Surgical procedure of the cochlear implant is not very difficult in cases with normal middle and inner ear structures. In cases with chronic otitis media, including post-operative ears, however, subtle modification of the standard surgical method is necessary. Except for ears with no active infection for years, staged operation is always recommended as a safer way for successful hearing restoration. In the first stage, complete eradication of the pathological foci and closure of external ear canal are encouraged. Then, implantation of a device should be performed a couple of months later. When the lead wire is running under the thin epithelium that covers mastoid bony surface, exposure of the wire tend to happen very often, even if it is carefully covered and reinforced with muscles and cartilage plates and other connective tissue. This kind of trouble could end up with total slip-out of the electrode array. In many cases of chronic suppurative otitis media of long duration, highly intractable germs like MRSA are causing inflammation. They should be controlled very carefully before and after surgery. Cochlear implant is generally very effective in those hearing impaired patients with middle ear problems, and is recommended with special care.

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It has passed fifteen years since the first operation of the intra-cochlear multi-channel cochlear implant was done in Japan. We review the surgical complications, device troubles and reimplants through a questionnaire survey to in the related 49 Japanese institutes. Major complications were as follows; flap necrosis, facial nerve stimulation, acute otitis media. Extirpation of the implanted device was performed in 54 cases (2.94%). The causes of the explant were mostly due to surgical problems such as the improper insertion of the electrode, slipout of the array, necrosis of the flap, or infection. Device failures which occurred only in 8 cases (0.44%) were less frequent than surgical problems. Complications should be reduced with tightly controlled operation. Some points to carry out the reimplant in the same side were mentioned.

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Cochlear implantation has become a popular method to regain sensation of hearing for patients with profound hearing loss in Japan, and cases of pediatric implantation, which was not performed as frequently as in other countries, are rapidly increasing. Although early implantation is desirable considering the existence of critical period for speech acquisition, we should also aware that there are several points that have to be kept in mind during surgery and pen-surgical care in pediatric implantation. In this article, I will describe about the surgical procedures in pediatric cochlear implantation that are important to prevent undesirable post-operative and long-term complications. Based on our experience on 36 cases of pediatric implantation, the following points are thought to be important; the skin incision design, appropriate handling of the exposed dura and the sigmoid sinus during bone drilling, obtaining wide surgical view around the round window of the cochlea, control of otitis media, and prevention of post-operative infection.

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The use of microvascular free tissue transfer in head and neck has become an accepted and important method of reconstruction in the past 20 years. Between February 1995 and July 2000, 61 patients (61 free flaps) who underwent reconstruction with microvascular free flap transfer were reviewed. The number and type of free flaps performed were as follows : rectus abdominis flap: 29 cases, radial forearm flap: 15 cases, and free j ejunal flap: 17 cases. Rectus abdominis flaps were the most common flaps used for oral cavity or oropharynx reconstruction. Complications that occurred during the perioperative period were local infection, fistula, flap necrosis, lymphorrhea, and cervical hematoma. There were 4 cases of complete flap failure, resulting in an overall flap survival of 93.4%. There was lcase of partial flap necrosis. A successful outcome in microvascular surgery is dependent on a variety of factors, including atraumatic surgical technique during flap harvest and recipient vessel preparation, microvascular anastomosis, and planning of pedicle geometry to avoid vessel kinking or extrinsic compression.

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Thirty two patients with Basedow's disease were operated in Yamada Red Cross Hospital for recent 14 years and 6 months. Total thyroidectomy were performed in 7 patients, and Subtotal thyroidectomy were in residual 25 patients. In 25 patients who were performed subtotal thyroidectomy, normalization of the thyroid function were observed in 11, and hypothyroid were in 6, but recurrence of hyperthyroidism were observed in 1 case. None of the 32 patients who were operated were observed postoperative recurrent nerve paresis and hypoparathyroidism. Thirteen patients were determined as surgical operation for poor controled thyroid function, and 5 patients were determined afraid of combined thyroid malignancy. Recently Medical measurement was adopted in our department, in short, slow reduction of methymazole and block and replacement. Furthermore, surgical indication is determined by our department. Thirty two patients who were operated in our department were reconsidered about the surgical indication, and 19 patients were determined that surgery were not hurried. It is important that head and neck surgeons aggressively perticipate for the measurement of Basedow's disease, and it is necessary that head and neck surgeons the take the initiative for the determination of surgical indication.

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