A clinicopathological study of 10 cases of stomal recurrence following total laryngectomy treated at Kurume University Hospital from 1971 to 1986 was completed.The results of this study are summarized as follows:
1) The frequency of stomal recurrence was 5.8%.
2) Of these 10 cases, 3 cases were supraglottic (3%), 5 cases were glottic (7%), and 2 cases were subglottic (29%) carcinomas.The incidence of stomal recurrence was higher in subglottic carcinomas.
3) Nine cases out of 10 extend to the subglottic region.
4) The incidence of stomal recurrence was higher in emergency tracheostomy case.
5) Average of period from total laryngectomy to stomal recurrence was 9.7 months.
6) It is suggested that the cause of stomal recurrence is metastasis to the paratracheal lymphnode.
7) In order to prevent stomal recurrence, it is important to dissect paratracheal soft tissues bilaterally in high risk cases.
8) With regard to treatment, it is better to remove surgically the tumor and paratracheal soft tissues as completely as possible and to do postoperative radiation.

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The fine structures of Golgi-impregnated mitral, tufted and granule cells in the mouse olfactory bulb were investigated by a high-voltage electron microscope. Observation was focused exclusively on intraglomerular dendritic trees of mitral and tufted cells as well as granule cell spines. These structures could be precisely observed under high-voltage electron microscopy in contrast to the vague observation available by light microscopy.
Intraglomerular dendritic tufts of mitral and tufted cells possess a similar structure. Their most characteristic feature is varicose branches, which are morphologically classified into two parts, relatively thick parts and thinner parts.The latter consist of bead-like varicosities and thin segments less than 0.35μm, combination of which take on a thread and beads appearance. Another common structure is small, spine-like appendages which can be seen on all parts of the tufts.
Granule cell spines can be individually observed with the aid of stereoscopy, even where they are closely clustered. As a result, many more spines could be recognized by high-voltage electron microscopy than by light microscopy. The width of terminal swellings of spines in the granule cell layer are, in most spines, shorter than 0.4μm. On the other hand, in the mitral body and external plexiform layer, sizes of spines are much more variable ; larger ones with a width of between 1.0 and 1.5μm as well as smaller ones between 0.4 and 0.5μm are usually found.
Consequently, these findings described above proved to be useful for attaining a deeper understanding of both light and thin section electron microscopic findings of these structures.

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Paranasal sinus mucormycosis is a rare and often fatal condition that occasionally occurs in patients with debilitating disease. Five mucormycosis cases with paranasal sinus involvement are reported. Two also complicated diabetes mellitus. These diabetic patients rapidly developed meningitis after the onset of symptoms. One case was soon operated upon and necrotic masses with fungus were excised. Despite i.v. amphotericin B administration, two patients lost their consciousness in a few days, relapsed into coma and died. In these cases, the infection originated from the ethmoidal sinus and directly spread towards the orbit and brain. The remaining three cases with mucormycosis had operations after the initial diagnosis of sinusitis. All of the three patients are alive and well. The combination of an excisional operation and antifungal therapy resulted in favorable response. High resolution CT scanning is valuable both in planning treatment and monitoring the response to therapy.

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The threshold shift at 500Hz bone conduction under positive and negative static pressure of 400mmH₂O applied to the external auditory canal was examined in 20 patients of Meniere's disease with fluctuating low tone hearing loss, 21 patients of sensorineural hearing loss without fluctuating and 24 normal controls.In contrast to the 10 to 15dB threshold shift in the latter two groups (non-fluctuating group, 14.8±5.1dB at positive and 11.1±5.7dB at negative ; normal controls, 13.6±5.4dB at positive and 9.3±5.3dB at negative), the former showed a significantly smaller shift (3.2±6.1dB at positive and 2.3±4.5dB at negative) while hearing was depressed. However, when the hearing was improved, the pressure effect became greater even in the former group (11.3±5.3dB at positive and 9.1±4.8dB at negative).
To understand further details of these phenomena, we performed electrophysiological animal experiments. Through a small hole made on the guinea pig's cochlear bony wall, 300mmH₂O pressure was applied to the scala tympani and the threshold of 500Hz CM was examined in both endolymphatic sac obliterated ears and non-obliterated ears. In 14 non-obliterated ears 21.1±5.1dB threshold shift was recorded, whereas it was only 1.6±2.6dB in 9 obliterated ears at 4-6th postoperative days. These results seem to reflect that the endolymphatic pressure is great during the early stage of hydrops.
According to the present clinical and experimental studies, it may be safe to say that the fluctuation of hearing in Meniere's disease is the phenomenon accompanying with the fluctuation of the pressure in the scala media, namely, endolymphatic pressure may be greater when hearing was depressed.

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We experienced 102 cases of facial bone fracture during 16 months of 1986 to 1987. These cases were analyzed statistically concerning causes, age and locations of the fracture.
These fractures have increased rapidly in number. The causes were classified into three types; occurrence during sport, traffic accident and fighting, which were equal in number. There were 85% males and 15% females in the patient cohort, which were concentrated at the ages of 10-20 years. A large part of the fractures was mostly consisted of maxillo-facial components (95%). These trends were similar to the previous report of our clinic (1972-1979). On the other hand, not only severe dysfunctioning cases but also complicated cases increased in number, so that the several clinical aspects were reported.
Case 1 : 17-year-old male presented with retraction of left cheek caused by Rugby foot ball, whose maler bone was dislocated backward and anticlockwise, was treated with oroantral reduction and with the intermaxillary packing of silicon blocks.
Case 2 : 10-year-old boy with complaint of double vision occured by head blow to right eye. Pure type blowout fracture of the orbital floor was presented, which was reconstructed by silicon plate from the incision of the lower eyelid.
Case 3 : 59-year-old male presented with 6 month history of diplopia and retraction of left eye ball, had been under the conservative care by an eye doctor. X-ray examination showed the intraorbital soft tissue was blown out into the ethomoidal sinus.However the transethomoidal reduction was performed, the result was not satisfactory.
Case 4 : 17-year-old female visited emergently with facial destruction by traffic accident. Bilateral mid-third fracture of the face and fractures of the mandibullar processes were found. In order to pull out the maxilla, silicon blocks were packed into the maxillary sinus and intermaxillary fixation with bite plate was tried.However, the maxilla was receded backward and "dish face" deformity was appeared.

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Adult T cell leukemia (ATL) is one of malignant tumors originated from T-cell system, first described by Takatsuki in 1976. Most cases of ATL have been diagnosed in department of internal medicine and dermatology, because they usually show lymphoadenopathy and skin rash. However, it is rare that ATL has symptoms of otolaryngology.
We experienced a case of hoarseness with smoldering ATL. Patient was 51 years old male. He had a tumor in left vocal cord. Pathologically the tumor was malignant lymphoma originated from T cell. HTLV-1 was provided in his serum and proviral DNA was found in ATL cells. First cisplatin was given generally and soon radiotherapy was applied.Reaction of therapy was good and tumor of larynx disappeared gradually.Patient has been alive 6 years from the onset.

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The collicular organization of mammals such as the rabbit, cat, and monkey have been well studied.However, little anatomical or physiological information about the guinea pig has been available, Consequently, the author studied the descending and ascending projections of the superior colliculus in the guinea pig by using both anterograde horseradish peroxidase conjugated with wheatgerm agglutinin (WGA-HRP) tracing and electorophysiological techniques, and the following results were obtained.
1. Evoked potentials were recorded from the superior colliculus contralateral to the site of photic stimulation of the retina. Recordings from the superficial layer of the superior colliculus displayed negative waves, whereas recording from the deeper layer displayed positive waves.
2. After intraocular injection of WGA-HRP, anterograde labels were observed in the stratum griseum superficiale and stratum opticum of the superior colliculus contralateral to the injection site.
3. Eye movements with deviation toward the upward or contralateral side were elicited by electrical stimulation in the intermediate layer of the superior colliculus.
4. After injection of WGA-HRP into the superior colliculus, transported labels were observed in the dorsolateral basilar pons ipsilateral to the injection site, and the paramedian pontine reticular formation contralateral to the injection site.
These studies suggested that the pathway through the superior colliculus observed in the guinea pig is similar to that in other mammals. However, some differences may exist with respect to the processing of light signals and the mechanism causing eye movement.

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A complex set of sinuses, eminences and ridges lies in the posterior border of the tympanic cavity (posterior tympanum). The facial nerve canal is located between the facial sinus and the sinus tympani. The posterior limit is the posterior semicircular canal.The posterior tympanum is often the site of residual collection of granulation tissue or cholesteatoma, and is not directly visualized by the usual surgical approaches. Thus preoperative knowledge of cholesteatoma in these area is of obvious importance.
It has been accepted that high-resolution computed tomography (HRCT) has the significant advantage to provide specific information of the middle ear. Contribution of the HRCT for diagnosis of posterior tympanum was examined by three temporal bone specimens and one hundred subjects with normal middle ear.
In the experiments using the temporal bone specimens, each structure in the posterior tympanum was labeled by a fine needle. HRCTs were subsequently obtained to confirm the labeled structure.In one hundred subjects, it was examined whether each structure was also confirmed by the routine HRCT.
Results are as follows :
(1) Axial HRCT sections provided essential informations for the preoperative evaluation of the posterior tympanum.
(2) Such bony structures as the pyramidal eminence and the pyramidal ridge were the most prominent structures on the posterior wall.
(3) Laterally close to the pyramidal eminence lies one sinus which was marked by the needle placed in the facial sinus proper or in the lateral tympanic sinus ; It is the facial sinus in a wide sense.
(4) The other prominent sinus lies medial to the pyramidal eminence.It was marked by the needle placed in the sinus tympani proper or in the posterior tympanic sinus ; It is the sinus tympani in a wide sense.
(5) The ponticulus, the chordal ridge and the styloid eminence could hardly be identified in the axial HRCT.

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The present theory of eustachian tube function and middle ear ventilation posits that oxygen absorbed by the middle ear mucosa causes negative middle ear pressure which is relieved by periodic opening of the eustachian tube during swallowing and yawning.
Measured by a PO₂ sensor (Clark type) inserted into the middle ear cavity of normal adults through the eustachian tube, the partial oxygen pressure of the tympanic cavity was found 53.7±6.5 Torr (N: 22). It was about one-third of ambient pressure (about 150 Torr), and showed no change when the eustachian tube was opened by swallowing.
Our second study measured the effect of alterations in the systemic arterial blood oxygenation on middle ear gas exchange in 23 guinea pigs ventilated using 21% (room air), 50%, 70% and 100% oxygen at constant carbon dioxide blood gas tension. Partial oxygen tension (PO₂) of middle ear cavity was measured by inserting a PO₂ sensor into the tympanic bulla through a bore hole.
The following results were obtained : (1) POI of the middle ear cavity was 39.3±2.2 Ton at room air, 42.2±0.84 Torr at 50%, 46.6±1.1 Torr at 70% and 54.5±3.7 Torr at 100% oxygen breathing. (2) There was a significant correlation between P0₂ of the middle ear cavity and systemic arterial hyperoxygenation noted. Y=30.79+0.056•X (r=0.9440) (3) The rate of oxygen diffusion in the middle ear cavity was 2.665×10^-5ml/min/cm² and the rate of oxygen absorption in the middle ear space was 2.874×10^-5ml/min/cm². No significant difference between the rate of diffusion and that of absorption of oxygen in the middle ear cavity was noted.
In our third study, electron microscopy shows that the submucosal capillaries of the human mastoid cells are structures which facilitate the intra- and extravascular transport of substances.
It is known from these results that tympanic cavity pressure is kept equal to ambient pressure, or slightly higher to atomospheric pressure, by the respiratory function of the middle ear and mastoid cells so that outflow of air from the tympanic cavity to the pharyngeal orifice occurs during the ventilation of the eustachian tube at ambient pressure and inflow of air from the pharynx to the tympanic cavity is prevented in the absence of environmental pressure changes. The middle ear cavity has respiratory function, and in particular, such function of the mastoid cavity, which is larger in volume than the tympanic cavity, plays a significant role. It is concluded that this mechanism is a natural protective one, as one of the physiological mechanisms of the eustachian tube, which meets the purpose of protecting the middle ear cavity from infections from the pharynx.

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Formalin- or alcohol-fixed, paraffin-embedded laryngeal specimens were stained immunohistochemically with several kinds of monoclonal anti-Keratin antibody (KL-1, PKK-1, PKK-2, PKK-3), polyclonal anti-Keratin antibody, and epithelial membrane antigen.
Immunohistochemical technique was used by Avidin-Biotin Complex method with the following subjects ; normal epithelium 6 cases, dysplasia 15 cases, inflamation and polyp 12 cases, squamous cell carcinoma 47 cases. 6 specimens of squamous cell carcinoma were totally resected and alcohol-fixed, and other specimens were all biopsied and formalin-fixed.
Comparing these two methods, the alcohol-fixed specimen gave superior result to those obtained with formalin-fixed in its staining.
Non-staining area was recognized around basal layer by KL-1 stain in the normal epithelium. Enlargement of non-staining area was recognized in the dysplasia. Also, KL-1 staining showed positive staining with the keratinizing squamous cell carcinoma, and weak staining with the non-keratinizing squamous cell carcinoma. And, PKK-3 showed weak staining in the keratinizing squamous cell carcinoma. The results indicate that high molecular weight keratin (56 kilodalton) hardly localize around the basal layer in the squamous epithelium, and also in the non-keratinizing squamous cell carcinoma. The other way, this also suggests that low molecular weight keratin (45 kilodalton) hardly localize in the keratinizing squamous cell carcinoma. It is supposed that intracellular localization of keratin of dysplastic epithelium and squamous cell carcinoma varies from that in the normal squamous epithelium. Accordingly, monoclonal keratin stain is thought to be an useful method for the diagnosis of dysplasia and squamous cell carcinoma.

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Four symptoms of sequelae of Bell's palsy, such as abnormal synkinesis, facial spasm, contracture, and crocodile's tear were examined with 351 patients with Bell's palsy.As a result, it was seen transient sequelae-like symptoms which disappeared in recovery process.
These 4 symptoms were divided into the persistent symptoms which persisted or appeared (sequelae) after 6 months from onset and the transient sequelae-like symptoms which disappeared before 6 months from onset (transient symptoms).
The relation between the sequelae and the transient symptoms were examined.
Transient facial spasm were shown only in mild cases with early cure, and it was deemed that these had no relation to sequelae. Other transient symptoms were shown in the cases with moderate and severe palsy, and it was deemed that these had a close relation to sequelae.
The incidence of sequelae was 19%, and that of transient symptors was 23%.Therfore, in order to discuss the actual behavior of the sequelae, it is important to investigate the sequelae with rejection of transient symptoms.

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Four symptoms of sequelae (abnormal synkinesis, fahial spasm, contracture, and crocodile's tear) which persisted or appeared after 6 months from onset were examined with 351 patients with Bell's palsy.
The incidence of sequelae were 2% in the group having score (May-Hosomi's modified method, 90 points method) over 40 points within 1 months after onset.
Other hand, the incidence of sequelae were 15% in the group having score under 40 points at 1 weeks from onset, 30% in the group having score under 40 points at 2 weeks, 57% in the group having score under 40 points at 3 weeks, and 76% in the group having score under 40 points at 1 month.
From these findings, it was seen that the prognostication with a high accuracy was possible by the score.

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The purpose of this study is to investigate the induced eye movements by the cerebellar nuclei stimulation in the rabbits. Forty-five pigmested rabbits were used in this experiments. The cerebellar nuclei, especially medial nucleus, were stimulated electrically and the induced eye movements were observed.
The results were as follows.
1. The horizontal nystagmus was produced by the electrical stimulation of the medial, anterior interposed, or posterior interposed nuclei.
2. The horizontal nystagmus towards the ipsilateral to the stimulated side was observed when the caudal portion of the medial nucleus was stimulated.On the other hand, the horizontal nystagmus towards the contralateral to the stimulated side was observed when the rostral portion of the medial nucleus was stimulated.
3. The latency of the field potential in the vestibular nucleus by stimulating the medial cerebellar nucleus, and that in the reverse.situation, were 0.7 to 1.1 msec.
4. After the destruction of the lateral vestibular nucleus, no nystagmus was elicited by the stimulation of the medial cerebellar nucleus.
From these results, it can be concluded that there is the monosynaptic connection between the medial cerebellar nucleus and the lateral vestibular nucleus.This indicates that the stimulation of the medial cerebellar nucleus produces the excitation of the vestibular nucleus via the cerebello-vestibular fibers and produces the nystagmus in the pigmented rabbits.

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Phieboid olfactory test has wide clinical application for olfactory disturbance.
Many unclarified aspects still remain concerning the mechanism of smell after an intravenous infusion of Alinamin®.It is believed that when Alinamin® is infused intravenously and biproducts are discharged from the blood into the alveoli, odorous substances reach the nasal cavity through exhalation. In order to clarify the mechanism of smell in more detail, we conducted the following experiments : 1) Cases of laryngectomy were examined to determine if intravenous infusion of Alinamin® affected the olfactory organ. 2) Saliva specimens in healthy subjects were collected before and after intravenous infusion of Alinamin® and examined for the presence of a secreted odorous substance using a functional test. 3) Healthy subjects who were inhibited in their sense of smell were examined for the presence of garlic odor after intravenous infusion of Alinamin®.
The results were as follows:
1) 80% of subjects of laryngectomy without cotton in the nares and 20% of subjects of laryngectomy with cotton in the nares perceived the garlic odor.
2) Garlic odorous substance was not recognized in saliva specimens collected before and after intravenous infusion of Alinamin®.
3) The healthy subjects inhibited in their sense of smell and intravenously infused with Alinamin® perceived the odor at the same time as exhalation.
The above results indicated that the mechanism of smell after intravenous infusion of Alinamin® occurred via exhalation, but not through the other routes.

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