A fifty-three year-old female presented with an hemangiopericytoma of the maxillary sinus. The tumor occupied the left maxillary sinus, nasal cavity and ethmoid sinus. After pathological diagnosis of arterial obstructions of the maxillary artery feeding the artery of the tumor, a total maxillectomy was performed, in addition to intraoperative and postoperative radiation therapy. There was no recurrence of the tumor 10 months after treatment.

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Complement components CH50, C3, and C4 were measured in serum of 237 patients with nasal allergy or vasomotor rhinitis. These levels were correlated with clinical data to determine the role of complement in nasal hyperreactivity. Complement component levels increased with patient age and duration of nasal hyperreactivity. In the group of 20 to 39 year-old patients exposed to house dust, the C4 level was significantly related to duration of the disease; higher in the patients with 20 years duration than in patients with less than 20 years duration. There was no such correlation in patients with Japanese cedar pollinosis. There was some relation between paranasal sinusitis on x-ray and complement component levels of patients with nasal hyperreactivity, especially in those allergic to house dust.

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The adequacy of the measurement method standard of the heptatonic pitch-matching test (HPMT) proposed by Ohsaki et al. in 1983 was investigated. Eighteen ears were examined for subjective tinnitus pitch using HPMT. Each test measured the tinnitus pitch successively 10 times. In the ten measured values, both the mode and its adjacent tone accounted for more than 70% of exery case. The measured value was sufficiently reproducible when the minimum unit width of this scale was regarded as the extent of phisiological variation. The ten measured values of each case were then classified into six types (A-F), and the coincident ratios between those six types of measured value and the mode were compared for every case. The coincident ratios between the mode and both measured values-same value obtained (A) twice in succession or (B) twice at first but not necessarily in succession after two preliminary attempts, were 94% and 89% respectively. These ratios were higher than the coincident ratios between the mode and four other kinds of measured values. When two preliminary attempts were made in the measurement of HPMT, the value A was adopted as the approximate frequeny value of tinnitus pitch.
Based on the above results, the standard of the measurement method appears adequate. On the other hand, the B value can reasonably be utilized as a brief measurement method.

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Twelve adults with unilateral sensorineural deafness received an electrical stimulation (50, 100, 200, 400 and 1600-Hz squire wave) on the promontory in the deaf ear by transtympanic stimulation. Unilateral subjects were selected so that the sensation elicited by electrical stimulation could be compared to the contralateral acoustic sensation. Three kinds of sensation were elicited in the deaf ear: auditory sensation in 9 out of 12 ears, indescribable sensation-neither auditory nor somatic-in 3 out of 12 ears, and somatic sensation in 7 ears. Reports of an uncomfortable loudness level consisted of two sensations; (1) at the maximum auditory level or (2) somatic sensation level. Furthermore, the pitch discrimination for the pulse frequency was discomfiting to the unilaterally deaf subjects. All reported indescribable sensations were elicited in patients with deafness of unknown origin. Therefore, we suggest that candidacy for cochlear implant and the superior side for implantation is in ears with clearly defined etiology, even if the results of promontory test were equivalent.

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A case of laryngeal spindle cell carcinoma is reported. The polypoid tumor was composed of sarcomatous spindle cells and benign surface epithelia. Histogenesis of the spindle cells was evaluated with keratin and vimentin immunohistochemical staining and electron microscopy. The spindle cell component stained positively with vimentin but not keratin. Electron microscopic study showed presence of numerous desmosomes with cytoplasmic intermediate filament bundles, believed to be evidence of epithelial differentiation. Although the tumor did not exhibit squamous cell carcinoma, and immuno histochemical study suggested mesenchymal origin of the spindle cell, electron microscopy revealed monophasic spindle cell carcinoma.

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A rare case of neck plexiform neurofibroma is reported in a 43-year-old man complaining of neck tumor and dyspnea. The man suffers from schizophrenia and has been in a mental hospital for six years. CT and MRI revealed a neck tumor extending through the thyrohyoid membrane and projecting into the neck. The histological and clinical diagnosis was plexiform neurofibroma. There were no symptoms of von Recklinghausen disease. The tumor was completely removed without complication.

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Forty-three patients with head and neck carcinomas underwent neck dissections at the Department of Otorhinolaryngology, University of the Ryukyus Faculty of Medicine between January 1986 and September 1988. The stage of the disease was estimated clinically and compared to that derived from histological study of neck specimens. The clinical estimate of the disease stage was accurate in 53.5% of the cases. The stage of the disease was underestimated clinically in 34.9% and overestimated in 11.6% when compared to histological determination. The disease recurred more often in patients with more lymph node involvement and greater extension of pathological metastasis. Postoperative complications occurred in 12 paitents. Mediastinitis was determined to be the cause of death in one patient. Accurate operative technique is considered important in reducing recurrence and preventing postoperative complications in carcinoma of the head and neck.

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In only two of 70 cases of parotid gland tumor surgery with facial nerve preservation performed between June 1984 and March 1991, were we unable to locate the main trunk of the facial nerve. One tumor was a benign pleomorphic adenoma 45 mm in size, the other was an acinic cell tumor of 30mm. Preoperative diagnosis of both cases based on the findings of the physical examination, results of X-ray, CT, MRI, and sialography, was deep lobe tumor. Surgery revealed the location of both tumors in the lateral site of the main trunk of the nerve. There are few cases in which it is necessary to locate the facial nerve at the peripheral branch. Among these cases is a widely occupied mass between mandible, mastoid process and styloid process visualized on examination of X-ray, CT and MRI. The easiest route to locate the facial nerve from the peripheral branch was from the mandibular branch.

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Plunging ranula is a rare mucocele that extends to the submandibular region. A 15 year-old male presented with a plunging ranula originating from the sublingual gland. The ranula was surgically extirpated together with the sublingual glandular tissues through a submandibular skin incision. There has been no recurrence of the ranula 15 months after surgery. The pathogenesis, diagnosis, and treatment of the plunging ranula are discussed.

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A case report of endotemporal branching of the facial nerve is presented, and the literature on this anomaly reviewed. A 58-year-old female complaining of hearing disturbance and discomfort in her left ear presented with a mass in the ear canal. At surgery, the facial nerve was found to bifurcate into the mastoid. The anterior branch was smaller in diameter than the posterior branch, and the chorda tympani originated from it. Although the anterior branch was cut by the drill during surgery, facial nerve palsy did not occur postoperatively. The mass was histopathologically diagnosed as an adenocarcinoma, probably of ceruminous gland origin.

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Two-hundred-nineteen patients with mucocele of the lower lip were observed clinically. Mucoceles occurred most frequently in females and in younger patients. Compared with other reports in the literature, our results were similar in all aspects but age distribution. Blandin-Nuhn mucoceles and ranulas were also observed more often in females and in younger patients. Local and systemic pathogenesis were suspected causes of mucoceles of the lower lip. The relation between tumor duration and the histological changes was unclear, since patients would be less likely to notice changes in their lips in the early stages of mucocele, and since there may be periods of remission and relapse of the tumor. The tumor duration was comparatively short in 0-9 year-olds compared to patients over 40 years of age. This may be due to the fact that lesions are more likely to be noticed by parents of the younger patients, whereas older patients are apt to consult a doctor earlier due to anxiety over a possible tumor.

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Twenty-four Kyushu area institutions participated in a clinical study of Flutropium Bromide (Flubron). Ninety-six patients with allergic rhinitis and 20 patients with vasomotor rhinitis were enrolled and divided into two groups. One group received Flubron alone, the other received Flubron combined with an antiallergic agent. After two weeks, 80.4% of patients given Flubron alone, and 81.3% of the patients given the combination drugs reported responses of “slightly improved” and “better.” The rates of effectiveness were not statistically significant, however, the patients receiving Flubron alone showed less symptoms clinically than the combined-drug group. Slight side effects were reported in four patients, two receiving Flubron alone, and two receiving the combination of drugs. Based on these results, it was concluded that Flubron alone or Flubron combined with antiallergic agents can effectively treat patients with allergic or vasomotor rhinitis, without adverse effects.

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