A tonsillectomy was performed on adult patients with OSAS, Obstructive Sleep Apnea Syndrome, which was caused by tonsillar hypertrophy. As a result, clinical symptoms showed remarkable improvement.
Fifteen cases (48.4%) that had been rated at 16 or higher (a serious condition) in preoperative ESS, Epworth Sleepiness Scale, recovered to a normal level after the operation.
When compared to the cases whose ESS was 15 or lower, those at 16 or higher showed lower levels in the minimum SaO₂. Therefore, ESS severity is reflected in the severity of OSAS.

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There are some causes of unusual feeling of the mouth after medical treatment, such as after a tonsillectomy and a laryngomicrosurgery. We experienced some cases that unusual feeling of the mouth was occurred after dental treatment. Objective: Three men and six women (average age; 47.3±11.9years.) were examined by interview, taste examinations and measurement of salivary flow. Results: Six patients complained of a taste disorder, five complained of a feeling of numbness and four complained of no sense. There were six patients who were detected with an abnormal taste function by an electrogustometry, and five with a filter paper disc method. Serum zinc deficiency was recognized in three patients. Conclusion: Since a lingual nerve runs under the membrane of the floor of mouth near the part of the last molar, it is speculated that dental treatment near the molar influences feeling of the mouth.

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Many researchers have reported on decreased saliva secretion, suggesting a possible connection to sex hormones, yet specific evidence has remained inconclusive. We studied if apoptosis in male rat parotid glands changes according to the sex cycle. In our method, we extracted sexually mature rat parotid glands, and incorporated their images into a computer using a digital camera, and measured the number of TUNEL-positive cells per millimeter, using image processing software. As a result, a significant increase of TUNEL-positive cells during metestrus was noted, according to the sex cycle, regardless of age (weeks). In rat parotid glands, a significant relation between sex hormones and apoptosis was suggested.

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We reported three cases of lingual thyroid. A 37-year-old female with a complaint of throat pain, a 40-year-old female with no symptoms, and a 45-year-old female with a complaint of cough came to our clinic. Hemispheric swelling at the base of the tongue was pointed out in all cases. MRI examination showed these lesions as round masses at the base of the tongue and the thyroid glands were not present at the normal position. Tc scintigram showed accumulation only at the base of the tongue. We diagnosed these lesions as ectopic thyroids of the base of the tongue. High levels of TSH were found in all cases and low levels of F-T₄ were found in two cases. The administration of thyroid hormone led to a reduction of swelling of the lingual thyroid.

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Sentinel lymph nodes (SLN) first received lymph flow from a primary lesion of a malignant tumor. Our case subject was a 42-year-old male who suffered from tongue carcinoma (T 2 N 0) with three SLNs which were metastasized. The patient complained of tongue pain of the left side. Partial resection of the tongue and upper left neck dissection was planned.
Because sentinel lymphoscintigraphy revealed three hot spots, one of them was in the lower neck region, we performed a selective neck dissection (level I-IV). The lower SLN was on the borderline between level DI andIV. If the initial neck dissection was performed, this SLN may not have been removed. The three SLNs were the only metastatic nodes found in the pathological examination. In this case, SLN study was effective for diagnosis of lymph node metastasis.

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The objective of this study was to define the clinical implications of the immunohistochemical detection of lymph node micrometastases in patients with N O-stage hypopharyngeal cancer. Cervical lymph nodes stained for cytokeratins by the monoclonal antibody cocktail AE 1/AE 3 were systematically removed from 24 patients and examined. Patients with micrometastases showed a significantly worse survival rate than those without micrometastases (P<0.05). Nodal micrometastases were found in 10 patients (42%). Level III of cervical lymph node was involved more frequently (21%) in patients with lymph node micrometastases. This finding argues in favor of preventive neck dissection for N 0-stage hypopharyngeal cancer and indicates that immunohistochemistry for cytokeatins in the cervical lymph node of hypopharyngeal squamous cell carcinoma is clinically useful.

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In order to determine the indication of UPPP against patients of sleep apnea syndrome (SAS), we investigated simple tests that can be applied easily at the outpatient office of the hospital. We used fibroptic examination of the pharynx (or larynx), cepharography, snoring sound test, and apnea hypopnea index (AHI). As a result, patients with tonsillar hypertrophy and stenosis of the oropharynx due to swelling of bilateral pharyngeal walls, found at the snoring sound test and without risk of facial configuration. Although the surgery did not produce radical treatment results, UPPP played a valuable role in assisting other treatments.

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A 25-year-old man of extremely progressive pleomorphic adenoma was reported. First, a huge tumor arising in the parapharyngeal space was surgically removed by using the cervical-parotid approach. Nine months later, a cervical vertebral tumor at C 5/6 was found. Twelve months later, this metastasized tumor was extracted. The histological examination showed benign pleomorphic adenoma, which was similar to that of the initial tumor. None of the malignant pathological findings were observed in both histological sections. Sixteen months later, he died because of the development of extensive tumors in both lungs. Based on the rapid clinical course, metastasis to bone and lungs, and histological results, we diagnosed this case as a rare, progressive metastatic pleomorphic adenoma arising in a very uncommon region.

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Seven cases of intraparotid facial neurilemoma were reported. Magnetic resonance (MR) findings including tumor extension to the stylomastoid foramen, target sign and multicentricity as well as frozen section diagnosis were effective tools for diagnosis while aspiration biopsy cytology was not helpful in preoperative appraisal. Tumor extension to the stylomastoid foramen in MR imaging was a sign of preoperative facial nerve palsy. Comparison of histopathological findings with MR findings indicated that differences in local cell growth of the tumor causes target sign in MR imaging. Because intraparotid neurilemomas are often misdiagnosed as pleomorphic adenoma which shows tumor recurrence after scattering of the tumor cells in the surgical field, preservation of tumor capsules with the facial nerve accompanied by tumor rupture may be preserved in the surgery only when the diagnosis of neurilemoma is confirmed.

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In this article, we report one case of calcific prevertebral tendonitis and one case of abscess of the cervical intervertebral disk, in whom retropharyngeal abscess was suspected because of swelling and reddening of the posterior pharyngeal wall, but was ruled out using imaging tests. The former case was a 46-year-old female. She visited our department with complaints of pharyngeal pain and pain associated with neck rotation. Visual inspection suggested retropharyngeal abscess and she was hospitalized. Computed tomography (CT) of the neck revealed no abscess, but showed calcification in front of the second cervical vertebrae. Therefore, she was diagnosed with calcific prevertebral tendonitis. The latter case was a 58-year-old male. He received ureteral catheter replacements which were performed by an urologist every three months. On 1^st October 2001, neck pain and shoulder pain on both sides occurred after a nerve block was performed via the sacral hiatus. On 9^th October, he was hospitalized in the orthopedic department. He was transferred to our department because retropharyngeal abscess was suspected from the result of the neck CT scan. His swallowing difficulty was improved by infusions of antibiotics and steroids, but he was diagnosed with osteomyelitis of the cervical vertebrae associated with perivertebral abscess. Since paralysis on both sides of the upper extremities developed, abscess incision and drainage were performed by orthopedic surgeons.

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A case of a 61-year-old man is reported who was referred to our clinic because of a swelling of the right palatine tonsil, obstructing his respiration. In the past year, he had suffered multiple swelling of the neck lymph nodes, diagnosed histologically as Castleman's disease. At the age of 15, the patient underwent a tonsillectomy only on the left side, thus leaving the right side neglected.
The examination revealed a diffuse, tender enlargement of the right palatine tonsil and a tonsil-like tumor on the left side. After the tonsillectomy to treat the respiratory disturbance, histological examination revealed marginal zone B-cell lymphoma of the palatine tonsil. Postoperative follow-up has revealed no signs of recurrence. We describe this case with some comments based on the documentation.

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A retrospective study for 58 children patients complaining of snoring or sleep breathing disorders was performed. The patients were less than 12 years old and visited the outpatient clinic of the Department of Otolaryngology, Kagoshima University Hospital, between January 1999 and March 2003. The methods of treatment, including surgery, postoperative recurrence of sleep breathing disorders, and postoperative complications were investigated and discussed. Surgeries were performed for 21 cases. Bilateral tonsillectomy together with adenotomy were done in 11 cases, adenotomy in 6 cases, bilateral tonsillectomy in 3 cases, and bilateral tonsillotomy together with adenotomy in 1 case. There were no cases with a recurrence of sleep breathing disorder and complications such as immunodeficiency after surgery. These results indicate that the diagnostic criteria are essential and should be established for children obstructive sleep apnea syndrome.

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Synchronous unilateral tumors of the parotid gland are rarely found. Moreover, synchronous unilateral parotid gland tumors of different histologic types are extremely rare. In this paper, we present a case that Warthin's tumor and pleomorphic adenoma coexist in a unilateral parotid gland. A 65-year-old man with synchronous parotid tumors was treated at our hospital. The result of preoperative fine needle aspiration was pleomorphic adenoma. In the operation we identified facial nerves not from the main trunk, but from branches because we thought the tumor existed nearby main trunk of facial nerve and its volume was high. Pathological examination revealed that Warthin's tumor and pleomorphic adenoma were coexisting and not mixed. Both Warthin's tumor and pleomorphic adenoma are major tumors arising in the parotid gland, and the combination of Warthin's tumor and plermorphic adenoma occupy nearly 50% in the synchronous unilateral parotid gland tumors of different pathologic types, we could find only 20 other cases of synchronous Warthin's tumor and pleomorphic adenoma in the previous reports.

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Tonsillar focal infections have been suggested to play a role in the induction or exacerbation of autoimmune diseases. However, the detailed pathogenesis still remains unclear. We report cases of acrodermatitis continua of Hallopeau and multiple sclerosis, and discuss the suggestive pathogenesis as focal infections. The former case is a 50-year-old woman with a 3-month history of acrodermatitis continua in-volving fingertips, a nail, and a palm. We noted her history of chronic tonsillitis over 20 years, and then performed a tonsillectomy. Consequently, she was cured completely of those lesions. The latter case is a 28-year-old woman, who has been suffering from multiple sclerosis for 13 years with exacerbation of the disease triggered by tonsillitis at least 13 times. We performed a tonsillectomy on her. As a result, the frequency of disease exacerbation with upper respiratory infections decreased. No documentation of a case cured of both diseases by tonsillectomy has been reported.

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The piriform sinus fistula is known to cause acute suppurative thyroiditis or recurrent cervical abcess. Pharyngoesophagography is useful for the diagnosis. Conservative treatments such as administration of antibiotics, surgical incision and drainage are often done, however, a radical treatment includes complete removal of the fistula, fistelectomy and partial thyroidectomy.
We reported a case of a 31-year-old male with piriform sinus fistula, which had caused high fevers and painful swelling in the left neck since infancy. A fistula of the left piriform sinus was detected by pharyngoesophagography. Both a CT and an MRI showed atrophy of the left lobe of the thyroid. The patient took pyoctanin the day before the operation to detect the fistula. We were able to confirm the location of the fistula by staining during the operation and removed it completely. Five days after the operation, we comfirmed the closure of the fistula under pharyngoesophagography.

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Many otolaryngologic diseases are considered to be associated with psychogenetic factors. Although these diseases are common in daily practice, they are often difficult to treat. One such disease is oral discomfort involving spontaneous cacogeusia and glossodynia. We recently reported that spontaneous cacogeusia could be a symptom of depression, and that patients with oral discomfort tended to have depression more often than other diseases. Therefore, we examined the effect of SSRI, the recent first-line therapy for depression, on oral discomfort in the present study. We showed that SSRI therapy tended to be more effective than anxiolytic therapy, and that the efficacy was increased when SSRI therapy was combined with psychotherapy and counseling. Since otolaryngologists should treat depressed patients who only complain of otolaryngologic symptoms as effectively as possible, they should be prepared to manage patients in a state of depression.

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Clinical studies of 20 patients with Infectious Mononucleosis (IM) were performed from 1998 to 2003. In this study, We defined the criteria of IM as three cardinal symptoms (pyrexia, swelling of the lymph node and an increase monocytes) and the detection of serum VCA-IgM antibodies or EA-IgG antibodies. In this study, there were seven 10 year-old patients and eight 20 year-old patients. Sixteen of those cases showed symptoms of exothermic duration for less than one week. A high temperature of 38°C was recorded in 11 cases. There were 17 patients confirmed with liver dysfunction. Half of the patients needed about two weeks of recovery. Tonsillar exudates were confirmed in 18 patients, while cervical lymphadenopathy was defected in everyone. We reported a case of IM for which the diacrisis from subacute necrotizing lymphadenitis proved difficult. The patient wasa 27-year-old Japanese woman complaining of cervical lymphadenopathies and pyrexia, and the onset of tonsillitis was detected one week later.

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