Malignant melanoma arising in the nose and paranasal sinuses are rare compared to the skin, and their prognosis is very poor. During the past 15 years of 1986 to 2000, we recorded five of these cases. Common to these, the chief complaints were nosebleed and/or stuffy nose. Most of tumors arose from the mucosa of the nasal septum. The definite diagnosis depend upon the histopathological study, and such adjunct imaging modalities as MRI and RI were also much useful.
As for the treatment, a wide resection with free margins are desirable, but the clinical situations lend it impossible resulting in unsatisfactory resections with poor prognosis. Among our five cases, two expired within two years.

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A case of the spontaneous cerebrospinal fluid rhinorrhea was reported. A 54-year-old woman presented with a watery rhinorrhea of the left side that had gradually increased since 1998. She had been admitted to the hospitals with meningitis in December 1998 and in March 1999. Magnetic resonance images (MRI) showed the leakage of cerebrospinal fluid from the cribif orm plate and empty sella at the sphenoid sinus. She was admitted to our hospital and was underwent an endoscopic endonasal surgery to close the fistula using a fat plug from the abdomen and a free mucosal graft from the nasal septum. The fistula was found at the cribif orm plate but not at the empty sella. She has not presented CSF rhinorrhea for over one year after the surgery.

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We show our treatment plan for ranula, and discuss evaluation of exision of the sublingual grand. Our treatment plan for sublingual ranula is that we explain both a simple treatment method and a radical one (that is excision of the sublingual gland), whether it is the first onset or reccurence, and finally it depends on the patients decision which treatment is chosen. In case of plunging ranula we first perform puncture and pressure treatment for all of them as simple treatment, and cases of reccurence can choose between another simple treatment, and radical one (excision of the sublingual gland). The subjects of our investigation are 35 cases of sublingual ranula and 12 cases of plunging ranula who visited Kohri Hospital of Kansai Medical University for the past 5 years. Excision of the sublingual gland was performed on 25 of the 35 cases of sublingual ranula and 7 of the 12 csses of plunging ranula. These has been no reccurence in all cases.

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Cochlear implantation surgery in ossified cochlea is a challenge for otologist. The purpose of this paper is to present our therapeutic strategy for an adult patient with cochlear ossf ication who developed cholesteatoma one year after implantation. Three dimensional MRI study showing a surgically accessible perilymphatic space in the ascending segment of the cochlear basal turn played a significant role in the preoperative planning. Postoperative cholesteatoma was successfully removed with preservation of the implant. A vascularized temporalis fascia flap covering the electrode in a mastoidectomy cavity and the closed external canal skin seemed to be useful to create a stable middle ear cavity.

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Background : Management of the cervical lymph node is one of the most important factors to control head and heck carcinoma. We investigated the method of sentinel lymph node ( SLN ) detection for clinically positive neck metastasis. Methods : For 9 patients of tongue squamous cell carcinoma (N1: 5 cases, N2 : 4 cases, 5 males and 4 females), peritumoral perimucosal injection of Tc-99m -Rhenium colloid was performed, and followed by dynamic lymphoscintigraphy and hand-held gamma probe. All the patients underwent neck dissection, and after surgery we removed the lymph nodes from the resected tissue and measured the size and radioactivity. And then, examined metastasis in each lymph node pathologically. Results : In all cases, Rhenium colloid was accumulated in the lymph nodes ; identification rate was 100%. In most cases, accumulation was in the sub-mandible area and jugular chain. In 5 of 9 cases, it was accumulated in pathologically metastatic lymph nodes. But in the other 4 cases, it did not accumulate in the lymph node metastasis, which was distinguished clinically. In 2 cases, Rhenium colloid accumulation was detected in the contralateral lymph node. And in 1 case contralateral metastasis occurred where there was Rhenium colloid accumulation. Conclusion : When the sentinel lymph node had already metastasized and was blocked the lymphatic basin, injected colloid flowed to a different lymph node through another basin. We call this node "secondary SLN". We suggest detection of colloid in secondary SLN is useful for selecting the field of the neck dissection.

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Sellection of Flaps for head and neck, especially cranio-maxillo-facial reconstruction is determined by the following factors. Firstly, there is the recipient vessels or not. Secondary, there are the bone defect and/or soft tissue defect. Further, the prognosis of malignant tumor and the patient's general condition, age, sex etc are determine the best flap selection. We require the following peculiarities for the flap of cranio-maxillo-facial reconstruction. So called, three-dimensional maneuverability of the skin flap relative to the bone and the simplicity of bone trimming. The separated osteocutaneous scapular flap preserving the angular branch includes the ability to design multiple skin paddles (scapular, para-scapular, and ascending scapular flap) and two separated bone flaps (the lateral border and tip of the scapula) allowing improvment in three-dimensional spatial relationships for maxillary reconstruction. In addition, the scapular osteocutaneous free flap can be combined with such other flaps as the latissimus dorsi flap and the serratus anterior flap because the vascular supplies of these flaps also originate from the subscapular vessels. The essential elements of the maxillectomy defect are the body components of the hard palate, the anterior alveolar ridge, the anterior maxillary wall, and the medial nasal wall. Extending the defect into the orbit also entails loss of orbital rim, orbital floor, and medial nasal wall, and, occasionaly, the skin of the anterior cheek. We have performed maxillary reconstruction using the separated osteocutaneous scapular flap preserving the angular branch and the combined flaps with subscapular vessels. That is to say specifically, we use the lateral border of the scapula supplied by the periosteal branches of the circumflex scapular artery for reconstruction of the zygomatic body and anterior maxillary wall, and so the tip of the scapula supplied by the angular branch for reconstruction of the orbital rim and floor. The scapular or para-scapular flaps are used for reconstruction of the medial nasal wall or hard palate.

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The main purpose of the phonosurgery is to restore the normal voice. For the phonosurgical techniques, the laryngomicrosurgery and thyroplasty have been well established and are clinically employed all over the world. Here in this paper, the present condition of the laryngomicrosurgery is explained and discussed from the viewpoint of technical problem. The author emphasized that the laryngomicrosurgery is very useful to remove unnecessary mass like the vocal polyp. Hewever this technique is impotent to treat defective vocal folds and scar formation.

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We have performed laryngeal framework surgery and/or intracordal injection of atelocollagen for 57 patients with unilateral vocal fold paralysis during the last 15 years. One of arytenoid adduction, type I thyroplasty and intracordal injection, or arytenoid adduction combined with either of the latter two methods was chosen based on stroboscopic and conventional tomographic findings. In a few patients who underwent type I thyroplasty, silicon block was placed slightly more rostrally than the vocal fold. We removed a small lateroinf erior portion of the thyroid ala to obtain an easier access to the muscular process during the procedure of arytenoid adduction. To decide a size of silicon block during type I thyroplasty, and direction and strength of a thread for traction of the muscular process during arytenoid adduction was a difficult step of each procedure. Paradoxical movement of the paralyzed vocal fold was rarely detected stroboscopically. CT endoscopic images seemed to be useful method to assess positional difference between both vocal folds in the superior-inferior direction and paradoxical movement of the paralyzed vocal fold during phonation.

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Since 1976 we have been performing the tracheoesophageal (TE) fistulization for voice reconstruction after total laryngectomy. Out of 341 patients who underwent the TE fistulization, 276 (81%) had voice capability with TE phonation. Of 276 TE speakers, 201 underwent TE fistulization with sphincter mechanism against aspiration using bilateral esophageal muscle flaps. One hundred and seventy eight (89%) of these 201 TE speakers could swallow without aspiration problem. Over the past 10 years, a total of 24 patients underwent the tracheojej unal (TJ) f istulization for voice reconstruction after pharyngolaryngoesophagectomy with free jejunum reconstruction. Nineteen (79%) of 24 patients retained voice capability with TJ phonation. As far as swallowing function is concerned, eighteen (95%) of 19 TJ speakers could swallow without aspiration problem.

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