Uvulopalatopharyngoplasty (UPPP) has been a golden standard for the treatment of simple snoring and mild obstructive sleep apnea (OSAS). Surgeons usually performed UPPP by a scalpel, which is socalled cold knife. Because the long-term success rate was approximately 50%, it is necessary to find a new surgical technique for simple snoring and mild OSAS. Recent technological advancement enables the use of special devices, such as high-frequency electric cautery, laser and ultrasonically activated scalpel, for the treatment of simple snoring and OSAS. We call these devices hot knives. Among the treatments using hot knives, the cautery-assisted palatal stiffening operation (CAPSO) and the radiofrequency volumetric tissue reduction (RFVTR) are introduced in this paper. CAPSO is a mucosal surgery that induces a midline palatal scar that stiffens the floppy palate. RFVTR is a nearly painless procedure that can deliver controlled radiofrequency energy into the soft palate for the treatment of habitual snoring and mild OSAS. The resulting submucosal necrotic lesions of RFVTR are intended to alleviate snoring through volumetric tissue reduction of the soft palate and shortening of the palate-uvula length. Two different methods are discussed in the present study.

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In patients with birch pollinosis, oral allergy syndrome (OAS) is often complicated because of cross-reactivity. Alnus sieboldiana Matumura (Alnus s.) is a member of the alder family, which is often planted on denuded sites as a convenient countermeasure against landslide or afforestation. The previous epidemiologic study in Ashiya showed an evident relation between the number of airborne pollen grains of alder and the prevalence of alder pollinosis. In 902 residents, the prevalence of OAS was 6.3% in the mountainous area and 1.6% in the flatland area. In 143 schoolchildren, only 2 of 11 OAS children were associated with alder pollinosis. In 3, 997 residents, the prevalence of OAS was 4.0% in a new residental area in Takarazuka city. The quantity of the dispersed number of alder pollen increased the prevalence of both pollinosis and OAS. Lumbering of alder tree improved not only pollinosis but also OAS.
Cross-reactivity between apples and Alnus s. pollen was shown by immunoblot inhibition and the tissue prints using patient's serum and monoclonal antibody against major allergen of Alnus s. pollen. Profilin is thought to be a minor allergen, whereas OAS patients with systemic reaction showed marked reactions in both lymphocyte proliferative response and histamine release, and 4.5 U/ml IgE antiody to alder profilin by use of ELISA.

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Tonsillectomy has been a surgical approach to treat the children with chronic tonsillitis, respiratory failure as a result of hypertrophic tonsils, and focal infection such as rheumatic fever and acute glomerulonephritis. However, pediatricians in general have recently the tendency not to refer those children to otolaryndologists for tonsillectomy. In the current study, the questionnaire-based examination was done to show the indication criteria of tonsillectomy from the viewpoint of pediatricians in six regional hospitals/institutes. In the past five years, 1 to 5 children a year were referred to otolaryngologists for a tonsillectomy because of recurrent tonsillitis (5 institutes), chronic tonsillitis (3 institutes), respiratory failure because of hypertrophic tonsils (6 institutes), and focal infection (1 institute). All pediatricians reported that the surgical approach was effective, no children progressed to an immunodeficient state, only two had a minor complication of post-operative bleeding, and that respiratory failure because of hypertrophic tonsils will be the unique indication of tonsillectomy in the future. The focal infection will be effectively treated with the administration of susceptible antibiotics instead of operative stress for children.

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Some patients with birch pollen allergy (birch pollinosis) report oral allergic symptoms after eating fresh fruits and other vegetables. Recently, the number of those patients is gradually increasing in Hokkaido Prefecture, as they are Europe. The study was carried out on 276 patients (54 males and 222 females) with birch pollinosis, who came to my clinic during the scattering season of birch pollen in 2000, to evaluate the clinical characteristics of oral allergy syndrome (OAS) in birch pollinosis patients . The diagnosis of birch pollinosis was confirmed by seasonal clinical symptoms and the presence of birch specific anti-IgE antibody by RAST (a score equal to or greater than 2). OAS was cheked out by the interview and the original simple questionnaire to 40 kinds of fruits and vegetables . Some were examined by the presence of fruit specific anti-IgE antibody by RAST.
The results were as follows: (1) The incidence of OAS in birch pollinosis was 48.9%, totaling 135 patients (22 males and 113 females) in all patients.(2) The food allergens in OAS were apples, cherries, peaches, pears, melons, plums, and others, in order of frequency.(3) Most patients (84%) were sensitized by multiple allergens.(4) The high frequent symptoms were itching and swelling in the distributed region of trigeminal nerve.(5) The symptoms of OAS after consumption allergens occurred within 15 minutes in most patients (88.2%).
Results indicate that it is necessary to ask about in detail, oral allergic symptoms, including the onset time and food allergens, of all patients in birch pollinosis as the high-incidence of OAS.

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Some reports have been made about tortuosity of the internal carotid artery, and it has been said that most of the chief complaints were abnormal sensations in the throat.
Because we had questions about these complaints, we tried to find cases of tortuosity of the internal carotid artery.
As a result, we found 28 cases during the past two years. Nine were male, and 19 female, this complaint was thus found more frequently in females. Twenty cases were on the right side, 3 cases were on the left side, and 5 cases were on both sides. This revealed that it was definitely more frequent on the right side.
The most common chief complaints were about aural disturbance, on the other hand, abnormal sensation in the throat was found in only three cases. We have concluded that tortuosity of the internal carotid artery does not cause abnormal sensation in the throat.

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This case was an 11-year old child with a chief complaint of earache whose symptons had not improved despite a treatment at a nearby clinic. He was referred to our department for a treatment of his tongue tumor. The lesion presented an ulcerative picture with an irregular surface traversing the floor of the mouth and accompanied in duration extending beyond the median sulcus of the tongue . A biopsy revealed a highly differentiated squamous cell carcinoma . The disease staging at admission was diagnosed as T4N0M0 stage IV from the results of a general examination, including those of imaging diagnosis. The tumor responded slightly to two courses of chemotherapy (5-Fluolouracil and Cisplatin) and appeared to be reduced. However, it expanded to bilateral tonsil fossa even during external irradiation . The patient died 10 months after his first visit without showing response to intra-arterial chemotherapy administered three times.

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Most cases of malignant melanoma show poor prognosis because of the high possibility of distant metastasis and local recurrence. This paper describes a case of primary amelanotic malignant melanoma in the hard palatal mucosa of a 57- year-old man. This case shows that amelanotic malignant melanoma with primary lesion in the hard palatal mucosa was successfully treated with only an intra-tumoral injection of interfbron (IFN)-β, resulting in complete response (CR). This case had a CR after about 4 months. The number of local injections of IFN-β was 82, and the total quandty was 23, 200×10⁴IU. After this treatment, neither local recurrence nor local metastasis was clinically observed; however, the patient died of multiple liver metastasis.
Primary treatment of malignant melanoma is a wide range excision of the tumor lesion and its surrounding normal tissue. However, when it is not possible because, the specific anatomical structure of the head and neck make such treatment difficult, the intra-tumoral injection of IFN would be the optimum treatment.

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Oral Allergy Syndrome (OAS) is a distinctive type of IgE-mediated allergy resulting from direct oral contact with fresh fruits and vegetable. It is proposed to be a result of cross-reacting allergens in the foods and pollens.
We studied 255 patients (95 males and 160 females) with birch pollen allergy (BPA). The diagnosis was confirmed by the clinical symptoms of seasonal rhinitis and the presence of the specific antibirch IgE antibody by CAP-RAST (a class equal to or greater than 2). The onset of BPA, atopic symptoms, and a family history were examined. We asked about oral hypersensitivity to 32 kinds of fruits and vegetables such as apples, peaches, nuts, celery, and melons.
The results were as follows; 1) We found that 42.7% of birch pollen allergic patients had oral symptoms after fruit and vegetable ingestion. 2) The causative foods in OAS, in order of frequency, were apples, peaches, cherries, plums, and others. A total of 82% of patients with OAS showed hypersensitivity to more than two foods. 3) The OAS was significantly related to the duration of BPA. OAS-positive patients had a longer duration of BPA than OAS-negative ones (mean years 9.50 vs 5.99; p<.000005).4) The class for specific antibirch pollen IgE levels was significantly greater in OAS-positive patients than in OAS-negative ones (p<.0000001), whereas no difference was observed in total. IgE levels between the two groups. 5) The prick+prick technique was reliable and practical without too much pseudopodia.

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It has been suggested that inflammatory cytokines play an important role in the crisis and prolongadon of otitis media with effusion. NF-κB is a transcriptional factor that regulates the gene expressions of inflammatory cytokines. The aim of this study is to invesdgate the role of NF-κB activadon in the gene expression of inflammatory cytokines in cultured adenoidal fibroblasts.
The acdvadon of NF-κB was evaluated by electrophoretic mobility shift assay (EMSA). Furthermore, IL-8 gene expression was examined by RT.PCR and ELISA.
EMSA revealed that NF-κB was acdvated obviously by the sdmuladon with IL-1β in adenoidal fibroblasts. The expression of IL-8 was suppressed in a dose-dependent manner when the acdvation of NF-κB was inhibited by TPCK. These results suggested that the activation of NF-κB would be essendal for the expression of IL-8 in adenoidal fibroblasts.

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A case of nasopharyngeal angiofibroma was reported. The patient was a 10-year-old male, who complainted of right nasal obstruction and recurrent epistaxis of the right nostril.
An enhancement CT scan showed a large solid mass that occupied the nasopharynx, nasal cavity, ethmoid sinus, sphenoid sinus, infratemporal fossa, deep orbita, and optic canal with partial destruction of the anterior skull base. Preoperative superselective embolization was performed by using the Seldinger technique one day before surgery. The tumor in this patient was removed completely by craniofacial approach. He had no complication or facial deformity after the operation.

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Natural killer (NK) cells have been considered as the third lymphocyte other than and T lymphocytes. NK cells are capable of inflicting a defense function without adaptive immunity. That is, NK cells can mediate their cytotoxicity at the initial infection toward specific tumor cells or cells infected by viruses. By studying the distribution of the NK cell in the human nasopharynx, we intended to verify the immunological reactions in this region.
Whole-mount histological sections of the nasopharynx were prepared by using five autopsied cases. CD 16, 20, 4, and 8 were used as the prime antibodies. NK cells were identified at all specific sites, (superior-posterior wall, lateral wall, and inferior wall) within the nasopharynx. Moreover, NK cells were distributed along with the lymphoepithelial lesion of the mucosal epithelium; the distribution was more evident in the transitional cell layer than in the ciliated or squamous cell layers.
We concluded that the above-mentioned distribution of NK cells in the human nasopharynx play an important role in our innate immunity.

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This is a retrospective review of 725 tonsillectomies performed under general anesthesia from 1988 to 1997 at Kansai Medical University Hospital. The total incidence of postoperative bleeding was 11 cases (1.5%). Six cases (0.8%) required a second general anesthesia to repair the bleeding. Postoperative bleeding often occurred in cases of habitual angina, in case of patients 11-20 years of age, within 24 hours after the tonsillectomy, or in the left-sided tonsillar fossa. The risks and importance of management after a tonsillectomy, operation. should be fully rearized.

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Uvulopalatopharyngoplasty (UPPP) performed by one surgeon for a period of 9 years was evaluated on the basis of preoperative and postoperative data to determine whether the number of UPPP the surgeon performed and the period of experience in performing them have any effects on the outcome of the surgery. We examined nocturnal sleep, respiratory resistance, and MRI of the upper airway in patients preoperatively and 3 to 6 months after surgery for the 9 year period from 1990 to 1998. The patients were divided into 3 groups according to the 3 year period in which they were treated: period I (n=23), period II (n=10), and period III (n=16). Among patients in period I, the AHI improvement rate was 69.6%, and the proportion of 25% or more improvement was 56.5%. Among those in period II, the AHI improvement rate was 90%, and the proportion of 25% or more improvement was 70%. Among those in period III, the AHI improvement rate was 93.8%, and the proportion of 25% or more improvement was 75%. Comparisons of the results among patients in periods I, II, and III showed that the surgeon's experience has significantly favorable effects on the AHI improvement rate, postoperative respiratory resistance through the mouth, and postoperative transverse diameter of the pharyngeal cavity. The number of cases in which UPPP was performed in period I was 46. The period and amount of experience in performing UPPP are therefore regarded as being a prerequisite for the surgeon to master the UPPP method.

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A 58-year old man complained of a massive painless swelling in the left parotid area. His chief complaint was the inconvenience caused by the large size of the lesion.
Aspiration was repeated many times before the final surgical operation. Surgical resection of the cyst was not easy because it was large, extending from below the buccal region into the superficial lobe of the parotid gland. The gross specimen measured 11 cm at its greatest diameter. Histological examination revealed it to be a retention cyst. This cyst was resected completely without complications, and presently there are no signs of recurrence.

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Monitoring of respiration under unrestrained and noninvasive conditions is indispensable to determine natural respiration during sleep.A pressure sensor bed capable of detecting a decrease in electric resistance with compression was prepared (Denso Corp.) and used to observe respiration during sleep.
Subjects included four healthy adult volunteers (two males and two females, 25 to 31 years old) and 13 subjects with chief complaints of sleep apnea or snoring at night (8 males and 5 females, 25 to 62 years old and an average BMI 26.3). Apnea, blood oxygen saturation and movement of thoracoabdominal wall with respiration were monitored with the Microsleep.Respiration waveform during nightlong sleep was monitored by using the pressure sensor bed. Respiration during sleep was investigated comparatively by using the bed and the Microsleep.
Healthy subjects with normal respiration showed a regular respiratory waveform with the Microsleep and normal oxygen saturation and regular respiration with constant amplitude in respiration waveform. with the pressure sensor. Subjects who complained of snoring recorded constant amplitude and regular respiratory waveform with the Microsleep and the pressure sensor regardless of the sound of snoring as well as subjects with normal respiration. Subjects diagnosed as having a obstructive apnea recorded similar periodic respiration waveforms (Cheyne-Stokes-like breathing waveform) with that of apnea both with the Microsleep and the pressure sensor. These waveforms were observed in all eight cases diagnosed with obstructive apnea.
A correlation was obtained between Cheyne-Stokes-like respiration waveforms, apnea index (AI) and oxygen desaturation 4% index (ODI4) in the measured results with the Microsleep in an hour. Sleep apnea could be detected by using a thoracoabdominal spirogram during sleep.

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Forty-four patiants who had squamous cell carcinoma of the tongue, that could examine into the primary lesion and cervical lymph node, were studied. The evaluation of histopathological malignancy in the primary lesion of squamous cell carcinoma of the tongue was discussed, together with how this was related to cervical lymph node metastasis. It has been confirmed that carcinoma invades into the deep layers, carcinoma might become less differentiated.
Histological variables examined included invasion within the muscle layer, length of muscle layer, depth of invasion within the muscle layer, perineural and lymphovascular space invasion, histological differentiation (the whole, the part of invasive front, the change in deep layer).
A statistial association with cervical lymph node metastasis was found in the following factors: the depth of invasion within the muscle layer (p<.01), perineural invasion (p<.01), and grade of histological differentiation in the most invasive lesions (p<.05). It has further been shown that there is a close relationship between perineural invasion and the depth of muscle layer invasion. This suggests that perineural invasion is one factor that enhances the increase in depth of invasion within the muscle layer.
Our treatment policy for the above is that if carcinoma is not metastasis into cervical lymph node and the invasion of the muscle layer is less than 7mm in the primary lesion, we will resect the primary lesion only and then carry out a histopathological study to determine the prognosis.

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[in Japanese]

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[in Japanese]

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[in Japanese]

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In choosing a corrective procedure for patients with facial palsy following parotid tumor resection, nerve grafts are mainstays. They are used for defects in which a tensionless closure is not possible with primaty anastomosis. Two or three grafts are usually placed from the main trunk to peripheral nerve branches to the eye, cheek and lip, excluding the forehead and cervical branches. Epineural nerve repair is commonly employed for extratemporal grafting. After the nerve edges have been freshened with microscissors an epineural suture is performed under an operating microscope with 8-0 or 9-0 monofilament nylon. A green square of silicone sheeting is used beneath the nerve ends to improve visibility during suturing. For the first merhod, two sutures 180 degrees apart are used as traction sutures to rotate and expose in inferior border to the nerve. Usually, six sutures are used for the main trunk and fewer sutures for smaller peripheral nerve branches. The most critical factor affecting the final result is the degree of tension on the suture line. An increased tension contributes to wound separation, leading to both axon escape with neuroma formation and to fibrous ingrowth of scar tissue.

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