It has been widely pointed out that multislice CT (MSCT) is useful in middle ear disease. The evaluation of the pathological state of the middle ear using 3D CT imaging has been reported on up to now. It is well known that 3D CT imaging is susceptible to post-processing artifacts, whereas multiplanar reconstruction (MPR) is less susceptible to these artifacts. The usefulness of 2D CT imaging using MPR in the evaluation of ossicular lesions in middle ear diseases is discussed.
MSCT imaging was performed by Aquilion^® (Toshiba Medical Systems, Tokyo, Japan). The axial spiral scans were obtained. Dosimetric measurements using a head calibration phantom were performed for evaluating the radiation exposure of the lenses. The acquired high-resolution data were transferred to a workstation (ALATO VIEW, Toshiba).
In approximately 90% of ears, MPR image findings of the malleus handle, the incus long process, incudostapedial joint and the superstructure of the stapes were compatible with their operative findings. Ninety-five to 100% of ears without soft tissue shadows around the ossicles showed agreement between the findings of MPR imaging and the operation. The footplate of the stapes in 7 of 48 ears showed a “sclerotic” finding. Five ears had an “erosive” finding. There was no correlation between MPR image findings and the mobility of the stapedial footplate. The results suggest that MPR imaging is valuable for providing information on the ossicles except the stapes footplate.
MPR images showed abnormal findings in 29 of 32 ears (91%) with clinical otosclerosis, which showed demineralization located at the region anterior to the oval window corresponding to the fissula antefenestram, whereas the conventional axial images showed abnormal findings in 22 of 32 ears (69%). The results suggest that MPR imaging can detect small lesions in otosclerosis.

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Patients with Treacher Collins syndrome often exhibit conductive hearing loss due to middle ear malformation. We report a case of this syndrome in a 41-year-old woman with bilateral conductive hearing loss, in whom adjustment of hearing devices was complicated. After assessing HRCT images using Jahrsdoerfer's grading scale, we performed tympanoplasty type III-c on the left side followed by type III-i on the right side. The patient had an excellent outcome; ultimately hearing devices were not required. Preoperatively, patients with congenital anomalies of the middle ear can benefit greatly from prediction of postoperative prognosis; use of Jahrsdoerfer's grading system to assess HRCT images can help to ensure safe and effective surgical care.

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Olfactory neuroblastoma is a relatively rare malignant neoplasm, believed to arise from the epithelium of the upper nasal cavity. Approximately 300 cases of olfactory neuroblastoma have been described in the medical literature since the first case report by Berger and associates in 1924 introduced the tumor entity. To prevent the tumor invading the skull base, a combined transnasal and endocranial approach is essential. In general, the combination of surgery and radiotherapy seems to be the optimum approach to treatment, and its survival at five years is about 65%. We have experienced two cases of olfactory neuroblastoma and report them here with some considerations.
Case 1 was a 60-year-old female. She presented with nasal obstruction and magnetic resonance imaging revealed a mass limited to the nasal cavity. She was treated with partial maxillectomy by lateral rhinotomy and followed by postoperative irradiation. She is still alive with no evidence of local recurrence or metastasis about three years after the initial treatments.
Case 2 was a 35-year-old male. He experienced left upper neck swelling and computed tomography revealed a submandibular tumor. Tumor resection was performed, and histopathological diagnosis was myoepithelioma. After that he presented with nasal bleeding and left upper neck tumor, and magnetic resonance imaging revealed a mass in the nasal cavity that infiltrated intracranially and a swelling lymph node in the left upper neck. Biopsy was performed and those tumors were diagnosed as olfactory neuroblastoma. After reexamination, the submandibular tumor was histopathologically same as above. En bloc resection by craniofacial surgery and the left neck dissection was carried out with subsequent radiotherapy. The patient shows no recurrence or metastasis during a two-year follow-up.
In both cases, we reffered to Hyams' classification to determine treatment planning and found it useful.

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The case was a 68-year-old man. He attended an introductory consultation complaining of left nose bleeding. He was diagnosed with malignant melanoma by biopsy of black style part inside the nasal cavity. A shadow was recognized in the left maxillary by CT and MRI. Development was also recognized in the left nasal cavity. Local injections of interferon-β (3 million IU/day, 3/week) were carried out after chemotherapy (Cisplatin, Vinblastine Sulfate, Dacarbazine) and radiotherapy (5Gy×9, total 45Gy) was administered nineteen times. At present, after two and a half years obvious recurrence has not been recognized.

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Combined therapy for maxillary sinus cancer (operation, chemotherapy and radiation therapy) is a primary modality. Recently, selective-artery intrafusion of CDDP (cisplatin), 5-FU (5-fluorouracil) by using catheter insertion from the superficial temporal artery has become the prevalent chemotherapy. In this case we performed treatment by administering 10mg of Docetaxel (TXT) once a week instead of CDDP, 5-FU, and obtained an effective result.

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Calcium alginates are highly absorbent and gel-forming materials with haemostatic properties. The aim of this study was to compare the qualities of conventional gauze tampon and calcium alginate (KALTOSTAT^®) as nasal packing materials after endonasal operation.
A small amount of KALTOSTAT^® was used in the middle meatus as a nasal packing over a week with a view to promoting hemostasis and wound healing. The results with KALTOSTAT^® packing were compared to a control group of 22 patients with conventional gauze tampon packing and the two types of packing materials were found to be similarly effective in preventing bleeding while the packs were in situ, while KALTOSTAT^® was associated with significantly less bleeding on pack removal than the gauze tampon.
Our findings suggest that the main advantages of packing with a small amount of KALTOSTAT^® included absence of postoperative complications due to pressure, pain and bleeding on pack removal or clots in the nasal cavity.

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We made observations about the treatments and their effectiveness against 30 cases of nasopharyngeal carcinoma with cervical metastasis but without distant metastasis.
(1) We divided the 30 cases above mentioned into two groups, one group with neck dissection treatment and another group without it. No meaningful difference in the 5 year survival rate could be seen between the two groups, the rates 68 percent in the former group and 62 percent in the latter group.
(2) In the 16 cases of the former group, while we pathologically observed that carcinomas still remained in 4 cases, we were able to confirm the effectiveness of radiotherapy against cervical metastasis.
(3) Indications for neck dissection were thorough observation and examination after full dose irradiation for cervical lymph node metastasis.
(4) In all the cases in which patients died, the primary lesion was not controlled, so we can confirm control of primary lesion is critical for a good outcome.

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A 67-year-old man was admitted for vocal cord paralysis and dysphasia. He was suffering from dyspnea attack on aspiration in addition to his chronic obstructive pulmonary disease (COPD). Expansion of the piriform recess by videofluorography suggested vagus nerve palsy. We failed with conservative treatment but succeeded with operative treatment. We performed thyroplasty, adduction of arytenoid cartilage and bilateral dissection of cricopharyngeal muscle in a two-phase operation. The dissection of contralateral cricopharyngeal muscle was especially effective. We suspected the cricopharyngeal muscle of the diseased side had no systole. Tube nutrition was discontinued without dyspnea attack. In the literature, COPD brings potential dysphagia, and so we thought that in this case severe dysphagia occurred after the vocal cord palsy.

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Chronic progressive radiation myelopathy (CPRM) is a delayed injury to the spinal cord after radiotherapy. A 50 year-old male with hypopharyngeal cancer underwent intra-arterial chemotherapy and radiotherapy. Six months later he developed a pain in the left ankle and progressive weakness in his lower extremities. MR image demonstrated high signal intensity on T2 weighted images extending from C2/3 to Th3/4 and atrophy of the cervical cord. Neurological examination revealed weakness in extremities, parestheisa in extremities and abdomen, hyperreaction of deep tendon reflex and dysuria. Corticosteroid and anticoagulation therapy did not improve the neurological symptoms. The incidence of CPRM is rare, however, we should be aware of this possible complication following radiotherapy for head and neck cancer.

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In the present study, we evaluated daytime sleepiness in 32 patients with obstructive sleep apnea syndrome (OSAS) using epworth sleepiness scale (ESS). ESS scores of patients with OSAS were significantly higher than those of patients with simple snoring and healthy subjects. ESS scores of patients with OSAS were significantly correlated with apnea-hypopnea index, the longest apnea time, but not with the lowest oxygenation. It is suggested that ESS score is a predictive index of the severity of OSAS. We then examined whether ESS in combination with body mass index (BMI) can identify patients with OSAS among patients complaining of snoring. When the cut off points were 11 in ESS and 25 in BMI, the combination of ESS and BMI correctly classified 18 of 25 patients with OSAS (sensitivity=72.0%) and 7 of 10 patients without OSAS (specificity=70.0%). We concluded that the combination of ESS and BMI was useful for screening of sleep apnea syndrome.

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We report 39 cases of congenital cervical cysts removed operatively during a 20 year period in our clinic. The average age was 37.9 years old. (males: 33 years old, females: 44.3 years old) There were 22 males and 17 females. Ten cases (25.0%) were less than ten years old. The main symptoms were a cystic mass. Only 2 cases had a fistula. Signs of infection were found in 12 cases (30.8%). Simple excision of thyroglossal duct cysts was carried out in 10 cases without recurrence and 1 of the 29 cases who underwent radical excision (Sistrunk's procedure) recurred. To avoid recurrence, exact knowledge of anatomy as well as the correct preoperative diagnosis and adequate operative procedure are mandatory. Surgical excision of the central portion of the hyoid bone together with the fibrous tract extending to the base of tongue seems to be not warranted in some case, so long as complete eradication of the epithelial tissue can be made.

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A 22-year-old male underwent Bil-tonsillectomy and pharyngoplasty for Sleep Apnea Syndrome. Numbness and pain in the left hand appeared after the operation. A final diagnosis of reflex sympathetic dystrophy (RSD) as a surgical complication was made. There are many kinds of initiating events for RSD. It is recommended that the patient be examined carefully with a good understanding of RSD for early diagnosis.

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