A 74-year-old male had attempted suicide three months earlier by slitting his neck with a cutter knife. He was taken to the emergency department of another hospital in Tokyo, where his wound was closed, but no radiological exam was performed. Subsequently, he visited our hospital complaining of left neck pain developing when he swallowed with his head turned to the left. A long and thin metal piece was identified on X-ray and CT. We recommended operation however, the patient initially refused it because of not having enough. However, subsequently he provided consent for surgery, which was performed five months after the attempted suicide. We dissected a granulomatous lesion on the outer side of the left thyroid cartilage, detected a piece of a cutter knife blade and extirpated it carefully, then closed the wound. There were no complications such as bleeding or neuroparalysis left recurrent laryngeal nerve paralysis after the surgery. To find a metallic foreign object in the neck in cases of neck trauma, it is important to obtain a careful history from the patient and perform appropriate radiological imaging tests.

　Choristoma is defined as the presence of a histologically normal tissue in an ectopic location. Salivary gland choristoma is a heterotopic mass of histologically normal salivary gland tissue. Occurrence of a salivary gland choristoma in the middle ear cavity is extremely rare. In most cases, choristoma is associated with other abnormalities of the ossicular chain and facial nerve. We report the case of a patient with salivary gland choristoma, in which the patient was a 5-year-old boy with conductive hearing loss in the right ear. Examination revealed a whitish mass over the anterior and inferior portions of the right TM. Temporal bone CT revealed abnormalities of the ossicular chain. We first suspected congenital middle ear cholesteatoma, and performed exploratory tympanotomy. The operative findings revealed depression of the horizontal portion of the facial nerve with a mass underneath it, and absence of the long crus of the incus and of the stapes super structure. Based on these findings, we suspected facial neuroma, and excised a specimen for histologic study. Then, we could remove the mass. The postoperative course was uneventful, and the facial movements remained normal. Histopathology revealed aggregation of normal salivary gland structures. We then made the final diagnosis of salivary gland choristoma of the middle ear.

　The patient, a 36-year-old woman, was diagnosed as having moderate OSA (AHI=29.7/hr) by polysomnography. She was started on nasal continuous positive airways pressure (nCPAP) treatment, however, she could not tolerate the assisted ventilation, and desired surgical cure. We proposed two-phase surgery for her, however, she did not hope MMA. Finally, we planned nasal surgery, pharyngeal surgery and genioglossal advancement (GA) at the same time, because she had hypogrowth of the mentum.

　After the surgery, the AHI decreased from 29.7/hr to 4.9/hr. Also, a postoperative CT evaluation revealed transverse expansion of the pharynx.
　Two-phase surgery, including soft-tissue surgery (nasal, pharyngeal) and skeletal surgery (MMA), proposed by Stanford University, has recently come to be recognized as a treatment option for OSA. However, some patients still do not wish to undergo two-phase surgery, including invasive surgery such as MMA, in Japan. GA is useful for OSA patients with hypogrowth of the mentum and can be accomplished by soft-tissue surgery as one-time surgery. It is necessary to clarify the factors responsible for the OSA in each patient correctly, and select the appropriate surgical method to eliminate the responsible factor.

　Thyroglossal duct cyst is one of the most common congenital abnormalities of the cervical region. Complications are rare, although appearance of a carcinoma has been counted as one of the complications. We present the case of a 49-year-old man with a small papillary carcinoma arising in a thyroglossal duct cyst, with cervical lymph node metastasis. He was admitted to another hospital with the diagnosis of a painless anterior neck mass. Neck mass excision was performed, and histopathology of the resected specimen revealed cervical lymph node metastasis from a papillary carcinoma. The patient was referred to our hospital at this time. Contrast-enhanced computed tomography at our hospital showed a heterogeneous mass measuring 8 mm in diameter in the infrahyoid region of the anterior neck, and also suspicious metastatic lymph nodes at level II and level VI in the right neck. FDG-PET/CT revealed a slightly higher uptake in the soft-tissue component of the anterior neck mass, which was located in front of the hyoid bone as compared to the thyroid gland. A Sistrunk operation with central and right modified radical neck dissection was performed. Histopathology of the resected specimen revealed a papillary carcinoma arising from the thyroglossal duct and metastatic papillary carcinoma in the cervical lymph nodes. In our case, thyroglossal duct carcinoma was diagnosed by initial detection of a metastatic papillary carcinoma in the cervical lymph node, although it typically presents as a midline palpable neck mass. It remains controversial whether papillary carcinoma in the thyroglossal duct develops de novo or as a type of metastasis from an occult tumor nidus in the thyroid gland, thyroglossal duct carcinoma may be considered when metastatic papillary carcinoma was identified in the neck lesion.