Parapharyngeal space tumors are rare. However, due to the development of radiographic diagnostic methods, the number of such cases is increasing. Thirty-two cases of parapharyngeal space tumors which were resected at Kyushu University Hospital were retrospectively reviewed to analyze the surgical approach, complications, histology, and the usefulness of preoperative fine needle aspiration. Of the 32 tumors, 8 were pleomorphic adenomas, 10 were schwannomas, 3 were ganglioneuromas, 2 were myoepithelial tumors and 9 others. A cervical or cervical/parotid approach was selected for most of the cases. Pharyngeal edema occurred in 22 cases postoperatively, and all were temporal. Most of the permanent postoperative complications were cranial nerve palsy after surgery for tumors arising from the poststyloid parapharyngeal space. Preoperative fine needle aspiration was also found to be useful for the diagnosis of this tumor.

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Three patients demonstrating a visual disturbance due to rhinogenic optic neuropathy were investigated as subjects in this study. A CT scan and MRI showed either a cystic lesion or sinusitis of the posterior paranasal sinus. Two of the three patients underwent emergency endoscopic nasal surgery, which resulted in an improvement of their visual acuity in spite of a long interval of more than 8 days between the onset of symptoms and surgery. The visual loss of the other patient recovered without surgery, but a sphenoidal cyst closely related to the optic nerve was opened endoscopically to avoid the risk of a relapse. The pertinent literature related to rhinogenic optic neuropathy was also herein briefly reviewed.

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The voice pattern and treatment of patients with scarred folds was examined. A scarred vocal fold is difficult to treat. Many methods were tried but at the present time there is no absolute method and the condition is very difficult to cure. If there are bilateral scarred vocal folds the voice of the patient will be almost completely lost. To avoid scarred vocal folds it is important to diagnose the lesion correctly and to treat the vocal fold carefully during laryngomicro surgery.

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We herein report a case of pneumocephalus which developed 5 years following the treatment of a squamous cell carcinoma of the temporal bone by surgery and radiation therapy, which resulted in an open mastoid cavity. She developed meningitis and hydrencephalus, and her condition became critical, with a low level of consciousness. Eventually, her symptoms were successfully treated by the surgical removal of the sequestrum part in the temporal bone which included a labyrinth. The resulting dead space was filled using an abdominal rectus muscle flap. The patient had no recurrence of the neoplasm or CSF leak after the surgery. A wide range of post-irradiation complications are known to exist, including osteoradionecrosis, which may occur from several months to years following radiation therapy. When pneumocephalus develops in conjunction with serious diseases, such as meningitis and encephalitis, the consequences can be quite serious. When observing a patient after irradiation, one should pay carefull attention to the possibility of post-irradiation complications, as occurred in this case, in addition to a potential recurrence of the carcinoma.

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The results of the administration of Oral Balance® to treat intraoral dryness caused by radiation therapy which was used to treat head and neck cancer in our clinic was examined. No clinically significant difference was found in the amount of saliva in comparison with those who did not receive this medication. Questionnaires showed a slight decrease in the subjective symptoms of intraoral dryness and the feeling of viscosity among those who were treated with Oral Balance®. It is therefore thought that administration of Oral Balance® to head and neck cancer patients who have been treated by irradiation may thus lead to an improvement in their QOL.

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The pathogen was identified in 63 patients aged≥15 years with acute bacterial sinusitis who visited this clinic during the 4-month period from February 1, 2006. In addition, the sensitivity of 4 bacterial species including H. influenzae and S. pneumoniae to 8 antimicrobials were evaluated. The severity of the disease was classified based on the clinical findings and intranasal findings before treatment. The clinical effects of gatifloxacin (GFLX) were evaluated based on changes in severity after its administration. Seventy-four bacterial strains were detected in 58 patients: H. influenzae, 17.6%; S. pneumoniae, 16.2%; M. catarrhalis, 9.5%; and S. aureus, 9.5%. Antimicrobial testing showed that 61.5% of H. influenzae strains were resistant to ampicillin while 41.7% and 16.7% of S. pneumoniae strains were penicillin-intermediately resistant S. pneumoniae (PISP) and penicillin resistant S. pneumoniae (PRSP), respectively. Even these resistant strains showed no resistance to GFLX, and GFLX was effective in 88.7%. The results of the in vitro examination and clinical effects in this study suggested the usefulness of GFLX for the treatment of acute bacterial sinusitis.

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