A patient was diagnosed as having a cholesteatoma of the middle ear and thus underwent the surgery of middle ear. However, swelling was found in the posterior wall of the external auditory canal instead of the cholesteatoma at operation, which was later demonstrated to be adenoid cystic carcinoma after a pathological examination. We immediately performed a radical operation of the middle ear. However, the tumor was found to recur and invade both the middle cranial fossa and pyramid bone based on the CT and MRI findings 6 months later. As a result, the patient underwent a successful subtotal resection of the temporal bone. Our procedure for this operation is herein described in detail.

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A 50-year-old female with a right mandibular squamous cell carcinoma diagnosed as T4N1 underwent rt. partial mandibulotomy with resection of the total layer of the cheek and a rt. functional neck dissection. As a result, the mandible and rt. lower branch of the facial nerve were damaged. Therefore, a scapular osteocutaneous flap and a latissimus dorsi muscular flap, including the thoracodorsal nerve were elevated as a combined flap. The mandibular bone, oral mucosa and cheek skin were reconstructed using a scapular-parascapular bilobed skin flap with the sacpular bone. To restore function of the lower branch of the facial nerve, the thoracodorsal nerve of the latissimus dorsi muscular flap was sutured to the proximal end of the resected lower branch of the facial nerve, while the distal end of the latissimus dorsi muscular flap was divided and sutured to the muscle around the lip. The postoperative function and shape of the mandible were both found to be satisfactory. Moreover, lip movement was recognized 6 months after the operation. We thus conclude that the combined flap consisting of a scapular osteocutaneous flap and a latissimus dorsi muscular flap is useful for simultaneous reconstruction of the mandible and lower branch of the facial nerve.

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Glossal pain without any objective findings in the tongue is defined as glossodynia. We investigated the serum iron, serum zinc, oral candida, psychological elements and the function of the salivary glands in such patients with glossodynia. As a result, the serum iron level was low in 48% of such patients, the serum zinc level was low in 16%, the number of candida was more than one plus in 21%, the function of the salivary glands was low in 62%, and the CMI test was type III or IV in 39% of the patients. Based on these findings, we thus considered glossodynia to be concerned with a combination of such factors as a low serum iron level, a low function of the salivary glands, psychological elements and the presence of oral candidiasis. We performed a stellate ganglion block on such patients with glossodynia and this treatment was found to be effective in 84% of them. The block of the sympathetic nerve may thus have improved the blood flow to the tongue with local anemia while also increasing the total volume of the saliva in patients with a low salivary gland function.

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We prospectively studied cases demonstrating secretory otitis media caused by hyperbaric oxygen therapy (HBO). HBO was used in 37 patients (73 ears) and the incidence of secretory otitis media was 23%. Elderly patients had a high incidence of secretory otitis media induced by HBO. Secretory otitis medea induced by HBO showed no correlation with sex or the number of HBO teratments. Secretory otitis media was induced by HBO more often in the patients with a C type tympanogram than in those with an A tipe. In addition, a high incidence of secretory otitis media by HBO was also observed in the patients who had a past history of middle ear diseases.

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Over the past 30 years a chorda tympanectomy has proven to be effective in providing relief of vertigo symptoms in 80% of 415 Meniere's disease patients treated at our clinic who had otherwise failed to respond to any form of medical treatment.
1) these results were not inferior to other surgical approaches.
2) This type of surgery is a simple procedure which helps patients find relief from sensorineural impairment. Therefore this minor surgery should be the first treatment for Meniere's disease cases that prove difficult to cure using traditional methods. Even when symptoms occur again, both a vestibular nerve section and a labyrinthine destruction are available. This mechanism is therefore considered to be effective in correcting a local disturbance of automatic regulation.

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A 9-year-old boy was diagnosed as having a large follicular impacted dental cyst (tooth No.5). The cyst was infected and occupied the right maxillary sinus. It was fenestrated by a gingivobuccal approach and the tooth was removed. The cyst was irrigated by antibiotics through the gingivobuccal window. After it was fenestrated into the inferior meatus of the nasal cavity, the window in the gingivobuccal sulcus was closed. This nasoantral window played an important role in the reduction of the cyst and thereafter the reduced cyst was then removed. Computed tomography revealed the presence of a normal mucosa in the right maxillary cavity after operation. These results suggested that staged operations could thus be very effective in treating a large infected follicular dental cyst.

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We experienced two cases of neurinoma with one located in the tongue, and the other in the lateral cervical region. We herein report the radiographical and MRI findings. The Case 1 was located in the tongue and was suspected to be a malignant tumor with cystic degeneration on an enhanced CT, but the MRI findings showed a low possibility of malignancy because the cystic lesion proved to be an old hemorrhage and the pattern of growth was expansive but not invasive. The Case 2 in the lateral cervical region was at first regarded as an aneurysm by CT. However, the MRI findings showed no appearance of a flow void, and the tumor extended in an upper as well as in a lower direction. Therefore based on the MRI findings the most probable diagnosis was that of a neurogenic tumor. Based on the above findings MRI was thus considered to be useful in the diagnosis of these two cases since a malignant tumor and an aneurysm could be ruled out.

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A case of a giant parotid gland tumor diagnosed to be pleomorphic adenoma is herein described. A 64-year-old female presented with a mass which had grown to 10×10×13cm in size. Although the tumor was large, the suture of the wound after a surgical resection posed no problems. The facial nerve was also adequately preserved. In the post-surgical follow-up no evidence of either Frey's syndrome or tumor recurrence has been observed to date.

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The presence of a sensory component in the pharyngeal branch of the vagus nerve (PhB), including its peripheral distribution and central projection were studied by denervation and tracer experiments in the cat. The distribution of nerve fibers immunoreactive to protein gene product 9.5, a sensitive neuronal marker, calcitonin gene-related peptide and substance P in the pharyngeal epithelium was analyzed in both intact animals and in animals subjected to partial denervation by means of sectioning two out of the three nervetrunks; consisting of the glossopharyngeal nerve (GPN), the superior laryngeal nerve (SLN) and the PhB, while leaving one intact. The present results show that the GPN and SLN carry nerve fibers to the pharyngeal epitheliumrostral and caudal to the middle level of the epiglottis, respectively, while the PhB carries nerve fibers to the mesopharyngeal epithelium. Tracer experiments, by applying wheat germ agglutinin-horseradish peroxidase to the PhB, demonstrated retrogradely labeled primary sensory neurons in the jugular ganglion and transganglionic labeling of terminals in the interstitial subnucleus of the nucleus of the tractus solitarius (NTSis). These results indicate that the PhB contains a sensory component which originates from the jugular ganglion, innervates the mesopharyngeal epithelium, and projects to the NTSis.

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The clinical efficacy of ATP and dilazep dihydrochloride was examined in patients with vertigo or dizziness of the ENT field. Fifty (50) patients with vertigo or dizziness irrespective of whether the symptoms were peripheral or central, were divided into groups of 25 patients each, including a 3-drug combination group (Group I) in which medication consisted of 300mg/day of dilazep dihydrochloride, 3g/day of ATP preparation and 15mg/day of medazepam, and a group on medazepam alone (Group II). The drugs were given for more than 4 weeks while employing the blind envelope method. In terms of subjective symptoms such as nausea and vomiting, Group I showed a significantly higher improvement rating compared to Group II (p<0.05). As for objective symptoms, a significantly higher improvement tendency in a static examination was obzerved in Group I in comparison to Group II (p<0.05). The shorter the morbid period, the higher the global improvement rating was. Based on these results, the 3-drug combination of dilazep dihydrochloride, ATP and medazepam was considered to be very useful in the treatment of vertigo or dizziness in the otolaryngological field.

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Nilvadipine, a selective calcium-entry blocker, was administered to 17 patients who presented with complaints of dizziness and vertigo for 4 weeks and the clinical efficacy was studied. The rate of general clinical efficacy was “good” in 65% and “fair” in 100%. In two patients with hypertension, this drug induced normal blood pressure, while in patients with normal blood pressure, no change in the blood pressure was observed. In addition, no side effects were seen.

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Changes in the positive rate of a scratch test with aging were examined in the same students who all underwent a collective physical exmination and a relevant scratch test in both 1989 and 1992 in Shiraoicho, Hokkaido. The subjects consisted of first graders at an elementary school in 1989 who were then in the fourth grade in 1992, and fourth graders in 1989 who were then in the first year of junior high school in 1992. In both groups, the positive rate of the scratch test increased significantly in 1992 in comparison to the results observed in 1989. The increase in the positive rate of the scratch test as the students aged is considered to be due to the duration of the period during which the students were exposed to the allergen.

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In allergic rhinitis, patients experience several aggravating factors such as: stress, changes in temperature and fatigue. In this study, 5 cases of allergic rhinitis who presented complaining of general fatigue, anorexia and/or weight loss were treated using Hochu-ekki-to.
Case 1 was a 22-year-old female. She had been treated with hyposensitization using house dust allergen for the past several years, and her nasal symptoms were well controlled. However, after an operation for otitis media, her nasal symptoms once again worsened. She also complained of anorexia, weight loss, insomnia and tinnitis.
Case 2 was a 43-year-old female who had a past history of a total hysterectomy for myoma uteri, who also complained of anorexia and insomnia.
Case 3 was another 43-year-old female who had moderate anemia.
Case 4 was a 26-year-old male who complained of insomnia, fatigue and stress at work.
Case 5 was an 18-year-old male who complained of fatigue due to strenuous study for entrance examinations. All cases were treated with Hochu-ekki-to and all improved within a few days to one month. In particular, cases 1 and 2 were treated only with this Chinese medicine. Based on these findings, Hochu-ekki-to appears to be a useful treatment for allergic rhinitis associated with such poor physical conditions as fatigue, insomnia, anorexia and weight loss.

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Ritipenem acoxil (RIPM-AC) was clinically evaluated in 61 patients with sinusitis and the following results were obtained:
1) In the 51 patients in whom clinical efficacy of the drug was evaluated, the efficacy rate was 96% for acute sinusitis, 76% for acute exacerbations of chronic sinusitis, 63% for chronic sinusitis, and 84% for all patients.
2) The eradication rate of the isolated bacteria was 91% for Gram-positive bacteria, 100% for gram-negative bacteria, and 94% for all isolates.
3) The improvement rate (the percentage of patients who showed at least a mild improvements) of the X-ray findings was 69%.
4) Side effects were noted in 2 (3%) of 59 patients, and abnomal laboratory findings M1 (3%) of 30 patients, but none were of any particular clinical significance.
5) The safety rate was 95% (56/59).
6) The usefulness rate was 83% (43/52).
Based on these findings RIPM-AC is thus considered to be highly useful for the treatment of sinusitis.

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The clinical effects of ritipenem acoxil (RIPM-AC) were examined in 42 patients with tonsillitis, 8 with pharygolaryngitis and 15 with suppurative sialoadenitis and the following results were obtained:
1) The efficacy rate was 86% (25/29) for tonsillitis, 86% (6/7) for pharygolaryngitis, and 92% (11/12) for suppurative sialoadenitis.
2) The bacteriological response was “eradicated” in 39,“replaced” in 1 and “unchanged” in 1. The bacteriological eradication rate was 98%. Of the 55 causative organisms, all but 1 strain of Klebsiella pneumoniae was eradicated, with an eradication rate of 98%.
3) Side effects were observed in 3 (5%) of 63 patients, and abnormal laboratory findings were noted in 1 (3%) of 37 patients, but none of them were severe.
4) The safety rate was 94% (59/63).
5) The usefulness rate 83% (24/29) for tonsillitis, 86% (6/7) for pharygolaryngitis, and 92% (11/12) for suppurative sialoadenitis.
Based on these findings, RIPM-AC is thus considered to be useful in the treatment of tonsillitis, pharyngitis and suppurative sialoadenitis.

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We performed a transverse cordotomy on seven patients demonstrating bilateral vocal cord motion impairment since October 1992. This method proved to be quite easy to perform and also showed good results in preserving the patients'voice quality. However, we did experience two difficult cases. The first case was a 59-year-old male who developed aspiration post-operatively. The second case was a 70-year-old female who repeatedly showed adhesion at the cutting edge of the bilateral vocal cords and had to undergo endoscopic treatment three times. We herein report these difficult cases while, at the same time, reexamining both the criteria and methodology of this operative procedure.

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Thyroplasty Type I is a popular surgical procedure used to treat unilateral recurrent laryngeal nerve paralysis. We modified this operation, and removed free cartilage in four cases. If neccessory, the inner perichondorium was incised. The thyroplasty implant (silicon plug) was fixed in place with 4-0 nylon. The post-operative results were satisfactory in most cases. This is an easy procedure that can be used to control the force of compression. The plug can be easily fixed in place using 4-0 nylon because the space between the window and the inner perichondorium is widend by the remoral of free cartilase, however, it can also sometimes result in hemorrhaging and inflammation. The removal of cartilage from the window facilitetes thyroplasty Type I.

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We surgically treated 38 patients suffering from hoarseness due to unilateral recurrent laryngeal nerve (RLN) palsy. The surgical methods used included either thyroplasty type I, intracordal collagen injection, arytenoid adduction, or a combination of these. This paper describes the pre- and postoperative phonatory functions while also discussing the indication for each surgical method. Postoperatively, the vocal efficiency index (VEI) improved in all patients, while the mean airflow rate (MFR), the H/N ratio and pitch perturbation did not always show such an improvement. Unsatisfactory results were observed in patients who either had a prominent posterior or a vertical gap between the vocal folds during phonation and who underwent only a single procedure. These findings thus suggested that the selection of the most appropriate surgical method should thus depend on the position and degree of atrophy in the paralyzed vocal fold. In addition, the patient's age, degree of social activity and personal desire to obtain an improvement in their condition were also considered to be important factors.

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The optimum method for reducing a laryngeal obstruction in children caused by bilateral vocal cord paralysis has yet to be clarified. We used the simple method previously reported by Ejnell et al. for the laterofixation of one vocal cord in an eleven-year-old girl with bilateral midline paralysis of the larynx and obtained good results. The clinical outcome of this method in children has yet to be reported. Our findings thus suggest that this comparatively atraumatic method is useful in treating children with midline paralysis of the larynx.

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We treated 11 patients with unilateral vocal cord paralysis using the arytenoid adduction technique. As a result, the improvement of the postoperative maximum phonation time was satisfactory, however, the findings of the phonograms were not satisfactory.

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