A case of tracheal stenosis caused by a traffic accident was reported. A 39-year-old male was admitted to our clinic because of dyspnea after emergency tracheostomy. On admission, stenosis about 3 cm below the tracheostoma was found fiberscozically. Therefore, he was treated with a combination of of Nd-YAG laser irradiation and residual Silicone T-tube for 8 months post operatively. Since removal of the T-tube 5 years ago, there has been no indication of restenosis nor trouble with respiration. Although application of the T-tube for treatment of upper tracheal stenosis has been reported, a few studies are available on its use in middle tracheal stenosis. Based on our clinical experience, we recommound that the technique reported here is extremely useful for treatment of tracheal stenosis.

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A case of adenocarcinoma on the laryngeal surface of the epiglottis was seen in our clinic. The patient, a 59-year-old man, complained of an abnormal sensation in the throat. Laryngoendoscopic examination revealed a smooth and hemispherical tumorous lesion on the right side of the laryngeal surface of the epiglottis. Under general anesthesia, a laryngomicrosurgical biopsy was obtained using a direct laryngoscope. A moderately differentiated adenocarcinoma was diagnosed histopathologically. Subsequently, a supraglottic horizontal partial laryngectomy was performed. No indication of recurrence or metastasis was observed 7 months after surgery. It is quite rare for an adenocarcinoma to develop in the larynx. In our report of this case, the emphasis is upon treatment methods.

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Three cases of malignant fibrous histiocytoma (MFH) in the paranasal sinuses were reported. Case 1 was a 13-year-old boy with MFH of the left maxillary antrum. The tumor was removed by partial maxillectomy. The patient has been free from disease for 6 years following surgery. Case 2 was a 49-year-old male with MFH of the left maxillary antrum. The tumor was too large to remove completely. Thirteen months after the initial treatment, the patient died of cachexia. Case 3 was a 33-year-old female with MFH of the right ethmoidal sinus. Partial maxillectomy was done, but recurrences necessitated six consecutive excisions. Two years and 7 months after the initial operation, the patient died following intracranial invasion of the tumor and metastasis to the lung. All three cases responded poorly to both chemotherapy and radiotherapy. Ninety-three cases of MFH in the nose and paranasal sinuses have been reported in the literature. Patients ranged from 3 to 85 years of age. Forty-four were male and 49 were female. Tumors occurred on the maxillary antrum or maxilla (71 cases), on the ethmoidal sinus (5), in the nasal cavity (5), on the frontal sinus (2) and on the sphenoidal sinus (1). The 2-year cumulative survival rate was 52% and the 5-year 19%. Rate of metastasis and local recurrence were 31% and 40%, respectively.

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A case of a 63-year-old man with Warthin's tumor occurring in the bilateral parotid glands and the left submandibular gland is presented. Although the bilateral occurrence of Warthin's tumor of the parotid gland is reported often, this tumor occurs rarely in the submandibular gland. A technetium scan was positive in all three regions and remained positive in the post washout period. Bilateral partial parotidectomy and extirpation of the left submandibular gland were performed. The tumor was characterized by double-layered, finely granular and eosinophilic epithelium and lymphoid tissues in the stroma. No tumor cells were identified in the lymph nodes of the parotid and submandibular regions. Electron microscopy revealed epithelial cells containing numerous mitochondria witth abnormal morphologic features. The cristae of mitochondria were often numerous and were arranged in stacks. Little difference was observed between the parotid and submandibular gland using both light and electron microscopy.

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A very rare case of infiltrating lipoma was reported. A 1-year-old boy with a left neck tumor was admitted and treated in our department. Histological study revealed that the tumor was composed of mature normal-appearing fat cells which had infiltrated between muscle fibers. Infiltrating lipoma is an uncommon benign tumor not usually associated with the head and neck areas. Only four cases of such tumors involving the head and neck have been reported in the literature. Because this tumor has a higher rate of recurrence than ordinary lipoma, complete surgical excision is the treatment of choice. However, because of the rare incidence of this tumor, accurate preoperative diagnosis may be difficult. It is well known that lipoma has a low absorbance value in CT (-70-90HU). In our case, CT scans showed a low density mass (-76.8HU), and a reticular pattern which is not found in ordinary lipoma. These CT findings were assumed to be characteristic for this tumor. The CT scans is considered to be very useful in the differential diagnosis of lipoma.

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A very rare case of carcinosarcoma of the maxillary sinus, treated by irradiation and chemotherapy and terminating in death, was reported. The patient was a 65-year-old male complaining of pain and swelling of the right lower eyelid and cheek. X-ray examinations revealed destruction of the bony walls of the right maxillary sinus and ethmoid sinus. Histopathological and immunohistochemical examinations revealed that the tumor consisted of two distinct elements; squamous cell carcinoma and sarcoma. We believe our report to be the sixth case of a carcinosarcoma of the maxillary sinus reported in the literature.

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Using the TOHO MEDICAL INDEX (TMI) test, we investigated the roles of psychogenic factors and of autonomic nerve dysfunction during the clinical course of hyperesthetic rhinitis, including allergic rhinitis and vasomotoric rhinitis. The TMI test was administered to 62 patients with hyperesthetic rhinitis and 21 healthy persons with no history of allergic diseases. Patients with hyperesthetic rhinitis showed a tendency toward autonomic nerve dysfunction, while healthy persons did not. Moreover, the severity of subjective symptoms (sneezing, running nose and nasal obstruction) correlates closely to the high TMI test scores obtained among the hyperesthetic patients. Therefore, it is assumed that autonomic nerve dysfunction and psychogenic factors might contribute to the worsening of the subjective symptoms in hyperesthetic rhinitis. The TMI test is simple to administer and very useful in evaluating the characteristic backgrounds of patients with hyperesthetic rhinitis. Its results may be helpful to the clinicians in choosing the optimal treatment for this condition.

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Oral florid papillomatosis has the clinical appearance of a malignant tumor but falls into the benign tumor category. Although lichen mucosae oris is known to be a preceding lesion, the etiology remains unknown. A 67-year-old female complaining of an oral tumor visited out clinic. Examination revealed a case of oral florid papillomatosis disease secondary to the occurrence of lichen mucosae oris following the restoration of a dental crown and inlay using a number of dental metals. Diagnosis was confirmed histopathologically. The dental metals were removed, and the patient received two curses of combination chemotherapy (VMP regimen) using VCR, MTX and PEP. Subsequently, she was given orally UFT and the lesion disappeared as a result. No recurrence was observed after two years and four months of treatment. A report of this case includes a discussion of the etiology and treatment of this disease.

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We investigated the effectiveness and safety of fleroxacin on tonsillitis, pharyngolaryngitis, suppurative sialadenitis and infectious stomatitis in 94 cases treated in 31 institutions nationwide. Fleroxacin was given in doses of 200 or 300 mg daily for 7 days to 72 cases of tonsillitis, 16 cases of pharyngolaryngitis, 4 cases of suppurative sialadenitis and 2 cases of infectious stomatitis. The clinical efficacy rate was 88.9% in tonsillitis, 100.0% in pharyngolaryngitis, 75.0% in suppurative sialadenitis and 100.0% in infectious stomatitis. The bacteriological eradication rate was 93.7% in tonsillitis, 91.7% in pharyngolaryngitis, 100.0% in suppurative sialadenitis and 100.0% in infectious stomatitis. Side effects were observed in 2 cases of pharyngolaryngitis. One patient experienced nausea and abdominal pain and another a sensation of floating. Symptoms disappeared when drug administration was discontinued. Abnormal laboratory test findings included mild abnormal hepatic function in 1 case each of tonsillitis and suppurative sialadenitis. Our results indicate that fleroxacin is clinically useful in the treatment of tonsillitis, pharyngolaryngitis, suppurative sialoadenitis and infectious stomatitis in daily doses of 200 or 300mg.

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A multi-institutional study of CMX maxillary sinus instillation therapy in the treatment of sinusitis was conducted in accordance with a uniform protocol. The following results were obtained. 1. The rate of clinical efficacy (good and excellent ratings combined) was as high as 83.3% according to the doctors in charge and 81.1% according to the committee. 2. The efficacy rate based on X-ray findings was 60.3% according to the doctors and 59.3% according to the committee. 3. The bacteriological response was excellent with an elimination rate of 87.1%. 4. In 140 cases assessed for antibiotic safety, no side effects were reported. The above results suggest that CMX administered nasally is beneficial in the local treatment of sinusitis.

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A rigorously controlled study of 1% CMX for nasal use was conducted to assess its efficacy and safety and to establish the proper dosage in the treatment of sinusitis. 1. The clinical efficacy rate (good and excellent ratings combined) according to the doctors in charge was 72.7% for 20mg vs. 84.2% for 40mg, the majority favoring 40mg. 2. The committee rated CMX clinically effective at 72.7% for 20mg vs. 64.5% for 40mg. The majority of committee members rated CMX clinically effective at both 20mg and 40mg doses. 3. X-ray findings interpreted by the doctors yielded an efficacy rate of 55.2% for 20mg vs. 74.2% for 40mg, again tending to favor doses of 40mg. Committee members interpreted the X-ray data as showing efficacy rates of 64.2% for 20mg vs. 74.2% for 40mg. 4. In evaluating bacteriological response, a majority of 75.5% rated 40mg as the more effective dose, contrasted with 56.6% who rated 20mg as the preferred dosage. 5. A mild side effect was found in one case in the 20mg group, which disappeared after discontinuation of CMX. The above results suggest that CMX nebulization therapy is as effective as, and sometimes more effective than, the usual systemic therapy with antimicrobials or anti-inflammatory enzymes, hence being a useful local therapy in the treatment of sinusitis.

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