Giant Cell Reparative Granulomas (GCRG) often occur in the maxilla and mandible, and there have been few reports of their occurrence in the temporal bone. We experienced a case of complete resection after surgical treatment for GCRG originating from the temporal bone. The case was a 47-year-old female who was referred to our department with the complaints of headache and left ear pain. CT showed a mass lesion on the left skull that was suspected as extending to the tympanic chamber, middle skull base, and temporomandibular joint fossa. A biopsy from the middle ear revealed a giant cell granuloma. Lateral temporal bone resection, middle skull base combined resection, and temporomandibular joint combined resection were performed, and the tumor was completely removed. The dura mater defect site was reconstructed with the temporalis fascia, and the temporomandibular joint/zygomatic bone resection site was reconstructed with a serratus anterior flap with ribs. The patient received a good diet with a blender after the operation, and was discharged from the hospital about 2 weeks after the operation. Conductive hearing loss due to closure of the ear canal became apparent, but facial nerve and inner ear functions were preserved. GCRG has a high recurrence rate when total removal is difficult, and complete removal is desirable whenever possible. In this case, we report that a favorable postoperative course was obtained by performing total tumor resection jointly with neurosurgery and formative surgery.

[Background] A workshop for endoscopic sinus surgery (ESS) is important as a place of education to ensure the quality of surgery and maintaining safety. In Japan, the first ESS workshop was conducted in our department in 1993. The content was mainly about basic procedures and measures for complications; however, it has gradually been changing. We administer questionnaires to the trainees in order to evaluate and improve the quality of the workshop. In this report, we will summarize the results of the questionnaires for the past 5 years and discuss the evaluation and transition of the ESS workshop.

[Method] We provided an anonymous self-administered questionnaire survey to all 237 participants from 2013 to 2017. We then tallied the results of 64 of the 142 trainees who responded to the questionnaire and analyzed each item. The transition of the training sessions was then examined based on past data.

[Results] During the last five years, all of the participants evaluated the workshop as “good” throughout the training. The most evaluated lecture was “complications/bleeding and how to deal with them”. The workshop content had changed over time.

[Discussion] The participants of the workshop were highly satisfied, and the content was well received. The workshop is considered important for ensuring the quality of surgery and passing on the safety considerations. In the future, it is expected that the content will be further improved by examining not only the degree of satisfaction at the time of attending the course, but also the ripple effect thereafter.

A 48-year-old woman presented to our ENT department with a history of feeling something wrong with her throat and hoarseness. Endoscopic examination revealed vocal cord polyp and oropharyngeal papilloma, and we decided to perform laryngomicrosurgery. The anesthesiologist used propofol and remifentanil during the induction and we achieved direct laryngoscopic exposure. The patient developed severe bradycardia, which led us to administer atropine. Shortly thereafter, the patient went into asystole. We immediately removed the laryngoscope and performed chest compressions. After 30 seconds, she regained spontaneous circulation and sinus rhythm. We believe the phenomenon was caused by vagal reflex with direct stimulation of the larynx. Therefore, the patient underwent temporary pacemaker insertion prior to the second surgery. She again developed bradycardia during the reoperation but recovered after the quick administration of atropine. The operation was then completed with no further events.

Anesthesia with the combination of propofol and remifentanil is known to cause parasympathetic dominance, and laryngeal expansion is a procedure that can stimulate a vagal reflex. Vital signs should be monitored in collaboration with the anesthesiologist during laryngomicrosurgery, as the appearance of bradycardia requires a prompt response with atropine.

Epstein-Barr virus-positive mucosal skin ulcers (EBVMCU) have a relatively good prognosis among the diseases classified as EB virus-positive lymphoproliferative disorders. We experienced a case that was first diagnosed as acute epiglottitis and treated with antibacterial drugs, but the improvement was poor. An ulcerous lesion subsequently appeared on the epiglottis, and a biopsy was performed considering the possibility of a malignant tumor. Finally, we diagnosed the lesion as an EBVMCU.

EBVMCU often develop with the use of immunosuppressive drugs, and most of them are therefore improved by reducing or discontinuing the drugs used. Some of them may have an underlying disease that causes immunodeficiency, such as AIDS, as in this case, and in such circumstances, treatment of the causative disease is necessary.

Since it is important to distinguish intractable ulcerative lesions in the oral cavity and pharynx from head and neck cancer, histopathological examination by biopsy is critical. On the other hand, since histopathological findings are similar to malignant lymphomas, such as cHL and DLBCL that require differentiation from EBVMCU, a full medical history, including the use of immunosuppressive drugs, blood test findings and localization of lesions, is also an important indicator. In addition, infection prevention measures should be taken while paying attention to the possibility of infectious diseases at the time of examination.