The inferior pharyngeal constrictor muscle (IPCM) plays an important role in respiration, phonation and deglutition. The IPCM is composed of the thyropharyngeus muscle and cricopharyngeus muscle, however, they play different physiological roles. In this paper, a study of the histological properties and differences of IPCM was reported.
Ten pairs of IPCMs and hyopharyngeus muscles were obtained at autopsy from ten male patients without any pharyngeal or neuromuscular disease. Transverse fresh frozen serial sections 10-15μm and 30μm were cut. Histochemical demonstration of the activity of myosin ATPase (preincubated at various pHs), NADH-TR, SDH, MAG, phosphorylase and ACh-E, and PAS technique were carried out to examine muscle fiber type. The mus- cle fiber diameter was measured by immage processor.
According to enzyme reactions, human IPCM fibers were classified into two major types (type 1 and 2a fiber in skeletal muscle). Compared with limb muscle, IPCM was rich in oxidative enzymes and less active in glycogenesis and glycogenolysis. The cricopharyngeus muscle exhibited a higher percentage (77.1%) of type 1 muscle fibers than the hyopharyngeus muscle (25.1%) and the thyropharyngeus muscle (23.5%). Diameters of type 1 fiber were smaller than that of type 2a fiber. The cricopharyngeus muscle showed the smallest type 1 muscle fiber caliber. There was no difference in the size of type 2a muscle fiber among the three musculatures. In the cricopharyngeus muscle, a number of motor endplates were identified, and some muscle fibers possessed more than one motor endplate on serial sections. These were not found in the other two musculatures in our study.
Compared with the hyopharyngeus muscle and the thyropharyngeus muscle, the cricopharyngeus muscle has a higher proportion of type 1 fiber and numerous motor end- plates. Thus, the cricopharyngeus muscle may be suitably adapted to the maintenance of tonic contraction, forming the upper pinch cock.

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Endotoxin, which is known to have various biological functions, has been detected in the effusion from the middle ear of patients with secretory otitis media. We infused endotoxin intraarterially to 26 guinea pigs, and examined the effect of endotoxin on the inner ear using auditory brainstem response (ABR) and oxygen partial pressure of the perilymph as parameters. The latency of each wave of ABR was prolonged. The prolongation of the latency of wave I and the I-II interpeak latency were remarkable. A decrease in the oxygen partial pressure of the perilymph was observed.

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A small percentage of patients with secretory otitis media also have perceptive deafness. Endotoxins existing in the fluid retained in the middle ear are noted as a causative substance of perceptive deafness. Endotoxin was administered to the middle ear cavity and auditory brainstem response (ABR) was determined. At the same time, the effect of the endotoxin on the auditory system was examined. In the group receiving 0.2 ml/kg of endotoxin (1 mg/ml), no significant change in the latency was observed in any of the ABR waves. In the group receiving 0.2 ml/kg of endotoxin (5 mg/ml), no significant change was observed in wave I three days after administration. However, a significant prolongation in the latency was seen in the waves II, M and IV. As for the interpeak latency, a significant prolongation was observed in the I-II interpeak latency. When endotoxin was administered at high concentrations, such as 50 and 100 mg/ml, there were cases in which ABR was not present.

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Tympanic membrane perforation, among otic diseases, is an important condition often encountered in the routine outpatient clinic. There are many reports on experimental pathological study of animals trying to elucidate the healing process of tympanic membrane perforation. However, much remains to be clarified about the healing process and the various influencing factors.
In recent years, studies are reported using growth factors for tympanic membrane perforation. Some growth factors accelerate the healing of tympanic membrane perforation. Studies using growth factors have great potential for elucidating the healing process.

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It is known that 0.1 to 0.2 percent of the newborn population has hearing disorders which can lead to retarded development. The detection of infant hearing disorders, therefore, seems to be quite crucial. Although several screening methods for infant hearing loss have been proposed so far, a definitive test with sufficient reproducibility and reliability is yet to be developed. To establish a reliable method for early detection of infant hearing disorders, currently available literature related to this problem was reviewed.

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Blood flow in the finger tip (FBF), blood pressure (BP) and pulse rate (PR) in the finger artery was measured after sound stimulation in 7 adults with normal hearing. A Laser Doppler flowmeter (ADVANCE ALF-21) and a finger arterial blood pressure monitor (Ohmeda 2300, Finapres) were used. FBF definitely decreased after stimulation with short pure tone of at least 25 dB over the hearing level. Although increasing responses of BP and PR after sound stimulation were observed, these responses were not clear. In two cases, since the backgrounds of FBF were unstable, an averaging technique was required for useful recording. Results obtained suggested that the recording of FBF could be useful for objective audiometry.

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Hearing loss in patients with otitis media with effusion is generally conductive and cases of sensorineural hearing loss is said to be relatively rare. Details of sensorineural hearing loss remain unclear. In this study, the incidence of sensorineural hearing loss in patients with otitis media with effusion was investigated and the cause of the disease was studied. Subjects were 421 patients with otitis media with effusion who visited the outpatient clinic, Department of Otorhinolaryngology, Komatsushima Red Cross Hospital between April 1 and November 21,1987.
Patients with otitis media with e ffusion accompanied by sensorineural hearing loss were classified into two groups: one group in which hearing by bone conduction was slightly reduced (the moderate hearing group) and the other group in which hearing by bone conduction was markedly reduced (the low hearing group). The moderate hearing group included 21 patients (5.0%). However, the low hearing group included 16 patients (3.8%), and in 7of these (1.7%) hearing loss was considered closely related to otitis media with effusion.
All patients in the moderate hearing group were cured by treatments suc h as myringotomy. Improvement of symptoms was also observed to some extent by patients in the low hearing group. Early treatment was considered important when otitis media with effusion accompanied by sensorineural hearing loss is found.

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Foreign bodies in the external auditory canal are relatively common problems. Several methods for removing them have been described and utilized. A new technique for removing metallic foreign bodies from the ear using a small powerful magnet was introduced. A small powerful magnet (Hicolex-22A) was securely held by a forceps and successfully attached to the object. Consequently, the foreign body was easily extracted. This technique seems to be most useful for removing metallic foreign bodies from the external auditory canal.

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Acoustic neurinoma can be easily diagnosed by the following symptoms such as progressive unilateral hearing loss, tinnitus, and a feeling of dizziness. It also can be diagnosed by abnormal results of tests such as pure-tone audiometry, auditory brain stem response (ABR), and caloric nystagmus. Recently, with the development of imaging diagnostics, cases of acoustic nerve tumor without these typical symptoms or findings have been reported.
This paper reports the following six cases of acoustic neurinoma with atypical symptomology experienced in Tokushima Municipal Hospital: 1) two patients first developed sudden hearing loss,2) one patient had an abnormal tongue sense as the chief complaint,3)two patients had normal hearing, and 4) one patient showed a normal ABR.
The nerves of the internal acoustic meatus are the pars superior vesti bularis, pars inferior vestibularis, pars cochlearis, and nervus facialis. Examination methods for all of these nerves except the pars inferior vestibularis have been developed. Acoustic neurinoma often originates in the pars inferior vestibularis. The establishment of an examination method for tumors of this nerve is desirable.

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The observation of spontaneous nystagmus is important in diagnosing vertigo. However, in some cases, nystagmus disappears before the first examination. In order to predict nystagmus during an attack of vertigo, a vertigo reproduction video system was devised and used to diagnose vertigo.
Regarding horizontal-rotatory nystagmus and rotatory nystagmus, the nystagmus conditions estimated by the vertigo reproduction video system were in accordance with actual nystagmus.
A screen possibly corresponding to horizontal-rotatory nystagmus was selected in Meniere's disease cases and that corresponding to true rotatory nystagmus was selected in benign paroxysmal positional vertigo.
Patients suffering from vert ebral-basilar circulation insufficiensy showed various types of vertigo.
This video system is very useful in making differential diagnosis between Meniere's disease and benign paroxysmal positional vertigo and in judging abnormal sides.

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Among patients with vertigo, abnormalities are not always found with neurootological tests, CT and MRI. Magnetic Resonance Angiography (MRAngiography) on the vertebrobasilar artery system was performed on 10 cases, and the results were compared with those of 4 healthy volunteers. Good imaging of the blood vessels was seen in the volunteers, however, the 5 vertigo patients showed very poor imaging of the vertebral artery. Therefore, the difference between two groups might have been caused by the presence of vertigo.
Further studies are required for the negation of organic disease.

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Between April and June in 1990, health examinations were given to 3061 elementary and high school students in Ishii Town, Tokushima Prefecture, Japan. The examination investigated the incidence of allergic rhinitis. As a result, allergic rhinitis was recognized in 24.8% of examinees through visual inspection. The cases were more frequent among boys, and there were already many cases among elementary school students. As an allergen, or chard grass was most frequent and mite, house dust, Japanese cedar, short ragweed followed in order. By questionnaires and visual inspection, an incidence of approximately 50%was determined. Many students with allergic rhinitis give up receiving treatment. Educating students about allergic rhinitis how they should protect against it would be a probrem.

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Since 1984, the amount of Japanese cedar pollen has been measured with Durham's pollen trap at Kochi Nokyo General Hospital.
In this study, the relation between pollen counts and meteorologicalfactors in the Kochi area during past 9 years was investigated. A correlation was found between the total count of Japanese cedar pollen in the Spring and the number of sunshine hours in July of the previous year. A correlation was observed between the day pollen scattering began and the mean temperature in January. Regarding wind direction, the amount of Japanese cedar pollen per day was higher when a north wind blew in Kochi.
These data suggested that the amount of Japanese c e dar pollen could be dependent on some meteorological factors. A further investigation would be worthwhile.

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This paper discusses some problems in using speech and acoustic analysis in the field of otolaryngology. First, general analysis conditions are discussed. Next, some analysis methods, their assumptions and models are explained. Last, several important points in utilization are discussed. Recently, many special devices and computer softwares for acoustic analysis have become available in the field of otolaryngology. Many studies using such acoustic analysis methods for evaluating speech and voice disorders have been reported. Since acoustic analysis methods are based on some assumptions and models of normal voice and speech, it is not easy to apply these methods to pathological voice and speech. Wrong methods, or insufficient conditions are sometimes used because of poor knowledge of acoustic analysis. Even if proper methods and sufficient conditions are used, results are sometimes wrongly comprehended because of poor knowledge of speech and language. It is very important to learn the sufficient knowledge of acoustic analysis, speech and language to select the analysis methods and comprehend the results properly.

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Voice tremor has been associated with neurological disorders such as essential tremor, Parkinson's disease, cerebellar ataxia. Voice tremor most commonly accompanies essen- tial tremor which is a common neurologic disorder that is often an autosomal dominant trait. It may appear in childhood or later life and runs a slowly progressive course.
Voice tremor is characterized by rhythmic alternations in pitch and loudness of vowel sounds, and is usually accompanied by tremor in other parts of the body. The frequency ranges from 4 to 8 Hz. Physiological lesions or mechanisms of voice tremor have not been throughly studied. Essential voice tremor can resemble spasmodic dysphonia, therefore differentiation between essential voice tremor and spasmodic dysphonia must be made. Laryngoscopy and laryngeal electromyography are useful for diagnosis.
Currently available therapies for voice tremor are not satisfactory, however propranolol is most commonly used.

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Evaluation of pathologic voices can monitor changes in the clinical course, and make early detection of laryngeal pathologies possible.
In this paper, the evaluation of pathologic voices was reviewed and discussed.
Initially, pathologic voices are analyzed using an oscillograph and sound spectrograph. With computer processing, acoustic characteristics can be measured and used to evaluate pathologic voices. Perturbation indices of fundamental frequency and peak amplitude are useful in evaluating pathologic voices. Spectrum ratios, and noise energies are also useful. Recently, as one of the latest techniques, cepstral analysis was applied for the same purposes.

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The singing voice is controlled by quite complex physiological mechanisms. Our knowledge in this area is still limited, and much remains to be studied. A fiberscopic view of the larynx and the hypopharyngeal area during singing was recorded on a video system, simultaneously with the acoustic signal. The behavior of the hypopharynx was analyzed in detail by computer, and was related to the acoustic characteristics. It was demonstrated that certain singing skills such as vibrato and trill are closely related to the motion of the hypopharyngeal wall.

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The TNM classification and histopathological diagnosis are important in making a prognosis for laryngeal carcinoma. However, there has been some difference in prognosis among cases in the same stage of the same histological diagnosis. Immunostaining of an antibody against the antigen present in the proliferating cycle of the tumor is a recently developed method for evaluating the tumor's proliferation acrivity. Evaluating the proliferation acrivity may be useful in deciding therapeutic policy, as well as in assuming prognosis, because it provides information which cannot be obtained by H and E staining. Of the proliferating cell antigens, proliferating cell nucler antigen (PCNA) is expected to be used clinically, because its antigenicity is said to be stable even after formalin fixation and paraffin embedding of the specimens. In this study, histopathological findings as a prognostic indicator for laryngeal carcinoma, and PCNA as an indicator of proliferation activity, are discussed with reference to literature.

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The inner laryngeal muscles possess subtle cooperative movements to fulfill various laryngeal functions. Many assessments have been made to clarify these physiological functions, however various views not yet unified.
Laryngeal function in humans remains generally unclear despite results obtained from repeated animal experiments. However, with humans has not been easy. clarifying the physiological functions by experiments. Among current methods of study, the elec- tromyograph is considered to obtain the most potent measurements for elucidating the physiological mechanism of the inner laryngeal muscle in humans. Therefore, we assessed the problems remaining to be solved by summarizing existing findings in relation to the inner laryngeal muscle activity during respiration in humans as demonstrated by electromyographical studies reported thus far.

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The literature related to hemodynamics in sleep apnea syndromes was reviewed.
Hemodynamic abnormalities in sleep apnea syndromes include systemic and pulmonary hypertension during wakefulness and sleep and cyclic elevation in arterial pressure with each apneic episode and cardiac arrhythmia. These are thought to play important roles in nocternal sudden death.
Although many aspects of these abnormalities have been studied, cardiovascular, respiratory, endocrine and autonomic nervous system, the mechanism whereby sleep apnea causes abnormalities remains obscure.
There are relatively high incidences of unrecognized sleep apnea in patients with primary hypertension and of untreated sleep apnea causing hypertension.
In summary, further detailed investigation of hemodynamics in sleep apnea is needed, and sleep histories should be clinically required to detect patients requiring therapy for apnea.

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Polysomnographic recordings during spontaneous nocturnal sleep were made in 16 pa- tients (age range,3 to 60 years) suffering from sleep apnea and snoring. Continuous recor- dings of fingertip blood flow, mesopharyngeal pressure amplitude, arterial oxygen saturation, air flow and thoracic movement were made simultaneously.
Sleep apnea syndrome (SAS) was diagnosed in cases scoring more than 5 on the apnea index based on the proposal of Guilleminault et al. Seven of 16 cases were diagnosed as SAS. Four cases in this group showed an obstructive type of SAS, and 3 cases exhibited a mixed type.
Fifteen of 16 patients showed an irregular transient decrease in fingertip blood flow during the non-apneic period and a regular decrease about 3 seconds after ventilatory resumption during the apneic period. The remaining patient showed an unstable blood flow continuously. How a transient decrease in fingertip blood flow relates to ventilation during sleep is unclear. This transient decrease was referred to as a‘dip phenomenon of blood flow (DBF)’. The frequency of DBF in an hour was defined as the DBF index, and a statistical analysis of DBF index was performed.
The DBF index in the SAS group was found to be higher than that in the non-SAS group. The difference was considered statistically significant. SAS patients had more frequent episodes of DBF compared to non-SAS subjects. It was suggested that a higher tension of the sympathetic nervous system occurs in the SAS patients.
Significant increase in the DBF index was detected with decreasing SaO₂ (p<0.05), while no relation was found between the DBF index and mesopharyngeal pressure amplitude. The results demonstrated that peripheral blood flow is affected by pulmonary dysfunction in patients with upper airway obstruction.

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Adenotonsillectomy is frequently performed on children with upper airway obstruction, since the most common cause is adenotonsillar hypertrophy. Removal of a minimal amount of tonsil tissue may be immunologically better, however, removal of a wider area may be necessary to enlarge the airway sufficiently. Based on the foregoing, removal of the palatine tonsil on only one side and adenotomy (hemitonsillectomy and adenotomy: HTA)was performed in 6 cases of upper airway obstruction in patients under 5 years old. Five of these cases underwent nocternal polygraphic recordings before and one week after HTA. Airflow, thoracic movement, mesopharyngeal pressure and oxygen saturation were simultaneously monitored and the following results were obtained: the maximum amplitude of mesopharyngeal pressure remarkably decreased, and the minimum oxygen saturation increased to a normal range postoperatively.
Although all cases had good long te r m courses, two, both 5 years old, complained of snoring and sleep apnea again 30 or 37 months after HTA. On physical examination, the remaining palatine tonsils had hypertrophied while pharyngeal lymph follicles had not hypertrophied. Funnel chest, which had been observed in one of the 2 cases before HTA, had already completely disappeared. On polysomnographic examination, recurrence of upper airway obstruction was demonstrated. The remaining palatine tonsils were removed and thereafter the 2 cases improved both clinically and on the polygraphic test.
The remaining 4 cases were investigated by questionnaires, which sho w ed that they had no recurrence 5 to 39 months postoperatively. Pigeon chest, which had been observed in one of the 4 cases before HTA, had slightly improved.
These results suggest that HTA is valuable for preservation of immunological function, improvement of chest deformity and reduction of compensatory hypertrophy of Waldeyer's ring. Considering these advantages, HTA is considered a useful treatment for children under 5 years old with upper airway obstruction, although additional surgical treatment may be required in some cases due to recurrence of upper airway obstruction.

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During the seven years between July 1983 and June 1990,243 children underwent adeno-tonsillectomy. Questionnaires about symptoms of upper airway obstruction were sent to the families of these patients to investigate long term effects of adeno-tonsillectomy.
Adeno-tonsillectomy was an effective long time treatment for upper airway obstruction. The following symptom were important in diagnosing the severity of upper airway obstruction; sleep apnea, snoring, restless sleep, nocturnal enuresis, night sweating, chest deformity, oral breathing, somnolence and susceptibility to colds.

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Forty four patients with maxillary sinus carcinoma who were treated with combined therapy consisting necrotomy, radiation, and local chemotherapy at Tokushima University Hospital during the 9 years between January 1982 and December 1990 were reviewed.
There were 33 males and 11 females. The majority of the patients were o v er 60 years old, and the mean age was 65.8 years old.
According to the 1987 UICC TN M classification system,4 patients (9.1%) were in Stage II,17 (38.6%) were in Stage III, and 23 (52.3%) were in Stage IV.
The five-year survival rate was 43.1 % for patients with maxillar y sinus carcinoma (Stage II,75.0%; Stage III,54.7%; Stage IV,30.4%).
Local residue or recurrence of tumor mass was found in 15 cases. Nearly half were in the ethmoid sinus or the frontal wall of the maxillary sinus.

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We reviewed 94 patients with laryngeal cancer who were treated at Tokushima University Hospital during the 7 years between January 1982 and December 1988. The male/female ratio was-8: 1. The 94 patients included 51 (54.2%) with glottic cancer,37 (39.4%) with supraglottic cancer, and 6 (6.4%) with subglottic cancer.
According to the 1978 UICC TNM classification system,22 patients (23.4%) were in stage I,22 (23.4%) were in stage II,26 (27.7%) were in stage III, and 24 (25.5%) were in stage IV.
The five-year survival rate was 66.4% for patients with laryngeal cancer (stage I,87.2%; stage II,63.3%; stage III,63.5%; and stage IV,50.0%),77.3% for patients with glottic cancer (stage I,87.5%; stage II,100.0%; stage III,76.9%; and stage IV,14.8%), and 54.7% for patients with supraglottic cancer (stage I,83.3%; stage II,40.0%; stage III,30.0%; and stage IV,60.4%). For patients with subglottic cancer, it was 66.7%.
We had 2 cases of supraglottic cancer which were classified as T₁ lesions according to the 1987 UICC system, althrough they were T₄ lesions according to the 1978 UICC system.

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Malignant tumors of the head and neck most commonly occur in the elderly. Nevertheless, this disease can occur in persons under 40 years. In this study,16 patients under 40 years of age who had malignant tumors were studied and their age, originating site, in itial symptoms, tissue type and prognosis of the disease were examined. Patient age ranged from 5 to 37 years and there were 8 males and 8 females. The originating site was the nose and paranasal sinus in 5 patients and the pharynx in 7 (epipharynx in 4 and palatine tonsil in 3); these formed 75% of the total. Initial symptoms which did not fit the originating site were particularly found in cases involving the epipharynx. Regarding tissue type, nonepithelial tumor was observed in 12 patients,75% of the total. Lymphoma was found in 6patients, constituting 50% of the non-epithelial tumors.

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A statistical study was made of the incidence, gender, age distribution, site of development, histological type, interval of occurrence, risk factors and prognosis in 25 patients with multiple malignant tumors of the head and neck who were admitted to this department for treatment between January,1982 and December,1991. Literature on the pathogenesis of multiple cancer and suggested therapeutic measures was reviewed. The incidence of multiple tumors was about 6.2% and that of triple malignant tumors was about 0.7%. By gender, males accounted for the majority with 23 males and 2 females. By age distribution, the proportion of those aged 60 to 70 years was high, the average age being 67.7 years. By site of development, the number of laryngeal cancer plus lung cancer or laryngeal cancer plus esophageal cancer was large with 3 cases of the former and 2 cases of the latter. By site of multiplicity, the head and neck region was reported most frequently with 8 cases. By histological type, the combination of adenocarcinoma and squamous cell carcinoma was the most common with 8 cases. By interval of occurrence, synchronous occurrence (not more than 1 year) was found in 10 patients and metachronous occurrence (not less than 1 year) in 15 patients. By environmental factors, the influence of smoking and drinking was suggested. Smoking history and drinking history over a long period of time were noted in 2 out of 3 cases of triple malignant tumors. By prognosis, the prognosis of metachronous cases was poor compared with synchronous cases, with 9 deaths (60%) in the metachronous occurrence. As pathogenic factors for multiple cancer,1) accidental nature,2) internal factor,3) external factor and 4) field carcinogenesis were mentioned and discussed.
It is necessary to draw up an appropriate examination plan and therapeutic policy for each case using statistical results as a guide line.

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A statistical analysis was performed on 219 patients with peripheral facial palsy treated in the Department of Otolaryngology of Tokushima University Hospital between July 1989and June 1992. The incidence of Bell's palsy was 71.7% and that of Hunt's syndrome was 13.2%. Neither Bell's palsy nor Hunt's syndrome showed no significant difference in distribution between the sexes, laterality, seasonal alteration, and age at onset.
Both Bell's palsy and Hunt's syndrome were classified into three group s by the severity of paralysis, and the dosage of steroid was increased accordingly. In our high-dose steroid therapy, methylprednisolone, prostaglandin El and mecobalamin were used in combination.
The cure rate of this therapy for severe cases of Bell's palsy was 94%. There were few side effects, and the method of administration was simple, so the therapy was considered very effective for Bell's palsy.
However, in the tre a tment of Hunt's syndrome, the cure rate did not increase beyond 75% even when this therapy was combined with aciclovir.

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An investigation of microcirculation in the ear, nose and throat was performed.
Hemoglobin concentration which indicates blood volume in tissue was m easured with a spectrophotometric analyzer. Blood flow was measured with a laser Doppler flowmeter and a laser speckle flowmeter.
Normal ran g es of hemoglobin concentration and/or blood flow in the ear drum, the inferior turbinate, epipharynx, mesopharynx, soft palate, vocal fold, ventricular fold and the arytenoid region were studied. It was useful for differential diagnosis of pathologic conditions to compare these with normal ranges.
The continuous measurement of hemoglobin concentration and/or blood flow in the nasal mucosa and the finger tip in humans was performed. Continuous measurement of hemoglobin concentration and blood flow in the middle ear and the laryngeal mucosa of guinea pigs was performed. The effects of drugs on the autonomic nervous system and the microcirculation were subjectively analyzed.

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Injury to the parotid duct caused by a broken piece of windshield in a traffic accident has been relatively rare. Therefore, in some cases traumatonesis was performed in the course of emergency therapy without confirming the existence of a duct lesion.
This paper reported an example in which a cyst appeared in the salivary gland after treatment for a facial injury caused by a broken piece of a windshield. The patient, a 19year-old male, visited our department with complaints of swelling and tenderness on the cheek fourteen days after the initial treatment. Since palsy of the rami buccales of the facial nerves and a cyst at the outer side of the masseter were found, ligation of the main parotid duct and Leriche's surgery were performed.
Determination should be ma d e whether the parotid duct has been damaged before treating facial injury in certain cases.

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A 42-year-old male who complained of snoring and sleep apnea was studied with the simultaneous measurement of both cardiovascular parameters and mesopharyngeal pressures at the upper and lower sites at the base of the tongue. The data demonstrated that the upper airway was severely obstructed at the base of the tongue and cardiovascular disturbances were also associated. Nasal continuous positive airway pressure (Nasal CPAP) therapy was performed and the symptoms disappeared.
Nasal CPAP sufficient to releave sleep apnea an d fluctuation of blood pressure, prevent reduction of oxygen saturation, and remove upper airway obstruction and change of fingertip blood flow was respectively differentiated and the lowest positive pressure needed to avoid upper airway obstruction and cardiovascular disturbances was determined.
The measurement system is thought to be clinically useful and relia b le for evaluation of cardiovascular abnormalities with upper airway obstruction and determination of optimal value of nasal CPAP.

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Gas gangrene is very rare in the head and neck area. We report a case of gas gangrene of the oral cavity and neck. A 51-year-old man consulted our hospital with complaints of dyspnea and dysphagia on November 23,1988. His oral floor and bilateral neck were swollen. As his dyspnea was very severe, emergency tracheostomy was performed and in travenous antibiotics were administered. Hyperglycemia was also recognized, and treatment for diabetic disorder was further initiated. Seven days later, surgical debridement was performed because the neck swelling grew gradually and the computed tomography of the neck showed‘gas’in the soft tissue. Bacteriological examination did not reveal any bacteria. He recovered after the debridement and administration of antibiotics, and was discharged on February 18,1989.
Debridement with removal of necrotic tissue is thought to be important treatment of gas gangrene.

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Embolization was performed in two cases of angioma in the nasal cavity prior to surgery in order to minimize the amount of bleeding.
In case 1, the injected embolizing subs t ance (Ivalon) was insufficient, because the amount of bleeding during surgery was as much as 500 ml. Higher dosage of injected substance, however, sometimes leads to less bleeding and higher risk of complication. Since the optimum amount of injected substance has not been discussed further investigation of the standard injectable level should be carried out.
In case 2, the amount of bleeding was ver y little. Thus, embolization is useful as a method of peroperative blood loss prophylaxis in some cases.

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Two cases of tumor in the parapharyngeal space were reported. On CT scan, MRI, CAG and Ga scintigraphy, both tumors extended almost to the skull base and removed by external cervical incision. Histopathological examination revealed schwannoma in both cases. In one case, the tumor was considered to have originated from the vagal nerve because the vagal nerve was found in the tumor and dysfunction of the ipsilateral vocal fold was observed postoperatively. In the other case, the origin was not clear.
Previous literature on tumors in the parapharyngeal space was reviewed. It was possible to estimate the extent and the internal status of the tumor and to evaluate the relationship between the tumor and the surrounding tissue by CT and MRI. It is, however, difficult to remove the tumor by the oral method in cases with a huge tumor, since the structure of the parapharyngeal space is anatomically complex. Therefore, tumors in the parapharyngeal space are thought to have clinical importance, although they are relatively rare.

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A 42-year-old man developed a mass in the anterior neck which had increased in size in the past two months. A well circumscribed and firm mass was palpated at the midline of the neck below the hyoid bone. The clinical diagnosis was thyroglossal duct cyst. The mass was removed by Sistrunk's procedure. Histological examination showed a thyroglossal duct cyst with local involvement of malignant cells, suggesting papillary adenocarcinoma arising from the thyroglossal duct remnant. The patient's postoperative course was unremarkable for 19 months. Since thyroglossal duct carcinoma was rare, the clinical and pathological features were reviewed, and the method of diagnosis was discussed.

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Non-recurrent laryngeal nerve is very rare. The reported incidence of non-recurrent laryngeal nerve is 0.3 to 1.0 percent. We encountered a case of right non-recurrent laryngeal nerve in a patient with parathyroid adenoma. The surgeon must always be aware of the possibility of non-recurrent laryngeal nerve in surgery of the thyroid and the parathyroid.

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Bell's palsy as idiopathic is in about 60% of patients with peripheral facial nerve palsy. Therefore, peripheral facial palsy is often diagnosed as Bell's palsy. However, the peripheral facial palsy can be caused by severe diseases such as carcinoma, and is important to deal with carefully.
This pap e r reports the case of a 75-year-old male with facial nerve palsy. He also suffered from tinnitus, difficulty in swallowing, and left occipitalgia. Clinical examinations revealed that the facial palsy originated from temporal bone metastasis of hepato-cellular carcinoma. As therapy, the metastatic lesion was irradiated. The headache was relieved and the swallowing disturbance was also fairly improved. Even in primary hepatoma, palliative radiation therapy to the metastatic focus might be useful in view of the patient's quality of Life.
Temporal bone metastases are seldom reported, and metastasis of hepatocellular carcinoma is very rare even in the literature. In this case, not only biopsy results, but also both imagings and tumor marker played an important role.

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