The reliability of and problems with B-mode ultrasonography, color doppler echography and ultrasonically guided fine-needle asapiration biopsy on clinical materialsare discussed.
Between 1984 and 1988, ultrasonographic examinations were performed in 119 cases of parotid tumor. According to the echographic criteria for differential diagnosis of parotid tumor, the accuracy rate was 88.2%.
Since 1985, we have also performed ultrasonically guided fine-needle aspiration biopsy in 115 cases of parotid gland tumor. In the differentiation between benign and malignant tumors, the accuracy rate for benign tumor was 95.7%. There was only one false negative diagnosis in 23 cases of malignant tumor.
The accuracy rate for the histological diagnosis of benign tumor was 90%, and that for malignant tumor was 78%. No complication of aspiration biopsy occurred in this series.
Color doppler echography was used in several cases of parotid tumor. In a case of parotid adenocarcinoma, blood flow through many small vessels could be observed within the tumor.
It is concluded that ultrasonography is useful as a first examination to differentiate between benign and malignant parotid tumors.
Ultrasonographically guided fine-needle aspiration biopsy is a safe and reliable technique for the cytologic and histologic diagnosis of parotid tumor preoperatively.
Color doppler echography is probably useful to differentiate parotid gland malig nancy if many echoes of vessels are seen within the tumor.

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In this retrospective study of benign parotid tumors, 166 patients were treated with limited excision. No recurrences were observed in these patinets. Temporary facial paralysis occurred in 16.3% and Frey's syndrome in 42%. In comparison with the reported results of superficial parotidectomy, limited excision appears to be preferable in the treatment of benign parotid tumors.

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The authors operated on 178 parotid masses of different etiological-39 malignant and 139 benign-from 1976 to 1989. The facial nerve Was sacrificed in 13 benign lesions and in 32 malignant tumors.
When malignant tumors are removed the facial nerve is inevitably sacrificed, When a tumor, even of it is benign, adheres to the facial nerve, the involved branches of the nerve must be resected.
When the facial nerve was sacrificed, nerve repair or muscle transfer technique was employed. We restored facial function in parotid surgery according to the following principles: 1. When the top or bottom branch is sacrificed, nerve anastomosis or nerve grafting is indicated. 2. When the third or fourth branch, but not the top and or the bottom branch is sacrificed, nerve repair is not always required. 3. When the first or second branch is sacrificed, partial nerve grafting is indicated. 4. When the trunk is sacrificed, total nerve grafting is indicated.
To reinforc the effect of reconstruction by nerve repair, we have recently added muscle transfer techniques (the temporalis, masseter or digastricus) and facial suspension. When intra- and extra- temporal portions of the nerve are removed, muscle transfer techniques with facial suspension are employed. The aim of muscle transfer is to obtain dynamic and static reconstruction of the face. For facial suspension, we use a Gore-Tex Soft Tissue Patch.

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The author administered one of three Kampo medicines (Bakumondo-to, jiin- kokato and Gosha-jinki-gan) to adult otolaryngological patients with dry mouth and/or throat and evaluated the efficacy of the formulations by analyzing the patients' subjective symptoms and the salivary flow from the right parotid gland.
Bakumondo-to was used most frequently (by 37 of the 53 Patients).
Thirty to 60 minutes after the administration of Bakumondo-to, the average salivary flow rate (mg/min) was significantly higher than the pre-administration flow rate. However, a long lasting effect (2 hours or more) was not observed in this objective study, as some authors have claimed for this formulation.
Subjectively evaluated, the effect of this formulation was satisfactory. A marked increase of saliva was reported by 44% of patients 30 to 60 minutes after taking the medicine and by 48% 2hours or more after taking it.
The author also briefly describes and discusses the other two Kampo medicines.

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Saibokuto was given to 81 patients with abnormal sensation in the throat with or without dry sensation, and Bakumondoto to 18 patients with abnormal sensation in the throat with dry sensation.
Saibokuto was effective in 71% of the 81 patients, in 76% of the patients without dry sensation, and in 64% of those with dry sensation. It was less effective in patients over 70 years of age.
Bakumondoto was effective in 78% of the patients dry senation, and it was more effective in the older patients.
No side effects were noted with either drug.

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We have succeeded in cloning an Epstein-Barr virus (EBV) genome-negative clone and an EBV genome-positive clone of the A2L/AH cell line as a nasopharyngeal carcinoma model.
We have continued to culture two clones, since it is possible that EBV may disturb the mechanisms that regulate tumorigenicity when cells are grown in vitro for long periods of time. The EBV genome-positive A2L/AH clone has become tumorigenic in nude mice after many passages in culture, whereas EBV genome-negative A2L/AH cells are non-tumorigenic after the same number of passages. The data suggest that EBV may be associated, at least in part, with tumorigenicity in nude mice.

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For juvenile nasopharyngeal, angiofibroma which has extended into the pterygopalatine and infratemporal space, surgical approach to the tumor shoud be individualized depending upon the extent of the tumour.
Our surgical approach to the pteryngopalatine and infratemporal space is as follows. En bloc sharp resection of the anterior and posterior bony and mucosal wall of the maxillary sinus with partial resection of the posterior portion of the medial wall of the antrum, preserving the infraorbital rim, the zygomatic prominence, the alveolar process and the hard palate, enables the surgeon to dissect the tumor and ligate the nutrient vessels under direct vision in a wide operative field. For removol of tumors in the nasopharynx, a conventional transpalatine approach is added if necessary. After removal of the tumor, the resected wall of the antrum is replaced to its original site and fixed. Postoperative long-term follow up from 8 to 9 years in 2 patients revealed no apparent changes in the facial contour, although CT syowed moderate inhibition of the growth of the air-containing maxillary cavity.

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Four patients with Behcet disease (2 incomplete and 2 complete type) recurrent tonsillitis are reported. Oral aphthae were generally seen as the first symptom of Behcet disease and other symptoms appeared as the disease progressed. Blood examination revealed an increase of IgA and markedly elevated ESR, CRP and complement. Patients with recurrent oral aphthae should have complete physical examinations.
Streptococcal infection has recently been recognized as playing an important role in Behcet disease. Tonsillar focal infection was definitely suspected from the past history and the results provocation tests.
Tonsillar bacterial cultures revealed D group streptococcus in 50% of our cases. Tonsillectomy was performed in all 4 patients. Postoperative blood examinations were normal one month after operation.
The clinical symptoms became worse temporarily just after tonsillectomy, but the postoperative course was usually good.
Before and after operation, the complete type of Behcet disease was controlled with prednisolone and the incomplete type with colchicine. Surgery should be performed during the inactive stage of this disease to avoid postoperative deterioration.
The operation should be performed before the onset of severe ocular, neurological and vascular lesions, just as in other diseases secondary to tonsillar focal infection. We conclude that tonsillectomy was definitely effective in patients with Behcet disease and tonsillar focal infection.

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Oropharyngeal soft tissue profiles in 110 patients (92 men and 18 women) who snored, or had apnea during sleep, were evaluated by cephalometry in the inspiratory and expiratory phases. In patients diagnosed as having sleep apnea syndrome by polysomnography, the distances between the post nasal spine and the tip of the uvula and between the sella and the tip of the uvula in the inspiratory phase were significantly longer than in the expiratory phase. In patients with normal polysomnographic recordings there was no significant difference in the distance between these points. We conclude that cephalometry performed in each respiratory phase is useful in the diagnosis of sleep apnea.

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We evaluated 17 Patients with obstructive sleep apnea treated with uvulopalatopharyngoplasty (UPPP). Their mean age was 47.9 years (range 31 to 68 years). Polysomnography was, performed before and after surgery. We monitored the intra esophageal pressure to assess respiratory effort. After surgery, the intraesophageal pressure during sleep was improved in all but one patient. When it improved to half the presurgery level or to that of healthy adults, the number of apneic episodes per hour of sleep (apnea index) was reduced significantly. Transcutaneous pO2 variations almost disappeared. Intraesophageal pressure is very useful in the evaluation of respiratory disturbance.

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From A pril 1988 through April 1989, 22 patients with mandibular fracture were treated at the Osaka Dental University
1) There were 17 (77.3%) male patients, and 5 (22.7%) female patients. Their ages ranged from 1 year to 80 years. Over 19 (86%) of the fractuers in patients aged 16 to 46 years.
2) The causes of fracture in the 22 patients were as follows: traffic accidents, 7 (31.8%): fights, 5 (22.7%); sports, 4 (18.2%); industrial accidents, 3 (13.6%); falls, 3 (13.6%).
3) Orthopantomography or postero-anterior roentgenographic projection generally best demonstrates the mandibular fracture.
4) If the 22 patients, there were 37 fractures. Nine patients (41%) had a single fracture of the body. Thirteen (59%) had multiple fractures of the mandible: 11 patients (84.6 %) had two fractures and 2 (15.4%) had 3 fractures. Eight patients (36.3%) had condyle neck fractures. The condyle neck fracture was associated with fracture of the body of the mandible in 4 patients.
5) Seventeen patients (90.9%) were treated with closed reduction. Intermaxillary elastics applied to guide the occlusion are typically required for two days. Intermaxillary fixation for six weeks was performed in 16 of these. Four with condyle neck fractures were managed with intermaxillary fixation. One patient was treated with a chin cap fixation.
6) Five patients (including one edentulous patient) were treated with open reduction. Miniplates were used in the surgical treatment of these 5 patients.
Operation was performed after a preoperative attempt to restore occlusion with arch bars or dental wiring and elastics.
7) Although it is our policy to be as conservative as possible regarding surgery in the management of mandibular fractures, exceptions are made in patients with displacement of the condyle out of the fossa or with an edentulous mandible.

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A 3-year old girl was accidentally injured by a lead pencil thrust into the retropharyngeal wall by her brother. She was referred by her doctor at the Nakama Municipal Hospital to the Department of Otolaryngology of the University of Occupational and Environmental Health, because severe throat pain and high fever on March 15, 1988.
CT showed a foreign body in the retropharyngeal wall, and she was operated on under general anesthesia on March 17, 1988.
During the operation, arterial bleeding occurred due to damage of the vertebral artery. Bleeding was easily controlled. She was discharged on April 5, 1988, and was recovered uneventfully. The literature on retropharyngeal abscess due to trauma by a foreign body is reviewed.

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Recently a pediatrician asked “Why must an operation be done on tongue-tie?”. To answer this question we studied the degree of dysfuction in 81 patients with ankyloglos who visited our hospital from January 1985 to January 1989. Their ages ranged from one month to 8 years with a peak at age 3 to 6 months.
Deformity of the tongue was presented in all 81 patients, and 36 (44.4%) were treated surgically under GOF general anesthesia and 20 underwent incision without anesthesia. Thirty five of the 81 (43.2%) were referred to us by medical personnel and 23 of 35 (65%) not seem to have any problems of function. Sixty three of the 81 patients (or their parents) complained of malformed tongues.
No significant relationship was noted between the degree of sucking difficulty and of tongue deformity. Sucking difficulty of some patients seemed to be due to factors other than ankyloglossia, and in only a few cases was sucking difficulty due to ankyloglossia. Dysarthria in small children whose speech articulation is in the process of developing is difficult to evaluate. The literature dealing with disorders of articulation caused by tongue tie was reviewed and we conclude that tongue-tie is a very uncommon cause of dysarthria. There is cosiderable diversity in the opinions about indications for surgical treatment for tongue-tie among physicians, dentists, midwives and public health nurses. It is necessary to provide them with correct knowledge about the functional problems of tongue-tie and the indication for surgery.

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A bnomal sensation in the pharynx is either a subjective symptom of organic disease or a nonorganic disorder. We analyzed the psychological factors and autonomic nervous system function in subjects who had a nonorganic abnormal sensation of a lump in the throat during routine activities and /or while swallowing. They were asked to answer the Cornell Medical Index-Health Questionnaire (CMI), and autonomic nervous system function was tested with coefficients of variance in R-R intervals of electrocardiography (CV _R-R), and perspiration was measured with a newly devised apparatus.
Examinees were classified into four groups. A: CMI was Area I or II, and perspiration increase while standing was in the normal range. B: CMI was Area I or II, and perspiration increased significantly while standing. C: CMI was Area III or IV, and perspiration increase while standing was in the normal range. D: CMI was Area III or IV, and perspiration increased significantly while standing.
1) In the abnormal perspiration groups (B and D), those who had abnormal sensation in the pharynx tended to have sympathetic dominance, while normal perspiration subjects had parasympathetic dominance.
2) The Vallecular test battery shuld differentiate between nonorganic and organic abnormal sensation.
There was a close relationship between Vallecular test results and the types of CV _R-R curves; a positive Vallecular sign was presented with types IV, V, VI of CV _R-R
3) Vallecular testing showed that the vallecula epiglottica was more sensitive in the subjects with Areas III and IV of CMI.
4) Vallecular test results proved that psychologically induced perspiration increased significantly in nervous subjects while standing.

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The parapharyngeal space is an anatomical recess encased by the ascending ramus of the mandible, the parotid gland, the mastoid bone, the vertebral column and the pharyngeal wall. This potential space is clinically important, because it contains the great vessels of the neck, the deep cervical lymph nodes, the last four cranial nerves and sympathetic trunk, and because it is very vulnerable to extentions of neoplasms or infections from the surrounding tissues.
The authors examined the parapharyngeal region ultrasonographically, using an elctronic scanner, SAL-77A, 90A, and color doppler imaging equipment SSA-270A. To obtain a wider inside view through the narrow acoustic window between the bones, convex or sector scanning probes were usually used.
After setting the probe on the retromandiblar region parallel to the ascending ramus of the mandible, we first found the bifurcation of the carotid artery and scanned up carefully along the great vessels to the base of the skull. In this process, color doppler blood flow imaging is very helpful. The direction and speed of the blood flow inside the vessel can be assessed, so that we can differentiate the internal carotid, external carotid and jugular vein promptly. We demonstrate the normal anatomy of the parapharyngeal region and many lesions, such as neurilemmomas, A-V malformations, parapharyngeal extension of parotid tumors, lateral retropharyngeal lymph node metastasis, tonsilar diseases, etc.
In conclusion, ultrasonographic examanation of the parapharyngeal region gives useful and unique information about the character of a tumor and the relationship between the lesion and the surrounding tissue.

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The purpose of this study was to analyze qualitatively and quantitatively the age related histopathological changes in the human tongue.
After exclusion criteria had eliminated chnges of pathological origin, tongues were obtained from, 62 necropsies (32 from males and 30 from females). The age range was 7 to 82 years.
The tongue was routinely sectioned into five portions, and the lateral and dorsal lingual surfaces of specimens I (anterior part), III (central part) and V (posterior part) were examined.
Sections 4μm thick were prepared and stained with hematoxylin-eosin.
Three patterns of lingual epithelium were defined and examined.
The I-BAS one picture analyzer of ZEISS Co. was used to determine the areas of lingual epithelium in a defined area (2mm).
The results were as follows.
1) Qualitative analysis
In male tongues, the areas with a mixed pattern in specimen 5 increased with age. In female tongues, however, the areas of mixed pattern in specimen 5 did not change with age.
2) Quantitative analysis
The areas of defined epithelium decreased with age in all specimens.

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HLA-DR antigen is a class II MHC (major histocompatibility complex) antigen, and it is known to exist on the surface of macrophages, B-lymphocytes, and activated T-lymphocytes. It has recently been reported that epidermal and epithelial keratinocytes can express HLA-DR antigen in some tissues, such as the epithelium of the thymus and the pharynx. Kerationcytes are capable of releasing distinct immunomodulating cytokines, such as IL-1, IL-3, and GM-CSF. These functions are closely involved in HLA-DR expression when activated.
We investigated the intensity of HLA-DR expression on mesopharyngeal and hypopharyngeal epithelium by an image analyzing system of our own devising. Epithelial specimens were taken from the mesopharynx and hypopharynx of 15 patients with cutting forceps under general anesthesia. The specimens were frozen and sliced into 5μm-thick sections with a cryostat and stained with an indirect immunofluorescent technique. We determined the area of HLA-DR expression and the number of intraepithelially infiltrating T-lymphocytes per mm.
In patients under 15 years of age, HLA-DR expression was stronger than in those over 20 years of age, but no definite relationship was noted between T-lymphocyte infiltration and epithelial HLA-DR intensity. Several factors appear to affect pharyngeal epithelium, and this epithelium may contribute actively in local immune reactions.

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The morphology of salivary calculi was examined by X-rays, scanning electron microscopy and light microscopy. Fifteen calculi were obtained surgically from the submandibular glands of 13 adults and 2 children.
The salivary calculi were found to be formed by a mixture of organic and inorganic substances. No regular pattern was noted for the growth of the stones, the thickness and the arrangement of the laminated components were not uniform . Structures resembling bacterial bodies were frequently observed between the laminae by scanning electron microscopy, suggesting that secondary bacterial infection occurred repeatedly around the calculi during their growth.

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Four cases of systemic skin diseases with initial erosive lesions of the oral mucosa are reported.
Case 1. A 55-year-old woman had multiple erosive lesions of the oral mucosa and bullae of the skin. The erosions oral mucosa were irregular in shape and bled easily. The histopathological diagnosis was pemphigus vulgaris.
Case 2. An 82-year-old man had multiple erosive lesions of the mucosa of the oral cavity, pharynx, larynx and conjunctiva with bullae of the skin. Scars were formed in some lesions. The histopathological diagnosis was cicatricial pemphigoid.
Case 3. A 69-year-old man had multiple erosive lesions on the oral mucosa. He also had erythemas, bullae and erosions of the skin. The erosive lesions on the oral mucosa were markedly hemorrhagic. The diagnosis was erythema exudativum multiforme syndrome with bullae caused by a drug reaction.
Case 4. A 67-year-old woman had many metal dental fillings in her teeth for dental therapy. Erosions with white lesions were found on the buccal mucosa. Skin eruption was observed on the right hand. The histopathological diagnosis was lichen planus.
The forms and sites of the oral mucosal lesions in these cases were described and discussed.

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Two patients with dysphagia after anterior compression and fusion of the cervical spine are reported.
Case 1, a 40-years-old man, with ankylosing spondilitis and anterior decompression and fusion of the third and fourth cervical vertebrae. He complained of dysphagia after the operation.
Case 2, a 56-years-old man, complained of hoarseness and dysphagia had been dignosed Forestier's disease first. Later he developed quadriplegia. Anterior decompression and fusion of the fourth, fifth, and sixth cervical vertebrae were performed under the diagnosis of diffuse idiopathic skeletal hyperostosis (DISH). After the operation, dysphagia developed.
In Japan, About 30 cases of Forestier's disease with dysphagia had been reported and some were treated by removal of osteophytes. Today, Forestier's disease is considered to be a subtype of diffuse idiopathic skeletal hyperostosis (DISH)
For anterior decompression and fusion of the cervical spine, there are two major approaches: Whitedides-Kelly approach and Smith-Robinson approach. The latter is the most common used. Osteophytes are removed during this operation, but as we pass through the retropharyngeal space and change the shape of the cervical spine, dysphagia may bea result.

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