Eleven cases of parapharyngeal mass (2 recurrent pleomorphic adenomas, 2 fresh pleomorphic adenomas, 2 schwannomas, a lipoma, a hemangioma, a foreign body cyst due to bullet, a malignant lymphoma and a carcinoma in pleomorphic adenoma) are reported. If the radiolucent zone between mass and parotid gland is not seen, the mass is likely a tumor of the deep lobe of the parotid gland or large tumor going forward to parotid gland. Therefore, cases without a radiolucent zone should be operated on using a transparotid approach. If the radiolucent zone is seen, the mass is mostly likely extraparotid in origin. In these cases, a transcervical approach is recommended. The intraoral approach should be restricted to cases of extraparotid, small, well capsulated, low vascular and benign tumor. The intraoral approach should be avoided in cases lacking a radiolucent zone, because of the possibility of recurrence and the increased risk of facial nerve injury.

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Seven cases of severe maxillo-facial injuries treated over a four month period with problems in diagnosis and management are discussed. The conclusions are summerized as follows: 1. In cases with blowout fractures, antral balloon technic was effective. 2. In cases with foreign bodies in face, the sooner the treatment was undergone, the better the prognosis. 3. A CT scan coupled with orthognatic pantomography was indipensable in detecting not only intracranial lesion but fracture lines. 4. The otolaryngologist should be included, along with the neurosurgeon, ophthalmologist, plastic surgeon and dentist, in managing maxillo-facial injuries.

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Serum levels of squamous cell carcinoma related antigen (SCC-Ag) were measured by a radio immune assay in 13 patients with nose and paranasal sinuses cancer. These cases included 9 squamous cell carcinoma, one adenosquamous cell carcinoma, one transitional call carcinoma, one adenocarcinoma and one malignant melanoma. Five of 6 patients with untreated cancer showed positive serum SCC-Ag levels, while 6 chronic sinuitis patients were negative. All cases with untreated and recurrent squamous cell carcinoma showed positive results. Only adenosquamous cell carcinoma showed postive SCC-Ag levels in non-squamous cell carcinoma. Serum SCC-Ag levels of well differentiated squamous cell carcinoma were higher than in moderatory differentiated carcinoma. High pretreatment antigen levels declined to undetectable levels after surgery, irradiation, and chemotherapy, except in a poor renal function case. The findings suggest that SCC-Ag is a good tumor marker of the nose and paranasal sinuses, especially for squamous cell carcinoma.

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It is often reported that a brain stem tumor occasionally causes pure tone hearing loss. Abnormal findings in the auditory brain stem responses (ABRs) are also reported. In this article we report 5 cases of brain stem tumor we had experienced and consideres the mechanism of the onset of the pure tone hearing loss. We compare different types of pure tone hearing loss with abnormal ABR findings. In the patients with unilateral profound pure tone hearing loss, the normal wave III were not detected in the affected ear. From our results and from other workers' similar findings, we concluded that a unilateral and more than moderate pure tone hearing loss, accompanied by a brain stem tumor, is caused by the extention of the tumor at or near the site of the origin of the ABR wave III.

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Clinical characteristics of middle ear cholesteatoma in children and its surgical results were analyzed and discussed. From 1978 to 1986, 22 children under 10 years old were operated on in our clinic. The findings obtained were as follows: 1. The cases consisted of 15 ears having attic type cholesteatoma and 7 having adhesive type cholesteatoma which developed from the posterior superior quadrant of the adhesive ear drum. 2. Bacteriological examinations were positive in 16 ears and negative in 6 ears. Of the ears bacteria positive, gram negative bacteria were found in 8 cases. 3. Hearing loss was more severe in the adhesive type cholesteatoma because of the greater destruction of the ossicular chain, especially the stapes. 4. In the contralateral ear, otitis media exsudativa was found in 4 of 15 cases of attic type cholesteatoma, and 5 of 7 adhesive type. 5. In 10 cases the closed surgical procedures were used, the canal wall reconstruction method in 5 cases, and the open method in 7 cases. 6. Of the 10 cases operated on using the closed method, 4 cases were reoperated; 3 of them using the closed method, the other using the open method. Of the 5 cases operated on using the reconstruction method, 3 cases were reoperated; 1 using the closed method, 2 using the open method. Of the 7 cases operated on using the open method, 3 cases were reoperated. In 2 cases out of the 10 opened cases, a third operation was necessary because of recurrece. 7. Finally, 12 cases have maintatined a normal external ear canal shape and 10 cases have lost their posterior canal wall. 8. There were no differences in the recurrence rates between the surgical methods and the types of cholesteatoma, although the surgical method was decided without distinction of clinical findings. In conclusion, it would be possible to say that cholesteatoma in children could be operated on using the closed method at primary operation.

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The surgical results of 136 cases of middle ear cholesteatoma initially operated on in our clinic were studied. The cases were classified into either the attic type or adhesive type of cholesteatoma. The cases were further divided into group 1 or group 2. Group 2 consisted of cases operated on using anterior tympanotomy, a new technique originated in our clinic. In group 2, the rate of recurrence of cholesteatoma was 18% in the attic type and 24% in the adhesive type. The rate of recurrence was 20% with the closed method, 25% with the reconstruction method and 8% with the open method. The recurrent type cholesteatoma occured 3 times more often than the residual type and 80% of them were operated on again within 2 years. All group 2 cases were operated on with the closed method combined with the anterior tympanotomy. The rate of recurrence was 3% in the attic type and 14% in the adhesive type. From the results obtained, the usefulness of anterior tympanotomy in the surgical management of cholesteatoma was evaluated.

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Effects of peroral administration of glycerol (50 % glycerol, 12 ml/kg) on intra-facial nerve pressure was studied in five guinea pigs. A servo-nulling system (WPI Micro-Pressure System Model 900) was used to measure the interstitial fluid pressure of the facial nerve. At the same time, cerebrospinal fluid pressure was recorded. Glycerol lowered the facial nerve pressure as well as the cerebrospinal fluid pressure. We conclude that the decrease in the cerebrospinal fluid pressure was transmitted to the facial nerve via a fluid system in the facial nerve which connects with the cerebrospinal fluid. The present paper is the first to report the direct effect of glycerol on the interstitial fluid pressure in the facial nerve.

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A double blind comparative study was performed on cefuroxime axetil (CXM-AX), to evaluate objectively its efficacy, safety and usefulness in acute tonsillitis, using cefaclor (CCL) as the comparator. Either of the drugs was administered in the dose of 250 mg tid., in principle for 7 days.
1. In the evaluation of clinical efficacy, the efficacy rates of CXM-AX and CCL were 90.5% (95/105) and 88.2% (90/102), respectively, in the assessment by doctors in charge, and 88.6% (93/105) and 87.3% (89/102), respectively, in the assessment by the committee, without statistically significant difference between the two treatment groups.
2. When the bacteriological response was evaluated in each case, the elimination rate was 98.0% (96/ 98) in CXM-AX group and 98.9% (91/92) in CCL group, and there was no significant difference between the two groups either in this comparison or in the evaluation on the bacteriological response classified by causative organisms.
3. In overall safety, no significant difference was observed between two treatment groups. Adverse events, all of which were gastrointestinal tract symptoms, were observed in 2.6% (3/114) in CXM-AX group, and in 2.7% (3/111) in CCL group. Either in adverse events or abnormal laboratory findings, the difference in incidences was not statistically significant between the two groups.
4. The usefulness rates of CXM-AX and CCL were 93.3% (98/105) and 91.2% (93/102), respectively, with no significant difference. The above results suggest that CXM-AX is a very useful drug for the treatment of acute tonsillitis.

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Zaditen (2 mg/day for 8 weeks) was administered to 284 patients who suffered from allergic rhinitis. A high rate of improvement (84.4%) was observed. Significant relief in severe cases was not observed until the 8th week. The 3 main symptoms, sneezing, nasal secretion, and nasal obstruction, progressivety improved. The number of days that the symptoms were present was decreased in moderate or severe cases. This improvement was found in 94.7% of the patients within 4 weeks of drug administration. Drowsiness was the main side effect reported (8.5%). No patients dropped out of the study due to side effects. This suggests the usefulness of Zaditen.

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輪状咽頭筋切断術は嚥下障害の手術的治療としては非常に有用な方法であり, 様々なタイプの嚥下第 2期の障害に対して適応を有している. 1981年10 月の佐賀医科大学付属病院開院以来1985年12月末までに当科にて輪状咽頭筋切断術を行つた症例は3 例である. 2例がWallenberg症候群, 他の1例は 1976年上咽頭癌で7000 radの放射線治療を受け, その後より次第に頸部に食べ物がひつかかりうまく嚥下できなくなつたという症例である. 食道透視検査ではWallenberg症候群の2例には誤嚥が認められた. 輪状咽頭筋切断術施行後は, Wallenberg症候群においては誤嚥は著明に減少し, また通過障害も改善された. しかしながら他の1例では症状の改善は軽度であつた. Wallenberg症候群の2例については切除した輪状咽頭筋の病理組織学的検討も行つている. そのうちの1例について若干の考察を加えて報告する.

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輪状咽頭筋切断術はKAPLANが1951年に28歳男性のpoliomyelitis症例に施行したのが最初である. 次いでSUTHERLANDは1962年に本術式を咽頭憩室の治療に応用した. 以来, その優れた治療成績のもとに, 輪状咽頭筋切断術は嚥下障害, とくに第II期障害の手術的治療法の中核をなすものとして広く用いられるに至つている. その理由は, 比較的簡単でしかも安全な手術手技であること, upperpinch cockとしての作用がなくなる以外にとくに重篤な機能障害は生じないこと, 全ての型の嚥下第II期障害の治療に応用できること, などによる.
しかし, 輪状咽頭筋切断術についても解決すべき問題は少なくない. たとえば, 予後を見通した適応症例の選別法, 適応疾患の確立, あるいはその手術時期などについて十分な検討が加えられているとは言いがたい. さらに, 術後成績についても長期にわたつて評価された報告はない. また術式についても切断術なのか, 切除術なのか, あるいは他の術式と併用するのか, などの問題点がある.
以上のような観点に立つて, 本稿では「輪状咽頭筋切断の評価」という表題のもとに, 術前診断法, 適応症, 術後成績などについて, 5名の方々に種々の観点から検討していただいた. この特集が嚥下障害治療法の発展に役立てば幸である.

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Recently, recurrent laryngeal nerve paralysis after surgery for esophageal cancer has been noted due to extensive lymph nodes dissection in neck and upper mediastinum. Seven out of seventy-six patients (9.2%) operated in our hospital between June 1983 and April 1986 exhibited paralysis. We discuss the prevention and treatment of recurrent laryngeal nerve paralysis due to surgery of esophageal cancer.

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