Remarkable progress has been made in basic research on the sense of smell during the last few decades. This progress has been accelerated by the discovery made by Axel and Buck of the genes that encode olfactory receptors. These rescarchers won the Nobel Prize in Physiology or Medicine in 2004. The detection and discrimination of odor molecules in humans is mediated by 388 olfactory receptors that are expressed on olfactory sensory neurons. A basic understanding of the mechanism of odor reception is crucial to an understanding of olfactory dysfunction. Olfactory disorders can be classified as quantitative or qualitative disorders. The former category includes the deterioration or total loss of olfactory sensation, while the latter category includes distortions of the sense of smell. Quantitative olfactory disorders can be classified by the area affected by the disease into four major groups: (1) sino-nasal, (2) olfactory mucosa, (3) olfactory fila, and (4) central pathway. Chronic rhinosinusitis, which is the most frequent cause of olfactory disorders, is caused by the conductive loss of odor molecules. The second most common cause is postviral olfactory disorders occurring after an upper respiratory tract infection. The prognosis for olfactory function in individuals affected by these causes is relatively good. However, olfactory loss caused by neural disorders, such as posttraumatic olfactory loss, has a poor prognosis. Dysosmia, or a distorted sense of smell, is mainly caused secondary to postviral or posttraumatic olfactory disorders. Dysosmia is classified as either parosmia or phantosmia. Parosomia occurs in patients who are unable to correctly identify odors, while phantosmia involves the smelling of odors that are not derived from any physical stimulus. The mechanism of dysosmia has been clarified by basic research on olfactory reception and conduction.

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We report a 62-year-old man with left paramedian pontine reticular formation (PPRF) disorder. Seven years later, primarily found symptoms such as diplopia with left facial palsy and perceptual disorder changed to left one-and-half (OAH) syndrome. We compared results of neurootologic examination to those of magnetic resonance imaging (MRI), which has purportedly played a central role in diagnosis and management of multiple sclerosis (MS). MS is a prototypic inflammatory demyelinating disorder of the central nervous system. Our subject, however, had no lesions causing abnormal eye movement on MRI. He had abnormal neurootologic findings related to his disease, and neurootologic results appeared more sensitive than those of MRI. While MRI is invaluable in diagnosis, it can not reveal all MS lesions. We hold that, in addition to MRI, neurootologic examination is useful in diagnosing and evaluating abnormal eye movement.

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Pigmented villonodular synovitis (PVNS) is benign, usually involving the knee, foot, etc.
We report a very rare case involving the temporomandibular joint (TMJ).
A 43-year-old man, who was admitted for left-ear fullness was found in computed tomography (CT) and magnetic resonance imaging (MRI) to have a mass expanding from the TMJ to the skull base.
Removal of the lesion and the skull base defect was reconstructed under general anesthesis.
The man remains disease free 32 months after the operation.

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Facelift incision is used to cosmetically remove furrows and exess facial skin. In 1967, Appiani suggested facelift use in parotid gland surgery. In Japan, most parotid tumor surgery involves S-shaped incisions leaving visible scars. We used facelift incisions in 21 cases from January 1, 2007, to December 31, 2008, comparing surgery duration, tumor size, and complications. We found the facelift incision to be safe and to provide good cosmetic results.

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Lymphoepithelial carcinoma of the salivary gland is rare and manifests ethnic and geographic preferences. We report one such case in the parotid gland of a 55-year-old man with a painless mass in the left parotid region without facial nerve paralysis. The pathological lymph-node diagnosis of lymphoepithelial carcinoma necessitated total parotidectomy, left neck dissection, and facial nerve grafting followed by postoperative radiotherapy. In situ hybridization showed negative EBER, but serological results showed high VCA-IgA and anti-EBNA titers. The man remains free of locoregional recurrence and distant metastasis in the 3 years since surgery.

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We report two cases of adult multiple laryngeal papillomatosis, endoscopically excised using a microdebrider. Case 1: A 37-year-old man suffered from a sensation of a lump in the throat. Case 2: A 27-year-old man suffered from hoarseness. Both presented with multiple papillary lesions on the vocal cords and in the supraglottic area.
Using a laryngeal microdebrider under laparoscopy to resect lesions we obtained good vocal quality 12 months postoperatively in case 1 and 8 months after operation in case 2. Case 2 suffered recurrence on the left vocal cord. Both cases were diagnosed postoperatively as squamous papilloma and human papilloma virus (HPV) type-6 and 11 were genotyped in specimens from case 1 and 2, respectively.
Multiple laryngeal papillomatosis is benign, caused by human papilloma virus characterized by recurrent, disseminative respiratory tract growth. Current treatment is surgical, but preserving laryngeal function is an issue. The microdebrider thus effectively resects fine lesions without thermally damaging surroundings. This leaves fewer adverse effects and improves vocal quality more than the heated instruments such as the CO₂ laser widely used in Japan.

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A 35-year-old man who had gone into cardiopulmonary arrest upon emergency room arrival was mechanically intubated and ventilated in the ICU. Serum fT3 was 0.33 pg/mL, fT4 0.07 pg/mL, and TSH 195.0 IU/mL. He was diagnosed with myxoedema with severe laryngeal obstruction, given replacement levotyroxine (50 mg/day), and underwent tracheostomy. Following a gradual increase in levotyroxine, his general condition improved. The tracheostomy was closed on day 60. Four months after admission, he was discharged without complications, and he recovering ordinary activity and walking on his own.

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We reviewed 13 cases of female laryngeal cancer related to smoking between 1990 and 2007. Five smoked and eight did not. Of the 8 nonsmokers, three lived with heavy smokers and one was exposed to smoke at work. In short, 4 (30.8%) were exposed to environmental tobacco smoke, relating 8 (61.5%) to smoking.
Despite the absence of general acceptance of a relationship between smoking/environmental tobacco smoke and laryngeal cancer, based on our finding, we recommend that otolaryngologists familiarize themselves and society in general with the risks of smoking and environmental tobacco smoke.

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Objectives: Carotid stenosis developing following radiotherapy, i.e., radiation-induced carotid artery disease, has rarely been examined in detail. We used ultrasonography to examine carotid arteriosclerotic changes following head and neck cancer radiotherapy.
Subjects and Methods: Subjects numbered 6—5 men and 1 woman—(mean age, 67.5 years) undergoing external head and neck radiotherapy. We examined carotid ultrasound findings shortly after radiotherapy was started. Measurements included maximum intima-media thickness (max IMT) over 1.1 mm of the carotid artery wall and the presence of plaque.
Results: Max IMT over 1.1 mm was detected in 4 right common carotid arteries (CCA), 4 left CCA, 6 right internal carotid arteries (ICA), and 5 left ICA. Abnormal vascular flow was detected in one patient. Plaque was most often observed in the carotid bulb.
Conclusions: Bilateral carotid arteriosclerosis observed in all subjects undergoing head and neck radiotherapy indicated that head and neck irradiation may be a risk factor in carotid arteriosclerosis because subjects showed many CCA lesions despite having no other risk factors than smoking.

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Angioedema is a rare disease characterized by mucosal or submucosal swelling. If this occurs in the upper pharynx or larynx, it may become life-threatening and requires emergency treatment.
We report a case of angioedema associated with C1-inhibitor (C1-INH) deficiency. A 51-year old woman seen for laryngeal edema and facial and neck swelling, showed no increased number of white blood cells or C-reactive protein. C3, C4, CH50, and C1-INH, functions were markedly decreased, however, indicating hereditary angioedema (HAE) or acquired angioedema (AAE). Additional examination showed decreased C1q, yielding a diagnosis of AAE.
Following tranexamic acid administrations no recurrence has been observed to date.

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Serious complications may accompany deep-neck infection. A 42-year-old man having mediastinitis and a necrotizing internal jugular vein caused by a deep-neck gas-forming infection was treated with antibiotics, surgical debridement, and vacuum-assisted closure (VAC) therapy, followed by complete recovery. We found VAC is useful in successfully treating infected tissue.

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We studied the clinical effects of mometasone furoate on subjects with seasonal grass pollinosis by comparing nasal and ocular symptom scores, medication scores and symptom-medication scores before and after treatment. Post-treatment scores were significantly lower than pre-treatment, as were vascular endothelial growth factor (VEGF), eosinophilic cationic protein (ECP), and eotaxin concentrations in nasal lavage fluid of treated subjects.
Our findings suggest that mometasone furoate is useful in treating seasonal grass pollinosis.

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