Primary pneumatization of the frontal bone occurs in the first year of life, but further pneumatization continues until 18 years of age. Elongation of the ethmoidal infundibulum and frontal recess, or upwards migration of the anterior ethmoidal cells has been proposed as a mechanism of frontal sinus development. The frontal sinus drainage pathway is displaced in the anterior or posterior direction depending on the pneumatization pattern of the frontoethmoidal cells. Also, frontal sinuses can be connected to the infundibulum or directly to the middle meatus depending on the superior attachment pattern of the uncinate process. Bilateral frontal sinuses are separated by their bony septum, and thus have their own drainage pathways. Contrary to this general rule, we experienced two cases of frontal sinuses that were connected to each other, showing a single drainage pathway from both frontal sinuses. We report these two cases along with a literature review.

Lobular capillary hemangioma (LCH) is a type of benign vascular tumor. It arises from vascular endothelial cells and contains capillaries arranged in a lobular pattern. In the head and neck, the most common presenting location of LCH is the lips, and presentation in the larynx is very rare. LCH might not be distinct from granuloma in macroscopic views. We report a 71-year-old female with LCH of the larynx that was totally resected via laryngeal microsurgery with a CO2 laser and briefly review the literature.

Thyroid cancer (TC) is the most common endocrine malignancy, with incidence increasing worldwide. Although most differentiated TCs have a favorable prognosis, radioiodine (RAI)-refractory differentiated thyroid cancer (DTC), BRAF inhibitor-resistant papillary thyroid cancer, and anaplastic thyroid cancer (ATC) remain major areas of unmet clinical need. The sirtuin (SIRT) family of NAD⁺-dependent enzymes has emerged as a multifaceted regulator of TC biology, with isoform-specific dichotomous roles: SIRT1, SIRT6, and SIRT7 act as tumor promoters through engagement of BRAF/MAPK, PI3K/AKT, epithelial–mesenchymal transition (EMT), and Hippo pathways, while SIRT3 and SIRT4 function as tumor suppressors via mitochondrial metabolic regulation. This review synthesizes recent developments that expand the therapeutic landscape: (i) the recognition that SIRT7 functions as a desuccinylase with preclinically identified oncogenic substrates, modifying KIF23 in ATC and LATS1 in PTC; (ii) the emerging roles of isoform-specific SIRT axes, including the NAMPT–SIRT1–PD-L1 axis, SIRT6-associated regulatory T-cell biology, and SIRT2 as a T-cell metabolic checkpoint, as determinants of immune microenvironment state and potential modulators of immune checkpoint inhibitor response; and (iii) the SIRT6–nuclear receptor coactivator 4 (NCOA4) ferritinophagy axis as a supported ferroptosis vulnerability in ATC, with potential but still hypothesis-generating relevance to dedifferentiated and RAI-refractory DTC. Importantly, the therapeutic logic for SIRT6 is disease-state-specific rather than contradictory: SIRT6 inhibition is rationalized in BRAF-driven aggressive PTC and DTC contexts where SIRT6 supports MAPK signaling, EMT, and ferroptosis resistance, whereas in SIRT6-high ATC, the same enzyme’s NCOA4-dependent ferritinophagy activity may instead be exploited to enhance ferroptosis sensitivity. We review the current SIRT modulator pharmacological toolkit—including EX-527, OSS_128167, and emerging SIRT7-selective inhibitors—and identify the substantial clinical translation gap, with no SIRT-targeted clinical trial yet conducted in TC, despite strong preclinical rationale. We outline biomarker-stratified combination strategies with BRAF/MEK inhibitors, multikinase inhibitors, immune checkpoint inhibitors, and ferroptosis inducers, prioritizing biomarker-driven preclinical validation and, where supported by efficacy and safety data, subsequent early-phase evaluation in BRAF V600E-mutant and SIRT6-high thyroid cancer. Sirtuins thus represent a mechanistically promising and potentially biomarker-stratifiable therapeutic hypothesis for difficult-to-treat thyroid cancer; however, clinical translation remains at an early stage and requires validated biomarkers, isoform-selective compounds, and disease-specific in vivo evidence.

Background and Objectives Obstruction of tracheostomy cannula (T-cannula) may result in devastating results, such as hypoxic brain injury and even death. Since the recent coronavirus disease 2019 (COVID-19) outbreak, nebulizing for humidification to prevent tracheostomy cannula obstruction has been controversial due to concerns about viral spreading through aerosol. The present study evaluated the risk of cannula obstruction and thereby suggest an adequate prevention method during the COVID-19 pandemic.Materials and Method From January 2020 to October 2020, we retrospectively analyzed medical records of patients who underwent tracheostomy at the Department of Otolaryngology at Asan Medical Center, Seoul, Korea. The frequency of tracheostomy tube obstruction was compared in patients who were or were not nebulized. Additional clinical variates included patient’s sex, age, smoking history, medical history, and current medical history were evaluated.Results Enrolled 226 patients were divided into obstruction (n=62) and non-obstruction group (n=164). T-cannula obstruction was related to period of tracheostomy, smoking history, pulmonary diseases, and nebulized use. In Cox proportional hazards analysis, ex-smoking (hazard ratio [HR]=1.962, p=0.033), current smoking (HR=2.108, p=0.027), and pulmonary diseases (HR=1.740, p=0.038) were related to T-cannula obstruction. When other factors were corrected, the risk of tracheostomy obstruction was significantly decreased in the nebulized group (HR=0.216, p<0.001). Mortality rate of this group was affected by only pulmonary diseases.Conclusion Nebulizer can be applied safely and helps to avoid the risk of T-cannula obstruction.

Laryngopharyngeal foreign bodies are among the cases most frequently encountered by otolaryngologists. Most foreign bodies can be easily removed without any complications. However, surgical removal is required in some cases. Therefore, a delayed diagnosis or misdiagnosis could cause fatal complications for patients who need a surgical approach. We report a rare case of extraluminal migration of a foreign body to the deep cervical space. The foreign body (a fishbone) was removed by a surgical approach. With a literature review, we also propose an algorithm for the management of suspicious foreign bodies in the neck.