A 2 year old girl had a foreign body (a fragment of plastic spoon) in the parotid gland, which had passed through the pharynx.
There was a recurrent swelling in right parotid gland and eventually right facial palsy.
It was difficult to diagnose the cause of the facial palsy until a biopsy of the parotid gland was carried out. We found that the facial palsy was due to this fragment of plastic spoon and that there was an evident inflammation in the surrounding tissue.

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A well ventilated middle ear space has been rebuilt using tragal cartilage. Practical procedures, postoperative care and preliminary results are described in detail in the text. Successful postoperative hearing were attained in 60% of 32 operated ears. Results were assessed as follows:
Air bone gap within 15dB, hearing improvement by 20dB or more, and average hearing exceeding 30dB.

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Clinical observations were made on 10 patients with maxillary tumors who had been treated with the combined therapy of necrotomy, irradiation and regional chemotherapy since 1970. All 10 patients had a recurrence within seven months after the combined therapy. As a secondary therapy, five patients were managed by conservative therapy and five underwent a total maxillectomy. Four are now living and well from three months to eight years following the secondary therapy of the total maxillectomy, re-irradiation and cryosurgery with no evidence of recurrence. One patient is living eleven months following the secondary therapy of infusion of 210mg of Bleomycin through the superior thyroid artery and re-irradiation of 2500 rads, but a biopsy of the anterior wall of the antrum was found to be positive for cancer. Five died of local recurrence within one year.
If the recurrence is localized at the anterior wall and the posterior wall of the antrum, a total maxillectomy should be performed. If the recurrence is localized on the lateral wall, the medial and inferior walls of the antrum, conservative therapy with necrotomy after a period of cryosurgery, intraarterial infusion of anticancer drugs, re-irradiation and anticancerous ointment should be considered.

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A 53-year-old man who had had a history of dysphagia and an abnormal sense of the pharynx for 2 months was first encountered in our department on December 1, 1978. On physical examination, a pulsating mass of a size of 5cm×4cm was found in the left retrotonsillar region. Carotid angiography of the traditional procedure revealed an aneurysm above the bifurcation, but did not clearly show the originating location. Angiography via the superficial temporal artery revealed that the aneurysm originated from the extracranial portion of the left internal carotid artery. After the daily Matas' test had been given for approximately one month, the left common carotid artery was first ligated. With an interval of 28 days, the left external carotid artery was ligated. Sixty days afterwards, the patient developed an abscess in the left peritonsillar region. Tonsillectomy and curettage of the intraaneurysm thrombosis was performed. Ninety then, the patient has had no problems. Eighty-one cases of extracranial carotid artery aneurysm reported in literature were reviewed. We emphasize that the arteriography through the superficial temporal artery is useful in determining the originating location of the aneurysm.

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The effect of levator muscle sling formation in cleft palate surgery was evaluated by electrical stimulation of the muscle at surgery. Palatal movement before and after sling formation was recorded using a force transducer. After muscle sling formation the soft palate had been elevated more effectively toward the retropharynx and its mobility increased remarkably. The surgical procedure, which had been proposed on the basis of anatomical considerations, proved to be effective for improving velopharyngeal function.

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Primary malignant lymphoma of the thyroid is relatively rare. A 57-year-old woman first developed a mass in the left thyroid region in 1974 at the age of fifty-four. In March 1977, she was clinically diagnosed was adenoma and hemithyroidectomy was performed. Microscopic examination revealed that the mass was Hashimoto's disease. Eight months following surgery, she complained of swelling in the right thyroid region. In October 1978, a biopsy specimen was taken from the right thyroid lobe and the histological diagnosis was non-Hodgkin lymphoma of diffuse histiocytic type (IgG, k type). The clinical stage was determined as CSII_EA on the basis of through examinations. A preoperative irradiation followed by hemithyroidectomy was performed. After the operation, chemotherapy and postoperative radiation were carried out. The patient has been free from the disease for about 9 months after the treatment. An extensive review of literature was made to cover some aspects of this disease.

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Cinnarizine (Roin^®) was administered to 20 patients with a chief complaint of vertigo, and effectiveness and side effect were evaluated. Cinnarizine was effective in 14 patients (77%) and the effectiveness was confirmed by objective assessments. On the other hand, tinnitus and hearing impairment were not improved. Seven patients (35%) complained of sleepness on the 2nd or 3rd day after the administration.

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Cerocral (Ifenprodil) was administrated to 50 patients with vertigo and equilibrium disorders and in 32 patients diphenidol had been previously administrated.
1) In 32 patients on diphenidol, the most effective rate was 47%, the moderately effective rate was 28% and no effect was seen in 25%.
2) In all 50 patients, the most effective rate was 40%, the moderately effective rate was 30%, and no effect was seen in 26%.
3) Good effects was seen in cases of the vestibular disorders with an apparent dysfunction of the central nervous system as seen in the Eye-Tracking Test and examinations for Optokinetic Nystagmus, however in some patients, good effects was seen in cases of the typical peripheral vestibular disorders in examinations.
4) As a result of neuro-otological examinations, Cerocral administration proved to be more effective in those with a higher unilateral impairment (Canal paresis=CP) of the vestibular nervous system, or higher unilateral positive findings in Mild-Caloric-Eye-Tracking Pattern Test (MCETP-test).

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Although the perceptive loudness of voices mainly corresponds to the sound pressure, it seems that other acoustic parameters to some extent influence the loudness sensation. For example, some investigators reported that a factor related to loudness was extracted as dominant by factor analytic studies of normal and pathologic voices, even when the reproduction level of the stimulus sounds was regulated to almost the same.
For elucidation, the relation between loudness sensation and various acoustic parameters of voices was studied. Normal and pathology related voices and synthesized vowels were used as stimuli, the method of paired comparisons was used as a psychometric procedure, and the analysis of variance was utilized as an analytic procedure on the obtained data.
The results were as follows:
(1) Sound pressure of voices corresponded to perceptual loudness.
(2) Increase in duration of voices resulted in increase of loudness.
(3) Lower fundamental frequency of voices increased loudness in the low frequency range. Beyond this range, the relation betwen the fundamental frequency and loudness did not have a linear relation. The effort in uttering the voice seemed to influence the loudness sensation.
(4) The relationship of loudness among the five cardinal Japanese vowels was complicated and is at present unexplainable.
(5) Comparing the pathologic voices uttered by patients with laryngeal cancers, vocal polyps, and unilateral recurrent nerve paralyses, voices of patients with laryngeal cancers were heard as the loudest, while such with recurrent nerve paralyses were heard as the softest. It seemed that the difference in degree of irregularity of waveforms as well as amount of noise components in the pathologic voices influenced the loudness sensation.
(6) From the study on the influence of small perturbation of single particular element of waveforms, such as amplitude or pitch perturbation, to the loudness sensation with the use of synthesized vowels, no distinct relation was obtained. Synthesized vowels, therefore, do not seem useful for this kind of study, as far as the present synthesizing technique is concerned.

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Variations of the vestibular Aqueduct (VA), endolymphatic Sac (ES) and the development of the peri-aqueductal air cell were studied using ten horizontally sectioned human temporal bones. Ten temporal bones consisted of each, two well pneumatized and poorly pneumatized ears without particular pathological finding in the ES, 3 ears with narrow lumen and various pathological conditions of the ES, a ear of neonate and both sides from a case of unilateral meniere's disease. Medial view graphic reconstruction of the cochela VA, ES and peri-aqueductal air cell were performed for the better understanding of the three dimensional anatomy among these structures.
The ear with well developed peri-aqueductal air cells showed well developed funnel shape dilatation of the distal VA, and the poorly developed ear showed poorly developed funnel shape dilatation, respectively. The ES extended from near the upper margin to the lower margin of the VA in either well or poorly pneumatized ears. No direct relation was detected between the penumatization of the ear and the patency of the ES lumen. However, 3 cases which showed the narrowing of the ES lumen by various pathological findings such as eosinophilic deposit in the lumen, polypoid change in the perisaccular space and the tree-branch-like separation of the ES showed underdeveloped pneumatization. One case of Meniere's disease showed a decreased patent area of the ES in the affected side. Poorly developed pneumatization of the temporal bone may be considered as a predisposing factor of the endolymphatic hydrops due to decreased anatomical volume of the VA and ES.

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