The visualization of the sinus tympan is inadequate using routine surgical approaches to the middle ear and mastoid because of the overlying fallopian canal. Therefore, it is not easy to completely remove a cholesteatoma involving a deep sinus tympani. We herein report a case of a 10-year old male with a cholesteatoma deeply invading the sinus tympani after undergoing surgery for adnesive otitis media. The use of the retrofacial approach to the sinus tympani through the mastoid posterior and medial to the facial nerve allowed us to perform a complete removal of the cholesteatoma from the deep sinus tympani with a direct view. The patient had no facial weakness or sensory hearing loss after the surgery. In addition, no findings of residual cholesteatoma were seen at 1.5 years after the surgery.

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Branchio-oto-renal syndrome (BOR)is a dominant inherited disease. This syndrome triad consists of hearing loss, branchial abnormalities, and kidney malformation. We experienced a case of BOR that included a cartilage nevus and a heterotopic salivary gland. Other findings included a preauricular fistula, a protruding ear, and mixed hearing loss. High-resolution temporal bone CT showed inner and middle ear malformations. When he was 11 years old, the patient was suspected to have BOR. His renal function was examined and both a malfunction and dysfunction were found. His father had a neck tumor and also wore a hearing aid. His grandfather also had a neck tumor, thus suggesting the autosomal dominant nature of this disease. A diagnosis of BOR was made. The neck masses were removed from a histopathological examination. Although a brachial is the most common finding in BOR, the branchial lesions in this case were cartilage naevi and a heterotopic salivary gland, which are rarely associated in BOR. The etiology of this disease is also discussed.

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The clinical effect of Burow's solution on intractable chronic otorrhea of the external and middle ear was investigated. The subjects consisted of 25 ears from 18 patients ranging from 2 to 88 years of age, including 16 male ears and 9 female ears. The diseses and the number of ears were as follows: 9 ears with a chronic infection or eczema of the external ear canal, 3 ears with chronic granulated myringitis, 8 ears with chronic otitis media with a perforation, and 5 ears with a postoperative cavity infection of chronic otitis media. Burow's solution was dropped into the ear canal for about ten minutes or small cotton balls soaked with solution were applied directly to the lesion. As a result, 17 of the 25 ears (68.0%) were cured, 6 (24.0%) improved, and 2 (8.0%) remained unchanged. Some patients complained of a stinging sensation or pain in the ear during treatment, but there were no other major side effects. Audiometric examinations showed no ototoxicity as a result of using the solution. Burow's solution was thus proven to be a very effective and safe topical solution for the treatment of external and middle ear infections with intractable chronic otorrhea.

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The superior cornu of the thyroid cartilage courses upwards and backwards, ending in a rounded knob attached to the lateral thyroid ligament. There is a paucity of published literature on anomalies of the superior cornu of the thyroid cartilage. However, I herein report a case of an anomaly of the superior cornu of the thyroid cartilage. A 71-year-old male with a one-year history of swelling and tenderness in his right neck consulted our hospital. On a 3D-CT examination, the tip of the superior cornu of the thyroid cartilage was observed to be turned laterally and it was also accompanied by a lateral bending of the greater horn of the hyoid.

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We herein report a suspected case of myositis ossificans. The patient was an 8-year-old girl whose chief complaint was swelling in the right preauricular region. The mass was hard, nontender and relatively movable. CT scans showed 5 shadow-like teeth in the temporal muscle. To make a definitive diagnosis, we surgically removed them near the coronoid process and their histological picture showed them to be very similar to teeth. We at first diagnosed multiple ectopic teeth based on the CT findings, however we were not able to find an other similar reports in the literature regarding ectopic teeth. MRI films showed an edematous brightness change in the temporal muscle and the shadow-like teeth on the CT findings showed a zoning pattern equivalent to maturation of bone tissue from the central to peripheral part, and we therefore concluded that the patient most likely had myositis ossificans. Myositis ossificans is classified into two types, namely traumatic or nan-trau-matic, and particularly traumatic type in the facial region tends to occur more frequently in the masseter muscle. There have only been a few reports of non-traumatic type cases occurring in the temporal muscle. Moreover, non-traumatic multiple cases are even more rare. We describe this suspected case of myositis ossificans, although the final diagnosis may possibly change in the future.

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We herein report two cases of non-regional lymph node metastasis due to bladder cancer and thoracic esophageal cancer. The first patient with bladder cancer was a 72-year-old man who underwent a total cystectomy at another clinic. Two months after surgery, an enlargement of the left cervical lymph nodes was noted which thereafter progressed. Therefore, an excisional biopsy was performed and transitional cell carcinoma was thus diagnosed. Thereafter, multiple skeletal metastasis were detected as a result of a detailed examination. As a result, only prophylactic treatment was provided, and the patient died soon thereafter. The second case was a 55-year-old man with thoracic esophageal cancer. An enlargement of the right parotid gland was noted 5 months after presentation and the patient also complained of pain. Thereafter, right facial palsy was noted. As a result, a total excision of the right parotid gland was performed. A histopathological examination resulted in a diagnosis of squamous cell carcinoma. We thought the patient had metastasis from esophageal cancer to the parotid lymph nodes. Following the operation, radiation therapy was administered, but cancerous cachexia occurred and the patient died soon thereafter. In conclusion, we consider that cases of non-regional lymph node metastasis are therefore not indicated for curative treatment.

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The aim of this study is to evaluate the effects of late toxicity of concurrent chemoradiotherapy on the quality of life, especially regarding patients with laryngeal or pharyngeal carcinoma, treated with chemoradiotherapy. Patients answered a questionnaire on the Quality of Life-Radiation Therapy Instrument (QOL-RTI) for Japanese, more than 1 year after treatment. We compared the QOL scores after treatment and determined the present statuses based on the scores before treatment and the statuses before chemoradiotherapy. As a result, no significant difference was found in the QOL scores before and after treatment. In a study of each question, only the QOL score on the volume of saliva decreased significantly after treatment. In comparison with patients treated only by radio-therapy, there was no significant decrease in the QOL in patients treated with concurrent chemoradiotherapy. Furthermore, we analyzed the factors associated with the changes in the QOL scores due to the above treatment. Factors such as age, T and N stage, the radiation response, and adjuvant chemotherapy, were not associated with any changes in the QOL. However, the group which was evaluated more that 2 years after the treatment had significantly higher QOL scores than the group evaluated less than 2 years after the treatment. However, regarding the volume of saliva, no difference was founding either group. The QOL scores regarding the ingestion of food and swallowing, therefore were found to not decrease during the late period after chemoradiotherapy. However, xerostomia was found to linger due to the after effects of this treatment.

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Some types of nasal bleeding are difficult to control. Such cases include arteriolar bleeding in-volving repeated spouting with no clear-cut change in the wound surface; bleeding from the posterior parietal region of the nasal cavity, with no distinct bleeding sites on an anterior rhinoscopic examination; or both. A 56-year-old man presented with posterior nasal bleeding from the posterior parietal region of the left inferior nasal concha. The author describes the use of the Hunnicutt technique, electrocoagulation, and compression tamponing for the treatment of nasal bleeding in this patient. We should take carefully into account collapsed areas of nasal tissues and potential bleeding sites in the nasal cavity in order to effectively treat nasal bleeding.

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Hemmagioma of the nasal cavity is an uncommon neoplasm. We herein present a case of adult hemagioma of the nasal cavity treated successfully by an Nd: Yag laser in our hospital. The patient experienced no untoward events due to the use of the Nd: TAG laser. No excessive bleeding or postoperative bleeding was encountered. An excellent long-term function can thus be obtained using the Nd: YAG laser to treat hemangiomas of the nasal cavity.

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Radiofrequency volumetric reduction (RFVR) has recently been suggested to be useful as an effective and safe approach for the treatment of turbinate hypertrophy. We performed RFVR by somnoplasty using a radiofrequency generator device for the treatment of nasal obstruction, snoring and obstructive sleep apnea (OSA) due to turbinate hypertrophy and evaluated its safety and efficacy. Twenty patients complaining of nasal obstruction, snoring and OSA secondary to inferior turbinate hypertrophy were enrolled in this study from November 2001 to March 2002. The effect and safety of RFVR was confirmed by this study.

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We performed an acoustic analysis of 6 patients with simple snoring and of 8 patients suffering from obstructive sleep apnea syndrome (OSAS). Simple snoring and OSAS due to a wide range of obstructive lesions from the soft palate to the base of the tongue, show a constant frequency distribution of the snoring sounds when recorded randomly for an acoustic analysis. When OSAS were mainly due to an obstruction in the soft palate, such patients tended to show two types of peak characteristics regarding the snoring sounds. When we evaluated 30 different snoring sounds during one night, the patients with simple snoring sounds showed a single peak at a frequency of less than 1,000Hz, while OSAS patients showed several peaks at higher than 1,000Hz. From these results, we thus conclude that snoring sounds should undergo an acoustic analysis at night in order to better screen for potential patients with OSAS in the future.

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Our new surgical technique for the vocal fold cyst was presented. The mucosal incision was placed laterally to the cyst on the superior surface of the vocal fold near the ventricle. The reason for making lateral incision is to minimize the effect on the mucosal wave if scarring occured. The lateral microflap was elevated and the cyst was exposed from submucosal area. Then, microflap was holded using a heart-shaped grasper and the cyst was separated using various dissectors. When the cyst was lifted from surrounding connective tissue, the cyst could be exenterated easily using sideopen-forceps. After the removal of the cyst elevated lateral microflap was placed back.

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