Sinus fungal infections are classified into four categories: acute invasive, chronic invasive, chronic non-invasive, and allergic fungal rhinosinusitis (AFRS). Acute invasive sinonasal rhinosinusitis is associated with various symptoms, such as visual impairment and cerebrovascular disease, and has a very poor prognosis (50%). We herein report a case of sinus fungal infection leading to internal carotid artery involvement and cerebral infarction along with a review of the literature. The patient was a 78-year-old male. His chief complaint was pain in the back of his left eye, of which he had been aware for two weeks prior to visiting our hospital. While he had been monitoring his progress, his symptoms showed little improvement, so he came to see us. He had a history of drug-induced pneumonia and was administered methylprednisolone. Based on the findings of computed tomography of the sinuses and head contrast magnetic resonance imaging, a diagnosis of fungal sinusitis was made, and the patient was scheduled for surgery on the same day. During hospitalization, the patient developed internal carotid artery involvement and cerebral infarction due to an acute invasive sinus-type fungal infection and underwent bypass surgery. This patient was in the high-risk group in terms of long-term steroid use and immunodeficiency due to malignancy, so it is important to always consider intraorbital and intracranial complications.

Fisher syndrome is an autoimmune disorder characterized by an acute onset of external ophthalmoplegi, ataxia, and decreased tendon reflexes. It is a subtype of Guillain-Barré syndrome (GBS). We herein report the case of a patient who initially presented with acute sinusitis and was subsequently diagnosed to have Fisher syndrome after undergoing a challenging diagnostic process. The patient was a 33-year-old man who exhibited extraocular muscle paralysis that had progressed from the initial sinusitis. Imaging findings led to the suspicion of partial thrombosis in the cavernous sinus and narrowing of the internal jugular vein, thus leading to a diagnosis of cavernous sinus thrombosis complicated by Lemierre’s syndrome. The administration of antibiotics and thrombolytic therapy were initiated. The patient’s extraocular muscle paralysis was resistant to treatment, and his complaints of unsteadiness persisted. We considered Fisher syndrome in the differential diagnosis and performed a test for anti-GQ1b IgG antibodies in the blood serum. The blood test results were positive for anti-GQ1b IgG antibodies, thus leading to the patient’s diagnosis of Fisher syndrome. In cases presenting with refractory extraocular muscle paralysis and ataxia, it is extremely important to conduct a thorough examination while carefully considering Fisher syndrome in the differential diagnosis, including testing for anti-GQ1b IgG antibodies in the blood serum.

Lemierre’s syndrome is an infection of the head and neck region, as typified by the oropharynx, which leads to thrombophlebitis of the internal jugular vein and severe systemic symptoms, such as septic embolization and the development of remote-infected abscesses. Antimicrobial agents have led to a decrease in mortality rates, however, an early diagnosis and timely treatment remain necessary. In this report, we describe a case of Lemierre’s syndrome in which the patient suffered extensive thrombosis due to unilateral sinusitis but was successfully treated without any sequelae. A 45-year-old male, was brought to our emergency department with a consciousness impairment. Contrast-enhanced CT tomography showed bilateral external jugular veins, bilateral internal jugular veins, bilateral transverse sinuses, and a left sigmoid sinus. In addition, ground-glass nodules were observed in both lungs, thus raising the suspicion of Lemierre’s syndrome. Left pan-sinusitis was suspected as the causative infection, and left endoscopic sinus surgery was performed under general anesthesia. After surgery, there was a rapid improvement in the patient’s physical condition and clinical symptoms. Based on a review of 16 cases of Lemierre’s syndrome due to sinusitis that have been reported to date, it is difficult to definitively conclude that surgical intervention improved the prognosis. However, it is important to consider the timing of surgical intervention as well as to select the appropriate antimicrobial therapy.

Actinomycosis is a chronic granulomatous disease caused by anaerobic Gram-positive rods belonging to the genus Actinomyces. These bacteria normally colonize the oral cavity without harming the human body. However, they become pathogenic when the immune system is compromised due to tissue damage and infection. Approximately 40% of all such cases occur in the head and neck region; however, actinomycosis is rarely found in the paranasal sinus. We herein report a case of actinomycosis of the paranasal sinus that was initially suspected to be fungal rhinosinusitis. A 66-year-old man was referred to our department for further examination and treatment of a tumor in the maxillary sinus, which was detected on computed tomography (CT). Sinus CT revealed calcification, and T2-weighted MRI revealed hypointense areas in the right maxillary sinus. CT and MRI led to a clinical diagnosis of fungal rhinosinusitis. Therefore, we performed a biopsy and endoscopic sinus surgery under local anesthesia. The bacterial culture revealed the presence of Actinomyces. At 2 months after the operation, the postoperative course was uneventful. Actinomycosis of the paranasal sinus is difficult to differentiate from fungal rhinosinusitis based on the clinical course and diagnostic imaging. Although surgical treatment is the first choice of treatment, antimicrobial therapy is also an option. If a unliteral calcified lesion is observed in the paranasal sinus and fungal rhinosinusitis is suspected, then actinomycosis should be considered in the differential diagnosis.

We performed a retrospective observational study of 148 patients who were treated for laryngeal cancer at the Department of Otolaryngology, Head and Neck Surgery, Jikei University Kashiwa Hospital, between January 2015 and December 2020. The median patient age was 74 years old. The subsites were glottis (n = 120), supraglottic (n = 25), and subglottic (n = 3). The clinical stage was 0 = 4, I = 57, II = 35, III = 27, and IV = 25. The initial treatments were surgery, radiation alone, chemoradiotherapy, induction chemotherapy, and palliative treatment in 60, 68, 9, 2, and 9 patients, respectively. The median observation period was 48.3 months. The 5-year overall survival (OS) rate was 65.7%. Of the 139 patients who received curative treatment, the 5-year OS was 70.1%, and the 5-year disease-free survival (DFS) was 61.4%. Among the 38 patients who underwent total laryngectomy, the 5-year OS rate was 56.1%, and the 5-year DFS rate was 50.0%. Total laryngectomy cases were compared between groups divided by (≥ 75 years old) and presence of overlapping cancers, but no significant difference was found in the OS in either set of groups. The prognosis of patients treated for radical laryngeal cancer in our department was the same as that in previous studies, and age and the presence of overlapping cancers were not prognostic factors in total laryngectomy.