We employed electrophysiological and histological techniques to investigate the afferent projection of the superior laryngeal nerve (SLM) to the nucleus of the tractus solitarius (NTS) in the medulla oblongata and its cortical projection in the cat. Sensory fibers of the SLN were labelled anterogradely with WGA-HRP immersed directly in the central cut-end of the SLM. Labelled nerve terminals were observed densely in the ipsilateral interstitial subnucleus of the NTS in its caudal portion, and in considerable numbers in the ventrolateral subnucleus of the NTS. Labelled terminals were also observed rostrally in the ipsilateral medial subnucleus of the NTS. These findings were confirmed electrophysilogically by recording field potentials evoked by stimulating the ipsilateral SLN. Postsynaptic exoked potentials were recorded approximately 4 msec after the SLN stimuli. Cortical exoked potenials were recorded at the frontal part of the orbital gyrus bilaterally with a latency from 10 to 14 msec after stimulating the SLM. These results suggest that sensory information from the pharyngolaryngeal region is transmitted synaptically to the swallowing motor cortex via the NTS, especially in the interstitial subnucleus.

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Clusters of neuronal cells which have intense immunoreactivity to tyrosine-hydroxylase were found in intralaryngeal ganglia. Under electron microscopic bservation, they contained a vast amount of large cored vesicle in the neuronal somata, and the vesicles resembled to small intensely fluorescent (SIF) cells. Found in the synpathetic nervous system. Moreover, the vesicles also contained leucine enkephalin. Almost all SIF cells were observed near fenestrated-type capillaries in the intralaryngeal ganglia. It may be suggested that they also participate in autonomic regulation in the larynx.

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We have introduced the personal computer for three-dimensional (3-D) reconstruction of the larynx. The specimens could be embedded in paraffin or resin along with reference marks and sectioned without distortion for accurate superimposing. This 3-D reconstruction system basically consisted of the personal computer, display, digitizer and Cosmozone-2SA as software. Specimens without a reference mark could be analyzed for modeling purposes by arranging them according to a supposed base line. The 3-D reconstruction method was considered to be a useful and helpful tool for daily use which rendered easy recognition of the stereo-images of selected subjects according to the amount of data.

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Configuration analyses of epipharyngeal aperture, laryngeal vestibular area, intercuneiform cartilage width, posterior and anterior pharyngeal prominence and lateral pharyngeal constriction, were statistically undertaken during swallowing utilizing a fine caliber fiberoptic. A fiberscope is inserted and fixed in the epipharynx through the nostril to obtain a clear precise view of the larynx and hypopharynx like a bird's-eye view. The following findings were clarified. Constrictive forces due to the aryepiglottic folds precede the epiglottis narrowing before its tilting toward the laryngeal aperture. Posterior muscle forces mainly resulting from the superior pharyngeal constrictor muscle are stronger than the anterior muscle forces lekely to be due to the tensor veli palatine muscle at the epipharyngeal level during swallowing. Cuneiform movements and narrowness of the laryngeal vestibule demonstrated that glottic closure precedes tilting of the epiglottis.

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An experimental study focusing on relaxation and contraction of the cricopharyngeus muscle as monitored by E. M. G., and intraluminal pressure recordings in a total laryngectomy under general anesthesia, was done. Furthermore, freshly extracted canine inferior constrictor muscles were used for the purpose of assurance of cause of variety on phonation and/or swallowing regarding bursts of action potential and/ or abrupt pressure changes. After swallowing, an appearance of intraluminar positive pressure is suppressed by suxamethonium chloride, but a transient negative pressure in consequence of the passage of bolus, which is among tonic consecutive bursts at rest. Similar phenomenon are assured by an experimental use of mechanogram and highly concentrated potassium contracture. The variety of muscle contraction of the cricopharyngeus was attested by an immunohistochemical staining method utilizing PAP (peroxidase anti-peroxidase).

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We report 5 cases of functional deafness in children. The patients, 4 females and 1 male, ranged in age from 6 to 10 years. All cases had not complained of hearing loss and were detected by screening audiometry at their schools. Their hearing levels by pure tone audiometry ranged from 41 dB to 86 dB and the audiogram showed bilateral perceptive deafness. Although we could not determine the source of the conflict in schools or homes, two of the subjects were considered to be suffering from psychogenic hearing loss because of their singular responses to the audiometry or the progress of symptoms. On the other hand, it was considered that the other two children could not understand the standard instructions for the pure tone audiometry test. We suggest that a portion of the children who are detected to have a hearing loss by screening audiometry in schools may consist of children with psychogenic hearing loss and those who cannot understand the instructions for the pure tone audiometry.

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We report two cases showing a temoporary threshold shift (TTS) in the aided ear. Case 1, a five-year-old boy, started wearing a hearing aid in the right ear. His right ear become progressively deaf after one week, so the hearing aid was removed and placed in the left ear. The right ear recovered to its former level, however the left ear become progressively deaf. Case 2, nine-year-old girl, used a body-worn hearing aid in the right ear since the age of three. She showed progressive deafness after changing to the behind-the-ear hearing aid. Therefore, the hearing aid was changed back to the body-worn hearing aid. After one month, her hearing recovered to its former level. It is suggested that the 1 kHz peak in the frequency response of the behind-the-ear hearing aid caused TTS. We point out the necessity of frequent audiometric testing and adequate management of hearing aids.

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A case of a 70-year-old man with a brain abscess in the left temporal lobe caused by ipsilateral chronic otitis media with cholesteatoma is reported. To date, management of otogenic brain abscess have been controversial. After controlling the intracranial lesion with preliminary antibiotic therapy and drainage, the remaining cholesteatoma was successfully treated with radical mastoidectomy. The ease and accuracy of evaluation of intracranial lesions by computerized tomography scanners and the use of multiple antimicrobials with increased spectrum decreased the need for therapeutic surgical intervention for otogenic brain abscesses.

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Pilomatrixoma was reported by Malherbe in 1880. It is also generally called “calcifying epithelioma”. We report a case of a 13-year-old female who had suffered from infra-auricle mass. Surgical treatment was performed and histological findings revealed the pilomatrixoma originated from hair matrix cells. This case is umcommon in the field of otolaryngology. The management of this disease is briefly reviewed.

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Although many anti-allergic drugs have been recently developed and used for primary treatment of nasal allergy, some patients require additional surgical treatment. Conchotomy, electrocoagulation or cryosurgery are usually used as surgical treatment. Recently new surgical treatments using CO₂, laser or trichloactic acid are employed and are getting good results. We are using contact Nd-YAG laser for nasal allergy treatment. We examined its usefulness in patients with nasal allergy of the all season type. The patients consisted of 21 males and 6 females. Six months after the treatment, the improved rate of sneezing, nasal discharge and nasal obstruction were 79%, 79% and 95%, respectively. We believe that contact Nd-YAG laser is a useful tool for the treatment of nasal allergy.

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A forty-year old male with a primary complaint of stuffy nose and epistaxia of the right side was referred to our clinic because of a readily bleeding nasal mass and exophthalmus of the right side. A computed tomography revealed an extended tumor invasion originating from the right maxillary sinus and that extended to the epipharynx and mesopharynx. The case was refractory to PPM induction therapy, consecutive irrigation therapy of 5-Fluoro Uracil through the superficial temporal artery and irradiation therapy with 5000 cGy of ⁶⁰Co. An extended total maxillectomy followed by laser vaporization of the middle cranial fossa has finally been successful in complete remission of this basal cell carcinoma for three years. This article refers to pathological classifications, etiology, treatment and prognosis of the tumor.

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A 34 year-old female complained of right nasal obstruction and rhinoblenorrhea. We found a necrotic mass at the right middle meatus and performed a biopsy. The results of histological observation indicated fungus ball (aspergillosis suspected), so that we diagnosed this case as a typical case of mycosis of maxillary sinus prior to surgical treatment. In this paper, we report the case and discuss mycosis in the paranasal sinus.

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Fibrous dysplasia is a benign disorder of fibro-osseous tissue. In the head and neck regions, the maxilla and mandible bones are most frequently involved. We, herein, report a case of fibrous dysplasia which originated in the ethmoid sinus. The differentiation of fibrous dysplasia and ossifying fibroma is not unequivocal. From the macroscopic and microscopic findings of our case and some literatures, we determined that it is not feasible to distinguish fibrous dysplasia from ossifying fibroma. Therefore, we considered that it might be more appropriate to term both conditions “benign fibro-osseous lesion”. The accepted treatment for these lesions is surgical resection or curettage. Many authors have suggested that cosmetics and function should be preserved if at all possible, since in both cases the lesions are classified as benign. However, fibrous dysplasia of the ethmoid sinus, tends to proceed on a more “malignant” course, growing faster and threatening vital structures such as the optic nerve and the base of the skull. Therefore, in cases such as ours, we concluded that complete removal of lesions must be ensured, followed by careful postoperative observation.

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A 50-year-old female complained of swelling of the right upper eyelid and slight exophthalmus. She was treated with surgical excision and irradiation and has shown no recurrence. The authors review the treatment and prognosis of malignant lymphoma of the paranasal sinuses, especially of the frontal sinus. Combined therapy showed the best results, but the prognosis is not favorable. It is concluded that the patients with non-Hodgkin's lyphoma in the frontal sinus should be followed up carefully.

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Thirty-six cases comprising 38 whitish lesions in the oral cavity were reviewed in our clinic from November 1982 to May 1989. The cases were treated surgically and examined histologically. The results obtained were as follows: 1. Among the patients with oral whitish lesions, males were much more frequent than females. There was a predominance in the older age group from age 60 to 69 years. 2. Seventeen cases (44.7%) were found to be simple epithelial hyperplastic lesions which were the largest number histologically. Eight cases were invasive squamous cell carcinoma and four cases showed mild to severe dysplasia. 3. The most frequent location for oral whitish lesions was on the tongue. Malignant and premalignant lesions were also concentrated in the tongue, especially on the lateral margins. 4. A total of 88.9% of the malignant whitish lesions caused local pain and 77.8% of the lesions contained an ulcerative focus. A relatively small number of benign whitish lesions resulted in local pain and showed an ulcerative focus. It is very difficult to distinguish lesions possessing malignant potentials from simple epithelial hyperplastic lesions. However, the results from this study may prove useful in determining future policies.

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A case of dysphagia after extirpation of a carcinoma in the soft palate is reported. The patient complained that the bolus tended to enter the nasal medium entered the nasal cavity through a defect in the soft palate. A speech aid was used to close the defect. This treatment sufficiently alleviated the disturbance. Thirteen month later, entrance of the contrast medium disappeared even if the instrument was detached. This could suggest that the use of speech aid helps the increase of the levator veli palatini and tensor veli palatini muscle contraction and the increase the function of the impaired soft palate. A speech aid is a useful tool for closing small defects of the soft palate which cause swallowing disturbances.

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A 42-year-old male complaining of tonsillar hypertrophy, which was diagnosed as the second stage of syphilis, is reported. In this patient, milk-white granulation, so called condyloma latum, was observed in the pharyngeal and tonsillar mucosa and anus. These are typical symptoms of second stage of syphilis. Serological testing is important for the diagnosis and treatment of syphilis. Recently the early stage of syphilis case has been increasing. Otorhinolaryngotists should have a knowledge of this disease.

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A six-year-old boy presented fever, pharyngeal pain and a very tender neck mass in the right side. CT-scanning showed a right parapharyngeal mass and an enlarged cervical node in the upper deep cervical region. Peritonsillar abscess was not observed. Subsequently, the clinical criteria for the diagnosis of Kawasaki syndrome were satisfied. This unusual presentation is discussed with a previously reported case in the literature.

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Laryngeal lipoma appears to be an unusual finding in the laryngeal region. We reported the case history of a 57-year-old male who initially suffered from a bulky mass in the hypopharynx in 1966. The mass was removed using direct laryngoscopy under local anesthesia in July, 1966. However, the mass recurred in December 1966, January, 1972, December, 1972. March 1983 and most recently in October, 1988. Each of the five times, the mass was again surgically removed. It has now been 18 months since the most recent irradicative surgery using the unique lateralpharyngectomy method and there has been no recurrence.

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Recently, many cases of laryngeal stenosis due to burns have been surgically treated by our otolaryngologists with developement of emergency treatments. We report a case of a 37-year-old postburn female who attempted suicide by a gasoline fire in a car and had late laryngeal stenosis. She was burned on her face and right neck skin, and suffered dyspnea and hoarseness about a month after her injury. Laryngeal stenosis was found by laryngeal fiberscope, and an emergency tracheotomy was performed. She was operated on and her larynx was reconstructed by the laryngofissure method after completing dermatological treatment. Laryngeal stenosis due to burns comprises a wide variety of conditions which are operated on case by case. We discuss the treatment of laryngeal stenosis and emphasize that the most important factors in surgical treatment for laryngeal stenosis are complete extirpation of granulation and adequate core mold.

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A case of benign symmetric lipomatosis is discussed. The patient was a 46-year-old male who presented slowly enlarging soft multiple tumors on the neck and the back, over the couse of 8 years. He had been a habitual alcoholer for 26 years. The laboratory data revealed liver dysfunction and hyperuricemia. Because the tumors expanded into the deep neck tissue, some of them were extirpated cosmetically. Histological examination revealed accumulation of mature fatty cells lacking a membranes. In spite of occasional reports in Europe, the disease has been very rarely reported in Japan. We were only able to find 10 cases in the literature.

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Four cases of malignant reticulosis were evaluated retrospectively. The patients reported here were an 83 year-old female, a 65 year-old male, a 43 year-old male and a 44 year-old male. Among these patients, two survived and two are deceased. In order to confirm the clinical significance of these cases, we evaluated clinical features, such as local appearance, histological findings and clinical course for each patient. Our observations indicate that the nasal cavity lesion is relatively localized in the survired cases. On the contrary, adjacent tissue invasion extending into the nasal septum and/or hard palate perforation was noted in the mortal cases. Pathohistological findings in the necrotic tissue revealed that atypical cells gathered in some places and polymorphic infiltration was found in the survired cases and atypical cells scattered widely in the mortal cases. From our results, pathology of atypical cell distribution appears to be the most important factor in influencing prognosis.

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A case of parkinsonism associated with aspiration is reported. He suffered from recurrent pneumonia due to aspiration. Esophagography showed a delay in the oral stage of deglutition and severe aspiration. Only a small amount of contrast medium entered the esophagus during deglutition. Electromyographic findings of the geniohyoid, thyropharyngeus and cricopharyngeus muscles showed abnormal activity patterns of these muscles. Our neurologic examination suggested that the main cause of the dysphagia in this patient was a disturbance of the coordination of the muscles which participated in deglutition. We were finally compelled to perform a laryngectomy.

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A case Forestier's disease (58-year-old male) with dysphagia is reported. Rentogenogram of the cervical spine and CT revealed anterior osteophyte bridging from the C4 to the C6 vertebral bodies. Esophagogram showed impairment of the bolus passage and a slight degree of aspiration. The exuberant bone was excised via a lateral cervical approach. After surgical treatment the dyaphagia disappeared. The findings of the esophagogram were almost normal.

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Intestinal Behcet's disease including esophageal ulcer has been recognized in recent years. We report a case of Behcet's disease with esophageal ulcer. Previously reported cases of Behcet's disease with esophageal ulcer are reviewed and it's treatment is also discussed. In the presest case, a 21-year-old female who had been suffering from dysphagia since age 13, visited our hospital on Mar. 2, 1987. The esophagogram showed stenosis and multiple small ulcer in the upper esophagus. We suspected this to be a case of Bechet's disease because of 2 major symptoms (aphtous stomatitis, genital ulcer) and 2 minor symptoms (arthritis, esphageal ulcer) in her history and physical examinations.

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