Otorhinolaryngologic emergent diseases are sometimes life-threatening involving airway problems such as acute epiglottitis, peritonsillar abscess, deep neck infections and foreign bodies in the trachea and bronchus.
With regard to acute epiglottitis, this disease occurs mainly in adults in Japan, while it is common among children in European countries and North America.
Recently, however, an increased incidence of this disease has been reported both in Japan and abroad. The mortality rate was about 1.3% in our series.
Peritonsillar abscess is one of the most common emergent diseases in otorhinolaryngologic practice. The male: female ratio is about 3 to 1 and it is seen more often in males.
The peak incidence is the third decade. Anaerobic bacteria were detected in 62% of the patients.
As complications, deep neck infection, laryngeal edema and mediastinal abscess were found in 1.0%, 0.6%, and 0.3% of patients, respectively.
Deep neck infection is also a life-threatening disease when it extends to the mediastinum.
Basically, abscess in the neck should be excised and drained outward as soon as possible. However, early abscess or small abscess could be initially treated by intravenous administration of high-dose antibiotics. The indication for antibiotics for neck abscess has not yet been clearly demonstrated. Foreign bodies in the trachea and bronchus are decreasing in Japan in recent years. This may be due to increased education and awareness of public health in our society.
Since fiberoptic bronchoscopy has become common in our medical practice, foreign bodies have been removed by chest physicians using fiberoptic bronchoscopes more often than by otorhinolaryngologists using rigid bronchoscopes. Therefore, the role of otorhinolaryngologists in removing foreign bodies is now showing an annual reduction. However, foreign bodies in the trachea and bronchus of children should still be removed by rigid ventilating bronchoscopes, becuase fiberoptic bronchoscopes are not available for children.
Otorhinolaryngologists are still responsible for treating this condition.

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Pontine hyperintense lesions seen on T2-weighted MRI were thought to be related to disequilibrium. Some of these lesions have a low signal on T1-weighted imaging, while others have an iso-signal. The purpose of this study was to clarify the relationship between neurological findings and pontine lesions detected by MRI. The subjects were 11 patients (6 males, 5 females; age range: 30 to 83 years [mean: 64.1 years]) with pontine hyperintense lesions identified on T2-weighted MRI. We compared the clinical signs and the MRI findings. Six of the patients had low-intensity areas on T1-weighted images, and the other 5 had iso-intensity areas. Six patients complained of vertigo, and 5 complained of dizziness. Eight complained of positionaly evoked disequilibrium. Positional nystagmus was seen in 4 patients. In 9 patients, abnormalities were found on the ENG test, including the saccadic eye movement test, ETT, and OKP. Numbness on the lips occurred in 2 patients, and cerebellar signs were present in 4. None of the patients had facial paralysis. Disequilibrium originating in the central nervous system was suggested in 10 patients. Clinical examinations revealed similar findings in patients with a low signal on T1-weighted MRI and those with an iso-signal. Our results indicate that pontine lesions identified by T2-weighted MRI cause vertigo or dizziness, and, in most cases, these lesions cause abnormal neurological or neurological abnormalities.

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Although otogenic intracranial infectious complication is now rare, it can still have a serious outcome. We report here a young child with intracranial infections secondary to extension of acute otitis media. A 5-year-old boy developed thin epidural empyema in both the middle fossa and posterior fossa ipsilateral to the otitis media. Mastoidectomy was urgently performed and the posterior fossa abscess was drained to the external canal through the opened mastoid. The patient recovered uneventfully.
We considered that this potentially serious condition developed in this case because of poor understanding by the patient's mother about the necessity of antibiotics, which resulted in the purulent otitis media being only partially treated.
A literature survey of otogenic intracranial complication in Japan for the period 1992-2000 showed on 26 cases of which males were predominantly affected with the ratio of 4:1. The peak incidence occurred in patients in their forties and fifties. Cholesteatoma was the most common underlying problem (65.4%) in the period, which was similar to 1982-1991. However, acute otitis media as a cause of intracranial complication became three times more frequent in the 1992-2000 period. Brain abscess was most common, exceeding 50% of reported cases, and epidural abscess also increased in incidence. Causative pathogens included streptococcus species, pseudomonas, staphylococci, and some other microbes, and these were similar in both period. Cases following middle ear surgery were less common in the latter period.

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Sebaceous epithelioma is a rare skin tumor with sebaceous differentiation. Histopathologically, it is composed of undifferentiated basaloid cells, differentiated sebaceous cells and transitional cells. Our patient was an 80 year-old man with an asymptomatic tumor in the right external auditory canal. The tumor was 1.2×0.8cm and had a stem at the lower wall of the external auditory meatus and could be completely resected. During a one-year follow-up period, there was no recurrence of the tumor.

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Postnasal drip is one of the symptoms of chronic sinusitis, and is often refractory. However, sinusitis is not the only cause, and among other conditions, Tornwaldt's disease can also cause postnasal drip.
We report a case of Tornwaldt's disease with postnasal drip that was improved by surgery. Cyst opening was sufficient to treat the postnasal drip in this case. However, since there is a risk of cyst relapse, long-term follow-up is necessary.

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A 52-year old female presented with recurrence of painful induration in the left cheek after simple total hysterectomy for uterine myoma. Exploration of the cheek mass was performed via an oral approach. The histopathological study revealed thrombus of the vein, and we made a diagnosis of thombophlebitis of the facial vein.

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We report a case of giant aspergillosis of the sphenoid sinus. The patient was a 67-year-old female who presented with a headache. CT and MRI showed an irregular shadow in the sphenoid sinus and partial bone destruction of the sinus wall. Histopathlogical examination of an intranasal biopsy specimen revealed aspergillus. Endoscopic intranasal sphenoidostomy was performed to drain the sinus and for observation. Histopathlogical examination of the fungus ball also showed aspergillus, which was not invasive to the submucosa tissue. The patient was successfully treated with surgical debridement of the involved sinus and nasal saline irrigation.

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We report two cases of orbital abscess. Case 1 was a 16-year-old male who presented with right orbital pain and general malaise. Case 2 was a 43-year-old male who presented with swelling of the right eyelid. CT scans revealed orbital abscess and sinusitis. Both patients were treated with surgical drainage, antibiotics and endonasal operation, and both recovered without any complications. The clinical courses in our patients are reported and we also discuss the infectious route, diagnosis, treatment and causing bacteria based on reports in the literature.

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We treated a 61-year-old male with impaired left visual acuity due to optic canal fracture. The optic nerve was decompressed by the endoscopic endonasal approach. The patient had restored normal visual acuity a few days after surgery. Observation of the sphenoid sinus by fiberscope is thought to be very helpful and essential for diagnosis. Optic nerve decompression with corticosteroid pulse therapy should be performed as soon as possible after injury.

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Three patients with intractable recurrent oral ulcers were treated at our institute. The etiology of the recurrent oral ulcers is unknown, but local immunologic disorder is hypothesized, and there are 2 clinical subtypes; Becet disease suspected type, and non-specific ulcers.
The clinical etiology of recurrent oral ulcers may differ according to the primary region, but currently it is not possible to differentiate an intractable recurrent oral ulcer from Becet disease when oral ulcer occurs as the only symptom. Prednisolone was administered for 2 of our cases, and this was effective. Furthermore; when the ulcers recurred, they responded quickly to high dose prednisolone. Long-term follow up is necessary, because some recurrent oral ulcers may be early manifestations of Becet disease.

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We have treated 4 cases of laryngeal tuberculosis during the past 6 years. All patients complained of hoarseness. Laryngoscopic findings revealed glanulomatous lesions in the vocal cords and in the false vocal cords. After antituberculous treatments, their local findings markedly improved.
It is difficult to diagnose elevated lesions as laryngeal tuberculosis, since local findings and the age distribution of this disease are similar to those of laryngeal carcinoma.
Although laryngeal tuberculosis is rare in modern Japan, it is important to be aware that this disease still exists.

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After a partial laryngectomy on patients with laryngeal cancer with unilateral vocal cord fixation, we reconstructed the widely removed arytenoid region with a part of the thyroid cartilage or the hyoid bone. To maintain the sufficient blood flow, the sternothyroid and thyropharyngeal muscles were conserved when the thyroid cartilage was utilized. The sternothyroid muscle was preserved when the hyoid bone was utilized. The cartilage or bone was directly and firmly fixed to the cricoid cartilage. The inside of the cartilage or bone was covered with a local skin flap from the anterior neck.
In two patients, the lateral half of the thyroid ala on the affected side was used in reconstructing the arytenoid. In one patient, the half of the hyoid bone on the unaffected side was used. The supraglottic tissue including the epiglottis was simultaneously removed in two of the three patients. After surgery, the functions of phonation, respiration and swallowing were conserved satisfactorily without recurrence of the cancer in all three patients.

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Cervical lymph node metastases from genito-urinary neoplasms are rare. Left-sided neck metastases or supraclavicular metastasis are predominant because of the anatomy of the lymphatic system. Case 1 was a 23-year-old man with enlarged left supraclavicular lymph nodes. Biopsy was performed, revealing testicular cancer (teratocarcinoma). Subsequent computed tomography (CT) showed multiple large lymphadenopathies from cervical lymph nodes to retroperitoneal lymph nodes. Modified neck dissection was performed for metastatic testicular carcinoma after several courses of chemotherapy. As previously reported, no metastasis was found in levels I and II in our case.
In case 2, a 50-year-old man presented with an enlarged left supraclavicular lymph node. Biopsy specimen showed metastatic adenocarcinoma from the prostate. A subsequent CT showed no lymphadenopathy and no bone metastasis except for the neck metastases. Radical neck dissection was performed for prostatic carcinoma metastatic to the neck after radiotherapy. Metastases were found in every level from I-V and the left axillary lymph nodes in our case. In the case of prostatic metastasis, an aggressive and micrometastatic tendency was reported and it was difficult to detect micrometastases before surgery. We recommend radical neck dissection in neck metastases from prostatic carcinoma and selective neck dissection (levels III, IV, V) in neck metastases from testicular carcinoma.

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Recurrent laryngeal nerve injury is an important complication of thyroid cancer operation. Therefore, before surgery for thyroid cancer, it is important to establish whether the patient has non-recurrent laryngeal nerve (NRLN), which is an anomaly associated with the aberrant right subclavian artery.
Our patient was a sixty-year-old female, in whom NRLN was detected prior to surgery for thyroid cancer. In this case, enhanced CT revealed a vascular image running behind the esophagus at the level of the upper margin of the aortic arch and subsequent MRA revealed the aberrant right subclavian artery.
Enhanced CT scanning between the neck and the upper margin of the aortic arch can show aberrant right subclavian artery. Thus, in patient with thyroid cancer, enhanced CT is useful not only to evaluate lymph node metastasis but also to reveal the NRLN.

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A 71-year-old male presented with a tumor of the larynx originated from the subglottic space adjacent to the anterior commisure. Movement of the vocal cords was well maintained and no huskiness of the voice was noted. Biopsy revealed adenoid cystic carcinoma. A partial resection of the larynx was performed with subsequent radiation therapy of 50 Gy. After one year follow up, no recurrence has been noted.
Adenoid cystic carcinoma of the larynx is rare. Surgical resection is the first choice of therapy because the effectiveness of radiation therapy and chemotherapy are limited. Long-term follow-up is necessary since this tumor may develop slowly, and recurrence or distant metastasis is common.

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Complications of central venous catheter placement such as pneumothorax, hemothorax, and air embolisms are common. We report a case of hydromediastinum with bilateral pleural effusions after operation for laryngeal carcinoma. The patient developed hydrothorax on the second day after the central venous catheter placement due to the perforation of the superior vena cava wall by the catheter tip. This case emphasizes the fact that hydrothorax can occur long after the catheter placement, and we must continue to consider this possibility following all head and neck surgeries.

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Matrix metalloproteinase-1 (MMP-1) is known as a lytic enzyme and degrades type I collagen which constructs of bony tissue. Recently, attention has been focused to the relation between bone destruction and MMP-1.
In this study, we examined the presence of MMP-1 immunohistologically in tissue speciments from 42 cholesteatomas, and studied the relation between MMP-1 and the patient's clinical signs. To examine the effect of age, we divided patients with primary cholesteatoma into two groups; 14 years old or older (24 patients) and younger than 14 (11 patients). As clinical signs, we evaluated the presence of active inflammatory changes such as otorrhea and granulation as well as the degree of bone destruction compared with bone destruction scale.
As a result, there was a significant correlation between the signs of active inflammatory findings and the degree of bone destruction.
Immunohistological expression of MMP-1 was found in 40 (95%) of 42 specimens. MMP-1 was present in 6 (14%) cholesteatoma epithelium, 39 (93%) cholesteatoma debris and 24 (57%) granulation under the epithelium. In patients with active inflammatory clinical signs, the MMP-1 level appeared significantly elevated in the debris and in the granulation tissue of the cholesteatoma. There was also a significant correlation between the MMP-1 level in granulation tissue and bone destruction.
These findings suggest that MMP-1 in inflammatory lesions might accelerate the bone destruction and indicate the necessity to preoperatively treatment inflammation in cholesteatoma patients.

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