A total of 684 chordoma cases including 134 Japanese cases has been reviewed in the present study. Most of chordomas occur in the thirties and forties. In Japanese cases the average age for sellar chondromas was 51.8 years, which was above the average age of 42 years for this series. There were 76 (57%) head and neck chordomas among the 134 Japanese cases. Talking cervical chordomas, the first and second cervical vertebrae and their surrounding tissues were more involved than other regions. Among the cranial chordomas clival chordomas (30 cases) predominated followed by sellar (10 cases), nasopharyngeal (4 cases) and parasellar chordoma (1 case). In counties other than Japan there is a predominance of males, but in Japan 53 cases were males and 69 females: a female predominance of 1.3 to 1. There were three major initial manifestations of clival chordomas, they were diplopia initially followed by visual disturbance and then headache in Japanese cases. The initial symptoms of sellar chordomas were visual disturbance (7/12) and diplopia (1/6), accompanied by exophthalmos, headache and nasal obstruction. The initial symptom of cervical chordomas were nasal obstruction, deviation of the tongue and maldeglutition. Headache is the cardinal symptom of cranial chordomas. There are such cases as subdural or subarachnoid haemorrhage due to damage to the basilar artery, resulting in death. At the first examination the inspection and palpation of chordomas appearing in the pharynx is extremely important for early diagnosis. To differentiate chordoma from chondrosarcoma and chondoid sarcoma is considerably difficult. Phosphotangstic acid and reticulum stain are useful to differentiate chordoma from chondro-sarcoma. Treatment consists of surgical therapy, chemotherapy and radiotherapy independently or in combination. Chordoma is resistant to the radiotherapy. In Japan 17 clival chordoma cases were autopsied, and eight cases (47%) had metastases. In 23 clival chordoma cases, 10 cases (43%) died within one year. The average survival rate of clival chordomas was one year and one month. In 10 sellar chordoma cases no death was reported less than one year. In cranial chordoma cases, sellar chordomas had a better prognosis than clival tumors.
A total of 262 cases with peripheral facial palsy was seen during the 7-year-period starting April 1967. Of the 262 cases, 160 cases (61.1%) were Bell's palsy, 40 cases (15.3%) were Hun is syndrome and the remaining 62 cases were others. Among the 62 cases, 24 were due to trauma, 21 to ear infections, 10 to ear surgery and 7 to tumors. The following observations were made concerning Bell's palsy and Hunt's syndrome. 1) The monthly difference in incidence varied in each year and there was no particular month when the incidence of facial palsy was considered to be high. 2) The incidence of Bell's palsy was high in the twenties, thirties and forties, altogether comprising 61.3% of all cases. There were 60 males and 38 females in the above three age groups. In the age group under 19, female incidence was greater than that of the male, 19 to 8. A little higher incidence of Hunt's syndrome was seen in the thirties and the sixties, but the incidences in other age groups were approximately the same. A detailed study on 23 cases with Bell's palsy revealed that an exposure of the affected ear to cold air as a causative factor was found in only 10% of the cases. The facial paralysis was the first manifestation in 50% cases with Bell's palsy and in 26% of Hunt's syndrome. Otalgia was the first symptom in 5.6% cases of the Bell's palsy and in 30.4% cases of Hunt's syndrome. Only the cases with the presence of herpes in the external ear were considered as Hunt's syndrome in the present study. Complete recovery within 6 months was seen in 66.3% of Bell's palsy and in 60.1% of Hunt's syndrome. Imcomplete recovery was seen in 21.7% in each of both disorders. No improvement has been seen in 10% of Bell's palsy and in 17.4% of Hunt's syndrome.
FT-207, a newly developed anti-metabolite, has been given orally for treatment of 28 cases of malignant tumors of the head and neck regions. The treatment was composed of three modes of cancer therapy; 1) administration of FT-207 alone, 2) combined therapy of FT-207 with irradiation, 3) chemotherapy of FT-207 following irradiation. The following results were obtained; the agent appeared to be effective in 56% of all cases, including 67% of fresh cases and 50% of recurrent ones. In particular, it was markedly effective in cases who were treated concurrently with chemotherapy of FT-207 and irradiation, so that the radiationsensitizing effect of FT-207 was strongly suggested. In histopathology of these lesions, it was efficacious not only in cases of adenocarcinoma which had been reported by previous authors, but also in those of squamous cell carcinoma. The mild side effects were seen in 5 cases who presented anorexia and/or stomatoglossitis without blood disturbance or others.
The authors report two cases of accidental swallowing of sealed drug packages (press through pack). In the first case the pack passed into the stomach but acute mediastinitis developed subsequently. In the second case the foreign body was removed under esophagoscopy without causing complications. The authors warned of an increasing incidence of such foreign bodies in the esophagus and discussed the importance of early diagnosis and prevention of such accidents.
The authors report a case of leiomyoma which developed at the dorsum of the tongue of a 5-year-old female was visited the hospital with a complaint of a tumor at the tongue. Occurrence of leiomyoma in the head and neck region has been suggested extremely rare and 17 cases have been reported in Japan until 1975. 54% of these cases developed at the nose, 30% at the tongue and others were seen in the neck and submandibular region. Leiomyoma can be classified into superficial leiomyoma, vascular leiomyoma and bizarre leiomyoma (leiomyoblastoma or epitheloid tumor). The present case was thought to be a superficial leiomyoma.
As micro-surgery has become very popular in the field of otorhinolaryngology, it has become absolutely necessary to grasp the object microscopically not only during surgery but also during daily treatment of outpatients. We have been using commercially available binocular lupe, but because of its small magnification, we have not been quite satisfied. Even if one can afford to have an operating microscope in the outpatient consultation room, it takes too much time to set for handy use. Therefore, I have tried attaching the light-weight MediScope (TOKIBO Co.) with cold light source and fiber bundle for light guide on the ordered head-mount. The result is quite satisfactory. The specification of this MediScope is as follows, type-prismatic binocular type, magnification-5×, visual field-45 mmφ, working distance-300 mm, and depth of visual field 12 mm.