The larynx is subdivided into three regions: supraglottic, glottic and subglottic. In neonates or infants, the laryngeal mucosa is covered with respiratory epithelium except for the vocal cord and the aryepiglottic fold. Most malignant neoplasms of the larynx are squamous cell carcinomas.
In this study, we focused on the features of the extension and the histopathologic findings of each type of laryngeal carcinoma and reviewed literature regarding the origin of carcinogenesis. Squamous cell carcinomas of glottic-type laryngeal carcinoma originate from squamous epithelium of the vocal cord. Because of the early appearance of hoarseness, glottic cancer is found at an early stage, and the prognosis is generally good.
In contrast, supraglottic and subglottic type laryngeal carcinomas show various characteristics not only in their pattern of extension but also in the histopathologic findings. In particular, the so-called transglottic carcinoma invades the laryngeal frameworks, and the prognosis is poor.
Carcinogenesis of the supraglottic laryngeal carcinoma was thought to be highly correlated with squamous metaplasia of the respiratory mucosa of the supraglottic larynx. Metaplasia is highly associated with aging. Smoking habits as well as exposure to air pollution accelerate squamous metaplasia of the mucosa. Even in mucosa of the ventricle, where it is completely covered with ciliated glandular epithelium in neonates and infants, metaplasia was found to occur in adult larynges.
Using immunohistochemical methods, we also stained the glottic and so-called “ventricular carcinomas” using antiserum as a marker. Expression of epithelial membrane antigens was predominantly observed in glottic-type carcinomas. The expression of a secretory component, produced locally in the cytoplasm of glandular cells, was intense in most ventricle carcinomas. We believe that some carcinomas in the laryngeal ventricle originate from cells of the secretory glandular acini or epithelium.

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Two cases of bilateral facial nerve palsy are reported. Case I was a 57-year-old female who developed facial palsy of both sides simultaneously, and turned out to be suffering from GuillainBarré syndrome. Her facial palsy recovered soon after the start of treatment along with the underlying disease. Case 2 was a 65-year-old male who developed left facial palsy first, followed by right facial palsy 13 days later. He was eventually diagnosed with multiple myeloma. The patient died despite active treatment, and his bilateral facial palsy did not change until his death. In both cases, bilateral facial nerve palsy was the initial manifestation of the underlying diseases. The mechanism of bilateral palsy was considered to be polyneuritis in Case I, and unknown in Case 2, but myeloma cell infiltration to both facial nerves was considered a possibility. Although bilateral facial nerve palsy is rather rare, it is particularly important to do a thorough differential diagnosis when seeing a patient with such palsy, since a serious underlying systemic disease may exist.

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This study was designed to compare large dose steroid therapy and lipo-PGE¹therapy in 22 previously untreated patients with Bell's palsy accompanied by diabetes mellitus. Thirteen patients were treated with large dose steroid therapy, while the remaining 9 were treated with Lipo-PGE¹ therapy. No significant differences in patient backgrounds, such as age, sex, and the side of palsy, were present between the two treatment groups. Furthermore, no significant differences in the mean palsy score at the time of presentation or at the time of aggravation were present between the two groups. Cumulative recovery rates after treatment did not differ significantly at 4 weeks or at 2 and 6 months between the two groups, nor were there any differences in the therapeutic outcomes between the groups. Fasting blood glucose levels during the period of treatment were elevated in all 13 patients receiving steroids, but not in the lipo-PGE1 group. Diabetes mellitus was also aggravated in the steroid group, but not in the lipo-PGE¹ group. These findings indicate that lipoPGE¹ therapy improves the blood flow to facial nerves, promoting recovery from Bell's palsy. Furthermore, lipoPGE^1, therapy is useful for the treatment of Bell's palsy accompanied by diabetes mellitus because it has the same recovery rate as that of large dose steroid therapy, but it does not aggravate diabetes mellitus.

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A rare case of intranasal angiomyolipoma is reported. A 48-year-old male presented with a slowly progressive right nasal obstruction and recurrent epistaxis of the right nasal cavity. An intranasal examination showed a soft and easily bleeding mass in the right anterior nares. CT scan findings showed an enhanced soft tissue mass arising from the anterior edge of the right inferior turbinate without bony destruction. The patient had no clinical signs of tuberous sclerosis. The tumor was removed through the vestibule using a transoral approach under general anesthesia. Histopathologically, the tumor was composed of mature fat cells, vascular spaces lacking elastic tissue, and bundles of mature smooth muscle cells. There has been no recurrence for two and half years.

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The effects of contact Nd-YAG laser surgey on perennial allergic rhinitis patients were studied in 100 patients. The bilateral inferior turbinates were vaporized under local anesthesia as an outpatient procedure. The patients were 44 males and 56 females, aged 9-70 years. About one month after surgery, the improved rates of sneezing, nasal discharge and nasal obstruction were 85%, 76% and 92%, respectively. Six months after surgery, the improved rates were 80%, 71% and 88%, respectively. One year after surgery, the improved rates were 67%, 60% and 74%, respectively. We believe that contact Nd-YAG laser surgery for perennial allergic rhinitis is useful, but in our study, a recurrence of nasal symptoms occurred in 16-18% after one year. We recommend revaporization in patients whose nasal symptoms recur.

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We report a case of trichilemmal carcinoma with infiltration of the facial nerve in a 77-year-old man. Since the tumor was accompanied by invasion of the facial nerve, a parotidectomy with tumor resection was performed. Histological examination showed frequent trichilemmal keratinization in the central portion of the nests and revealed perineural invasion. Based on these findings, we suspected a malignant proliferating trichilemmal cyst (MPTC), rather than a malignant trichilemmoma (MT). We discuss briefly the histopathological differences between MPTC and MT.

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We studied 129 cases of submandibular gland sialolithiasis during an 18 year period between 1981 and 1999. An ultrasonic examination was the most useful for diagnosing sialolithasis. One hundred and two patients cases were treated by resecting the submandibular gland, in which about one third suffered from temporary paralysis of the mandibular branch of the facial nerve. We also examined the paralysis factor. It was related not to the amount of experience of the surgeons but to the surgical method. Exposure of the mandibular branch of the facial nerve caused paralysis more, and the method to avoid exposure of the nerve was thought to be more suitable for submandibular sialolithiasis operations.

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From 1990 through 1998, 143 patients with laryngeal cancer were treated in our department. Of the 143 patients, 94 had glottal, 43 had supraglottal, and 6 had subglottal cancer. The 5-year survival rate in patients with laryngeal cancer was 90.0% for stage I, 81.3% for stage II, 77.9% for stage III, and 42.6% for stage IV. The 5-year survival rate was 86.5% for glottal, 55.9% for supraglottal and 66.7% for subglottal cancer patients. The laryngeal preservation rate was 90.4% for stage I, 60.5% for stage II, 21.4% for stage III and 28.1% for stage IV.
A loco-regional recurrence occurred in 24 of 143 patients (16.8%). The salvage rate for these patients was 45.8% (11/24). Six of 11 patients who died of primary disease and nodal failure (including 2 stomal recurrences) had supraglottic stage N carcinoma.
In conclusion, laryngeal preservation surgery should be recommended in the early stages of cancer after radiation failure and local recurrence. It is recommended to dissect the anterior compartment including the delphian lymph node, pretracheal, and parathyroidal nodes bilaterally for patients with laryngeal tumors that have significant anterior subglottic extension, tumors arising in the subglottic region, or advanced tumors arising in any region, especially the supraglottis.

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Five hundred eighty-five patients with thyroid tumors were surgically treated at our department between 1985 and 1997. A benign tumor was noted in 351 patients, and a malignant tumor except malignant lymphomas was observed in 234 patients. Neck X-ray, echography, CT and/or MRI were done in most patients. In 383 patients who underwent fine needle aspiration cytology, sensitivity was 91.7%, and specificity was 80.4%, with an accuracy value of 53.3%. Pathologically, papillary and follicular cancers were diagnosed in 202 and 24 patients, respectively. In 226 patients with well-differentiated thyroid cancer, a hemithyroidectomy with isthmectomy was performed in 47.8%, a subtotal thyroidectomy in 32.3% and a total thyroidectomy in 12.8%. Prophylactic neck dissection including R1 or D1 was performed in 75.7%. Neck dissection for N1, was performed in modified ND including D2a or radical ND including R2 and D2b. A pathological N positivity was shown in 66.7% of papillary cancers and 44.4% in follicular cancers. In 24 cases of extracapsular extension, local recurrence occurred in 4 cases. The ten-year survival rate was 98.5% in those with non-invasive papillary cancer and 92.9% in follicular cancer. Otherwise, it was 75.0% in patients with extracapsular invasion.

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Renal clear cell carcinoma rarely metastasizes to the head and neck region without metastases to another organ. We encountered a case of renal clear cell carcinoma that metastasized to the thyroid gland and the sphenoid sinus.
The patient was a 46-year-old man. In June, 1995, he was diagnosed as having renal cell carcinoma and underwent left nephrectomy. This was followed up with an injection of INF, 2 times/week. In December, 1997, he noticed swelling in his throat. The mass was 40×45mm, elastic, hard, and moved with swallowing. It was diagnosed as clear cell carcinoma by fine needle biopsy. Thyroidectomy was performed on 11, May, 1998. In August, 1998, visual loss occurred. A tumor involving the sphenoid sinus was detected on CT. Endoscopic sinus surgery was performed on 30, August, 1998. It was diagnosed cytologically as clear cell carcinoma. He died on 16 November due to bleeding from the recurred tumor.
Renal cell carcinoma mainly metastasizes through the blood system. The metastases to multiple organs usually depend on the caval system. In this case, no metastasis was found other than in the head and neck region. It is possible that metastasis through Batson's plexus was responsible for the metastasis being limited to the head and neck region.

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We report two cases of chronic thyroiditis that caused dyspnea due to tracheal stenosis. The first patient was a 50-year-old male and the other was a 45-year-old female. Both patients complained of dyspnea. A CT scan demonstrated a diffuse large goiter and tracheal stenosis. They both had caught a common cold, and after that they complained of dyspnea. We performed a total thyroidectomy in the first patient, and a subtotal thyroidectomy in the second one. After the operation, in both cases, the tracheal compression and dyspnea disappeared. A thyroidectomy is useful for dyspnea that is due to tracheal stenosis and caused by chronic thyroiditis.

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The glottal flow efficiency (GFE), defined as alternating current component/direct current component of glottal air flow, or AC/DC by Isshiki, and the glottal power efficiency (GPE), defined as acoutic glottal power/aerodynamic glottal power by van den Berg were studied to compare the flow rate, vocal intensity, subglottal pressure, and glottal area.
The GFE was found to be a good indicator of the glottal area and vocal fold stiffness, while the GPE was not a good indicator because the noise produced at the glottic also contained acoustic energy.
The drawback of the GFE was its inability to correctly reflect the glottal condition, when the air flow provided for phonation was at an unusually low rate or the vocal intensity was at an extremely low level.
The critical GFE value indicating a complete glottal closure was estimated at around 50.

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The clinical effect of cetirizine hydrochloride on Japanese cedar pollen allergy patients was analyzed by compairing treatment before the start of the pollen season and treatment after the pollen had been scattered.
1. Based on the symptom-medication score method, treatment before the pollen season shows a significantly lower value than that of treatment within one or two weeks after the pollen had been scattered.
2. Analysis also revealed that this medication relieved nasal symptoms, even in cases, occurring after the season had started.
3. Cetirizine hydrochloride was an effective initial treatment for the clinical effects of Japanese cedar pollen allergic reactions.
These results suggest that cetirizine hydrochloride is useful for the treatment of Japanese cedar pollinosis.

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Some anti-bacterial agents have been reported to have immuno-potentiation effects and to show synergy in their anti-inflammatory effects. To study the immunomodulatory effect of Levofloxacin (LVFX), one of the new quinolones, we investigated the influence of LVFX on the production of cytokine in human tonsillar lymphocytes. Palatine tonsils were obtained from 10 patients (5 males and 5 females, ages 15-26 y. o.) who were tonsillectomized for the treatment of recurrent tonsillitis in the Department of Otolaryngology, Wakayama Medical College. Informed consent was obtained from all patients to use their tonsils for this study. The tonsillar lymphocytes were stimulated by Staphylococcal enterotoxin B (SEB, 100ng/ml) and were divided into two groups according to the incubation time with LVFX (5μg/ml or 50μg/ml), the 24 hour-group and the 48 hour-group. Production of cytokines (IL-lα, IL-1β, IL-8, IL-12, IFN-γ, and TNF-α) in the supernatant was measured by solid-phase ELISA. TNF-α production of tonsillar lymphocytes was markedly sup-pressed in both groups incubated with 5μg/ml and 50μg/ml of LVFX (p<0.01) and IFN-γ production was also suppressed in both groups (24 hour-group, p<0.01 and 48 hour-group, p<0.05). IL-8 production of tonsillar lymphocytes was markedly suppressed only in the 24 hour-group incubated with 5μg/ml of LVFX (p<0.05). On the other hand, LVFX showed no influence on the production of IL-1α, IL-1β, or IL-12 of tonsillar lymphocytes.
In conclusion, LVFX, one of the new quinolones, has some immunomodulatory effects on tonsillar lymphocytes through the suppression of proinflammaroty cytokine production such as IL-8, IFN-γ, TNF-α and may show the synergistic anti-inflammatory effect with its anti-bacterial properties.

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