Twenty-four subjects were classified into two groups: Group I, 18 patients with loss of teeth (6 with loss of an anterior maxillary tooth, 5 with upper complete dentures, 5 with loss of lower molars and 2 edentulous mandibules); Group II, 6 patients with malocclusions, including 1 with open bite and 5 with mandibular protrusions. The method used for an asses-sment of articulation was based on the 100 Japanese monosylable articulation test. Sound analysis was performed with a sound spectrograph to reveal any vocal changes due to dental disorders.
1) The articulation score in Group I was 71.4-96.0% (average 88.95%); in Group II it was 88.4-97.0% (average 92.95%). Out of the 24 subjects, 18 had a score of 80% or more.
2) In Group I, 12 subjects (66.6%) misarticulated/d/ and /n/, 9 (50%) /dz/, 8 (44.4%) /t/ and 6 (33.3%) /ts/, /r/. Alveolar sounds /d/, In/ and /t/ sounded more like bilabial sounds /b/, /m/ and /p/. Sibilant sound /d/ sounded like /r/.
3) In Group II, four subjects misarticulated /d/, and 3 /s/, /dz/, /dg/. Alveolar /d/ and sibilant sounds /s/ sounded like /r/ and /∫/.
4) The sound spectrogram showed the same trend in seven out of eight subjects with loss of teeth and malocclusions. During the articulation of /s/, /ts/, /t∫/ and /n/ sounds, F2 was raised increasingly farther from the baseline, so that the space between F1 and F2 was increased. The tongue moves forward as a compensatory effort to overcome the dental abnomalities.
The results lead to the conclusion that ordinary conversation is unaffected by dental dis-orders.

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Since the first successful closure of cleft palate with a mucoperiosteal flap by von Lang-enbeck, many improvements have been added, not only operative techniques but also in speech therapy, orthodontic treatment and anesthesiology.
The author reviews the history of cleft palate surgery and describes recent trends in the treatment of cleft palate patierts with respect to speech development and maxillary growth. Formerly, surgeons repairing cleft palate focused only on good speech results, but now they must think of maxillary growth at the same time. It is now well known that the early operation (at 1-2 years of age) with a mucoperiosteal flap results in maldevelopment of the maxilla.
Several methods which can preserve maxillary growth have been described, but problems remain in gaining good speech results. The author discusses these methods, including his two stage method (Osada method).

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Motor speech disorders (dysarthria) comprise a group of speech disorders resulting from disturbances in muscular control due to impairment of any of the basic motor processes involved in the execution of speech. During the period of 10 years from 1980 to 1989, the incidence of motor speech disorders in the author's clinic was 16.7% (248 out of total of 1, 485 patients with language and speech disorders). In clinical practice, it is quite important not to overlook progressive neurological diseases, such as bulbar palsy . In this paper, points of clinical examination are described together with perceptual and acoustic methods of evaluation of pathological speech. The importance of total rehabilitation of dysarthric subjects is emphasized, and the use of different types of speech aids is recommended.

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In 94 patients with carcinoma of the tongue, oral floor and oropharynx, articulationfunction was evaluated with 25 and 100 Japanese monosyllables after operation. Simpleresection with CO₂ laser mess was performed in 68 patients. The range of resection waslimited to half of the tongue for oral cavity carcinoma and a little beyond the lateral wallfor oropharyngeal carcinoma. More than 80% of the monosyllables were understandableafter this operation, indicating that the articulation was well conserved by laser surgery. In18 patients with oral cavity carcinoma, more than half of the tongue was removed. Understandablemonosyllables ranged from zero to 82%, depending on the size of the resection.Reconstruction with a myocutaneous flap had little effect on articulation. Nine patientswith oropharyngeal carcinoma had wide resection to the adjacent site from the primary sitein the oropharynx or other region. From 5 to 83% of monosyllables were understandable.After wide resection of the base of tongue, articulation was poor. Articulation was moderatelydisturbed by combined resection of hard palate, and restored well by reconstruction witha rectus abdominalis myocutaneous flap.

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Eighty nine children with recurrent parotitis were investigated immunologically. Cultures of their saliva frequently yielded Streptococcus mitis and Neisseria sicca (N. sicca). Serum antibody levels to N. sicca were significantly lower (p<0.005) in the patients than in the controls. In the saliva, the antibody titers against all bacteria examined were significantly higher (p<0.005) in the patients. The lymphocytes blastogenic responses of the patients were significantly lower (p<0.025) than those of the controls when the cells were stimulated with the soluble antigen of N. sicca, although no significant differences were observed between the patients and controls when the cells were stimulated with phytohemagglutinin. CD 4 positive to CD 8 positive ratio of the peripheral blood lymphocytes of the patients was lower than those of the controls. Neutrophil functions and serum complement levels were the same in the patients and the controls. A significant difference in the frequency of HLA-CW1 was found (corrected p<0.024) between the patients and the controls. Bacterial vaccine therapy was very useful in preventing repeated suppurative inflammation of the parotid gland. These observations guggest that a low responsiveness of lymphocytes to N. sicca may be important in the pathogenesis of recurrent parotitis.

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The results of sialography and histopathological examination of the salivary gland were correlated in patients with Sjögren's syndrome and with chronic thyroiditis. Sialographical and histopathological features of the salivary glands, and serological and histopathological examination of the thyroid gland were performed in 109 confirmed and 35 suspected cases of Sjögren's syndrome.
1) In determining the histopathological severity of the salivary gland lesions from sial-ography, the parotid sialogram was more useful than the submaxillary sialogram.
2) The degree of abnormality in parotid sialograms correlated well with the histopatho-logy of the labial gland.
3) Biopsy of the labial gland was useful in the histopathological diagnosis of Sjögren's syndrome, but histopathological changes were more prominent in the submaxillary than in the labial gland.
4) Thyroidal microsomal and thyroglobulin antibodies were detected in 34.5% and 22.4%, respectively, of the 109 confirmed cases of Sjögren's syndrome.
5) The antibody titer was higher in patients with more severe histopathological changes of the thyroid gland. Thyroidal microsomal antibody levels, in particular, were correlated with the absence or presence of lymphocytic infiltration of the stroma.
6) No significant correlation was noted between the histopathological grading of the thyroid gland and of the salivary glands.
7) Approximately 30% of patients with confirmed Sjögren's syndrome also had chronic thyroiditis.
8) The results show that histopathological examination of the labial gland in severe cases of Sjögren's syndrome is sufficient, but biopsy of the submaxillary gland is necessary in mild cases. Sjögren's syndrome and chronic thyroiditis may have a common etiology.

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Kimura's disease is rather rare soft tissue eosinophilic granuloma. We describe the clini-cal, pathological and immunological features in 18 patients with the disease.
The lesion developed most frequently in the subcutaneous tissues of the parotid region, and proceeded into the parotid gland. It was characterized by eosinophilic granuloma with marked proliferation' of lymph follicles. Since the lymph nodes were also involved systemically, it seemes to be a systemic disease.
The most characteristic clinical laboratory findings were a marked increases in the serum IgE level, IgE antibodies to Candida and eosinophilia in the peripheral blood. IgE was found in the lymphoid tissue of the granuloma. When the granuloma was reduced by radiation therapy or surgery, the serum IgE level and the peripheral blood eosinophilia decreased markedly. Therefore, IgE, IgE antibody and eosinophil chemotactic factor are thought to be produced in the local lesion.
Since approximately 80% of serum IgE was absorbed by candida-mannan, this disease is presumed to be caused mainly by atopic allergy against candida-mannan. Further studies are necessary for a final conclusion.

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The volume of salivary secretion of 351 persons (177 males and 174 females) was measured by the 10-minute chewing gum test. This study showed that the salivary secretion of females is greater than that of females at all ages, and salivary secretion decreases with age, more so in females than in males. Females over the age of 40 have a reduction of salivary secretion. Thirty patients with dry mouth older than 60 years of age were treated with Byakko-ka-Ninjintoh, a traditional oriental medication, a thirsty feeling improved in 58.8% of females and 50% of males.
Salivary secretion as determined by the gum test, increased from a mean of 12.10ml to a mean of 16.70ml in treated males and from a mean of 10.05ml to a mean of 13.35ml in treated females. Thus in the group of 30 elderly patients, salivary secretion increased from 10.73ml to 14.47ml. These are statistically significant increases.
Byakko-ka-Ninjintoh is a useful medication for xerostomia.

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The usefulness of MRI in the diagnosis of tongue cancer was examined by comparing MRI findings with those of clinical and histological studies.
1. The size of tongue cancers estimated by MRI was almost equal to or larger than that of the tumor plus area of necrosis demonstrated determining histologically. Therefore, it is concluded that MRI is useful in the extent of surgical excision.
2. Inflammatory reaction around tumor tissues following biopsy or irradiation often gave false-positive findings in MRI studies.
3. In cases of early cancer of the tongue, MRI often failed to indicate tumor invasion of the tunica muscularis which was confirmed histologically.
4. MRI was very effective in delineating soft tissue contours in the tongue. In particular, information about the lingual artery and septum of the tongue was useful for determing the range of incision.
5. Since MRI was effective in obtaining the 3-dimensional range of tumor invasion, it was useful for planning the skin flap at the time of operative repair.

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A patient with swelling of the parotid gland was examined by CT sialography and ultrasonography. Abcess formation and necrotic changes were found in the parotid region. Subtotal parotidectomy was performed. The pathological diagnosis was multiple adenolymphoma with rupture and granulomatous change. Histologically the tumor showed glanulomas with Langhans' type giant cells replacing extensive areas of an adenolymphoma, Both Ziel-Neelsen's staining and auramine staining were negative . There was no evidence of tuberculosis elsewhere in the body. It was concluded that the unique histologic features in this patient were caused by a reaction to the extravasation of lipiodol used in sialography.

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Benign hyperplasia and/or hyperkeratosis of the oral mucosa were investigated clinically and histologically in 108 caces. Lesions were more frequent in patients over 30 years of age. There was no sex difference. The most common site was lingual mucosa.
Histpathological studies revealed epithelial dysplasia in 15 cases, with no male/female difference. Dysplasia of the epithelium tendend to grow outward like a tumor, unlike lesions without dysplasia.
Surgical extirpatoins, including laser operations, were done in all cases. Carcinoma of the tongue developed from the lesion after more than 10years in only 2 cases.
It is concluded that these lesions should be completly cured at an early benign stage, because treatment is difficult and the prognosis is poor in advanced oral cancer.

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A comprehensive retrospective study of 1004 patients with cancer of the parotid gland from 126 participating institutions in Japan was carried out from 1978 to 1989 at the request of the Japanese Joint Committee on TNM classification. The series included those first diagnosed between 1958 and 1989. This nation-wide study was conducted by the Departments of Otolaryngology, Oral Surgery, and Surgery of the participating institutions.
The 1987 UICC (Geneva) TNM Classification of Malignant Tumours was used in this study.
The collected information about the patients included age, sex, physical findings, histological diagnosis, treatment, follow-up findings, etc.
1. There were 589 males and 415 females.
2. A total of 198 patients (20%) had Stage I disease, 299 (30%) Stage II, 238 (23%) Stage III, and 269 (27%) Stage IV.
3. A total of 118 patients (12%) had Ti tumors, 414 (41%) T2, 312 (31%) T3, and 160 (16%) T4.
4. The overall incidence of cervical lymph node involvement was 24%, ranging from 9% in patients with adenoid cystic carcinoma to 49% in those with undifferentiated carcinoma.
5. The overall incidence of distant metastasis was 4%.
6. Adenocarcinoma was the most common histological type (25%), followed by mucoepidermoid tumor (22%), adenoid cystic carcinoma (16%), carcinoma in pleomophic adenoma (14%), epidermoid carcinoma (12%), undifferentiated carcinoma (5%), and acinic cell tumor (5%).
7. Surgery alone was the most common method of treatment (50%) for primary lesions, followed by postoperative radiation (22%).
8. The overall crude survival for 5 years was 52% and for 10 years 32%.
9. The relationship of the stage to the 5-and 10-year crude survival rates was as follows: stage I, 5 years 80%, 10 years 62%; stage II, 5 years 70%, 10 years 41%; stage III, 5 years 49%, 10 years 31%; stage IV, 5 years 24%, 10 years 15%.

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In order to observe the lumens of the salivary ducts, Stensen's duct and Wharton's duct, we used an ultrafine fiberscope 0.75mm in diameter.
This apparatus consisted of a thin fiberscope, a light source unit, a CCD camera and CRT monitor. This procedure was performed without local anesthesia, and direct views of the inside of the salivary duct were obtained and recorded through a U-matic VTR system and by still photography.
It is concluded that this apparatus is useful because of its small size.

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Sjögren's syndrome was diagnosed in 127patients classified into four groups as follows:
Group Asicca alone with immunological abnormality (58 patients)
Group B overlap syndrom (24 patients)
Group C sicca unaccompaniedby immunological abnormality (27 patients)
Group D subclinical sicca (18 patients)
Subclinical Sjogren's diseases lacking sicca symptoms have been revealed recently by newly prepared, specific antinuclear antibodies.
Recurrent parotid swelling is frequent in such patients.
Six of the 18 patients were observed for long terms (10 to 18 years) and their clinicalfeatures and laboratory findings were examined to define the features of subclinical sicca. Clinical manifestation:
Three of the 6 had dry eyes, dry mouth and arthralgia temporarily during upper respira tory infection, pregnancy, birth and abortion.
Subjective symptoms were generally absent for long periods.Laboratory findings:
The sialogram of Sjogren's syndrome is characterized by punctate, globular orcavitary sialectasis.
Typical sialograms: Small punctate type in 5 and globular type in 1 of 6 patients.
Typical histological changes in biopsies of the parotid gland were seen in all 6: diffuse infiltrations by B cell lymphocytes around the duct and blood vessels.
Rheumatoid factor and anti SS-A antibody in 100% even in the early stage. Anti SS-B antibody in 1 patient. Hyper gammaglobulinemia in 5. Rheumatoid factor, anti SS-A antibody and hypergammaglobulinemia were equally frequent in Groups A and D.
Definitive diagnostic procedures, such as typical sialography and autoantibodies (anti SS -A antibody, rheumatoid factor) are requirea to establish the diagnosis in the early stages of latent Sjögren's syndrome.

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There have been only a few reports on tumors of the accessory parotid gland, an ectopic parotid gland located away from the parotid gland proper. We treated a 66-year-old female with a tumor of the accessory parotid gland. The patient had had a tumor in the right buccal region from 20 years, but she visited our department because the tumor had enlarged during the past year. A 3.0×2.5cm tumor without tenderness of adhesion was observed in the center of the right buccal region. Perioperative findings showed a tumor independent of the parotid gland proper. The histopathological diagnosis was pleomorphic adenoma.

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Four cases of benign lymphoepithelial lesion (BLL) of the parotid gland and one case of malignant lymphoma in the parotid gland are reported. The BLL showed the following histological findings: 1) extensive lymphoid cell infiltration, 2) atrophy of acini, 3) hyperplastic metaplasia of ductal epithelium and formation of epimyoepithelial islands. In one of the four cases the disease was limited to the unilateral parotid gland which appeared to be a neoplasm. In two patients the diagnosis was primary Sjögren's syndrome, and the fourth patient, who had scleroderma, had secondary Sjögren's syndrome. The malignant lymphoma was B cell lymphoma (diffuse large cell type); epimyoepithelial islands were also found in this parotid gland. The presence of epimyoepithelial islands was composed chiefly of ductal epithelial cells and only a few myoepithelial cells. The term “BLL” should be used as a pathological, not a clinical, diagnosis.

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Case 1: A 60-year-old female complained of tongue pain which started right after the death of her husband due to stomach cancer. This pain was augmented by her cancerphobia, but it diminished after definitive diagnosis by tongue biopsy.
Case 2: A 55-year-old female who was being treated for iron deficiency anemia com-plained of glossalgia. Her pain diminished after improvement of her anemia.
Case 3: A 34-year-old female complained of glossalgia. There were no definite labora-tory or pathohistological abnormalities except a suggestion of some circulatory disturbances.
The characteristic feature of glossalgia is superficial and persistent pain with no clinical abnormalities. Most patients are middle-aged females. A relationship to psychological and autonomic nervous system disturbances has been suggested.
Glossalgia must be differentiated from trigeminal neuralgia.

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We report here 2 recent cases of continuous taste disturbance after dental anesthesia (inferior alveolar nerve block) a rare complication.
Case 1: a 41-year-old woman
The patient received local anesthesia for treatment of a left mandibular molar and lost the sense of taste on the left side of her tongue. She first visited our outpatient clinic because of the taste disorders three months later. Electorogustometry (EGM) and filter-paper disk method gustometry showed a disturbance of the left chorda tympani nerve area and atrophy of the fungiform papillae on the left side of the tongue was also observed. Eleven months after the dental treatment the fungiform papillae and the results of gustometry were normal.
Case 2: a 22-year-old woman
The patient received local anesthesia for extraction of a right mandibular molar and subsequently developed loss of taste on the right side of the tongue. She visited our outpatient clinic three months later. Atrophy of the fungiform papillae on the right side was also observed. Her gustatory sense began to improve four months after the extraction and was normal at 13 months.
From these findings we consider that the cause of the taste disturbance on the same side of the chorda tympani nerve area after inferior alveolar nerve block was the direct injury of the chorda tympani and lingual nerve. Electrogustometry (EGM) and filter-paper disk method were effective for diagnosis. Atrophy of fungiform papillae on the same side and disappearance of taste on the same side in the intravenous taste test were also considered to be effective as complementary diagnosis. Prognosis was satisfactory for both of the 2 cases. Key words: taste disorder, dental anesthesia, inferior alveolar nerve block, chorda tympani nerve

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A polymerase chain rection (PCR) method was developed that permits the detection of 2 types of Epstein-Barr virus (EBV) with a single pair of primers complementary to both EBNA-2A and EBNA-2B sequences. The amplified lengths of these sequences are different. The use of this pair of primers in PCR enabled the detection of type A and type B EBV by polyacrylamide gel electrophoresis (PAGE) and ethidium bromide staining. These amplification products were confirmed by Southern blot hybridization with oligonucleotide probes that were complementary to both EBNA-2A and EBNA-2B sequences.
With this method applied to throat washings from 33 healthy donors, type A EBV was detected in 5 and type B in one. Tests of 9 patients with nasopharyngeal carcinoma showed EBV type A in 8 and type B in one.
The results show that type A of EBV may be predominant in the Wakayama area. We conclude that our newly developed PCR method is very useful in the detection of two types of EBV genomes.

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Pharyngeal foreign bodies seen in our ENT department from January, 1980, to June, 1990, were analyzed statistically.
Pharyngeal foreign bodies were found in 126 patients 48 males and 78 females. These accounted for 40.9% of the total number of foreign bodies in 308 patients treated in our ENT department during that period.
Their ages ranged from 7 months to 85 years, averaging 42.3 years. Of these, 109 patients (86.5%) were over 20, and 63 (50.0%) were females 20 to 69 years of age.
Fish bones accounted for the largest number (95.2%) of foreign bodies in the pharynx.
Other foreign bodies, were Japanese cedar tree needles in 2 cases, gauze in the epipharynx in 1 case, complete dentures in 1 case, paper and cellophane adhesive tape in 1 case and hair in 1 case.
These foreign bodies were most frequently found in the palatine tonsil (51.6%).

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In our previous study we discussed the causes of obstructive sleep dyspnea (OSD). The 5 constricted areas in ODS are: nasal cavity, epipharynx, uvulopalate, root of tongue, and larynx. Constrictions of the uvulopalate and root of the tongue are very difficult to diagnosis, and their treatment is complex. In this study, we describe the diagnosis and most effective treatment for OSD in a middle-aged female patient with severe snoring and sleep apnea.
She was first examined by polysomnography with meassurements of intraesophageal pressure (EP). The results of polysomnography indcated severe OSD with a lowest SaO₂ of 34%. Tracheostomy and uvulopalatopharyngoplasty (UPPP) were performed. Three weeks after UPPP, SaO₂ monitoring with obstruction of the tracheostomy hole showed a lowest SaO₂ of 72%, but dyspnea remained. Fluoroscopic examination of her mesopharynx, showed contriction at the root of her tongue. M

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It has been considered that the articulation point of pharyngeal fricatives and africatives and pharyngeal stops in cleft palate speech is in the mesopharynx and that glottal stops and produced in the glottis. Using fluorovideoscopy and naso-pharyngofiberscopy, we found the following:
1) The so-called pharyngeal fricateves and africatives were both produced at a point between the base of the epiglottis and the arytenoids. So these articulations should be called laryngeal fricatives and africatives.
2) The articulation point of pharyngeal stops varies with the following vowel.
3) Glottal stops are associated with dynamic movement of the larynx.

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To evaluate the sensitivity and the specificity of several diagnostic methods recently used in the preoperative diagnosis of parotid cancer, the results of preperative examinations of 24 patients with parotid cancer and 64 with benign parotid tumor were analyzed. The sensitivity values of sialography, sialo-CT, MRI, and ultrasonic examination for the diagnosis of parotid cancer were 68.8%, 68.8%, 68.8%, and 86.4%, respectively. However, the sensitivity of ultrasonically guided fine needle aspiration for parotid cancer was 76.2%. The specificity values of these five methods for the diagnosis of benign parotid tumor were almost the same. Although it is mandatory to try to improve the sensitivity and specificity of fine needle aspiration biopsy, it is considered to be necessary to reach a comprehensive diagnosis, combining the results obtained by the above mentioned different imaging techiques.

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