The external nose is one of the most prominent features contributing to the attractiveness of man. A thorough grasp of the anatomy of the external nose is necessary for any operative procedure involving the nose. Yet a search of the pertinent literature has, revealed few studies specifically treating the external nose, particularly regarding the nasal cartilege. Professor R. Takahashi, however, has always stressed the importance of the relationship between the external and internal nose. Our investigations have been pursued with the relationship in mind, especially those concernes with the nasal septum and the lateral nasal walls. The comparative. anatomy of the nasal cartilages in mammals (Amano) and an embryological study of the lower lateral cartilages (Okihisa) have already been reported from our department. The present study concerns the structure of the cartilaginous portion of the external nose in adult man, an area of investigation which has been partially reported elsewhere.
Serial coronal and frontal sections of the external nose, procured from 19 cadavers ranging in age from 35 to 78 years, were examined. To observe the spatial relationship of the various parts of the external nose, the noses in an additional 4 cadavers were dissected and examined under magnification or with the naked eye.
Cartilaginous segments not usually described in textbooks were consistently found in the region corresponding to the slanted arm of the N-shaped junction of the upper and lower lateral cartilages. These carlitaginous segments which were found on both sides symetrically, were larger than the sesamoid cartilages and more horizontally situated. This cartilage, distinctive from the sesamoid cartilage, was given the name intermediate cartilage. The designations given to the nasal cartilages differ among various investigators, but, on the basis of the results of my observations, the names proposed by R. Takahashi, shown below, appear to be the most appropriate.
Superior lateral cartilage
Inferior lateral cartilage
Accessory cartilages lesser alar cartilage
sesamoid cartilage
intermediate cartilage
The inferior lateral cartilages described by some as contributing to the framework of the alar portions did not appear as supporting structures of this portion of the nose in my studies. At the junctions of the nasal bone and cartilage or between the cartilages, considerable overlapping of the edges was observed. Especially, the latero-inferior edge of the superior lateral cartilage was found inserted below the corresponding edge of the inferior lateral cartilage with few exceptions. This was also true at the junction of the nasal bone and cartilage, and the two were firmly connected by connective tissue.
The inferior edge of the superior lateral cartilage possessed numerous indentations or slits extending for a considerable distance superiorly. These were not visible to the naked eye but were seen easily under magnification. These slits were observed by Strastma to extend up to 2/3rds of the length of the cartilage but were found only as far as the lower 1/3rd of the cartilage in my study. In addition, the complicated form described by the antero-inferior edge of the superior lateral cartilage appears to be greatly influenced by the form of the supra-alar sulcus and the development of the nasal septum.
The results of this study concerning the relationships and forms of the various components of the nasal pyramid imply that the external nose is not a simple structure of various tissues but an organic structure with the main purpose of maintaining the airway.

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A forty-nine-year-old male was admitted to the ENT ward of Osaka Rosai Hospital because of a swelling of the right zygomatic area. An abnormal shadow and a thin wall of the maxillary sinus were found by X-ray examination.
An exploratory sinusectomy was performed, but no tumor was found. Following the procedure, tumorous swellings appeared in the parietal and right buccal areas.
These swellings were removed and their pathological examinations revealed no malignancy but chronic inflammation consisting of many plasma cells, a few lymphoid cells, neutrophil cells and capillaries with thickened endothelial cells.
The patient was moved to Osaka City University Hospital and a revision of the maxillary sinusectomy was performed. A partial bone defect and a large amount of elastic granulation were found in the maxillary sinus. The histopathological examination revealed chronic granulomatous inflammation, swelling of endothelial cells of capillaries, plasma cells and lymphoid cell infiltration.
These findings together with his past and family history and positive W-R indicated the presence of syphilis of the maxillary sinus.
Anti-syphilitic therapy improved the subjective and objective symptoms.

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Basic and clinical evaluations of a new macrolide antibiotic, Midecamycin (MDM) were performed. The results obtained are as follows:
1) In vitro antibacterial activity: Against 80 strains of coagulase positive staphylococci isolated from the otorrhea of purulent otitis media, the MIC, measured by agar plate dilution method, distributed with two peaks, ≤0.19-12.5mcg/ml and 50-≥100 mcg/ml. Further, MIC of MDM was ≤0.19-1.56 mcg/ml against Streptococcus hemolyticus, Diplococcus pneumoniae, and ≥100 mcg/ml against Escherichia coli, Proteus mirabilis, Klebsiella pneumoniae, Pseudomonas aeruginosa. A tendency toward the cross resistance with MDM and another macrolides was observed at high concentrated MIC.
2) Stability of MDM solution: As to the stability of 10 mg/ml solutions of MDM, there was no fluctuation in its colour, pH and antibacterial activity within a 14-days period when. the solutions were kept at 5°C and 37°C.
3) Results of clinical treatment: When MDM was administered applied locally in 50 cases of the acute or chronic purulent otitis media, it was good in 25 cases, fair in 19 cases, and poor in 6 cases. When the cases in which it was good and fair were considered together, favorable results were obtained in 44 cases, that is 88 per cent of all the cases.
4) Side effect: no side effect was observed when MDM was locally used.

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The patient was a 28-year-old housewife who had a swelling and pain on the left cheek for 14 days. Dental examination showed a decayed left upper third molar and pain on the left upper teeth to percussion. It was observed that the left inferior turbinate was pushed toward the nasal septum and the nasal floor superiorly.
X-ray films in intraoral technique revealed resorption of the roots of the left upper teeth. from lateral incisor to the second molar. A postoperative cyst in the left maxillary sinus was recognized in rhinological X-ray examination.
The patient was successfully treated by a radical operation on the paranasal sinus, extraction of the teeth 4-7 and alveoplasty.

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Most surgeries in the field of otorhinolaryngology have been performed under regional anesthesia for many years in this country. Recenty, however, general anesthesia is getting more popular though its percentage is still low.
From the standpoint of anesthesiologists surgery of ENT has certain characteristics. One of which is, apart from malignant diseases, that otorhinolaryngologic operations are performed generally on young age groups. Secondly, as most operations involve the airway or structures in the immediate vicinity of the airway, care must be given to airway management. Thirdly, it is frequently necessary for the anesthesiologist to removed the anesthetic equipments from the head of the patient for the purpose of maintaining a clear operation field.
Over the ten years and six months from February 1966 to June 1972, a total number of 10216 ENT surgeries were performed at Jikei University Hospital. Of these, 1047 (10.2%) cases were managed under general anesthesla. This report surveyed these 1047 cases from the anesthetic standpoint. Difficulty was experienced in tonsillectomy, microlaryngoscopic surgery, surgery of hare lip and cleft palate, bronchoscopy and removal of foreign bodies in the upper airway.
The success of anesthetic management is dependent not only on the skill and good judgement of anesthesiologists but also on the close cooperation between the surgeon and anesthesiologist.

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