital after the lesion had increased in size over the previous six months. An elastic hard mass measuring approximately 3cm in diameter was observed on the lower part of the right ear. We initially suspected a parotid tumor, but imaging did not show typical signs of a parotid tumors, Warthin tumor, or pleomorphic adenoma. The tumor was resected, and a histopathological diagnosis of PTT was made based on the characteristic presence of trichilemmal keratinization.

PTT can recur and become malignant, but it has not recurred in our patient during the 3-year postoperative follow-up period. We are continuing to monitor the patient’s course with careful follow-up examinations. This case serves as a reminder that skin tumors or skin appendage tumors can occur in the head and neck area.