[in Japanese]

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Behcet disease (BD) is a multisystem disorder presenting with recurrent oral and genital ulceration, uveitis, and skin eruption. BD is known to be one of the tonsil related diseases because the patients have a high incidence of history of tonsillitis that worsens symptoms of the disease. In this report, we performed tonsillectomy in four patients with BD. The patients consisted of each two males and females, aged from 12 to 57 years with 37 years the median value. Of four patients, three had a history of recurrent tonsillitis that worsened their symptoms. Three patients showed a high serum ASO level. By 10 months after tonsillectomy, all patients had improved symptoms; two patients especially showed disappearance or marked improvement in all symptoms involving oral, eye and skin lesions. These results suggest that tonsillecto my may be an effective clinical treatment for Behcet disease.

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We studied 38 cases of submandibular sialolithiasis who underwent operations in the Department of Otorhinolaryngology, Head and Neck Surgery, Kitano Hospital, Japan between May 1994 and May 2004. CT scan was thought to be most suitable for preoperative examination. All 7 patients with distal stone location, 22 of 23 patients with stones of the perihilar region, and 1 of 8 patients with stones of parenchyma were free of stones by transoral removal of stones under general anesthesia. When the stone could not be palpated bimanually, submandibulectomy had to be carried out for the treatment, but in all cases that stones could be palpated bimanually, transoral removals were successful wherever the stones were. When we perform transoral removals, we don't suture the Wharton' s duct and mucosa of the oral floor, but in 30 cases of our transoral removals, plunging ranula was found in only one case, and recurrence of lithiasis and damage to the lingual nerve could not be found. Transoral removal should be the treatment of choice in patients with submandibular stones that can be palpated bimanually.

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The case was a 48 year-old-woman, and the chief complaint was swelling of the right submandibular part. She noticed the swelling since around Oct. 2002 and on Nov. 27, 2002 the case was introduced to our department by a dentist for a checkup. Palpating indicated hard mass at a size of 28×20mm in front of the submandibular gland. An inflammatory mass was suspected from the test result and image findings, and the patient was scheduled for follow up. It was resected for diagnosis on Mar. 19, 2003 due to an enlarged phyma. A histopathology diagnosis of an abscess and granulat ed tissue formation was reported. Because the same locus had enlarged further when seen on Oct. 6, 2003, external dental fistula was suspected. It was reported to the dentist that the possibility of external dental fistula was low. Because stoma formed in the mandibular direction, which was confirmed on Dec. 16, 2003 when we inserted conductor, we presented the case to the dentist again. The tooth was extracted and there has been no recurrence to date.

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Reproducibility of the gustatory thresholds with Salsave test was examined for 30 healthy volunteers. Volunteers without taste disorders or any systemic complications such as diabetes mellitus and hypertension were involved in the study. The concentration of zinc in serum was checked and confirmed to be within the normal range in each subject. The Salsave test was performed by the rising method and the recognition and detection thresholds were determined three times with a 4-week or longer interval. In the results, the gustatory recognition threshold was decreased in the second and the third examinations compared to the first examination. However, there was no significant difference in the gustatory detection threshold between each examination. The recognition threshold was not correlated with the detection threshold in one case and was remarkably higher than the detection threshold. The findings demonstrate the reproducibility of the Salsave test and the importance of the detection threshold in Salsave test as a benchmark in following up a patient with taste disorder.

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Data for 100 adult patients that underwent PSG in our hospital during a 14-month period from April 2003 to May 2004 were analyzed. Seventy-five patients were diag nosed as SAS. Forty-three patients were using n-CPAP. In four of them n-CPAP was withdrawn. The compliance was 91%. Two cases that dropped out were improved by the operation. Combination therapy can be recommended to improve the compliance of n-CPAP and long-term treatment of SAS.

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We investigated the influence of the grade of tonsillar hypertrophy and the presence of nasal disease on the treatment by CPAP (Continuous Positive Airway Pressure) in patients with sleep apnea syndrome. In the groups of tonsillar hypertrophy at grade 0 (no hypertrophy) or grade 1, CPAP was effective. In the group of grade 2, AHI (Apnea-Hypopnea Index) improved to over 80%, but AHI still remained to over 10. In the group of grade 3, however, the effect of CPAP was poor. In patients with nasal disease, the effect of CPAP proved to be worse in every group. In the groups of grade 0 and 1, the influence on the effect of CPAP was more severely damaged by the presence of nasal disease, as compared to the grade of tonsillar hypertrophy. In the groups of grades 2 and 3, on the contrary, the influence of the tonsillar hypertrophy was more severe than the nasal disease.

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We report a case of parotid gland malignant mixed tumor extended to the parapharyngeal space. The patient was a 73-year-old male complaining of a subparotid swelling without facial palsy. MRI examination demonstrated a large mass in the right parapharyngeal space, which extended near skull base. The tumor was resected surgically using the push up method by medial mandibulotomy. Microscopic examination showed that the tumor was composed of adenocarcinoma and malignant myoepithlioma. There was no component of pleomorphic adenoma as a background, which is usually identified in a case of carcinoma in pleomorphic adenoma. The patient was given radiation therapy of 60Gy/30f after surgical extirpation.

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Taste disorders often occur following transection of the chorda tympani nerve (CTN) during middle ear surgery. It has been shown that the severeness of taste disorders and the recovery period varied in each case. In this paper, we observed the distribution of the fungiform papillae (FPs) of the tongue macroscopically following tran section of the CTN. Fifteen ears of 15 patients (8 men and 7 women) were subjected to this study. The distribution of FPs in the apex liguaes was classified as follows. A: FPs which were located in the operative side atrophied and disappeared (n=2). B: FPs were found in the operated side within 1cm over the midline of the tongue (n=3). C: FPs were found in the operated side more than over 2cm from the midline (n=2). However FPs at the corpus linguaes were never found in the operative side over the midline of the tongue (n=7). These findings indicate that not only the apex liguaes but also the corpus linguaes may have innervation crossover or reinnervation, and that the reinnervatioin can extend more than over 2cm beyond the midline of the tongue.

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We conducted a bacteriological study of 209 patients with peritonsillar abscess treated in our in-patient department between October 1983 and March 2004. The patients were 160 males and 49 females ranging in age from 2 to 80 years (average age 33 years). Purulent effusions taken from the abscesses were cultured under aerobic and anaerobic conditions at the bacterial laboratory of Oita University Hospital. Bacteria were isolated in these cultures. Antibiotic susceptibilities were tested by a microdilution method. Antimicrobial resistance was defined according to the criteria of the National Committee for Clinical Laboratory Standards.
We detected 351 strains of bacteria in 187 (89%) of the 209 patients. About half of the patients showed mixed infection. Two hundred twenty-seven of the 351 strains were aerobic; the remainder were anaerobic. Aerobes were detected in about 70% of the patients, anaerobes were detected in 40% of the patients, and both types were detected in 20% of the patients. The aerobes most frequently identified were S. pyogenes (17.2%) and S. milleri group bacteria (17.2%), then non- S. milleri Oral streptococci bacteria (5.8%). Fifty-three percent of aerobes were β-hemolytic strep tococci. The anaerobes most frequently identified were Prevotella spp.(26.2%), Fusobacterium spp.(20.2%), Anaerobic gram- negative rod (19 .4%), and Peptostreptcoccus spp.(8.1%). About 40% of the S. pyogenes isolates were resistant to ofloxacin. About half of the S. milleri group isolates were resistant to cefotiam. Twenty-two percent of S. pyogenes, 20 % of Oral streptococci, and 9 % of anaerobes were clindamycin-resistant.
All patients in whom antimicrobial resistant pathogens were detected were treated successfully. However, when treating peritonsillar abscess, we should take into consideration the growing number of S. milleri group bacteria that are highly resistant to cephalosporin and the potential for the presence of clindamycin-resistant pathogens.

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We analyzed the clinical and histological findings of 46 patients with nasopharyn geal carcinoma (NPC) treated at Saga University hospital between 1981 and 2004. The patient population included 35 men and 11women, aged 20 to 80 years (mean: 57 years). As primary treatment, eight patients received combination therapy of peplomycin followed by radiation; 22 patients received neo-adjuvant chemotherapy followed by radiation; 16 patients received CDDP-based concurrent chemo-radiotherapy. The five-year survival rate of all the patients was 46%. Compared to treatment with peplomycin followed by radiation, concurrent chemo-radiotherapy significantly increased five-year survival rate of patients with NPC.

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A 12-year-old male with mandible fibrous dysplasia is reported. He was suffering from a swelling of the right cheek. Examinations by magnetic resonance imaging (MRI) and computed tomography (CT) revealed a mass at the ramus of mandible. Biopsy was performed and the histological examination diagnosed fibrous dysplasia. In order to avoid deformity and dysfunction of the lower jaw, we did not perform surgical resection and followed up without any treatment. After three years observation, the mass regressed spontaneously.

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The incidence of retropharyngeal abscess has decreased due to advances in antibiotics treatment.
We observed a case of retropharyngeal abscess in a 10-year-old male with autoimmune hepatitis, who had been treated with steroids and immunosuppressive drugs.
We performed incisional drainage of the abscess orally. Mycobacterium fortuitum was detected from aspirated pus within the abscess.
We successfully treated this patient with combined antibiotics appropriately sensitive to Mycobacterium fortuitum.
This is the first case report of retropharyngeal abscess caused by Mycobacterium fortuitum.
Similar condition could occur as a complication in immunosuppressive patiant.

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Contact-endoscope is a useful tool for evaluation of the tongue microstructure. However it is difficult to fix the endoscope on the tongue continuously due to instability of the hand. We devised a stable fixed method. With the suction-irrigation system on the endoscope for sucking the tongue, the best negative pressure was 200cm H₂O. In addition, we used the endoscope holder. Using this method, it is possible to observe the tongue microstructure for a period of over sixty seconds.

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Purpose: To evaluate the efficacy of rapid superselective high-dose cisplatin infusion and high-dose-rate radiotherapy for previously untreated patients with advanced tongue cancer.
Patients and Methods: Four patients who rejected radical surgery were given superselective intra-arterial infusions of cisplatin (100-120 mg/m²/week) with simultaneous intravenous infusion of thiosulfate to neutralize cisplatin toxicity and conventional extrabeam radiotherapy (30-50Gy). And then high-dose-rate radiotherapy and tracheostomy was undergone under general anesthesia. Two patients with persistent neck disease received neck dissection.
Results: One patient is alive without disease 4 years and 4 months after first visit to our hospital. Atrophy of her tongue is seen but she is able to have oral intake the same as before without pain. One patient died with lung metastasis and without loco-regional recurrence eight months after first visit to our hospital. Deep tongue and oral floor ulcer occurred in this patient. The remaining two patients are alive without disease and severe adverse effect although the follow-up periods are short.
Conclusions: We confirmed the efficacy of superselective arterial infusion and high-dose-rate radiotherapy for advanced tongue cancer. Further studies are needed to establish the indications, long-term outcome and possible late adverse effects of this treatment.

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Plasmacytoid dendritic cells (PDCs) have immunoregulatory roles, linking innate with adaptive immunity. In the present study, we investigated the characteris tics and the function of tonsillar PDC. PDCs were isolated from human tonsils and analysed by flow cytometry. The expression of toll-like receptors (TLRs) mRNA was also analyzed by RT-PCR. In addition, PDCs were stimulated in vitro with CpG DNA, and cytokine production in PDCs was determined by ELISA. The result showed the characteristics of tonsillar PDCs, which were Lin-, CD4⁺, CD11c^-, CD40⁺, CD123⁺, HLA-DRmod, CD80^-, CD86^-, CD83⁺. The expressions of TLR7 and TLR9 mRNA were detected in PDCs. Differential cytokine production via TLR9 signaling was observed in PDCs. A type CpG, CpG2216 induced IFN-a production, whereas B type CpG, CpG2006 and co-stimulation with anti-CD40 antibody induced IL-12 production in tonsillar PDCs. These findings indicate that PDCs might play an important role as a link between innate and adaptive immunity in the tonsil.

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There is great variability in the MR findings of pleomorphic adenoma, which are the most common tumors of the parotid gland, reflecting the various proportions of cellular. mvxoid. and fibrosis components.
The purpose of our study was to correlate the magnetic resonance (MR) features and histopathological findings of pleomorphic adenoma and to interpret these findings. We reviewed MR studies of 60 pathologically proven pleomorphic adenoma. Forty-five cases (75%) showed high signal intensity for the normal parotid gland on T2-weighted images. The diagnostic clue of pleomorphic adenoma is to find the myxoid component, which shows a high intensity on T2-weighted images. Nine cases (15%) showed iso or hypo intensity on T2-weighted images. Six cases (10%) showed hypointensity on T2-weighted images, reflecting fibrosis. We speculated that hypercellularity with less myxoid stroma reduced the intensity on T2-weighted images.
Although it has been reported that pleomorphic adenomas typically have a high signal intensity on T2-weighted images, 25 % cases of pleomorphic adenoma demonstrated iso intensity or hypo intensity in this study.
It is likely that understanding these relationships between T2-weighted signal in MRI and pathological findings will improve diagnosis of parotid pleomorphic adenoma.

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Neuroleptic medications may affect swallowing function. This report described 15 cases of neuroleptic-induced dysphagia and their swallowing functions were assessed by videofluorography. All the patients were administered one or more drugs including bensodiazepine sedatives, antidepressants, and antipsychotic drugs. Six patients had a history of aspiration pneumonia. Videofluorographic examination showed slow oral transport of the bolus. Pharyngeal clearance of the bolus was generally disturbed. These swallowing disorders resulted in impaired oral and pharyngeal swallowing phase. In patients who received withdrawal or modification of the drugs, gradual improvement of dysphagia was successfully achieved. Clinicians should be aware of the disease entity of neuroleptic-induced dysphagia and that it is a reversible feature.

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