Three hundreds and twenty-six cases of malignant neoplasm of the head and neck were investigated clinically with special reference to the clinical significance of neck dissection. An anatomical investigation of the accssory nerve was combined in order to establish a new technic to prevent postoperative trapezius paralysis, one of the greatest troubles after neck dissection.
The conclusions are as follows:
1. Cervical lymphoadenopathy was found in 67% of epipharynx cacinoma, 50% of carcinoma of the hypopharynx and cervical esophagus, 50% of mesophaynx carcinoma, 48% of carcinoma of the tongue, 33% of laryngeal carcinoma, 24% of maxillary carcinoma, and 6% of carcinoma of the thyroid gland, before treatments.
2. Cervical recurrence occurred after therapeutic neck dissection in 37.5% for carcinoma of the tongue, 15.4% for carcinoma of the hypopharynx and cervical esophagus, 14.3% for maxillary carcinoma, and 10.8 % for laryngeal carcinoma without local recurrence. The rate of cervical recurrence with local recurrence was 66.7% for carcinoma of the tongue, 40% for carcinoma of the hypopharynx and cervical esophagus, and 30% for cancer of the maxillary sinus, repectively.
3. Lethal cervical recurrence after therapeutic neck dissection was found most frequently in paratracheal lymph nodes for subglottic type of laryngeal carcinoma and carcinoma of the hypopharynx and esophagus and submandibular lymph nodes for carcinoma of the tongue.
4. Cervical recurrence was developed after preventive neck dessection in 37.5% for cancer of the tongue, 13.9% for cancer of the larynx, 7.7% forcancer of the maxillary sinus, and none for cancer of the hypopharynx and cervical esophagus, without local recurrence. The rate of cervical recurrence with local recurrence was 75 for cancer of the larynx, 18.7 for cancer of the maxillary sinus, and 25% for carcinoma of the hypopharynx and cervical esophagus, respectively.
5. In general, neck dissection is not necessary for cases with no palpable cervical lymph nodes, except for cases with cancer of the tongue, in which preventive neck dissection should be done on the affected side. When local recurrence has been developed, preventive neck dissection must be performed simultaneously with treatments of the primary pathology.
6. For cancer of the maxillary sinus or epipharynx which is difficult to be treated with en bloc operation, surgery can be done with less recurrence rate after inactivation of the cancer cells.
7. In 56 of 90 cases (62%) functionally investigated, disorders of the trapezius muscle was developed after ordinary neck dissection.
8. In order to maintain the function of the trapezius muscle, accessoriocervical plexus and ramus trapezoideus of the C4 should be preserved in the lateral cervical triangle. With this technic only three cases in twenty-nine developed functional disorders.

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The tympanic membrane is one of the high speed vibrating organ in a body as well as the vocal cord. It is suspected that hemodynamics in it is different from that in the other organs. No documentation, however, has been available concerning this presumption.
The purpose of this study is to investigate peripheral blood flow characteristic to the tympanic membrane which is a high speed vibrator.
The experiment was performed on 82 guinea pigs which were exposed to various levels of sound. The changes in blood volume of the tympanic membrane were estimated by Benzidine staining after momentary fixation with liquid nitrogen during sound stimulation. Furthermore, the blood volume of the tympanic membrane was measured by counting radioactivity of R. I. S. A. which had been injected prior to sound application.
The results obtained were as follows.
1) The blood volume in the tympanic membrane decreased with increasing sound intensity.
2) The greatest blood volume value was observed under quiet circumstances C 0 phon).
3) Following the application of sound, the blood volume was first reduced around the intermediate region which vibrated most violently. The blood volume was then decreased near the anulus of the tympanic membrane.
4) The results obtained by two different experimental technics mentioned above showed almost the same tendency.
5) The blood volume in the tympanic membrane was almost the same for different pitches at a given intensity level (70 phon), except for 8000 and 500 Hz: it was slightly greater for 8000 Hz and occasionally (in one of six animals) less for 500 Hz than for other pitches.
6) The results support that the blood volume in the tympanic membrane is affected by physical factor such as a high speed vibration.

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Concerning researches on tensor tympani muscle and stapes muscle, many researches have been conducted with experiment animals and human auditory ossicles muscle since HENSEN (1878) observed tensor tympani muscle in the canine middle ear cavity contracting reflexively at sound stimulus.
In measuring micro deflection of membrane of the tympanum based on the auditory ossicles muscle reflex by means of impedance or measurement of external auditory meatus pressure, there was lack of consideration in the way of surgical operation and the conditions of measuring apparatus at experiment. Especially, it was impossible to measure the deflection of membrane of the tympanum without making a portion of the existing measuring apparatus contact the external auditory meatus membrane.
To accomplish the purpose of experiment without such a defect, a supersmall size photo-transistor was used as detection element for deflection of membrane of the tympanum and a change was detected in the volume of reflected light from membrane of the tympanum due to deflection of membrane of the tympanum.
It was then amplified with mechanical direct current amplifier, to which galvanometer was applied, and was recorded with oscillograph. In this way, the author devised a way to record deflection of membrane of the tympanum according to auditory ossicles muscle reflex without contacting external auditory meatus and auricle.
Prior to clinical experiment, the models of external auditory meatus and membrane of the tympanum were prepared and preliminary basic experiment was conducted.
Through this experiment, optimum values f or proper distance between membrane of tympanum and the photo-transistor and for brightness of light source were determined.
Further, nearly linear proportional relationship was confirmed between quantitative change in depression of membrane of the tympanum and the volume of reflected light due to deflection of membrane of the tympanum.
In the clinical experiment, 36 adults' ears with normal auditory acuity were used. Pure-tone of 70-100 phon, which is comparatively strong against sound stimulus, was loaded into the opposite ears at 250-8000 Hz for a short time.
When the photo-transistor was receiving reflected light from membrane of the tympanum without stimulation, there was obtained a pulse wave curve nearly corresponding to the cycle of electrocardiogram which was taken simultaneously.
Reaction of membrane of the tympanum to sound stimulus was classified into the following three types:
Type 1: A pulse wave curve shows a linear change corresponding to sound stimulus on the side of plus or minus.
Type 2: The amplitude of a puls wave is increased to single thread or multi thread corresponding to sound stimulus.
Type 3: The amplitude of a puls wave shows controlling tendency corresponding to sound stimulus.
The frequency of reaction is 53% on the side of plus and 12. 5% on the side of minus in the case of Type 1, 27 % on the side of plus and 3 % on the side of minus in the case of Type 2, and 4. 5% in the case of Type 3.
When the direction of reaction was taken into consideration, the frequency of reaction was 80% on the side of plus and 15. 5% on the side of minus.
Reaction to sound stimulus by cycle appeared most frequently at 500-, 1000-, and 2000 Hz, as in the existing report.
In reaction to such non-sound stimulus as air jet toward external auditory meatus and contact stimulus, there was the greatest frequency in Type 1 and 2.

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