The patient was a 58-year-old woman who presented to the hospital with the chief complaints of fever, sore throat, and difficulty eating. The patient was diagnosed with acute tonsillitis based on redness and swelling of tonsils and adhesion of white moss. The patient was admitted to the hospital for treatement with intravenous antibiotics. After the antibiotic administration, the patient’s sore throat tended to improve, but fever and swelling of the right tonsil persisted. A blood test showed an abnormally high soluble interleukin-2 receptor (sIL-2R) level of 7,720 U/mL, and malignant lymphoma was considered. The right tonsil was biopsied, and there was no finding of malignant lymphoma. The patient’s symptoms improved with continued antibiotics and the patient was discharged. sIL-2R was normalized two months later, and the swelling of the right tonsil was improved.

Although sIL-2R is known to be elevated in infectious diseases including acute tonsillitis, there have been no reports of abnormally high sIL-2R levels as in this case. In this paper, we report that an abnormally high sIL-2R level can occur in acute inflammation. sIL-2R elevation increases the possibility of malignant lymphoma, but since it is elevated in a variety of pathological conditions, it is important to consider other diseases and the clinical course.

The patient was a 75-year-old man who complained of severe headache for three days and black postnasal discharge just prior to the first consultation. Cranial CT revealed soft tissue concentration shadow and bony defect of the right internal carotid artery (ICA) ridge in the sphenoid sinus. Contrast-enhanced MRI indicated suspected fungal isolated sphenoid sinus disease (ISSD). The patient was hospitalized for further examination and treatment. As angiography showed no pseudoaneurysm in the right ICA, right endoscopic sinus surgery was planned with the Neurosurgeon under preparation for right ICA embolization. Pathological examination of the right sphenoid sinus mucosa and culture diagnosed ISSD with nonspecific inflammation. Similar with this case, patients with ISSD often present with severe headache which is caused by non-specific inflammation. Since slight epistaxis has been reported with ICA injury, we managed this case with full risk assessment and preparation for surgery. As far as we are aware, among 31 cases that exhibited ICA injury and epistaxis, most of the cases revealed pseudoaneurysms of the ICA; however, three cases did not show it. We concluded that it is desirable to take into account ICA damage caused by sphenoid sinusitis, even if a pseudoaneurysm is not found with imaging.

In recent years, the ultrasonic bone scalpel (SONOPET^®) has been used in the fields of neurosurgery, orthopedics, and maxillofacial surgery, as a device for safe and reliable bone removal with minimal risk of soft tissue damage. In the field of otorhinolaryngology, there have been scattered reports of its use in the fields of rhinology and otology, but there have been few reports in the field of head and neck cancer.

In this report, we discuss the use of the SONOPET^® in resection of the maxilla and mandible in six cases of oral cavity, maxillary sinus, and oropharyngeal cancer, and describe its usefulness in these cases.

The SONOPET^® has advantages when performing sagittal segmentation of the mandible or when resecting the bone margins in detail, and when there is soft tissue, such as muscle, on the back surface of the bone to be resected. The disadvantage is that bone resection is more time consuming than it is with a reciprocating caging saw. However, it is also useful for teaching inexperienced osteotomists because it allows for slow and safe instruction with minimal bleeding from the resected bone surface and good intraoperative vision.

In this report, we describe the experience of a patient who was diagnosed as having pharyngeal syphilis after a history of pharyngeal carcinoma, which was difficult to diagnose despite three histological examinations. The patient was a 48-year-old man who developed a sore throat one month prior to his visit to our hospital. He was treated with antimicrobial agents at a previous hospital and his symptoms improved, but he was referred to our hospital for further thorough examination because of residual mucous membrane swelling in the hypopharynx. Laryngoscopy revealed a mucosal eruption from the left larynx to the parietal fossa, and contrast-enhanced CT of the cervical region revealed multiple lymphadenopathy, raising the suspicion of nasopharyngeal carcinoma. After three histological examinations, no malignant findings were found in the pathology results. Additional blood and biochemical tests were performed, and both the Treponema Pallidum Hemagglutination Assay (TPHA) and rapid plasma reagin (RPR) test were positive. The histological examination was reevaluated and spirochetes were detected in the pharyngeal tissue. A diagnosis of second-stage pharyngeal syphilis was made because a syphilitic skin rash was also observed on the head and upper extremities. Ampicillin 1,500 mg/day was administered, and the patient’s findings improved. Pharyngeal syphilis occurs most frequently in the mid-pharynx and rarely in the hypopharynx. It is difficult to suspect syphilitic infection based upon findings from a patient with syphilis, unless the typical pharyngeal mucosa is examined, which is common in the mid-pharynx. However, the number of patients with syphilis continues to increase, and it is necessary to treat patients with pharyngeal syphilis in mind.