The sense of taste during a meal plays two important roles. First, it is important to recognize valuable nutrients in foods, for example, energy sources which are sweet, electrolytes which are salty and protein sources with umami tastes. That helps to main tain homeostasis and nutritional balance. Second, taste serves to insure that animals will reject spoiled or toxic foods, since sourness orbitteress, etc. are alarm signals, preventing dietary disorders. Glucose, from carbohydrate digestion and gluconeogenesis, tastes sweet snd is the major energy source used to maintain body temperature and motor activity. When energy intake is below the required level or when people develop diabetes, preference for sweentness is increased. Electrolytes in the body fluid, mainly sodium and chloride ions, are strictly controlled, maintaining a narrow range of concen tration in body fluids. Once animals face restriction of these ions, a strong preference for salty foods is observed. Salt preferences are often increased in patients with essen tial hypertension or hyper aldosteronism, since the sodium ion in saliva increases and con sequently the taste threshold for salt is elevated. Umami taste materials, L-glutamate and 5'-ribonucleotides, were developed in Japan as seasonings. These compounds and other L-amino acids are widely distributed in animal and plant tissues . Essential amino acids are essential sources of body protein. Umami taste is a precise cue to recognize the presence or absence of dietary protein. Just as each L-amino acid has a different taste profile in humans, animals probably learn to select the particular deficient one quantia tively in cases of deficiency. The sense of taste also controls digestion processes post prandially, aiding in the maintenance of homeostasis.

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The fundamental principles of using anti bacterial agents are:
1. Determination of the causative bacteria.
2. Sensitivity of the causative bacteria to anti-bacterial agents.
3. Distribution of anti-bacterial agents to the site of infection.
4. Safety of the anti-bacterial agents used.
5. Dosage, route of administration, and duration of treatment.
6. Cost effectiveness of anti-bacterial agents.
We know that the most important pathogen of tonsillitis is still S. pyogenes, so ampicillin is usually the antibic of choice for tonsillitis caused by this bacteria. However, antibiotic resistance has become an important problem in tonsillitis canused by organisms with biofilm, β-lactamase produsing bacteria, clamida, etc. The distribution of antibacterial agents to tonsils is also an important factor in the therapy of tonsillitis. We investigated the distribution of various anti-bacterial agents to tonsils and the antimicrobial sensitivity of the major causative pathogens of tonsillitis. The findings of this study suggest that it is better to choose a β-lactam agent at first.

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1) Thirty seven cases of acute tonsillitis seen in out hospital in 1989 and 1990 were compard with the same number of controls.
2) A total of 503 strains the bacteria were isolated from patients with acute tonsillitis in our hospital or Nakatsugawa Municipal general Hospital in 1989 and 1993. The differences amonge these bacteria were analyzed according to the year and the locality.
3) Thirty one strains isolated from 47 patients with peritonsillar abscess in our hospital from 1985 through 1993 were studied.
4) The major bacteria in throats with acute tonsillitis were S. pyogenes, H. influenzae and S. aureus.
5) S. pyogenes was most frequently isolated, but the incidence varied with the location and year.
6) S. pyogenes showd exellent sensitivity but H. influenzae and S. aureus were resis tant to ABPC because of the increased number of strains producing β-lactamase.
7) S. pyogenes was detected mostly in the early stage of peritonsillar abscess and Anaerobic bacteria were found in the late stager, after one week at least.

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Patients with oral disease often visit our department with complaints of difficulty opening the mouth. A 17-year-old male who had cheek pain when opening the mouth also complained abnormal noise in his right cheek. He had no history of facial injury. His face looked symmetrical, but a bony mass on the right maxilla was palpable. X-ray showed an enlarged right coronoid process. Plain computed tomography in the coronal and the axial sections clearly indicated the relation between the coronoid process and its surrounding bony structures. In compliance with his wishes, we operated through an intraoral approach. After the operation, his complaint disappeared immediately. Pathological examination revealed osteochondroma.

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In the reconstruction of the lips, it is necessary to consider not only the repair of tissues, but also the cosmetic appearance and the function.
Since 1990, we have performed 18 lip reconstructions with 22 flaps in addition to the small local flaps used in cases such as cleft lip and macrostomia. In 10 patients the reconstruction followed resection of a malignant tumor, in 3 it was for repair after removal of a benign tumor and in 5 it was to repair scarring. We used Estlander-Abbe flaps in 6 patients, latissimus dorsi M. C. flaps in 4, rotation flaps in 4, nasolabial flaps in 4, fan flaps in 2, and cheek mucosal flaps in 2. In 5 of these patients, we also constructed semi-dynamic tensor fascia lata supports for the lower face.
The flaps took successfully in 16 patients, but in 2 there was partial necrosis. One of these had postoperative bleeding from a cavernous hemangioma, the other had had full-dose irradiation.
In lip reconstruction, we must reconstruct both, mucosa and skin, choosing local facial donor sites which match both color and texture. Estlander-Abbe flaps, nasolabial flaps, and fan flaps are still useful, but we must distant flaps for patients with large defects after resection of a malignant tumor and for those who have had full-dose irradiation. More over it is very important to prevent leakage of saliva and food by adequate supports for the angles of the mouth.

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Twenty six patients with bilateral enlargement of the submandibular glands were evaluated with respect to clinical and histological features. The clinical diagnosis was Kütner's tumor in 4 patients, sialodochitis fibrinosa in 2, sialadenosis in 14, malignant lymphoma in 3, amyloidosis in 2 and sialolithiasis in 1. Three patients are described in detail, 1 with sialadenosis, 1 with malignant lymphoma and 1 with amyloidosis. In case 1 sialadenosis was associated with anorexia nervosa. Histological examination of the salivary glands showed pale and swollen acinar cells. In case 2 (malignant lymphoma) the submandibular glands were characterized by firm swelling resembling Kuttner's tumor. They were replaced by infiltrating lymphocytes which were immunoreactive for pan T. The blood serum test was positive for HTLV-I. The firm swellings in case 3 were due to amyloidosis. Biopsy showed thick amorphous materials stained with Congo-red located around the blood vessels.

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A 58-ear-ld female, who had had developed right otitis media with effusion far three months and abnormal sensation in the face. A CT showed a tumor with calcification in the right parapharyngeal space. No assosiated lesion Was seen in the head or neck.
The tumor was removed through a transmandibular and transpalatine approach. The pathological diagnosis was poorly differentiated squamous cell carcinoma.
After the operation, the primary site was sought, but it has notl been found yet.The patient was given chemotherapy and radiation therapy. This carcinoma seemed to riginate in aberrant squamous cell tissue.

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A rare case of adenolymphoma with tuberclosis of a parotid gland is reported.A 47-year-old male had had swelling of the left parotid gland for three months. On admission, the tumor showed adscess formation and necrotic changes. Under general anesthesia, the left parotid gland was resected. The pathological diagnosis was adenolymphoma with tuberculosis. Histologically, the tumor was composed of typical adenolymphomatous regions and granulomatous changes with Langhans type giant cells. Both Ziel-Neelsen's and auramine staining were positive. There was no evidence of tuberculosis elsewhere in the body. A combination of INF, REP And EB was administered. To date, neither local reccurence nor adscess formation has been noted.

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Malignant melanoma in the head and neck region is very rare. The prognosis of mucous membrane melanoma is worse than that of melanoma of the skin.Four patients (2 males and 2 females) with malignant melanoma in the oral cavity and pharynx were treated in our department from 1981 to 1994. Their ages ranged from 45 to 75 years. Two patients treated with with chemotherapy (DAV) and CO₂ laser surgery during the first admission survived more than two years. One patient treated with immunotherapy (interferon-beta), in addition to CO₂ laser surgery and chemotherapy, remains in good condition. Another patient who was treated with chemotherapy only died after just over one year. These results suggest that surgical resection with CO₂ laser, chemotherapy and immunotherapy, such as INF, might be useful in the treatment of malignant melanoma.

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The lateral border of the parapharyngeal space includes the mandible, parotid gland, and pterygoid muscles, and the pharyngeal muscles form the medial border. We have recently treated five females with tumor in the parapharyngeal space (two pleomorphic adenomas, one teratoma, one neurilemmoma, and suspected neurinoma). In this paper we describe these patients and discuss the operative procedures and the usefulness of CT and MRI. Various approaches were used: oral, cervical, and cervical-transpharyngeal with side mandibulotomy. The surgical approach which provides the clearest view is the best operative method.

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