Accessory parotid gland tumor is uncommon. We surgically treated two patients with tumor of the accessory parotid gland. Case 1. A 62 year-old male who complained of a rapid growing tumor of the left cheek. The firm, no-well defined, tumor (diameter about 5 cm in size) was surgically removed with Stensen's duct and a margin surrounding of normal masseter muscle through a transparotid approach. Histologically, it was diagnosed as a carcinoma in pleomorphic adenoma. After surgery, there had been no recurrence of tumor for 6 years until he died of pneumonia. Case 2. A 51-year-old male had an elastic hard, well-defined tumor (diameter 3 cm) in the right cheek. The tumor was surgically removed with preservation the Stensen's duct under a microscopy by the subcutaneous cheek flap. Histologically, it was diagnosed as a pleomorphic adenoma. At one year follow-up, the patient has no evidence of recurrence. The functional and cosmetic results are excellent. Based on this experience, we discuss the preoperative diagnosis of the tumors and appropriate management.

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A 23-year-old female with a large pharyngeal cyst extending to the parapharyngeal space is reported. Since the presumptive diagnosis by diagnostic imaging and cytology was benign cyst, marsupialisation was performed microscopically. After the resection of the anterior wall of the cyst, several sutures were placed around the periphery to join the cyst wall to the pharyngeal mucosa. Twenty months later there is no sign of recurrence of the cyst. Diagnostic imaging was useful in determining the operation method.

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Recently the incidence performance of functional neck dissection (FND) increased because of using of free graft and considering quality of life. The patency of internal jugular vein (IJV) after FND is important, because the possibility exists that bilateral jugular vein occlusion leads to serious postoperative morbidity. The study group consisted of 28 patients who underwent a functional neck dissection at least on one side of the neck. The patency of IJV was examined by ultrasonogram 1 month to 5 years postoperatively. In one of them occlusion of the IJV was disclosed. In two patiets IJV was narrowed but patent. The preservation rate of patency of the IJV was 96% (27 of 28). The cause of IJV occlusion in our case was serious complications after operation. Further studies are needed to know the cause and the course of narrowed IJV.

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Radial forearm flaps are often used for reconstruction in head and neck surgery. The Allen's test must be performed prior to creation of forearm flap to assess collateral circulation supplying the hand through the ulnar artery and the palmar arches. It is generally accepted that if the results is normal, the hand will be free from vascular complications. We measured blood pressure at both index fingers of 22 patiants (from one day to five years and seven months after operation), to evaluate changes in blood flow that is caused by resection of the radial artery. All the patients showed normal Allen's test before operation. In the flap side hand, blood pressure was significantly less than that in another hand. The decreasing rate of mean blood pressure (MBP) : (contralateral side MBP-flap side MBP) / healthy side MBP, was averaging 6.9%. Althogh the rate was more than 20% in a case right after operation, it gradually became better after operation. In the earlier group (less than 60 days after operation), the rate was significantly higher. However all cases had no symptom of vascular complications, such decrease of blood pressure suggested allowable change for circulation of the hand after resection of the radial artery.

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Adenomatous tumor of the middle ear, including adenoma and adenocarcinoma of nonsalivary gland origin, is relatively rare and is classified into mixed type and papillary type. It has been reported that the former exhibits a better clinical course than the latter. In the present report, we describe two cases of adenomatous tumors of the middle ear, one is mixed type and the other papillary type. Although the postoperative course has been uneventful so far in the patient of papillary type, a local recurrence was found in the case of mixed type. It was stressed in the present paper that careful follow-up study is mandatory even in the case of mixed type tumor.

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Experience with otosurgery using an athelocollagen sponge (Terudermis) is reported. The collagen sponge was utilized to repair the defect of skin and subcutaneous tissue on the exposed bone underlying wounds that destroy the periosteum. This area tends to have a poor blood supply. Early epithelization accompanied by the developing strict subcutaneous tissue was a good and valuable result in cases undergoing surgery for external meatal cholesteatoma or tympanoplasty with mastoid obliteration. Epithelization was reduced and skin recovered late and poorly due to unexpected posto-perative infection in cases undergoing surgery for mastoid obliteration, in which collagen sponge was utilized to obliterate the mastoid cavity and subcutaneous dead space. It is most important that the postoperative wound containing collagen sponge be open and uninfected. It is necessary to avoid and prevent infection to successfully treat dermo-periosteal defects during the otosurgery.

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