To determine the etiology of obstructive sleep apnea (OSA) in children with cerebral palsy (CP), a survey using questionnaire was conducted on parents of 233 CP children (1 5 years old. mean age : 2.7) and on those of 343 control children during a routine medical check up at the age of three. The prevalence of habitual snoring and nasal obstruction was 63 and 20% in CP children, which were significantly higher than in control children. Sleep apnea episodes and stridor were noted in 19.7 and 15.1% of CP children. A screening sleep study was performed using Apnomonitor II and a pulseoximeter(Pulsox 5) in 48 CP children whose questionnaires revealed habitual snoring and sleep apnea, and it was found that 27 and 58% of the children had on apnea hypopnea index (AHI) of greater than 5 and a low level of SaO, (LSaO) of less than 85% respectively. When another 10 CP children visited our hospital for treatment of severe OSA, precise evaluations including pharyngeal pressure and fiberscopic examination during sleep as well as a sleep study using an inductive prezysmograph (Respigraph) were performed. Adenoid and/or tonsillar hypertrophy were noted in only 4 children, and the main cause of sleep apnea in the other 6 children was pharyngeal collapse at the lingual base. Their OSA was successfully treated by adenotonsillectomy in 2 children, adenotomy in 2 children, UPPP and lingualplasty in I child, tracheostomy in 2 children, and nasal CPAP in I child. Before treatment of OSA in CP children, precise evaluation is recommended in order to perform appropriate treatment.

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Clinicopathological investigations of five surgery requiring dental diseases caused by maxillary lesions were conducted. 1) The maxillary lesions were acute maxillary sinusitis and a postoperative maxillary cyst. 2) The clinical symptom was persistent check pain, even though the maxillary lesions were improved and there were no lesions in the tooth crown or periodontal tissue. 3) All of the teeth with dental diseases caused by maxillary lesions had percussion pain. 4) The pathological findings of the dental diseases were ascending pulpitis and pulpal necrosis caused by maxillary lesions. 5) When patients complain of persistent cheek pain even though maxillary lesions are improved and there are no lesions of the tooth crown or periodontal tissue, we should doubt the presence of dental diseases, caused by maxillary lesions (ascending pulpitis and pulpal necrosis)

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It is not known whether the optokinetic afternystagmus (OKAN) can be evoked by cyclo-rotatory optokinetic stimulation (C OKst) or not. Accordingly, this study was designed to investigate the problem by using a rotating white dome with random dots. Optokinetic nystagmus (OKN) and OKAN in standing upright, supine, and prone positions were recorded and analyzed with an infrared-ray CCD camera and computed picture analyzer. During stimulation, rotatoary OKN showed clearly, but there was no slow rise component. The OKAN was continuously recorded and analyzed. The component of this OKAN was found only in the head-horizontal direction (yaw axis) in all different head positions. It appeared fairly constantly in the prone posture. The velocity storage mechanism (VSM) had to be charged by the C-OKst, but the OKAN (1st phase) appeared only in the yaw axis, not in the roll axis.

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We correlated the histopathology of 32 cases of salivary gland tumors with MR imaging and flow cytometric DNA analysis. All malignant tumors were my isivasive and/or had an ill-defined margin. Fifty-seven percent of the pleomorphic adenomas were shown as a high signal intensity area on T2 weighted images. Fifty-six percent of Warthin tumors were shown as a low or iso signal intensity area on T2 weighted images associated with the cystic portion. Sixty seven percent of malignant tumors were characterized by DNA aneuploidy and/or a total percent age of the S phase fraction plus the G2+M fraction higher than 10%. It was less than 10% and the Ki-67 positive fraction was higher than 20% in all pleomorphic adenomas. The Ki-67 positive fraction was less than 20% in 78% of Warthin tumors. The histopathology of all malignant tumors, 86% of the pleornorphic adenomas, and 89% of Warthin tumors was correctly predicted by the combination of MR images and flow cytometry. We suggest that the MR images combined with flow cytometric analysis of fine needle aspiration-derived materials is useful in the pre operative histopathologic diagnosis of salivary gland tumors.

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Of patients with a postoperative maxillary defect, around 30% are thought to have trismus to some extent. In these patients, some difficulty in fabricating a maxillary prosthesis is expected. In this study, 54 patients with trismus were compared with a control group to find some proof of difficulty in making a maxillary prosthetics. Fifty-four of trismus less than 20mm of a mandibular stroke were experienced out of 185 patients with maxillary prosthetics between October 1984 and October 1992. The trismus was divided into 4 groups of less than 5mm (1case), 5mm-10mm (10 cases), 11mm-l5mm (19 cases), and 16mm-20mm (24 cases). These case were analyzed by in taking an impression failure, average weight of the prosthesis, time needed to complete the prosthesis and some special form of prosthesis. No apparent differences among the 4 groups or with the control group were found. The cause of the difficulty in making a prosthesis for such patients with trismus are suggested not to be simply due to the range of mouth opening but also to the complexed space formed by the dental defect, alveolar bone defect, spreadability of the lip and the cheek. the mandibular stroke and the so called scar bundle of the cheek next to the defect.

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To prevent post-surgical dysphagia in oral or oropharyngeal cancer patients, crico-pharyngeal myotomy and laryngeal suspension are recommended; however, its indication has been controversial. When it was thought that patients would lose the mechanisms of laryngeal elevation or mechanisms to produce oropharyngeal pressure we opted for crico-pharyngeal myotomy, and laryngeal suspension: total or subtotal glossectomy with bilateral resection of suprahyoid muscles, and wide resection of the oropharynx including the tongue base. In this paper, we report the usefulness and limitation of crico pharyngeal myotomy and laryngeal suspension after wide resection of the tongue or oropharynx.
(Patients and Methods) From April 1992 to January 1996, 19 patients received circa pharyngeal myotomys and laryngeal suspensions along with their initial operation for oral or oropharyngeal cancer. Their ages ranged from 28 to 69years. Fourteen had tongue cancer and 5 had oropharyngeal cancer. We examined the relationship between the ability to have an oral diet and the extent of mobile tongue resection, extent of tongue base resection, and extent of resection of the lateral wall of the oropharynx, reconstruction method, and age.
(Results) Fifteen of the 19 patients (68%) could have an oral diet when they were discharged. The extent of tongue base resection (more than 50%) and age (_??_60) significantly affected post surgical aspiration. Two patients who had total glossectomy with total tongue base resection could have an oral diet. They were 41 and 51 years old. One 35-year-old patient who had total glossectomy with wide tongue base resection (80%) was able to have the same diet as his family. On the other hand, 4 elderly patients (_??_60) who had wide resection of the tongue base (_??_50%) could not have an oral diet at all. (Conclusion) A crico pharyngeal myotomy and a laryngeal suspension can contribute to the prevention of post surgical dysphagia. However, if an elderly patient (_??_60) has had wide tongue base resection (_??_50%), he may not be able to have on oral diet. In these cases, we have to opt for additional methods, such as total laryngectomy, to prevent aspiration.

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In order to evaluate the growth potential of head and neck carcinomas, the S phase cell labeling index (SLI) of biopsied specimens from 106 patients was determined immunohistological examination using anti-BrdU monoclonal antibody. Expression of epidermal growth factor receptor (EGFR) was also investigated in these specimens. The results were statistically compared with clinical findings. and the conclusions were as follows: SLI was higher in advanced cases than in early cases, and it was higher in patients with lymph node metastasis than in those without metastasis. The survival rate showed a strong tendency to be lower for patients with higher SLI. No relationship was found between SLI and origin of head and neck carcinomas. No relationship was found between SLI and differentiation of carcinomas. Expression of EGFR showed no relationship with T classification, but the incidence of positive expression of EGFR was higher in patients with lymph node metastasis than in those without metastasis. Patients positive for EGFR tended to have lover survival rates than EGFR negative patients. The incidence of positive expression of EGFR was statistically higher in patients with hypopharyngeal carcinoma than in those with other head and neck carcinomas. No relationnship was found between the expression of EGFR and differentiation of carcinomas. Patients with positive expression of EGFR showed a strong tendency to have a higher SLI. SLI and the expression of EGFR may well reflect the growth potential of head and neck carcinomas, and it seems very likely that they are can be used to evaluate the oncological characteristics to predict the out come of each case.

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