Many publications have repeatedly indicated that there seems to be a correlation between neoplastic disease and certain types of psychological situations. However, such studies subjected malignant tumors in head and neck region are scanty so far.
We applied Cornell Medical Index Health Questionnaire (CMI) and Maudsley Personality Inventory (MPI) to collect medical and psychiatric data from 86 patients (56 males and 30 females) with head and neck malignant tumors and 115 control patients (73 males and 42 females) with head and neck diseases other than malignant tumors. Analysis of CMI data using Diagnostic Sheet, Fukamachi's method and Modification of Abe's method, and analysis of each of Extroversion-Introversion scale scores, Neuroticism scale scores and Lie scale scores of MPI led the following conclusion.
1) Both male and female patients with head and neck malignant tumors showed to be more depressive than their control patients were. Especially, between the two patient groups in males, there was a statistically significant (p<0.05) difference.
2) Regarding neurosis, autonomic nerve dysfunctioning and extroversion-introversion, none of these factors seemed to be related with the morbidity of head and neck malignant tumors.
Further exploration of this issue, with a special attention to the relationship between depression and head and neck malignancy should be conducted, if possibly, from a prospective point of view.

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We reported the data on 25 patients with nasopharyngeal carcinoma from 1984 to 1989, who recieved chemo-radiotherapy for initial treatment and follow-up by additional maintenance of chemotherapy for 2 years. The result of this study is as follows.
1. The 20 males and 5 females were included.
2. A median age of the patients was 62 years.
3. Stage grouping study showed 3 cases of stage II, 6 of stage III, and 16 of stage IV.
4. The local control rate was 92% and the rate of control in the cervical region was 96%.
5. However, the overall 4-year survival rate obtained by the Kaplan-Meiers method was 50%.
6. The cause of patients' death was mainly distant metastasis.

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The lingual root is an area where the thyroid gland develops and small salivary glands composed of both serous and musous glands are distributed in the submucosa. In this paper the foramen cecum and mucous glands at the root of the tongue were histologically investigated in serial sagittal sections of the medial portion of the lingual root.
The materials were obtained from 59 autopsied cases, excluding the cases with metabolic disease, brain tumor and neck tumor in whom the original disease might exert direct or indirect effects to the gland tissue.
The frontal end was determined to be the line which connects the right and left palatoglossal arch junctions with the tongue, and the rear end the line of transition of the vallecula to the epiglotis. The specimen was cut in half along the median lingual sulcus and median glossoepiglottic fold. Each serial section of 4, um in thickness was cut from the median plain to the lateral and stained with Hematoxylin-Eosin or Pas-Alcian blue at pH 2.5.
The results of the study were summarized as follows. 1) The foramen cecum was histopathologically confirmed in 12 cases out of 59(20%). The ratio of the detection did not show any difference between both sexes and in the groups of different age.
2) The mucous gland opening into the mucosal epithelium, which were located at the side of the lingual apex from the Ebner's gland or serous gland, were detected in 45 out of 59(76%).
3) The serous glands were morphologically classified into 4 types, which were the shallow and uniform type, shallow and dispersed, deep and uniform and deep and dispersed. The foramencecum was confirmed most frequentlly in the deep and dispersed type than in the others. Thereason of this finding was discussed from a viewpoint of enbliology.
4) It was detected that the duct of the lingual root mucous gland opend not only into crypts of the sublingual gland but also directly to the mucous epitherium.
5) Atrophy of glandular cells, proliferation of the interlobular connective tissue and dilatation of the ducts were observed as histological changes of aging.

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Recently four tissue toxic proteins namely major basic protein (MBP), eosinophil peroxydase (EPO), eosinophil-derived neurotoxin (EDN), and eosinophil cationic protein (ECP) were found in eosinophilic leucocytes. Although the characteristics of these proteins concerning tissue damage in the local site of type I allergic reaction have been investigated mainly in lower respiratory tract, the actual clinico-pathological roles of these proteins in nasal allergy are not clarified. Contrary, eosinophils also have histaminase, arylsulfatase, phospholipase D, which are considered to act on a negative feedback mechanism in allergic reaction through inactivation of chemical mediators. Therefore, estimation of ECP and simultaneously arylsufatase B in nasal secretion and the sera from patients with nasal allergy may clarify the dynamics of clinico-pathological state, especially in the late phase of allergic reaction in each patients. ECP concentrations in the nasal secretions from 22 patients and in the sera from 12 patients with nasal allergy were measured by RIA method. The activities of arylsulfatase B in the nasal secretions and the sera were also estimated in the same specimens as ECP by measuring its hydrolytic activity using p-nitro cathecol sulfate as a substrate. The results obtained were as follows ;
1) There was a significant correlation between ECP concentrations in the nasal secretions and the severities of clinical symptoms, especially the degree of nasal obstruction. ECP concentrations also significantly correlated to the score of eosinophilic leucocytes in the nasal smears.
2) The serum ECP concentrations significantly correlated to the number of eosinophilic leucocytes in the peripheral blood, and also showed slight tendency of correlation to the severity of clinical symptoms.
3) Arylsufatase B activities in the nasal secretions significantly correlated to the score of eosinophilic leucocytes in the nasal smears. There was a significant correlation between ECP concentration and arylsulfatase B activities in the nasal secretions. However, there was no correlation between arylsufatase B activities in nasal secretions and clinical symptoms.
From these results, it was suggested that estimation of ECP in nasal secretion would be available in evaluation of the severity of nasal allergy in relevance to the infiltration of eosinophilic leucocytes. And it was also suggested that since ECP and arylsulfatase B might be released from eosinophilic leucocytes with non-independent manner, the role of arylsulfatase B in down regulation of the allergic reaction was not significant.

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The pathogenesis of middle ear cholesteatoma has been thought to be invasion of squamous epithelium originated from the external ear skin including the tympanic membrane. There is no evidence, however, that the external ear skin has more potential to form cholesteatoma than that of other sites. In this report experimental middle ear cholesteatoma of guinea pigs originated from the external ear skin was histologically comparered with that originated from the auricular skin.
Cholesteatoma as dermal cyst was seen in the middle ear of almost all animals (25/28 = 89. 3%), using a free skin graft (3 x 3 mm), regardless of the skin taken from superior (group A) or inferior (group B) part of the external ear, or the auricle (group C) eight weeks after skin implantation. The activity of epithelium such as keratinization was evident in group C. There is, however, no obvious difference in surrounding granulation tissues among group A, B, and C. In a half of this series, cyst wall was broken and its contents (debris) mainly consisted of keratin were put on surrounding granulation tissues three weeks after skin implantation. Striking keratinized epithelium and subepithelial inflammations in relation to the amount of debris were observed at the eighth week. These findings suggest that the external ear skin does not have specific potential to form cholesteatoma and keratin plays some roles in growth of cholesteatoma.

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Dual motor innervation by the bilateral recurrent laryngeal nerves (RLNs) has been demonstrated in the human arytenoid muscle (AR). Whether AR of the dog receives dual motor innervation remains to be cleared yet, although the canine larynx is frequently used in experimental studies. To answer this question, the author observed the muscular structure in detail and anastomotic nerve branch between the bilateral RLNs, and then carried out glycogen depletion experiments on AR of dog compared with typical unpaired ARs of monkey and of guinea pig.
1) Muscular structure
AR of the dog consisted of three parts of muscle bundles : the transverse arytenoid muscle (TVA), ventricular muscle (VT) and anonymous small bundle provisionally named the smaller interarytenoid muscle (IAm). While TVA and VT were paired type, IAm was unpaired type and lay horizontally on the dorsal aspect of the sesamoid cartilage around the midline. So the canine AR displayed a trigastric muscle as a whole.
2) Anastomotic nerve branch
By the vital staining with methylene blue, the arytenoid branch of canine RLN ramified in three directions : anteriorly to the bellies of TVA and VT, medially to the anastomotic branch and superomedially to IAm. By the silver impregnation method of Barker and Ip, the bilateral IAm ramuli were found to form collateral anastomoses and terminate disorderly on the individual fibers.
3) Glycogen depletion experiments
When an electrical stimulation was applied to the unilateral RLN in the monkey and the guinea pig, about one half of AR fibers were unstained with PAS staining and, in turn, these unstained fibers were known to be innervated by the ipsilateral RLN. While these unpaired ARs receive dual motor innervation as a whole muscle, every individual fiber is innervated by the unilateral RLN.
In the canine VT and TVA, almost 90% of fibers were depleted of glycogen on the belly of the stimulated side, while the reverse was on the nonstimulated side. This finding suggests that most fibers of canine VT and TVA are ipsilaterally and the remaining fibers are contralaterally inner- vated. About one half of fibers of IAm were unstained and the others were stained. This pattern was similar to that observed in the monkey and the guinea pig. Therefore, IAm receives dual motor innervation from both RLNs as a whole muscle.

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The result of transcutaneous intrafold injection and its influencing factors were studied for fifty five procedures in fifty two patients with unilateral recurrent nerve paralysis. Maximum phonation time, mean air flow rate and amplitude perturbation quotient of the voice were normalized or improved after the procedures more than 85%. In general assessment with functional and acoustic examinations, 76% of the procedures showed significant improvement. The paralysis after the thoratic surgery, right vocal fold paralysis and the paralysis complicated with sulcus vocalis tended to have insufficient improvement after injection. The most significant correlation to the result was shown in the degree of vocal fold augmentation immediately after injection. It was depend on the surgeon's technique and the patient's problems such as an anatomical abnormality of the larynx and an insufficient inhibition of the gag reflex.

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In order to clarify the neoplastic-mesenchymal cell interaction, tumor structures were histologically classified into duct, solid and scattered types, and stromal changes were observed in each type with histochemical techniques.
The quantitative and qualitative differences of the stromal components as proteoglycan and collagen were histochemically differed in these morphological features. Ca++ATPase was ultrastructurally localized on the plasma membrane of myoepithelial cell in salivary glands. The activity of Ca++ATPase changes in tumor cell differentiation of pleomorphic adenoma and adenoid cystic carcinoma.
These results suggest that the stromal components and Ca++ATPase play an important role on the tumor cell proliferation and differentiation in these tumors.

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Recent years, active anterior rhinomanometry using a anesthetic face mask is probably more commonly employed than active posterior rhinomanometry because of occasional failure in obtaining the oropharyngeal pressure in the latter method. Thus, in attempt to overcome the disadvantage in active posterior rhinomanometry, we employed a fine nasal catheter(#8F infant feeding nasal catheter)through the nasal cavity instead of a peroral mouth piece.
Nasal resistances in a normal adult were measured by mask active posterior rhinomanometry with a mouth piece or a nasal catheter for obtaining postnasal pressure using Rhinorheograph MPR2100(manufactured by N ihon-Kohden Co., Ltd.).
In adult, no significant differences of unilateral and bilaterel nasal resistances between with the mouth piece and with the nasal catheter were found either on inspiration or expiration.
It could be concluded in this fundamental study that active posterior rhinomanometry with the fine nasal catheter is useful and has no proceduaral ploblems.

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Hydroxyapatite granules were employed for mastoid obliteration in cases of aural cholesteatoma.
After eradicating a cholesteatoma by the canal-down technique, the canal wall was reconstructed with cortical bone chips, and the mastoid cavity was obliterated with hydroxyapatite granules. Tympanoplasty by this technique was performed on 48 ears with aural cholesteatoma. There was no recurrence of cholesteatoma during the follow-up period of two years after surgery. One case of residual cholesteatoma was found in the mesotympanum. There were two cases in which the hydroxyapatite granules became exposed through the posterior canal skin. An air-bone gap of less than 20 dB was achieved in 73% of all the patients.
Experimental studies in guinea pigs have demonstrated that hydroxyapatite granules do not undergo morphological changes in and are tightly interdigitated with newly formed bone tissue growing from bulla bone one year after hydroxyapatite implantation in the temporal bullae. The newly-formed bone showed incomplete osteon structures. Excellent biocompatibility and bone adaptability of hydroxyapatite granules were demonstrated experimentally.
It is concluded that tympanoplasty with mastoid obliteration using hydroxyapatite is safe and useful for avoiding mastoid cavity problems and for preventing the recurrence of cholesteatoma.

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