The guidelines from the American Academy of Sleep Medicine and the Japanese clinical practice guidelines for sleep apnea syndrome (SAS) both have algorithms for diagnosing and treating SAS. These guidelines both describe the need to evaluate patients with sleep apnea requiring treatment for upper respiratory obstructive disease and maxillofacial malformation and to consider surgery after evaluation. However, there have been few reports indicating how many patients complain of sleep-related disorders exhibit both upper airway obstruction and maxillofacial malformation. The subjects were 744 patients, aged 18 years or older, who visited the Ota Memorial Sleep Center from January 1 to December 31, 2017. Each subject underwent overnight polysomnography (PSG), temporal head x-ray (cephalogram), upper airway examination by an otorhinolaryngologist, computed tomography (CT), and rhinomanometry. We analyzed the frequency of upper respiratory obstructive disease and maxillofacial malformation. The maxillofacial morphological frequency of −1SD or less was 3.5% for the maxillary index, 7.5% for the mandibular index, and 30.0% for the submandibular growth index. The frequency of cases considered for treatment by otolaryngologists, tonsillar hypertrophy was 16.1%, deviated nasal septum was 13.0%, and chronic sinusitis was 18.0%. In this study, it was clarified that there is a certain proportion of upper respiratory tract-related risks among patients who consult with complaints of sleep-related disorders.

Tracheostomy for patients with low lying larynx, obesity, or brevicollis is sometimes difficult to perform because of limitations of the surgical view and troublesome postoperative management. Cricotracheostomy is useful for such patients in spite of the partial removal of the cricoid cartilarge. We reviewed 14 cases of cricotracheostomy that were performed at our department and examined the effectiveness of the procedure.

Overall, 10 of 14 patients presented with low lying larynx, obesity, and brevicollis; however, there were no major complications, such as reinsertion difficulty and subcutaneous migration of the cannula. Moreover, 5 of 14 patients underwent long-term intubation for pneumonia associated with coronavirus 2019 (COVID-19). To shorten the time from fenestration to cannula placement, we developed an inverted U-shaped fenestration procedure. In 2 of 14 patients, surgery was performed under local anesthesia owing to upper airway obstruction caused by a tumor. Notably, cricotracheostomy was considered a safe procedure as the cricothyroid membrane and operative field are adjacent; moreover, if asphyxiation were to occur during surgery, the procedure could be changed to cricothyroidotomy. In 4 of 14 patients, the stoma was closed. Follow-up examination at 6 months after closure revealed no complications, such as airway stenosis.

Cricotracheostomy is a safe procedure for patients with low lying larynx, obesity, and brevicollis. Furthermore, this procedure can be used for long-term intubation in patients with COVID-19 pneumonia, under local anesthesia, and in cases where laryngeal stoma closure is possible. However, because of the possibility of long-term complications, patient selection should be performed carefully.

In response to the results of the CheckMate 141 study, we started treatment with nivolumab for recurrent and metastatic head-and-neck squamous cell carcinoma (HNSCC) in October 2017. In this study, we examined whether nivolumab could prolong the prognosis in clinical practice. The subjects were patients who underwent palliative treatment for recurrent and metastatic HNSCC at our hospital from January 2010 to October 2019. We then extracted the nivolumab administration group and the pre and post nivolumab insurance listing groups, and divided them according to the availability of nivolumab administration after October 2017. The 1- and 2-year survival rates of the nivolumab administration group were 58.9% and 46.6%, respectively, which were higher than the CheckMate 141 study. In the pre and post nivolumab insurance listing groups, the overall survival rate was higher in the post group (the 1-year survival rates were 43.9% in the pre group vs. 70.5% in the post group, and the 2-year survival rates were 21.7% and 57.2%, respectively) (p < 0.001). The early Best Supportive Care (BSC) transition rate was lower in the post group (the BSC transition rates within 1 year after the start of palliative treatment were 52.3% in the pre group and 9.3% in the post group). In conclusion, the effect of nivolumab to prolong prognosis can be confirmed at our hospital, and the patients who receive BSC at an early stage have decreased because of the increase in treatment options for palliative drug therapy due to the development of nivolumab.

Bilateral facial nerve palsy is very rare and systemic disease must be considered as a cause. We present a case of bilateral facial nerve palsy caused by otitis media with antineutrophil cytoplasmic antibody (ANCA) -associated vasculitis (OMAAV).

The patient was an 80-year-old man. He became aware of left hearing loss and left ear pain two months ago. This was preceded one month earlier by the appearance of a left facial nerve palsy, which was treated as left Bell’s palsy but did not resolve. The patient subsequently developed right facial nerve palsy and came to our clinic for examination. At that time, the facial nerve palsy score was 12 points bilaterally, and no cause was found. We suspected bilateral Bell’s palsy and treated the patient in the hospital, but there was no improvement. MPO-ANCA was positive and we suspected OMAAV. After consulting with an internist, the patient was transferred to a specialised hospital. At 3 months from the onset, the patient had a bilateral facial nerve palsy score of 2. Four months after the onset, cardiac arrest occurred during rituximab use and cardiopulmonary resuscitation was performed. Seven months after the onset, the facial nerve palsy score was 14, and the score has not changed since then. OMAAV should be considered in the differentiation of bilateral facial paralysis.