KOHEI YAMAHARA

RATIONALE: Traumatic stapediovestibular luxation is a rare but potentially devastating condition that may cause severe vertigo and hearing loss. Optimal management remains controversial because surgical manipulation around the stapes carries the risk of additional inner ear damage, whereas some patients recover with conservative treatment alone. PATIENT CONCERNS: Two patients presented with vertigo and hearing impairment after accidental penetrating ear trauma caused by cotton swabs. DIAGNOSES: High-resolution computed tomography demonstrated stapes footplate invagination into the vestibule in both cases. INTERVENTIONS: In Case 1, early surgical repositioning of the stapes was performed on the third day after injury because of complete footplate invagination accompanied by bone-conduction hearing loss and severe vertigo. In Case 2, conservative management was selected because bone-conduction thresholds were preserved and vestibular symptoms improved spontaneously. OUTCOMES: In Case 1, postoperative recovery included rapid resolution of vertigo and improvement of bone-conduction thresholds, particularly at low frequencies. In Case 2, vestibular symptoms resolved without surgery, although a mild residual air-bone gap remained. LESSONS: Bone-conduction deterioration, degree of footplate displacement, severity of vertigo, and depth of invagination on high-resolution computed tomography appear to be key factors for treatment selection. Conservative management may be safely continued in selected cases with mild posterior partial luxation and stable bone-conduction, whereas early surgical decision-making is essential when surgery is indicated to optimize vestibular and auditory outcomes.

A 62-year-old woman with poorly controlled type 2 diabetes mellitus presented with a fever and altered consciousness. The patient was diagnosed with diabetic ketoacidosis (DKA) with a positive blood culture for group A Streptococcus. Although the source of infection was initially unclear, contrast-enhanced CT revealed a retropharyngeal abscess (RPA) and descending necrotizing mediastinitis (DNM) that required surgical drainage. RPA with DNM is rare and potentially fatal in adults and is often missed without high clinical suspicion. In severe DKA, altered mental status and hemodynamic instability may obscure the underlying infection, emphasizing the importance of a thorough evaluation.

OBJECTIVE: To evaluate the safety and feasibility of transaxillary robotic thyroidectomy (TART) in Japan by comparing early cases with video-assisted neck surgery (VANS). METHODS: Single-center retrospective review of 31 consecutive thyroid lobectomies: 16 VANS (Nov 2020-Feb 2025) and 15 TART (Mar 2022-Feb 2025). TART used da Vinci Surgical system (da Vinci) Xi for early cases and predominantly da Vinci SP thereafter. Indications included differentiated cancer ≤4 cm, cN0, unilateral disease without extrathyroidal invasion, or follicular tumors 3-5 cm. Operative time, blood loss, hospital stay, complications, and cosmetic outcomes were evaluated and compared with statistical analysis. RESULTS: All procedures were completed without conversion to open surgery. Blood loss (16.5 g vs 25.8 g) and length of stay (6.3 vs 6.1 days) were comparable. Complications included two transient recurrent laryngeal nerve palsies after VANS and, after TART, one axillary bleed controlled under local anesthesia and one lymphatic leak; overall rates were similar. High cosmetic satisfaction was reported in both cohorts. CONCLUSION: Early experience shows TART is feasible and safe in Japan, achieving perioperative outcomes comparable to VANS with excellent cosmetic results.