We experienced a case of neck gas gangrene preceded by mycosis. The patient complained of a sore throat, high fever, and swelling of the neck and pharynx, while a neck abscess with gas was apparent in the parapharyngeal space on a CT scan. After drainage and debridement, the patient's local and general conditions both improved. Anaerobic Streptococcus was identified by a bacterial exam and obsolete candida by a pathological exam. After surgery, the patient was treated by both antibiotics and local irrigation with fluconanzole. We thus concluded that the neck mycosis most likely preceded the formation of the abscess.

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Ninety-one patients with hypopharyngeal carcinoma who were treated at our hospital from 1988 through 1997 were retrospectively analyzed regarding their treatment modalities and results. Each patient received one of the following ttreatment modalities; FAR (5-FU, vitamin A, radiation) therapy, chemotherapy (CDDP, peplomycin), and a pharyngolaryngoesophagectomy, or a combination of these treatments. The cause-specific cumulative 5 year survival rate of all patients was 52%. The five year survival rate of the group receiving surgery was 68%, and this number was significantly higher than that for the group not undergoing surgery which has a rate of only 37%. Based on our findings, the administration of chemotherapy was not observed to result in any increase in the survival rate.

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Forty-six cases with multiple primary cancers (9.8%) among 471 cases in the head and neck region who had been treated at the Department of Otolaryngology at Tokyo Women's Medical University from 1988 to 1997 were clinically reviewed. The mean age of these patients was 65 years and the male: female ratio was 10: 1. Fourteen cases arose synchronously and 32 metachronously. The most frequent site of multiple primary cancers was the larynx in 25 cases (54.3%). Of these cases, there were six in the lung (24.0%) and five in the stomach (20.0%). A high incidence of second primary cancers was found in the esophagus (10 cases) and stomach (8 cases). The prognosis of laryngeal cancer was analyzed according to the presence of multiple cancers. The 5-year survival rate of patients with only laryngeal cancer was 81.7% while those with multiple primary cancers was 66.8%.

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The case of a pontine tumor in a 2-years-old female is presented. Both a preceding and coexisting disease hidered a correct diagnosis. The patient complained of a left hearing loss after a mumps infection at 10 months of age before she was referred to us. She thereafter developed bilateral acute otitis media and left slight facial paralysis 10 days prior to the first visit. A detailed evaluation of both the facial palsy and hearing loss could not be performed because of her age. Despite intensively treating the otitis media, the facial paralysis did not improve. Finally, MRI revealed a left pontine tumor. In small children, such as in this case, it is difficult to perform a detailed analysis of faical paralysis and hearing loss. This case shows the importance of a detailed examination to rule out a neoplastic origin in pediatric facial paralysis, even when other diseases coexist.

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A case of an extremely rare parotid gland tumor with an elevated CEA (carcinoembryonic antigen) level is reported. A 73-year-old man with an elevated serum CEA level was examined in detail at an internal department, but no abnormal signs were found. Thereafter, he visited our otological department because he had noticed some swelling in the parotid gland. Although no pain or facial palsy was recognized, the CT and 67Ga scintigram revealed signs of a malignant tumor, and the patient was thus operated on. During the operation the tumor was completely removed, but it was impossible to preserve the facial nerve because the tumor had invaded it. The findings of a histopathological examination indicated papillary cystadenocarcinoma. The serum CEA level returned to normal after the surgical resection of the tumor and thereafter it has shown no signs of an increase. In general, a few cases of salivary gland carcinoma tend show an elevated CEA level, and in such cases it is very important to regularly measure the CEA level with a close follow-up. It is therefore important to remember that malignant tumors of the salivary gland sometime show an elevated serum CEA level.

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The vulnerability of the facial nerve in senile facial paralysis was studied. The ratio of severe cases in senile patients was higher and the cure rate was also significantly lower than that in young patients. The recovery time was also longer in the senile group and the basal diseases had no influence on the severity of facial paralysis. These results suggested that the facial paralysis in the senile group showed both the vulnerability of the facial nerve and a difficult recovery.

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It is not unusual that patients with head and neck cancer suffer from taste dysfunction after treatment with chemotherapy, radiotherapy or surgery. However, the characteristics and degrees of taste dysfunction have not yet been fully investigated. In this study, the Salsave test and the whole mouth gustatory test were used to evaluate the taste function of patient with head and neck cancer. A paper containing salt crystals was prepared for the Salsave test. In the whole mouth gustatory test, five different tastes and five concentrations of solutions were used for each patient. The results suggest that taste dysfunction appears to be multifactorial and can be observed to some degree after any treatment for head and neck cancer. These factors associated with taste dysfunction should therefore be taken into consideration in the treatment of patients with head and neck cancer.

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A 18-month-old child suffered an injury to the external nose when he fell down with a pacifier in his mouth. The stopper of the pacifier tore up his nose at both the columella and bilateral aras. The incised wound reached a depth of about 8mm. The cause of injury was presumed to be due to a stopper that was thin and hard enough to tear child's nose and a ring that was large enough to conduct the power of impact to the nose through the stopper.

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Primary malignant tumors of the nasal cavity are relatively rare. Sixty-four patients (37 males and 27 females) with malignant tumors of the nasal cavity underwent curative treatment at Kurume University hospital between 1987 and 1996. Histologically, there were 22 with squamous cell carcinoma, 9 with malignant melanoma, 8 with adenoid cystic carcinoma, 5 with malignant lymphoma, 3 with adenocarcinoma, 3 with transitional cell carcinoma, 2 with anaplastic carcinoma, 1 with small cell carcinoma, 1 with basal cell carcinoma, 1 with papilaly adenocarcinoma and 1 with malignant change in squamous papilloma. All 64 patients underwent multidisciplinary treatment including surgery, irradiation and chemotherapy. The cause-specific five-year survival rate and local control rate were 64 percent and 63 percent, respectively. The five-year local control rate for patients with surgical treatment alone was 41 percent, whereas that for patients with multidisciplinary treatment was 86 percent.

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In the past 9 years, 38 patients of the maxillary cancer were treated by a combination of radiation and surgery. Sixteen patients showed the orbital involvement as confirmed by a CT scan and/or MRI. An orbital excenteration was necessary in 6 patients, due mainly to deep intraorbital invasion, while in 10, the orbital contents were preserved despite the involvement of the orbital capsule. The local rate of the orbital region in the latter patients evaluated at 48 months after the initial surgery was 44%. For the treatment of the recurrence at the orbital capsule. The application of gold grain (Au¹⁹⁸) thus appeared to be a useful tool for further preserving the eye.

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In order to study the usefulness of endoscopic sinus surgery (ESS) for postoperative maxillary cyst (POMC), the postoperative findings of the lateral wall of the inferior meatus after fenestration for the removal of a cyst wall by ESS was compared with that by an extranasal approach (ENA). Sixteen cases were investigated in the present study including 9 cases ranging from 41 to 71 years of age and consisting of 4 males and 5 females who were operated on by ESS, and 7 cases ranging from 33 to 70 years of age and consisting of 3 males and 4 females who were operated on by ENA. All cases were operated on during the same period between January 1996 and April 1997. To estimate the effect, the size of fenestrarion was classified into 3 stages including; closed (stage I), stenotic (stage II) and open (stage III). We classified 4 cases (44.4%) to be stage II and 5 cases (55.6%) to be stage III after ESS. On the other hand, 3 cases (50.0%) were stage I, 2 cases (33.3%) were stage II and 1 case (16.7%) was stage III after ENA. These results suggest that ESS is more effective than ENA for keeping the fenestration open in POMC.

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Chemical mediator-release blockers are well known to be more effective in the treatment of nasal obstruction in nasal allergy than H1 receptor antagonists. However, they require a longer administration time before therapeutic efficacy is observed. Remicut (emedastine difumarate) has various pharmacological effects such as the inhibition of chemical mediator release from mast cells induced by antigen and substance P and the suppression of eosinophil infiltration in the nasal mucosa. In order to study on the utility of Remicut in perennial nasal allergy, 48 patients were enrolled in this study consisting of 33 patients for safety and 26 patients for effectiveness who were treated with 2-4mg/day of Remicut for 8 weeks. The results were as follows: a more than moderate inprovement rate for sneezing, rhinorrhea, nasal obstruction and the degree of hindrance in daily life were 48.0%, 53.9%, 56.0% and 63.7%, respectively. Similarly, a more than moderate improvement in the symptoms was evaluated at 2, 4, 6, and 8 weeks after Remicut treatment was observed in 41.7%, 66.7%, 68.8% and 76.9%, respectively. The final global improvement rate was 65.0% after 4 weeks and 73.6% at the end of administration. Six patients had adverse reactions. Five out of six patients complained of drowsiness while the other patient complained of stomach pain. The safe or almost completely safe rate was 100%. Based on these results, the overall benefit rate was 65.0% at 4 weeks and 77.8% at the end of administration.

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