We have treated five patients with fibrous dysplasia in the paranasal sinuses for ten years. There were one male and four females of 11-64 years old. In all patients, operation was performed and diagnosis of monostotic fibrous dysplasia was made from surgical specimens. Blood testing showed no abnormal data. CT of the paranasal sinuses revealed a diffuse high density mass in four cases and a cystic mixed density mass in one.
RI scintigraphy was performed in four cases and showed abnormal ^99mTC-DTPA accumulation in all patients and no ⁶⁷Ga accumulation in one patient. So, CT and ^99mTC scintigraphy were useful for regional diagnosis. In the surgical therapy we chose the total resection in one patient and partial resection in four patients. As to post-operative courses, cosmetic and functional problems were not encountered, but tumor enlargement was found in two cases which was performed partial resection. Patients, age, region and size of the tumor should be considered when we choose a surgical method. Careful postoperative observations is mandatory for a long time.

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Fracture dislocations of the middle third of the face usually involve a coplex combination of the three types of fractures initially described by LeFort and simple malar bone fractures classified by Knight and North.
During 1989, 18 patients with midfacial fractures were treated with titanium rigid internal fixation devices (plates and screws). Access to the LeFort I and II components was through extended gingivobuccal incisions, and fixation was with titanium multihole compressin plates and screws 3 to 9mm in length. These screws were placed in a monncortical fashion. The attempt was made to bridge the LeFort II and/or I components on each side with a single straight plate attached exactly over the zygomaticomaxillary buttress to reform the walls of maxilla. The separated nasomaxillar suture lines were reduced and stabilized, usually with a micro-compression plate in a monocortical fashion. Rigid internal fixation with titanium mini-and micro-compression plates should be considered as an alternative treatment for most fractures of the middle third of the face.

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The olfactaty disturbance caused by Tegafur was studied by clinical and experimental approach.
I. The clinical study
There were 5 paticnts with olfactoty disturbance caused by Tegafur during the past 5 years in our hospital. The clinical characteristics were as follows.
1) The degree of olfactory disturbance is severe.
2) The endoscopic finding of olfactory mucosa was almost normal.
3) The average of administration period was about 1-2 years.
4) The prognosis is poor.
II. The experimental approach
1. Short term administration in 3 weeks. The influence of Tegafur to the dividing cells in the guinea pig's olfactory mucosa was studied immunohistochemically using anti-Bromodeoxyridine (BrdU) antibodiss. The results were as follows.
1) The number of cells taking up BrdU decreased with increasing doses of Tegafur.
2) There were no marked morphological changes such as atrophy of the olfactory epithelium or a decrease in the number of olfactory cells.
2. Long term administration in 1.5 years. The histological changes of the guinea pig's olfactory mucosa were studied immunohistochemically using antisera to BrdU and to proliferating cell nuclear antigen (PCNA).
The results were as follows.
1) Cells taking up BrdU and containing PCNA disappeared in the olfactory epithelium
2) The morphological changes, such as atrophy of the olfactory epithelium, a decrease in the number of mature olfactory cells, and degeneration of olfactory vesicles or cilias were seen. It is suspected that long-term administration caused continuing inhibition of the cell division in the olfactory epithelium, following the morphological changes mentioned above. Olfactory disturbances in human may be caused by the same mechanism.

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This paper deals with our attempt to achieve full understanding of the three dimensional structure of the operative field when performing surgery of the nose and the paranasal sinuses.
Aided by computer graphics, the nasal cavity and paranasal sinuses were reconstructed from CT images. CT images of bony structures and surgical landmarks (the optic nerve and the intraocular muscles) were traced and fed into a personal computer. CT images were rotated in each of the three perpendicular axes (x, y, z axes). Two appropriate points of reference were chosen on the display and the distance between them was measured. The subjects consisted of 12 adults (5 males, 7 females, 12 side) suspected to have paranasal sinusitis in whom normal or only mild membrane thickening was demonstrated by CT.
Our attempt revealed the following: An opening in the ethmoid sinuses via the maxillary sinus can be made 36±5mm anteriorly to posteriorly (mean±standard deviation). The counter opening in the inferior meatus can be made as large as 26±3mm in width and 19±5mm in height. The length of opening of the ethmoid sinuses via the middle meatus was 38±3mm. The depth of the ostium maxillare from the antero-superior edge of the inferior turbinate was 15±3mm. When the sphenoid sinus is opened via the maxillary sinus, the shortest distance between the central point of the optic nerve and the lateral wall of the sphenoid sinus was 12-14mm (3 cases), while the distance in 12 cases was 21±3mm when the sphenoid sinus was opened via the nasal cavity.
In conclusion, reconstructing three-dimensional images from CT scans helps surgeons understand the spatial relationship of the maxillary paranasal sinuses.

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Sinusitis has been reported to be the most major causative disease of olfactory disorder. According to our data during last 3 years, 47.5% of all the cases with olfactory disorder was attributed to sinusitis. We estimated the olfaction of the cases with sinusitis and rhinitis by 4 olfactory function tests such as T & T olfactometry, intravenous olfaction test using propylthiamine (Alinamin test), Smell Identification Test (SIT) and the detection threshold test using Phenyl Ethyl Alcohol (PEA). The results of SIT and PEA tended to be parallel not to one of the Alinamin test but to one of T & T olfactometry and showed that the olfactory disorder with sinusitis tended to be worse than with common cold and nasal allergy. In these olfactory disorders, it was shown that the olfactory epithelial damage was an important factor as well as the respiratory problem by the nasal mucosal swelling etiologically. The correlational study between the patency of olfactory cleft estimated by radiograph and the detection threshold test using PEA showed better opened olfactory cleft didinot always mean beffer olfaction in the cases of severe disorder. Histopathological findings of olfactory epithelium obtained from biopsy also revealed the inflammatory change to several degrees in each case, respectively, at the site of olfactory epithelium involved in sinusitis. Furthermore, experimental sinusitis in rabbits implied the delayed recovery from inflammatory damage in the olfactory epithelium in comparison with the one in the respiratory epithelium.

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Fourty-nine patients with blowout fracture of orbital floor or medial orbital wall treated at our Department from October, 1981 to April, 1993 were studied statistically in order to investigate the relation between the time or methods of operation and postoperative results. Orbital floor fractures were frequently occurred in teens of age. The grade of double vision was severer in cases of pure type blowout fracture than impure type fracture. In 32 cases of orbital floor fracture, either eyelid approach, transantral approach, or the two combined approach was used, and the defects of orbital floor were reconstructed with autogenous bone grafts from the anterior wall of maxillary sinus, orbital floor, or iliac bone in 18 cases. Eyelid approach was superior to transantral approach in the postoperative results on double vision. The prognosis of patients reconstructed with anterior wall of maxillary sinus was worst in cases of orbital floor reconstruction. Postoperative improvement of double vision was better in patients having surgery within two weeks after the injury than in those having surgery more than two weeks later.

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This report describes 12 cases with Le Fort type multiple facial fractures in the period between January 1977 and December 1992. Surgical treatment including reduction and fixation was performed in 10 cases with postoperative patients'satisfaction. The purposes of the treatment were to adjust dental occlusion and to restore facial skeleton, while minimizing any morbidity associated with the surgical repair. Pre-formed models of the upper and lower gums were helpful in the adjustment of dental occlusion. Correct anatomic structure was obtained by reducing the maxilla zygoma complex in relation to the cranial base above and the mandible below. In addition, reduction of the zygomatic arch contributed to the forward projection of the retracted maxilla zygoma complex. Reduced bones were fixed as rigidly as possible with the aid of wires and titanium miniplates. Intermaxillary fixation played a supplementary role. Three of seven Le Fort type III fracture cases showed cerebrospinal fluid leak from the injured anterior cranial base. The leak spontaneously stopped within a few days in two cases while one, left untreated elsewhere for three months, underwent surgical repair via the transethmoidal route. It should be kept in mind that multiple fractures of the facial skeleton often accompany injuries of other part of the body such as intracranial hemorrhage, fracture of the vertebra and so on.

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The changes of secretory glands of the inferior turbinates in nasal allergy and chronic sinusitis were investigated by using the lectin histochemistry technique. Hypertrophies of the nasal glands in both nasal allergy and chronic sinusitis were observed. Mucous glands in the nasal allergy mucosa were strongly stained with WGA, SNA, and UEA-I. Serous glands in the nasal allergy mucosa were specifically stained with Con A. In the chronic sinusitis mucosa, differentiations between mucous cells and serous cells in the nasal glands were not clear, and branching structures of the nasal glands were also observed. Glandular cells in the chronic sinusitis mucosa were strongly stained with only UEA-I. These results suggest that there are hypersecretions of normal mucin in the nasal allergy mucosa and abnormal mucin in chronic sinusitis. These abnormal mucin cause the tethering phenomenon of the muco-transport system in the chronic sinusitis mucosa. In the experimental study, it was revealed that histamin had no effect on the changes of structures and secretory components of the nasal secretory cells.

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Expression of cytokines and cell adhesion molecules was evaluated in chronic sinusitis and nasal allergy, which are the most popular nasal inflammatory diseases. Also, the effect of viral airway infection on these expressions was investigated.
The results are summarized as follows.
1. Employing specific reverse transcriptase polymerase chain reaction assays, mRNAs of various kinds of cytokines and cell adhesion molecules were detected in maxillary sinus mucosa of the patients with chronic sinusitis. The expression of IL-1α, β was more frequently in acute phase of the disease. The mucosal T cells were thought to play an important role on the expression of these cytokines and on the pathogenesis of the disease. The extracellular matrix may participate in the persistent activation of these T cells.
2. An enhanced expression of the mRNA for various cytokines was observed in nasal mucosal samples of nasal allergic subjects after the administration of allergic antigen or substance P, although the expression of IL-2 and IL-4 was low. These cytokine production may induce the cellular infiltration and the late phase reaction through the activation of cell adhesion molecules. Also, substance P may regulate allergic reaction via enhanced production of certain regulatory cytokines.
3. Respiratory syncytial virus (RSV) enhanced Th-2 like cytokines production but not Th-1 like cytokines production in mitogen stimulated human tonsillar cells. In nasal epithelial cells, RSV induced the expression of intercellular adhesion molecule-1 by itself but not through production of cytokines. The enhanced synthesis of Th-2 like cytokines and cell adhesion molecules in airway infected with RSV may contribute to the unique inflammatory processes.

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Nasal mucosae were obtained from inferior turbinate of normal adults (N), adults patients with chronic sinusitis (CS) and adults paients with allergic rhinitis (AR). Maxillary mucosae were also obtained from N and CS patients during sinus surgery. Our quantitative histochemical study shows that no significant difference was observed in the number of goblet cells between groups N, CS and AR in nasal mucosa, and between groups N and CS in maxillary mucosa. The number of submucosal gland cells (SGC) of nasal mucosa in CS and AR was significantly increased compared with that in N. The similar significant increase was found in the SGC of maxillary mucosa of CS. Moreover, the area occupied by SGC in submucosa was significantly increased in both nasal mucosa and in maxillary mucosa of the patients.
Our results suggest that both hyperplasia and hypertrophy of submucosal glands could be a major factor of hypersecretion in CS and AR. A cause of hyperplasia and hypertrophy of the glands was discussed in relation to inflammatory cells.

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In the most nasal bone fracture cases, local swelling, edema and pain caused by injury make clinical examination to be very difficult. Thus radiological evaluation becomes important. Nasal bone fracture has been diagnosed by Waters' view and/or soft roentgenogram which could detect fracture but not its detail. We tried to evaluate the fracture more objectively, introducing three dimensional computed tomography (3D-CT).
We concluded the results as,
1. Data from axial CT by SOMATOM DRH was recontructed to the 3D-CT in eight patients with fresh nasal bone fracture.
2. 3D-CT display demonstrated dislocation of nasal bone clearly and objectively.
3. Patients and their families could easily understand nasal bone status with 3D-CT display.
4. Doctors could simulate the operation procedure.
5. Radiation exposure dose problem to the lens was minimised with our slice protocol.
6. Clinical problem to occupy CT room for 3D-reconstruction could be solved by utilizing other special computer transferring CT data.

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Nineteen patients who had olfactory disturbance caused by chronic sinusitis were treated by endoscopic endonasal sphenoethmoidectomy. A standard olfactory acuity test (T & T olfactometry) and an intravenous olfaction test with alinamine ^® (prosultiamine) were performed to evaluate improvement of olfactory disturbance in these patients before and after the operation. The results were evaluated 3 to 9 months (mean 4.9 months) after the operation.
The standard olfactory acuity test showed that 15 out of 19 patients (78.9%) recovered more than 1 grade in the recognition threshold. An administration of steroid hormones in the from of nasal drops under the head down position was useful as a postoperative treatment for olfactory disturbance.
Endoscopic endonasal surgery was useful for the improvement of olfactory disturbance caused by chronic sinusitis because of meticulous removal of pathologic mucosa of the olfactry cleft and the paranasal sinuses.

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Recently coin/button shaped batteries have been widely used for watches, calculators, hearing aids and children's toys. They tend to be foreign bodies especially in the children. By now only child cases of the micro-alkaline battery fareign bodies in the nasal cavity have been reported. We report here child case and an additional an adult case. Once the micro-alkaline battery is lodged in the nasal cavity, the mucosa is severely damaged even with a prompt removal. Damaged tissues develop to darkly by brown granulation which is yielded by the sidero-deposition. The micro-alkaline battery damages the nasal mucosa by following three mechanisms; 1) low voltage current burns, 2) cauterization by leaked alkali and heavy metals and 3) contact pressure necrosis.

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To clarify the role of substance P (SP) and vasoactive intestinal paptide (VIP) in the secretion and allergic reactions of the nasal mucosa, we measured their concentrations in nasal secretions from patients with nasal allergy and chronic paranasal sinus infection by means of competitive enzyme-linked immunoassay and investigated influences of the intranasal provocation and antiallergic drugs on SP and VIP levels in nasal secretions. Mean levels of SP and VIP in nasal secretions from normal subjects were significantly higher than those in plasma. SP and VIP levels in nasal secretions from patients with nasal allergy were significantly higher than those of control subjects, while those levels of patients with chronic paranasal sinus infection were significantly lower than those of normal subjects and allergic patients. However, there were no significant differences of SP and VIP levels in plasma among these groups. The intranasal provocations with allergens and histamine induced rapid decreases of SP and VIP levels in nasal secretions during 15min, and their levels gradually increased to the prior leves, 2 or 3 hours after the provocation. Those findings indicated that SP and VIP are actively secreted into the nasal secretions. Their high levels in the nasal secretions may result in the hypersensitivity of the nasal mucosa, and their decreases after the intranasal provation may be attributed to the temporal exhaustion of SP and VIP in the nasal mucosa. Furthermore, anti-allergic drugs, such as azelastine, ketotifen, oxatomide and terfenadine, suppressed SP and VIP levels in the nasal secretions in spite of the differences of their anti-histamine effects. Those drugs may interrupt the vicious circle between mast cells and SP for the histamine release. The more severe allergic symptoms were, the higher SP and VIP levels were in nasal secretions from patients with nasal allergy. The more effective the anti-allergic drugs were for the improvement of allergic symptoms, the deeper the decreases of SP and VIP levels were in nasal secretions after medication. These findings suggested that SP and VIP levels in the nasal secretion may be better and objective parameters to indicate the severity of allergic symptoms and clinical effectiveness of anti-allergic drugs.

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Several recent clinial studies concerned with degenerative diseases in the central nervous system have reported an associated olfactory dysfunction. It has been postulated that these defects in olfactory acuity may be the results of imbalances in specific neurotransmitters in the brain. Little is known, however, about the effect of the primary neurotransmitters, noradrenaline, dopamine, and acetylcholine on central olfactory processing. To better understand these disorders, we have begun investigation into the effects of these neurotransmitters by use of electrophysiologic techniques. The projection between the ventral tegmental area (VTA) and the olfactory tubercle (OT) was examined in the rat. Stimulation of the olfactory bulb (OB) determined if the OT neurons were olfactory-related. VTA stimulation produced a change in neuronal activity in 77% of the neurons tested, with 41% being inhibited, 24% excited, and 12% had mixed response. Intravenous administration of haloperidol was used in examination of the role of dopamine in this neural connection. The results suggest that the VTA-induced inhibitory response on OT neurons is mediated by dopamine, whereas excitatory responses are not. The VTA inhibitory influence projects primarily to olfactory-related neurons, since 60% of olfactory-related OT neurons were inhibited as compared to 34% of non-olfactory-related neurons. OT neuronal activities following OB electrical stimulation were examined before and after administration of dopamine and dopamine antagonist. The inhibitory response to stimulation was attenuated by systemic haloperidol administration, but the excitatory response to stimulation rarely was modulated. Topical application of dopamine by iontophoresis extended the duration of inhibition in 56% of the neurons sampled; the excitatory response was attenuated in 33% of neurons. These findings suggest that dopamine in the OT could be involved in modulations of neuronal activities related to olfactory transduction as a facilitatory factor. Thirty-three percent of OT olfactory-related neurons were excited by stimulation of the locus ceruleus (LC). In contrast, only 10% responded with excitation to stimulation of the LC among the OT non-olfactory-related neurons. By the electrical stimulation of the horizontal limb of the diagonal band, neurons in the granule cell layer were excited, and those in the mitral cell and external plexiform cell layer showed inhibition, often followed by excitation. These responses were attenuated by the administration of atropine. These findings strongly suggest that the process of the olfactory information transduction was deeply influenced by the neurotransmitter system in the central nervous system.

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The nasal mucosa is considered to be the first defense line of the respiratory tract, protecting it from invading antigens. The local immunity of the nasal cavity has been well investigated and mucosal immunity has been proven to be present in nasal mucosa as well. We have been clarifying the mechanism of immune response in the nasal mucosa, employing mice as an experimental animal. Based on our quantitative analysis of the immunocompetent cell distribution in nasal mucosa, in the present study, the local immune response of murine nasal mucosa was examined when it was stimulated with repeated nasal challenges of protein antigen together with cholera toxin (CT), which is a potent mucosal adjuvant. In another study, the effect of viral infection in nasal cavity on the local and systemic immune response upon antigenic exposure to the nasal cavity was also examined.
As results, cholera toxin provoked IgA antibody response with the mobilization of IgA-bearing B cells into the epithelial layer and submucosa of the nose. A morphological study showed follicle-like lymphocyte aggregates in the nasal submucosa and it is speculated that these lymphocyte aggregates serve as mucosa-associated lymphoid tissue such as Peyer's patches, because high endothelial venules are found in lymphocyte aggregates and M-cell like epithelial cells are seen among the ciliated epithelial lining. Type A influenza virus infection in the upper respiratory tract augmented systemic and local antibody (IgG/IgA) response to ovalbumin introduced into the nasal cavity.
These results taken together suggest that nasal mucosa can be an afferent limb to provoke immune response of the nose and the effector site of systemic and mucosal immunity upon local antigenic exposures to the nose. Moreover, lymphocyte aggregates seen in nasal submucosa might be considered to be an inductive site of mucosal immunity, like Peyer's patch in the intestinal tract and it is possible that lymphocyte aggregates can be the source of antigen-driven B cells responding to the invading antigens to the nose. However, further direct studies designed from functional aspects are needed to have a definite answer.

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We have obtained olfactory evoked potentials (OEPs) by blast method. Our OEPs consist of five peaks which are N₁, P₁, N₂, P₂ and P₃. We have assigned each peak that N₁, P₁, are chemosensory somato-evoked potentials (CSEPs) of trigerminal stimulation by the pressure of the odorant gas, and N₂, P₂ are genuine chemosensory evoked potentials (CSEPs) by the odorant itself. However, the origin of P₃ was still unknown. In this study, we applied two odorant gases (amyl acetate and skatole) in the oddball paradigm to investigate whether P₃ is identical with P₃₀₀ or not. In the oddball paradigm, the amplitude of P₃ during rare stimulus is higher than that during frequent stimulus both by amyl acetate and skatole. Therefore we concluded that P₃ in the OEPs by the blast method is identical to P₃₀₀.

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