Although elective neck dissection （END） for early oral squamous cell carcinoma （OSCC） has low morbidity and mortality and is recommended as a treatment strategy, it is inevitable due to the nature of the procedure and many surgeries are performed unnecessarily. In Europe and the United States, sentinel node navigation surgery （SNNS） has been explored in clinical trials as a tool for managing early OSCC, which may help avoid unnecessary END. In Japan, we have encouraged the clinical use of SNNS in a domestic multi-institutional joint research. A phase Ⅲ randomized trial including 271 OSCC cases, which aimed to compare SNNS with END, found that the overall and disease-free survival rates did not differ, and the scores of neck functionality in the SNNS group were significantly better. It is anticipated that as the concept of SNNS becomes more widespread in the future, it will be necessary to subdivide micrometastases.

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Background: In the treatment of cancer in the elderly, we experience cases in which the outcomes cannot be followed as planned even if wound healing is good. In recent years, it has been globally recommended to carry out a geriatric assessment （GA） to identify risks in advance and perform necessary interventions.
Materials and methods: GA was performed from August 2019 to March 2020 for 105 patients aged 65 and over who were scheduled for surgery in our department. We conducted a retrospective study to investigate the relationship between GA and postoperative outcomes, such as complications, delirium, and non-home discharge.
Results: Non-home discharge was positive for IADL in all cases and was associated with MOS and reconstructive surgery （p=0.01, 0.01）. All cases had gastrostomy or tracheal stoma. Reconstructive surgery tended to be associated with both complications and delirium （p=0.08, 0.05）.
Consideration: Non-home discharge is considered to be highly probable in case of postoperative gastric fistula or tracheal stoma, IADL positive, and MOS positive or reconstructive surgery.
Conclusions: GA was performed on elderly patients scheduled for surgery in our department, and a relationship between non-home discharge and GA tools was found.

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Enhanced Recovery After Surgery （ERAS） is a package of various evidence-based perioperative management methods that enhance the quality of postoperative recovery. The Japanese version of the Quality of Recovery score （QoR-40J） is a clinical outcome which is widely used to evaluate the quality of recovery after surgery under general anesthesia. We evaluated the quality of recovery using the QoR-40J in 10 patients who had been managed according to our ERAS protocol for head and neck surgery followed by free tissue transfer reconstruction. We were able to conduct the ERAS protocol safely and to obtain QoR-40J scores in all patients. The mean overall score of QoR-40J significantly decreased from the day before surgery to postoperative-day （POD） 1, and tended to recover gradually from POD 2 to POD 7. It was suggested that the score trends of QoR-40J reflected the quality of recovery after head and neck surgery followed by free tissue transfer reconstruction. We would like to use the QoR-40J as an indicator to improve perioperative management and to construct a new standard of the ERAS protocol for head and neck surgery.

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The aim of this study was to examine oral intake status and AsR score, which is a simplified evaluation method for videofluoroscopic examination of swallowing （VF）in patients with hypopharyngeal and laryngeal cancer undergoing chemoradiotherapy （CRT）. A total of 24 patients, 15 with hypopharyngeal cancer and 9 with laryngeal cancer, were enrolled. We retrospectively investigated the results of VF and the use of nasal tube feeding in three periods: the start of CRT, at 1 month of CRT, and at the end of CRT. As a result, 7 of the 24 patients required nasal tube feeding at the end of CRT. The mean radiation dose at the start of nasal tube feeding was 45.4Gy. The mean number of days from the end of CRT to the end of nasal tube feeding was 22.0 days, and the mean number of days of using nasal tube feeding was 41.6 days. Using Receiver Operating Characteristic （ROC） analysis, the cut-off value of AsR score where oral intake was possible at one month after the start of CRT was 6. AUC （area under the curve）was 0.789.
According to this study, an AsR score of 6 or higher at one month after the start of CRT would be useful in determining whether oral intake can be continued.

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Although malignancies of the eyelid are relatively rare, it is necessary to know the characteristics of eyelid malignancy because head and neck surgeons are required to treat patients with cervical lymph node metastases. We report a case of primary squamous cell carcinoma of the lower eyelid conjunctiva with parotid and cervical lymph node metastases. The patient was an 80-year-old woman. She had been diagnosed as having conjunctivitis with eye discharge in the left eye for about 6 months and had been under observation at her local ophthalmologist. Two to three months ago, she noticed swelling of the left preauricular and upper neck, and was referred to our department. A 15-mm-large protruded lesion on the left lower eyelid conjunctiva, a hard nodule in the parotid gland, and enlarged lymph nodes in the upper-left cervical region were found, all of which were diagnosed as squamous cell carcinoma by fine-needle aspiration cytology. With the diagnosis of squamous cell carcinoma of the lower eyelid with metastases to the parotid gland and cervical lymph nodes, the patient underwent resection of the malignant lower eyelid tumor, total parotidectomy, neck dissection on the affected side, and reconstruction of the lower eyelid with a hard palatal mucosal flap and malar flap. Postoperative radiation therapy was performed on the affected side of the neck, and the patient is currently undergoing outpatient follow-up with no signs of recurrence for approximately one year after the surgery.

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Bone marrow hematopoietic stem cell transplantation has been increasing in recent years due to improvement of treatment outcomes. Chronic graft-versus-host disease （GVHD） is known to be a risk factor for secondary malignancy, and oral cavity cancer is the most common primary site. We report our experience of two patients with tongue cancer derived from chronic GVHD. One patient was a woman in her fifties who had chronic oral GVHD one year after bone marrow transplantation. She had a tumor with leukoplakia on the back of the tongue 12 years after the transplantation. She was diagnosed with squamous cell carcinoma of the tongue （cT4aN0M0）, and definitive surgery was performed. She achieved disease-free survival of more than one year. The other patient was a woman in her seventies who had chronic oral GVHD one month after bone marrow transplantation. She had a tumor on the back of the tongue five years after the transplantation. She was diagnosed with squamous cell carcinoma of the tongue （cT4aN3bM1: lung metastasis）. Due to poor performance status, best supportive care was selected. Because of concerns about metachronal and multiple recurrence after surgery in patients with chronic oral GVHD, long-term follow-up should be considered.

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We report a rare case of myxofibrosarcoma arising in the neck. A 67-year-old man presented with a neck mass. Contrast-enhanced magnetic resonance imaging showed a roughly well-defined tumor with enhancement in the neck. It was difficult to distinguish whether it was benign or malignant by fine-needle aspiration cytology. The neck tumor was resected for the purpose of diagnostic treatment. The tumor was pathologically diagnosed as a low-grade myxofibrosarcoma with positive surgical margin. Furthermore, neck dissection was performed as additional treatment. However, the surgical margin was also pathologically positive. Therefore, postoperative radiation therapy with 60Gy was performed. The patient has remained alive for 76 months without recurrence after the first surgery. Myxofibrosarcoma has a high local recurrence rate in patients with positive pathological margin in surgery, but it may be possible to achieve local control by postoperative radiation therapy.

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A 60-year-old man was treated with pembrolizumab for recurrence of lung metastasis after surgery for hypopharyngeal carcinoma. Three months after the first dose, severe hypothyroidism was observed. This was thought to be an immune-related adverse event （irAE） and treatment was temporarily discontinued. Levothyroxine was started, thyroid function recovered, and pembrolizumab was restarted. Seven months after the first dose, general malaise and anorexia were observed. On the basis of the decrease in serum ACTH and cortisol levels, we diagnosed hypopituitarism as an irAE. Hydrocortisone was administered and the general condition promptly improved. Hypothyroidism induced by immune checkpoint inhibitors is a frequently observed irAE and may be secondary to hypopituitarism, as in this case.

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Although multidisciplinary treatment, including resective and reconstructive surgery, should be considered for the management of advanced oropharyngeal cancer, severe postoperative dysphagia may occur, and laryngeal preservation may be difficult. Oropharyngeal carcinoma of the posterior wall is rare and has a poorer postoperative swallowing function and prognosis than that of other subsites, but detailed reports on swallowing dynamics are limited. Here, we report the case of a 76-year-old man. He underwent resection of the oropharynx, neck dissection, cricopharyngeal myotomy for oropharyngeal posterior wall carcinoma, and reconstruction with an anterolateral thigh flap. After surgery, the patient presented severe dysphagia but recovered the ability to swallow food that required mastication in approximately 2 months, and was discharged home. After approximately 4.5 years post-surgery, he remains able to consume regular food without showing any recurrence. We believe that preservation of most of the suprahyoid muscle group and cricopharyngeal myotomy were factors for maintaining swallowing function. In addition, by focusing on functional compensation, including postoperative rehabilitation, laryngeal preservation is suggested to help patients with oropharyngeal posterior wall cancer.

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There are few reports in the literature of metastasis of head and neck cancer to the thyroid gland. We report a case of metastasis to the thyroid gland from supraglottic cancer. The case was an 80-year-old female, cT2N3bM0, with right cervical lymph node metastasis surrounding the carotid artery. She was treated with Pembrolizumab after radiotherapy. CT imaging after seven courses of Pembrolizumab showed an increasing low-density area in the thyroid gland. Keratinized atypical cells on cytology and histology suggested thyroid metastasis of supraglottic carcinoma. Tracheostomy was performed due to airway stenosis caused by metastatic lesions.
Metastatic thyroid cancer can cause airway stenosis and bleeding as it progresses. The possibility of metastatic thyroid cancer should be considered when neoplastic lesions or thyroid function abnormalities are observed in the thyroid gland during treatment for squamous cell carcinoma of the head and neck.

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