We often clinically experience patients with oral aphtous ulcer but very few such patients with pharyngeal stenosis caused by scarring which follows ulcer formation. The authors herein report a case with pharyngeal stenosis which occurred after oral aphtous ulcer was cured. Although its pathological diagnosis was a granulosis, the specific disease that cause granulosis has yet to be determined. We resected the scar using a CO₂ laser and administered prednisolone, tranilast and Saireitou® after the operation. To date, there has been no recurrence of stenosis. Seven cases with similar clinical findings have been previously reported. Most of them were suspected of having clinical characteristics of Behcet disease. However, there has been no case which meets the complete definition of Behcet disease. Four of the seven cases were treated by a surgical approach while the other three were administered steroid. Surgical treatment is thus recommended for such cases demonstrating a recurrence of stenosis in spite of undergoing the above described treatment.

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A 72-year-old female was found to have a retraction at the posterior-superior quadrant (PSQ) of the left tympanic membrane. Computed tomography revealed a large destruction in the posterior cranial fossa and the inferiormedial portion of the pyramis including the jugular foramen. At operation, a large cholesteatoma was found to extend from the mastoid into the posterior cranial fossa and jugular foramen. It was interesting to note that this cholesteatoma was not related to the destruction at the PSQ or the tympanic membrane, i. e. no cholesteatoma was found in the epitympanum or the mastoid antrum. These findings thus suggested that this cholesteatoma in the posterior cranial fossa might be congenital.

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The case of a left carotid body tumor is herein reported. The patient was a 47-year-old woman who presented complaining of a left neck mass. Computed tomography, magnetic resonance imaging and angiography all demonstrated a tumor mass showing high vascularity which was located at the bifurcation of the left carotid artery. The clinical diagnosis of a left carotid body tumor was thus made. The patient showd satisfactory ballon occlusion test results without any neurological complications. Since the tumor strongly adhered to the carotid arterial wall, the tumor was resected together with the carotid artery. Although a reconstruction of the the carotid artery was not performed, no neurological complications were recognized except for partial palsy of some cranial nerves, which were injured intraoperatively. In the literature, 24 such cases of carotid body tumors, which had been operated on during the past 10 years in Japan, were also reviewed. In 8 of these cases, the tumor was resected together with the carotid artery which was not reconstructed in 4 cases. In these 4 cases, no neurological complications were recognized. It was thus concluded that the satisfactory results of a preoperative examination, including a MATAS test, thus indicated that a reconstruction of the carotid artery, which had been resected with the carotid body tumor, was therefore not necessary in this patient.

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A rare case of dermoid cyst arising from the deep lobe of the parotid gland and extending into the parapharyngeal space is herein reported. MR images of the tumor before operation showed a high and monotonous signal intensity in the T1-and T2-weighted images and a well-defined margin except for the area inside the parotid gland. In addition, t his tumor demonstrated a dumb-bell shape and shifted the internal carotid artery backwards. The trans-parotid was chosen as the surgical procedure and the tumor was successfully extirpated after cutting the stylomandibular ligament off in order to obtain a larger operative field.

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A thyroglossal duct cyst is caused by the remains of the thyroglossal duct, which usually disappears after 10 weeks of gestational age. Most thyroglossal duct cysts are located along the middle cervical line between the hyoid bone and the thyroid cartilage. We report a case of thyroglossal duct cyst located laterally along the margin of the left sternocleidomastoid muscle. The duct of the cyst was found to adhered to the left lateral portion of the hyoid bone, about 3cm away from the center. An accurate diagnosis was not made during the extirpation procedure, but was later confirmed by a pathologic examination of the specimen after operation. Although a traditional Sistrunk procedure was not performed to manage this laterally located cervical cyst, no recurrence appeared after the surgery.

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A case of synchronous triple primary cancer, i. e. in the mouth floor, hypopharynx and stomach is herein reported. The patient was a 72-year-old male who presented with oral pain of one month's duration. A mouth floor tumor had been pointed out by the dentist, and later a hypopharyngeal tumor was later found in the MRI. A stomach tumor was also detected by gastroscopy. Histologically the mouth floor tumor and the hypopharyngeal tumor proved to be squamous cell carcinoma, while the stomach tumor was diagnosed to be adenocarcinoma. At first, the oral cavity tumor and the hypopharyngeal tumor were operated on, however, the tumor later recurred in the neck.

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An 87-year-old female patient with recurrent squamous cell carcinoma invading the left side of her anterior skullbase was operated on. The anterior skullbase was reconstructed using our modified New's sickle flap. This flap is a kind of scalp forehead flap, which is an axially pattern flap with two pedicles. The first pedicle is the base of the superficial temporal arteries, the second pedicle is the part of anastomoses between the superficial temporal artery and the supratrochler artery. Our modified sickle New's flap is considered to be useful for the skullbase reconstruction when the other side of the skin cannot be used.

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An exploratory antrotomy of the maxillary sinus was performed in a 36-year-old male who presented complained of nasal bleeding and obstruction for differentiating maxillary cancer. The maxillary sinus was filled with a whitish-gray elastic soft tumor which had a pedicle adjacent to the maxillary ostium. A partial bony defect of the posterior wall of the maxillary sinus and orbital floor were found. The mucous membrane of the maxillary sinus was intact except at the maxillary ostium. Histopathologically, the specimen was composed of necrotic tissue and hematocele was diagnosed. Many authors have reported the mucous membrane of the maxillary sinus in hematocele to be well-preserved whether bone destruction is present or not. Such a phenomenon is also considered to be the differential finding for maxillary cancer. The preoperative MRI of this case showed the well-preserved mucous membrane of the maxillary sinus. Based on the above findings MRI is thus considered to be useful for detecting hematocele in the maxillary sinus.

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The clinical, histological and prognostic features of 72 patients with extranodal non-Hodgkin's lymphoma treated at the Department of Otorhinolaryngology, University of the Ryukyus, Faculty of Medicine from 1974 to 1994 were reviewed. Waldeyer's ring lesions were the most frequently encountered. The next largest category was the sino-nasal region. The survival rate of the patients with Waldeyer's ring lesions showed no superiority to that of patients with sino-nasal lesions. The use of chemo-radio combined therapy is expected to improve the overall prognosis of patients with non-Hodgkin's lymphoma in the head and neck. But the frequent occurrence of a T-cell phenotype in Waldeyer's ring lesions is considered to be an unfavorable factor which can result in a poor therapeutic outcome.

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Although the pathogenisis of idiopathic facial palsy still remains to be clarified, ischemia is thought to be one of the most possible factors. We confirmed in our previous study that the interruption of the petrosal artery, which provides the main arterial supply to the geniculate ganglion, resulted in a marked decrease in the facial nerve blood flow around the geniculate ganglion, and this thus later caused ischemic facial palsy. In the present study we investigated the natural course of facial palsy induced by an interruption of the petrosal artery. The results were as follows: 1) In 68 of 80 animals (85%) facial palsy developed (severe: 21, moderate: 22, slight: 25 animals), 2) In animals with severe palsy, a complete recovery of the facial palsy took about two months and pathological synkinesis was often accompanied in the recovery stage, 3) Animals with moderate or slight palsy improved within one month and the duration of palsy depended on the severity, 4) Regarding the behavioral course of facial movement, ischemic facial palsy caused by an interruption of the petrosal artery seemed to be analogous to idiopathic facial palsy in humans. Thus, this animal model might provides useful informations for evaluating the pathogenesis of idiopathic facial palsy.

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The amplitude of the evoked electromyograms of the affected side is larger than that of the unaffected side at the early onset of peripheral facial paralysis. This phenomenon is supposed to be due to a hyperexcitable state. To prove this supposition, the changes in the evoked electromyograms were studied both before and after compressing the facial nerve. When the amplitude of the evokggi electrorayograms after compression was larger than that of the evoked electromyograms before compression, it was then classifiq as type A, In contrast, when the amplitude did not change after compression, then it was classified/as type B. Finally, When the amplitude decreased significantly after compression, it was labeled as type C. The observation of type A, B and C facial nerves under electronmicroscopy thus showed the myelin sheath lamella to be mildly separated, while the axon was normal. Evoked electromyograms of the compressed 15S proup and the 30S group disappeared. Thus, the pathologic changes in the myelin sheath and axon were therefore considered to be severe.

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A 40-year-old woman presented complaining of frequent urination and pain during while urination. She had been treated with Tranilast (300mg/day) for thirty-five days for the prevention of post-operative keroid. A urinalysis, however, showed asceptic hematuria. She therefore was treated with antibiotics but no improvement in her symptoms was observed. A cystoscopic examination revealed a reddish and edematous vesical mucosa. The symptoms disappeared thirty days after terminating the treatment with Tranilast.

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A nasal allergy study against orchardgrass and ragweed was conducted on freshmann and senior university students (here after referred to as U-1 and U-4, respectively) in Nanjing Medical University, China. Orchardgrass is known to grow thickly along roadsides in Jiansu province around Nanjing University, and this was confirmed by the high positive scratch test rate results. We noticed that Chinese children also pick orchardgrass for fun just like Japanese children, and this habit is supposed to affect the development of sencitization against orchardgrass pollen. The positive rate against ragweed was higher in U-1 than U-4 students, but this may only reflect the amount of ragweed pollen scattered in the students' respective hometowns, as U-1 students were examined immediately after entering the university. No significant sex difference was observed against orchardgrass or ragweed. These findings lead us to speculate that a reversal of sex difference for the allergy apparently occurs at this age similar to the findings of our previous report.

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We examined the sex differences in the prevalence rate of nasal allergy based on the results of an annual collective health-check at an elementary school in Shiraoi-cho, Hokkaido held in 1989, 1990 and 1991. A substantial sex difference was ovserved as follows: the male pupils showed a higher nasal allergy prevalence rate than the female pupils, and this tendency was similar to the one observed in the sex difference in the positive rate of the scratch test reported earlier. We thus speculated that the observed sex difference in the prevalence rate of nasal allergy is thus associated with the mechanisms of sensitization development.

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