Olfactory neuroblastoma is a rare malignant tumor arising from epithelium derived from the olfac-tory mucosa. Anterior cranial base surgery is the first choice of treatment for patients with early-stage disease. We report one case of olfactory neuroblastoma in which anterior cranial base surgery was supported by a navigation system.

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A rare case of a primary ectopic meningioma originating in the anterior ethmoid sinus is reported. The patient was a 60-year-old woman complaining of swelling of the nasal bone. A CT-scan finding demonstrated a tumor-like lesion with destruction of right anterior ethmoidal bone and the medial wall of the orbit. The patient underwent a lateral rhinotomy under general anesthesia. The tumor was surgically resected and immunohistologically diagnosed as a meningioma. There has been no recurrence for one year.

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Orbital abscess is rare, but may result in fatal complications (meningitis, epidural abscess, subdural abscess, intracerebral abscess, cavernous sinus thrombosis) without proper treatment. We report 4 cases with orbital abscess who underwent endoscopic surgery and present the clinical history, bacte-riology and route of infection. Orbital abscess often shows a tumor-like shadow in the orbit on com-puted tomography, so surgical approaches are necessary for treatment and correct diagnosis.

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A 6-year-old girl with congenital fistula of accessory parotid gland is reported. She was referred to our clinic because of congenital fistula of the left cheek skin with watery discharge when she was 2 years old. After 4 years of follow-up, she was admitted to our hospital for surgical treatment. A CT taken before surgery showed the presence of accessory parotid gland and a structure similar to the fistula. Fistulography taken after induction of general anesthesia revealed cutaneous fistula of acces-sory parotid gland duct, and disconnection of the duct to the parotid duct. Surgical procedure replac-ing the cutaneous fistula to the oral mucosa resulted in physiological cure with less complication. To treat congenital fistula in the face and neck, a less complicated diagnosis method and surgical proce-dure should be considered with understanding of the pathophysiology of the patient.

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Primary malignant lymphoma of the thyroid gland is not a rare disease that we come across in our hospital. Here we report a rare case of adenomatous goiter infiltrated by malignant lymphoma. A 42-year-old woman was admitted to our hospital because of slow-growing anterior neck tumor and rapid-growing axillary tumor. The right anterior neck tumor was 12 cm in diameter and the right axillary tumor was 7 cm in diameter. Fine needle aspiration cytology revealed that these two tumors were class V and malignant lymphoma was suspected. We performed an open biopsy of the neck tumor and histopathological examination revealed that diffuse large B-cell lymphoma co-existed with adenomatous goiter. Eight courses of CHOP were conducted for the patient and CR was ob-tained in her axillary tumor but her neck tumor was NC. We performed surgical resection of the neck tumor and histopathological examination revealed the pathological CR of malignant lymphoma.

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Descending necrotizing mediastinitis is a very severe disease. We present two cases of descending necrotizing mediastinitis that were both successfully treated with surgical drainage and adequate an-tibiotics. The first case was a 49-year-old male with deep neck abscess. Cervical drainage was performed first. In spite of the cervical drainage and intravenous infusion of antibiotics, the abscess remained and extended to the mediastinum on computed tomography five days after the first operation. At the second operation, cervical drainage and thoracoscopic drainage were performed by thoracic sur-geons, and the abscess disappeared.

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Recently, new management of surgical wounds has spread among various facilities. We modified the conventional management of wounds in clean-uncontaminated head and neck surgery. This study compared the conventional method with the altered method, regarding the incidence of compli-cations such as surgical site infection, blood examination, and cost. From January 2004 to March 2005, the conventional management of wounds in head and neck sur-gery was administered in 65 patients. From April 2005 to December 2005, the altered management was administered in 57 patients. Both groups were well matched for age, sex, and site of operation. A film dressing was applied to the surgical wound immediately after surgery and left in place, and disinfectant was not applied to the wound until the sutures were removed in the altered manage-ment. An antibiotic dosage was given once during surgery in the altered method. Postoperatively, no antibiotics were given basically. On the other hand, the conventional dry gauze dressings were changed daily, and disinfectant was applied to the surgical wound in the conventional management.

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We applied a new bilayer artificial mucous membrane (atelocollagen) to the mucosal defect of 30 patients with cancer of the oral cavity (tongue: 22, oral floor: 3, etc.). The material was found to be easy to handle, adhere well and promote hemostasis, relieve pain, limit infection, and promote rapid epithelization with minimum contraction. The results suggest the safety and effectiveness of the ma-terial for clinical use. Key words: artificial mucous membrane, cancer of the oral cavity, atelocollagen, tongue cancer

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We placed T-shaped bile duct tubes (T-tubes) in the naso-frontal ducts of three patients with re-current frontal cysts or sinusitis resulting from drainage by the extranasal approach. The first pa-tient developed recurrent frontal sinusitis after anterior skull base resection for ethmoidal squamous cell carcinoma. The second patient had undergone 5 operations for a recurrent frontal cyst. The third patient experienced relapse of a frontal sinus cyst 40 years after initial surgery. A T-tube was placed for over a year in all three cases. The T-tube was effective in draining sinus discharge and demonstrated long-term stability without the need of fixation. We recommend the use of T-tubes for cases of frontal sinusitis, those with cysts in which there is difficulty controlling infection, or cases in which it is difficult to maintain the opening of the naso-frontal duct.

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In 1984, Ejnell et al, reported a simple method for laterofixation of the vocal cord to relieve dyspnea caused by bilateral vocal cord fixation. The merits of the method are as follows: 1) technical ease because of no need to access the arytenoid cartilage, 2) non-destructive surgical procedure and 3) no need for tracheostomy. There are several demerits: 1) difficulty to determine the points for in-serting needles on thyroid cartilage, 2) need for two surgeons, and 3) necessity of insertion of direct laryngoscope. The cause of the difficulty of determining the insertion points is that there have been no report on surgical landmarks on thyroid cartilage. In this paper, we report a surgical technique in detail.

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