The aim of the present study was to clarify the clinical characteristics of patients with vocal cord palsy in Okinawa. Using medical charts, a total of 130 cases with vocal cord paralysis were reviewed who were referred to Ryukyu University Hospital from 2000 to 2009. The incidence of vocal cord paralysis in males was 2.4 times higher than in females. According to the age distribution of patients, the most frequently affected patients were males in their 60's and females in their 70's. The left vocal cords were affected three times as often as the right side. The paramedian position was usually the position of the paralyzed vocal cord. Compared with the previous reports, the incidence of postoperative paralysis was high for surgeries for aortic aneurysms and heart disorders, and low for surgeries to remove thyroid tumors. The overall improvement of vocal cord paralysis was 25.4%. The improvements of paralysis due to endotracheal intubation and idiopathic paralysis were obtained in 81.8% and 43.8% of subjects, respectively. The present study suggested that surgeries for heart disorders, even without direct contact to the recurrent nerves, is a common cause of vocal cord paralysis.

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We conducted a study of the clinical characteristics of 125 benign parotid tumors that were surgically resected between July 2000 and March 2009, which included patient age and sex, histopathology, tumor size, tumor localization, and postoperative complications. There were 59 males and 66 females, with an age range of 15 to 88 years and an average age of 54.6 years. Histopathologically, pleomorphic adenoma was observed in 62 patients (49.6%), and Warthin's tumor in 45 (36.0%). Pleomorphic adenoma was more frequent in female patients than in male patients, and the average patient age was higher for those with Warthin's tumors than pleomorphic adenomas. The size of the extirpated tumors ranged from 10 to 160 mm, with an average of 29.9 mm. Twenty-eight of the 125 patients (22.4%) experienced transient facial palsy but recovered within 3 months. A salivary fistula occurred in 4.0% of the patients, but there was no Frey syndrome. Surgery is the treatment of choice for parotid gland tumors. Although active surgery is recommended for benign parotid tumors, both patients and their families should be made sufficiently aware of the possibility of postoperative complications when informed consent is obtained.

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The maximum speech discrimination score (SDSmax) on speech audiometry decreases with the progression of a hearing disturbance. However, no criteria have yet been established that can determine the SDSmax from the pure-tone threshold. This study analyzed the correlation between the threshold from pure tone audiometry and the SDSmax from speech audiometry in 604 ears. There was a clear correlation between the pure-tone threshold and SDSmax. The SDSmax was better than that from the pure-tone threshold in conductive hearing loss. The SDSmax was obviously worse than that from the pure-tone threshold in acoustic tumors (retrocochlear hearing loss), especially in patients with a moderate or severe hearing disturbance. There were no differences in the gradient of the speech audiogram curve between ears with normal hearing, conductive hearing loss, cochlear hearing loss and retrocochlear hearing loss. The positive rate of rollover was 60.6% and 56.6% in cochlear hearing loss and retrocochlear hearing loss, respectively.

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Pediatric deep neck abscess is a rare disease. This report presents two cases of pediatric deep neck abscess. Case 1 : A 3-year-old girl had neck swelling and the peritonsillar area was also swollen. She was hospitalized and treated with intravenous antibiotics. Computed tomography (CT) showed no abscess on the first day. Antibiotics were administered intravenously, but the neck swelling and pain did not change. Enhanced CT on the 5^th day showed a neck abscess at the right parapharyngeal space. Cervical drainage was performed by mouth under general anesthesia. The fever and sore throat thereafter resolved on postoperative day 1. She was in remission and left the hospital on postoperative day 5. Case 2 : A 6-year-old girl had cervical pain and neck swelling. She was hospitalized and treated with intravenous antibiotics. Enhanced CT on the 2^nd day showed a neck abscess at the retropharyngeal space. She underwent cervical drainage through the mouth under general anesthesia. The fever and sore throat both resolved on postoperative day 1. She was in remission and left the hospital on postoperative day 8. The two above cases both achieved remission through surgical drainage.

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Oncocytic carcinoma (malignant oncocytoma) is an extremely rare malignancy. We herein report two cases of oncocytic carcinoma arising from the submandibular gland and parotid gland. As these are minority cases, there are no established diagnostic criteria nor treatment policies. Case 1 was a 64-year-old male was diagnosed with primary parotid oncocytic carcinoma. We controlled the primary tumor through surgery and localized radiotherapy, but the patient developed distant metastasis two years after surgery and died four years after surgery later despite the use of chemotherapy. Case 2 was a 58 year-old male who was diagnosed with primary submandibular oncocytic carcinoma. We performed surgery as the first-line therapy. Chemotherapy using TS-1^® (120 mg/day) was used for two weeks before surgery, and resulted in tumor shrinkage. The patient was able to undergo radical curative surgery, although he has been continuously followed up to identify any recurrence or metastasis.

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Basal cell adenoma is relatively rare. We herein report a case of basal cell adenoma that was difficult to distinguish from an adenoid cystic carcinoma. The patient was a 72-year-old male with a chief complaint of a mass in his right preaulicular region. A mobile 2 cm tumor was noted by palpation. An MRI study revealed a space occupying lesion (SOL) of the right parotid gland. The signal intensities of SOL were low on T1 weighted images and high on T2 weighted images, and Gd enhanced the lesion. The tumor was removed by lobectomy of the righ parotid gland. The initial pathology was misdiagnosed as adenoid cystic carcinoma. The final diagnosis was reported later on the beginning of radiotherapy. The correct diagnosis of basal cell carcinoma was made based on the proliferation of neither the infiltrative growth nor the tip nerve surroundings outside the film, so the radiation therapy was discontinued, and the patient is now being closely followed as an outpatient. There has been no sign of recurrence or metastasis during the 1 year follow-up.

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