Recently, the effectiveness of intracystic injection of streptococcal preparation OK-432 has been reported for patients with cystic lymphangioma. We tried the same method for ten patients with ranula (5 cases oral floor, 5 cases plunging). Cystic lesions were diminished in all patients having this therapy. As side effects, increased fever (37-39°C) and local inflammatory reaction (pain) were observed in almost all patients, but they were manageable by using analgetic drugs. Intracystic injection therapy with OK-432 was thus quite effective for patients with ranula.

View full abstract

There are many patients with neck lymphadenopathies that include metastasis and inflammation. The diagnosis of mycobacterial infection is made by the assessment of characteristic histology, Ziehl-Neelson staining and agar cultures . However, definite diagnosis takes at least several weeks by these conventional methods . Recently, new diagnostic procedures based on molecular biology have been developed . The Gen-Probe Mycobacterium Tuberculosis Direct Test (MTD) is based on amplification of the ribosomal RNA (rRNA) of M. tuberculosis from clinical specimens and hybridization of amplified rRNA with a M. tuberculosis-specific DNA probe, as a rapid direct diagnostic method for tuberculosis. We applied the MTD method for cervical tuberculous lymphadenitis and detected M.tuberculosis rapidly; we could not detect M. tuberculosis by conventional culture or Ziehl-Neelson stain. Based on this result, we beliebe that the MTD is a very efficient method for the direct detection of M. tuberculosis in clinical small specimens collected by fine needle aspiration and for the rapid diagnosis of tuberculosis . A few reports on using the polymerase chain reaction (PCR) method for cervical lymphadenitis have been reported, but a DNA probe method for cervical lymphadenitis has not been reported . A carcinoma of the oral floor, which was not detected in any mycobacteria from sputum on admission, was rapidly diagnosed as M. avium from increased sputum by the PCR method after repeated chemotherapy and radical surgery. We must note that mycobacterial infection (especially M. avium and M. intracellulare complex) can develop suddenly after various cancer therapies.

View full abstract

A case of pharyngeal and laryngeal sarcoidosis in a 25-year-old female that was extremely difficult diagnose is reported. She complained of rt-submandibular pain and swelling. Her right tonsil showed remarkable swelling. A fiberoptic laryngoscopy revealed remarka ble swelling of the lingual tonsil and epiglottis. An exact diagnosis was made with great difficulty after a second biopsy. Histological findings of the tonsil showed non-caseous epithelioid cell granuloma, indicating sarcoidosis. Her chest roentogenogram showed normal lung fields and no hilar nor mediastinal lymphadenophathy. Administration of hydrocortisone sodium succinate and predonisolone was effective against swelling of the lingual tonsil and epiglottis.

View full abstract

In order to evaluate the stenosis of the upper airway in patients with sleep related breathing disorders (SRBD) while they were awake, we measured the upper airway volume in two groups of subjects, eight SRBD patients and seventeen normal controls without snoring, using three-dimensional (3D) MRI.
There were no significant differences between the SRBD patients and normal controls in terms of the volume of the upper airway, which includes the nasopharynx, oropharynx and hypopharynx. However, for the upper oropharynx, the volume in SRBD patients was found to be significantly smaller than that in the normal controls. In addition to this, the imaging of the 3D construction obtained by MRI showed a narrower contour of the nasopharynx or oropharynx in most of the patients with SRBD as compared to the normal controls.
Since 3D MRI made it possible to measure the exact volume of the pharynx as well as provide a finely contoured visualization, the diagnosis and treatment of SRBD patients is feasible.

View full abstract

Nine cases of oral floor infections, including abscrss and phlegmon, were seen during the period of 17 months from May 1996 to september 1997. The chief complaints upon the first visit ware submandibular swelling accompanied by odynopahgia . The causative lesions were dental in majority of cases but other lesions including sialoadenitis were also seen. Four cases presented the extension of the infection from the fascial space of the oral floor to other deep neck fascial spaces, leading to the more grave conditions.
About 33% of the cases were treated using conservative methods with success . Indications for surgical for surgical approach were comprised airways or no remarkable improvements after conservative treatment.

View full abstract

We report an autopsy case with a focal sepsis of the palatine tonsil based on diabetes mellitus. The patient, a 73-year-old male, was admitted with a fever and abnormal liver function. After 4 days he suffered a respiratory arrest. Resuscitation was attempted, but was unsuccessful. The patient's history was positive for diabetes mellitus.
In autopsy findings, macroscopically there were multiple abscesses in the right lobe of the liver and about a superthumb-tip-sized swelling with scattered abscesses of both palatine tonsils, and a hemorrhagic infarction of the upper lobe of the right lung and infectious spleen (120g). In addition, Klebsiella pneumoniae was identified by cultures in both abscesses of the liver and tonsils in the autopsy material. Histologically, numerous Gramnegative bacilli were detected in these abscesses. Fibrin thrombi with marked neutrophil infiltration were revealed in the pericapsular vein of the tonsil, the small-sized pulmonary artery and the small-sized vein of the liver and myocardium. In addition, hyalinization of pancreatic islets and a slight diabetic nephropathy (diffuse type) were observed, and irregular hyperostosis was found in both sterno-cost-clavicular joints.
From these results, it was concluded that generalized sepsis was caused by a superimposed infection of Klebsiella pneumoniae in a tonsillar focus based on diabetes mellitus.

View full abstract

We report two cases of infant osteosarcoma of the maxilla and mandibles about the clinical courses and treatment with a review of the literature.
The first case is a 13-year-old boy. Under the diagnosis of osteosarcoma of the maxilla, we performed an extended total maxillectomy including orbital tissue after chemotherapy and irradiation therapy. Then we reconstructed the calvarial bone flap and free rectus abdominis myocutaneous flap.
The second case is a 15-year-old boy. Under the diagnosis of osteosarcoma of the mandible, we performed a hemiresection of the mandible including the mastication muscles and parapharyngeal tissue after chemotherapy. Then we conducted reconstruction using the titanium-coated hollow-screw reconstruction plate system and a free rectus abdominis yocutaneous flap.
Neither case has ever shown tumor recurrence, and reconstruction has been satisfactory both functionally and cosmetically.

View full abstract

Two cases of sialodochitis fibrinosa are reported.
Case 1: A 37 year-old man had recurrent swelling of the bilateral submandibular salivary glands and parotid glands. His IgE level was elevated and a RAST test showed positive allergens for candida and house dust. After the oral administration of an anti-allergic drug for 4 months, he has been free from the swelling of salivary glands for 7 years without any medication.
Case 2: A 39 year-old man complained of recurrent swelling of the left submandibular gland. He had symptoms of nasal hypersensitivity and slight eosinophilia in a peripheral blood sample. A histopathological study of the submandibular gland showed marked infiltration of eosinophils and T lymphocytes around the salivary duct forming lymphoid follicles.
Clinical findings of these two cases suggest that type I allergy is implicated as a cause of sialodochitis fibrinosa.

View full abstract

We studied the urinary findings of 98 patients with IgA nephropathy after tonsillectomy. During one week after operation, a transient worsening of urinary findings were observed in 56% patients. Aggravation of hematuria was the most frequent finding. The aggravation of urinary abnormalities was temporary, and most of the patients showed the aggravation on the second post-operative day. The serial changes in the number of red blood cells and macrophages in the urine were examined in five patients, and corrected by the concentration of creatinine in the urine. The increase peaked from the second to the fourth day after the operation. Flow cytometry revealed that the increase in CD16-positive macrophages in the urine and CD16-positive monocytes in the blood corresponded to the time of aggravation by the urinary findings. CD16-positive monocytes in the blood were also increased on the second day after tonsillar provocation test. There is a possibility that the number of CD16-positive monocytes in the blood on the second day after tonsillar irradiation is a good indicator of the effects of the provocation test on IgA nephropathy.

View full abstract

Glossodynia and abnormal sensation in the throat are generally said to be mainly caused by psychological elements. We noticed that there were delicate differences between glossodynia and abnormal sensation in the throat. Then we investigated several items about glossodynia. Glossodynia occurs in older people and its affected term is longer than abnormal sensation in the throat. Many cases with glossodynia showed hypofunction of the salivary gland, and a high detection rate and density of Candida in the saliva. The effective rate of Oxazolam (Serenal) was low, and it was, in paricular, not effective at all for most aged patients with glossodynia. We believe that the key to solving glossodynia might exist greatly in the age of the patient. Therefore, we suggest that some cases should be called central glossodynia.

View full abstract

We investigated the physical appearance of oropharyngeal lesions in three cases of Osler disease. All three patients were women, respectively aged 54, 67 and 73 years. The chief complaint in each case at the initial consultation was recurrent epistaxis. Examination showed telangiectasia of the nasal septum and inferior turbinate mucosa. In all three cases, telangiectasia involved the oropharyngeal mucosa, tongue and lips simultaneously. One patient had telangiectasia of the precordia and arteriovenous fistulas of the lung. Another case involved telangiectasia of the palm. In patients with recurring epistaxis, the presence of telangiectasia is a characteristic of Osler disease. Consequently, in such patients, we examine not only the nasal cavity but also the oropharyngeal mucosa and skin.

View full abstract

We measured stimulated secretion from the minor salivary glands in the lower lip by a function test paper that we had developed. As a result, secretion from the minor salivary glands did not increase after mild taste stimulation, but it obviously increased after strong stimulation. The secretion disapeared almost entirely after 5 min. Investigating cases with xerostomia revealed that there were some minor salivary glands that did not secrete under no stimulation, while some of them began to secrete after strong taste stimulation. Furthermor, secretion continued even after 5min. This suggests that treatment such as a sour lemon drop could be effective for patients with xerostomia.

View full abstract

Sialolithiasis in the parotid gland is a lower case than submandibular salivary stone. The patient, a 41-year old female, visited our hospital with the chief complaint of rtpreauricular induration and repeated swelling in the rt-parotid lesion. An examination showed purulent discharge from the rt-parotid duct orifice and palpable small induration in the rt-preauricular lesion.
The sialography and plain CT scan findings revealed calcification in the rt-parotid stenon's duct. A surgical operation was performed with rt-preauricular incision. A stone of rice-grain size existed in the stenon's duct of the rt-parotid gland. The patient recovered completely without salivary fistula or facial nerve palsy. Discussions were made on the possible causes of this lesion.

View full abstract

Schwannoma is a benign tumor of Schwannsheath origin. It is frequently located in the Head and neck but is relatively rare in the oral cavity. A 17-year-old man, complaining of swelling on the lingual root, visited our hospital in March 1997. Extripation of the tumor was performed through an oral approach under a general anesthesia. The tumor was as large as 35×30×30mm, and was topathologically diagnosed as a Schwannoma including both Antoni A and Antoni B regions. A review of available Japanese literature of the last 64 years (1934 to 1997) disclosed 156 case of neurinoma of the tongue.

View full abstract

This study was carried out to determine the clinical effects of low-dose roxithromycin (RXM) therapy for the treatment of chronic tonsillitis. Forty patients were randomly assigned to two groups: 150 mg of RXM per day (test group) and 300 mg per day (control group) for averages of 47.2 and 46.5 days, respectively. The final overall efficacy rates (inclusive of excellent and good efficacy) were 76.2% (16 of 21 cases) for the test group and 63.2% (12 of 19 cases) for the control group.The two groups showed no statistical differences in terms of subjective or objective efficacy. No side effects were observed in the test group, whereas mild gastrointestinal symptoms appeared in two control group cases. Low dose application of RXM was thus proven to be as effective as the standard dosage.
It was speculated that the efficacy of low dose RXM therapy is mainly attributable to the immunomodulatory effects of 14 membered ring macrolides. These results suggest that the low-dose administration of RXM can be useful and safe for the treatment of chronic tonsillitis.

View full abstract

Basal cell adenocarcinoma is a low-grade malignant tumor of the salivary glands. A case of basal cell adenocarcinoma of the minor salivary glands in the epipharynx is reported. The patient was a 66 year old man whose chief complaint was hearing loss in the left ear. A tumor covered with fuzz was located in the left Eustachian cushion and diagnosed as basaloid squamous carcinoma by biopsy. The patient underwent radiotherapy and chemotherapy, but they were not effective. After a month, surgical excision was performed, and finally the histological diagnosis was basal cell adenocarcinoma. There has been no sign of local recurrence or metastasis during 15 months.

View full abstract

From 1989 to 1996, 44 patients with oral cancer were treated at Yamada Red Cross Hospital, and 19 patients of this group died.
Ten patients were recognized as having recurrence in primary regions, and 4 had recurrence in the neck region. Death not associated with oral cancers was reported for 7 patients, and we had 4 patients whose death was associated with therapy.
In these 4 patients, postoperative renal failure was noted in 2 patients, postoperative acute pancreatitis in 1 patient, and post irradiation pneumonia in 1 patient.
The following are essential for the prevention of therapy associated death; 1) Sufficient general evaluation prior to therapy; 2) Adequate selection of the therapy corresponding to the patient; 3) Careful and safe operation; 4) Frequent and sufficient examinations for cardio-pulmonary and renal functions in the postoperative period.

View full abstract

Mouthwash is generally used for the treatment and prevention of colds or other oral diseases, and its effectiveness is well known. But the proper way to use it has not been discussed sufficiently, many patients gargle in self-prescribed ways. Therefore we researched how patients were gargling with Gargle of Povidone Iodine and compared their methods with a currently recommended manual. As a result, it was found that many patients were gargling with mouthwash 3-6 times as diluted as the prescription in a short time. And it was also found that they gargled in a way mouthwash rinsed only their throat. These facts show that the mechanical rinsing and sterilization of gargling has not worked effectively. We discovered some problems in the current manual through our research. These results gave good information to“the establishing an effective method of gargling” that was our purpose.

View full abstract

Although palatine tonsillar cyst is no longer considered uncommon, giant cysts presented with clinical manifestations are still rare. We report our experience with a case of giant palatine tonsillar cyst.
A 74-year old male patient entered our hospital with a complaint of throat discomfort. A yellow-white cyst originating in the lower pole of the left palatine tonsil was noted. Under general anesthesia, the left tonsil was resected en bloc with the cyst. The excised cyst was 2.7×2.3×2.3 cm in size and contained yellowish mucous secreta.
Histopathological examination revealed that the cyst wall was lined with stratified squamous epithelium, and that the cyst contained an eosinophilic, amorphous substance. The crypts of the tonsil were swollen and filled with inflammatory cells and bacterial colonies. Some crypts were swollen, cyst-like, and filled with material similar to that found in the cyst. These findings led to diagnosis of a cyst secondary to the obstruction of crypts as a result of inflammation.
We also review the case of palatine tonsillar cyst reported in Japan and discuss their etiology with a review of the literature.

View full abstract

Between 1991 and 1994, 49, 141 patients visited Hakodate Municipal Hospital Emergency Center. Of the 49, 141 patients, 772 were emergency cases of oral and pharyngeal origin.
Of the 772 oral and pharyngeal emergency patients, 482 had inflammatory disease, 134 had foreign bodies, 124 had trauma, and 32 cases were categorized as other.
Oral and pharyngeal emergency cases are varied. It is necessary to pay attention to respiratory, swallowing, phonetic and cosmetic functions for treatment.

View full abstract