The superconductivity quantum interference device (SQUID) is a new device which can detect very weak magnetic responses from the human body. From five normal subjects and one patient with tongue cancer after hemiglossectomy reconstructed with pectoris major myocutaneous (PMMC) flap, the evoked magnetic responses in primary somatosensory areas stimulating oral and pharyngeal mucosa mechanically were recorded. The oral and pharyngeal mucosa were stimulated by touch and pressure probe and the evoked magnetic responses were recorded using magnetic sensor placed on the contralateral temporal area. In normal subjects, the evoked magnetic responses stimulating buccal mucosa, the upper and lower lips and the tip of tongue were recorded in the somatosensory areas of the temporal lobe in a straight line. In the patient whose tongue was reconstructed with PMMC flap, the evoked magnetic response stimulating the flap was recorded in the site identical to thesite stimulating the tip of tongue.

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It is considered that disturbance to the pressuretouch sensation of the oral cavity influences the oral phase of swallowing. This relationship between oral touch sensation and oral phase of swallowing was analyzed clinically in this report. Twelve patients selected from otorhinolaryngological or neurosurgical outpatients, and suffering from some disturbance to the oral pressure-touch sensation were examined with Semmes-Weinstein monofilaments (SWM). As the control for the experiment, 10 patients with no disturbance to oral touch sensation were taken from otorhinolaryngological outpatients. The patients were at first examined for the subjective disturbance of the oral touch sensation with SWM and asked whether they have any discomfort on swallowing. For objective confirmation and analysis of the discomfort on swallowing, a fluoroscopy of the oral phase of swallowing was performed. The results obtained were as follows; 1. the oral sensation in the patient whose bilateral trigeninal nerves were injured during an operation on a cranial base meningioma was untest able, 2. the intensity and range of disturbed oral sensation could be measured with SWM in the patients who received operations or radiation for a malignant tumor, and in the patients who have suffered from a vascular accident to the central nervous system, 3. the coefficient of correlation between intensity of disturbed sensation and subjective discomfort on swallow ing was higher than that between the range of disturbed sensation and subjective discomfort on swallowing, 4. the fluoroscopy of oral phase of swallowing showed abnormal findings in the patients whose lingual nerve was cut during the operation which was subsequently follow ed by loss of sensation in the tongue. In conclusion, the SWM was useful in assessing the pressure-touch sensation of the oral cavity. In addition, loss of sensation to the oral cavity appeared to have some influence on the oral phase of swallowing.

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To objectively evaluate oral function in the oral phase of deglutition, some dynamic imaging methods were demonstrated. Three types of examination: i. e. 1) real-time ultrasound, 2) video fluorography, and 3) dynamic MRI, were demonstrated in normal individuals and patients with dysphagia who had the tongue, floor of the mouth and lateral wall of the oropharynx resected after cancer excision, respectively. Recnstructed cases were used in Pectoris major musculocutaneous (PMMC) flap, free forearm (FFA) flap, and combined flap of the FFA flap and PM muscler flap recnstructed cases were used in.
Using ultrasound examination, the dorsum and root of the tongue, geniohyoideus and hyoglossus muscle, and hyoid bone movement could be observed clearly. Video fluoro graphy seems to be the most useful examination method for swallowing, because a lot of information, such as dynamic function at oral and pharyngeal phase in deglutition, bolus transfer in oral cavity, back flow from pharynx to nasal cavity in swallowing (i. e. velopharyngeal unclosure) and so on were obtained. Dynamic MRI examination, as used in this study, did not provide any significant information about oral phase swallowing, due to the long scanning time (more than once the swallowing time). Therefore, Evaluation for treatment of oral dysfunction in deglutition should be made due to the advente of both real-time ultrasound and video fluorography.

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Since 1986 we have used free flaps for head and neck cancer reconstruction surgery in about 300 cases. Of these cases about 200, 67% were related to the oral and mesopharyngeal areas. Previously we mainly used to employ the pectoralis major mc flap.Forearm flap and rectus abdominis mc flap are the most available flaps for free flap operations in many instances. In adddition, they are thought to be the best tissues to reconstruct a variety of defects in the head and neck area because of their freedom from pedicle such as a case of pectralis major mc flap, and because of their availability for quality and quantity. of the tissue. In the reconstruction of this area, the functional problemwhich mostly occurs is when tissue loss from lateral tongue and posterior mesopharyngeal area as well as the anterior tongue and vestibular oral base results from tumor excision. Hence we designed and put into practice three original techniques for these functional reconstructions.
1) Covering the surface defect sufficiently not to retract remnant functional tissue.
2) Volume reconstruction to enable to do function by slight movement of remnant small tissue.
3) Dynamic reconstruction to enable to do function by moving the reconstructed tissue itself.
The first technique, 1), is used in cases of saved continuity of functional muscle.
The second technique, 2), is used in cases of a very large loss of functional mass.
The third technique, 3), is used in cases where replaced tissue can be moved by contrac tion of remnant functional muscle.
However, the foerearm and rectus abdoninis mc flaps also have the limited ability concerning flexibility and elasticity. Therefore we tried to employ the peritoneal flap with the rectus abdominis mc flap toreconstruct through and through buccal defect. In addition we recognizedthe excellent availability of the peritoneal flasp for buccal mucosal replacement. Epithelization over the surface of the peritoneum is completed whithin three weeks. In cases of oral base reconstruction, its elasticity is also suitable. Also, we are trying to use the groin flap again to reduce damage at the donor site. Donor site loss is quite largeand not able to be overlooked.
I will now explain the changes associated with the reconstructional method over a long period of time and introduce a device for improvement of quality of life after surgery.

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Adenoidectomy has been frequently performed as part of the surgical management for otitis media with effusion (OME) in children, although its efficacy is still controversial. We attempted to apply contact Nd-YAG laser surgery under rigid endonasal endoscopy to adenoidectomy in order to vaporize residual adenoid and tubal tonsil tissue after conventional adenoidectomy in two cases of OME in children. In both cases, remarkable postoperative improvement in sonotubometry and tympanometry and no postoperative complications, such as stenosis or patulousness of eustachian tube by scar formation, occured. The present surgical procedure seems to be useful for treating some cases of persistent OME in children because of the adequate elimination of the effect of adenoid and tubal tonsil hypertrophy on OME.

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Six infants with tongue base cysts are presented.
All six patients manifested inspiratory stridor, suprasternal or intercostal retractions and feeding difficulty one or two weeks postnatally.
Intubation was carriedout in three cases and a nasal ventilation tube was used in one case. Lateral cervical x-ray and laryngeal fiberscopy were useful in making the diagnosis. Furthermore, thyroid scintigraphy was needed to rule out ectopic thyroid tissue. Four cases had cysts in the midline position at the base of the tongue, while the other two cysts were lateral being located to the left of the vallecula epiglottica.
Surgical treatment involved total resection of the outer portions of the cystic walls in all six patients. There has been no cyst recurrence, to date, in any of the six infants.
The pathological origin of the cysts in the midline position at the base of the tongue appeared to be the thyroglossal duct. The lateral cysts, located to the left of the vallecula epiglottica, appeared to be an atypical type of the thyroglossal duct cyst or to belong to another category termed vallecular cyst. The vallecular cyst is suggested the ductal retention cyst. The pathological origin of the cysts is not relevant to treatment or to patient management.

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Between 1986 and 1995, 30 patients with carcinoma of tongue (T1, T2) were treated at the Department of Otorhinolaryngology of Showa University Fujigaoka Hospital. The male to female ratio was 16: 14. According to our policy of avoiding biopsy, 21 of the 30 cases received surgical treatment (partial excision) at first. After surgery, 17 of these 21 cases then underwent radiotherapy (external radiation therapy). Patients not receiving surgery were treated with a combination of chemotherapy and radiotherapy. The local failure of the patients who are treated by surgery first was 3 of 21 cases (14.2%). The local failure of the patients who are treated with combination therapy was 2 of 9 cases (22.2%). All patients recieved salvage therapy. However, 2 patients were died due to recurrent neck node metastases. Our method of T1, T2 tongue carcinoma therapy should be improved for initial control of neck metastases.

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A 39-year-old female with sialodochitis fibrinosa of the bilateral parotid glands is described. She had no history of allergy.
On the microscopic examination of the mucus plug taken from the ducts, many eosino phils as well as a few neutrophils and bacterial colonies were seen.
Conservative therapy was not effective in relieving pain and swelling of the bilateral parotid glands.
She underwent a bilateral parotidectomy due to these symptoms.
Pathologic findings suggested bronchial asthma, due to subepithelial eosinophilic infiltration, eosinophilic impaction with desquamative epithelium, and inflammatory cells in affected proximal ducts.
No pain and swelling occurred following parotidectomy.

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Uvulo-palato-pharyngo-plasty (UPPP) is the most popular surgical technique to treat obstructive sleep apnea. However the ratio of improvement after UPPP is only about 50%. We evaluated the change of the soft palate after UPPP in order to find the reason for UPPP failure. The cephalometric data of the 33 UPPP cases (27 male, 6 female) were analyzed. The length and thickness of the soft palate were evaluated according to the period after UPPP [group 1 (n=15), less than 6 months; group 2 (n=8), 7 months-2 years; group 3 (n=10), over 2 years]. The site of obstruction after UPPP was examined in 16 cases of the 33 subjects using upper airway pressure measurement. As a result, the soft palate shortened from 39.3mm to 31.2mm after UPPP in all 33 cases . The length of the soft palate in groups 1 and 2 became significantly shorter compared with the preoperative length. However, after 2 years (group 3), the length of the soft palate was not significantly short compared to the preoperative length. The soft palate changed its thickness from 11.2mm to 13.2mm postoperatively in all 33 cases. The soft palate in groups 1 and 3 was significantly thick compared to the preoperative thickness. With the pressure measurement, we found residual obstruction in the soft palate after UPPP in 3 out of 7 UPPP failures.
Thus, we concluded that some UPPP failures may have the thickened soft palate which cause residual obstruction at the level of the soft palate after surgery.

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To clarify the role of zinc in the mechanism of salivary secretion, the effects of zinc deficiency on the salivary glands were investigated using a rat model of acute zinc deficiency prepared by administration of a zinc chelator, dithizone. Acetylcholine hydrochloride was intraperitoneally injected in order to monitor morphological changes of the glands due to stimulated salivary secretion. For the observation of zinc locations, the submandibular glands from normal rats were prepared into ultra-thin sections using the Timm's method for examination under a transmission electron microscope.
The degranulation of the granular duct cells and acinar cells in response to acetylcholine hydrochloride, as seen in the control rats, was strongly inhibited in rats with acute zinc deficiency. The contractile response of the actin microfilament bundles in the myoepithelial cells to acetylcholine hydrochloride, as seen in the control rats, was also absent in the zincdeficient rats. Furthermore, electron microscopy of the submandibular gland stained by the Timm's method disclosed prominent zinc localization at the membrane surface, granules and vesicles of the glandular epithelial cells and in the pits of the myoepithelial cells. These findings suggest that zinc, together with many zinc-dependent enzymes, is closely involved in the degranulation of the secretory granules in the glandular epithelial cells, and also in the contraction of the myoepithelial cells in the submandibular gland.

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Apoptosis of tonsillar lymphocytes plays an important role in the ethiology of several tonsillar diseases. We cultured tonsillar lymphocytes, and investigated Fas antigen positivity by flow cytometric analysis. Specimens of palatine tonsils were obtained from 9 patients who underwent tonsillectomy in our department. Three cases were diagnosed as non-inflammatory tonsillar diseases such as tonsillar hypertrophy (group A), and six cases were diagnosed as recurrent tonsillitis (group B). The patients had a mean age of 35.0 years, with a range of 6 to 72 years. The Fas positivity of group B was statistically higher than that of group A, but the reactivity for SPEA (Streptococcal Pyrogenic Exotoxin-A; a superantigen derived from Streptococcus pyogenes) was weaker than that for SEB (Staphylococcal Enterotoxin-B; superantigen derived from Staphylococcus aureus). Mean while, the age was inversely proportional to the positivity of Fas, and the lymphocytes from hypertrophic tonsil expressed Fas antigen more strongly than that from withered tonsil. It seems that both the size and change in aging of palatine tonsils is affected by the apoptosis of tonsillar lymphocytes.

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It has been considered that peritonsillar abscesses include peritonsillar cellulitis, in which an abscess is not actually formed. They are generally differentiated by comfirmation of pus discharge by exploratory puncture. However, we, performed intraoral ultrasonography by placing a microprobe directory in the oral cavity for differential diagnosis of peritonsillar abscess and peritonsillar cellulitis, determined the location of the lesion, in particular its relationship with the palatine tonsil, distance of the lesion from the mucosa and the carotid artery, and the volume of the lesion, and then compared the volume of the lesion estimated by intraoral ultrasonography with the actual amount of pus discharged by puncture. The results suggested that intraoral ultrasonography allows for accurate determination of the location and the contents of the lesion and is useful in general clinical practice of otorhinolaryngology.

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It is reported that nocturnal secretion of growth hormone was impaired in adult patients with Obstructive Sleep Apnea Syndrome (OSAS).
Growth hormone secretion in children is strongly associated with slow-wave sleep and the peak during slow wave sleep is generally initiated 30 to 90 min after sleep onset. The first peak is generally the largest, with secretion of as much as 24-40% of the total 24h GH output (Martin 1973). We studied the effects of growth hormone secretion during sleep in children with sleep breathing disorders.
Materials and methods:
Subjects: Between 1995. 7. 1 and 1996. 6. 30, 24 children aged 4-12 ys, 13 boys and 11 girls, mean age 7.10 ys who underwent adenotonsillectomy and who often snored were studyied.
Methods: We investigated somatomedin C levels of the children undergoing adenoton silectomy during both on pre-and postoperative states using the radioimmunoassay technique.
Analysis: During pre-and postoperative states, we compared the somatomedin C levels by statistical analysis.
Results: There was a significant increase in somatomedine C levels from 170.46±91.58 during the preoperation state to 222.0±114.29 during the postoperation state (A Student's t-test was used, p<0.001). Comparing group 1 children (having forced respiration) and group 2 children (having no forced respiration) during sleep, There was a significant increase in the somatomedin C level of group 1 children after surgery, althogh there was no significant difference with group 2 children during pre-and postoperative states.
Conclusion: It is reported that OSAS leads to disordered sleep architecture and impairment of physiologic slow-wave sleep-related growth hormone secretion. OSAS in children is often associated with tonsillar adenoidal hypertrophy.
In this study, we present findings that somatomedin C levels in children who often snore increased significantly after undergoing adenotonsilectomy.
We conclude that nocturnal secretion of growth hormone in children with sleep breathing disorders improved after adenotonsilectomy, because the rate of slow-wave sleep increased.

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Malignant potentiality in oral leukoplakia was studied by evaluating the p53 gene. The p53 gene mutation was examined using the PCR-DGGE method in cases of malignant transformation. The p53 gene could be conveniently detected using conventional paraffinembedded specimens. Nine out of 124 cases of oral leukoplakia showed malignant transformation. Three out of 5 cases of leukoplakia were accompanied with ulcers, and 4 out of 6 cases had the pathological diagnosis of dysplasia transformed into malignancy. The p53 gene mutation was found in 1 out of 9 cases with malignant transformation .

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A rare case of hypoglossal neurofibroma was reported in a 47-year-old female. Her chief complaints concerned pain in the right temporal region and swelling in the right subaural region. A CT scan revealed an enhanced tumor mass in the right parapharyngeal space. The tumor was removed using an extracervical approach. The tumor involved the hypoglos sal nerve. The histological diagnosis was neurofibroma. Postoperatively, she developed right hemilingual paralysis and an incomplete palsy of the right vocal cord.

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A 4 years-old boy consulted our hospital complaining of sleep disorder (apnea andsnore). His soft palate was swollen and uvula was deviated to the left by tumor. CT and MRI revealed that tumor was cystic lesion occupied the parapharyngeal space and it extended to the cranial base. We excised the cystic tumor with the peroral approach. The cystic tumor adhered to the auditory tube and faucial tonsil. The cyst was bronchial cyst by the pathological examination. We suppose that the cyst arised from the second bronchial apparatus from the findings of operation. After operation, He was relieved from sleep disorder.

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We studied the results of a tonsillar provocation test by electrovibrator. The provocation test was performed in 45 patients with suspected tonsillar focal infection, 45 patients with chronic tonsillitis and 5 normal cases.
1) The tonsillar provocation test was positive in 57 .8% of the patients with suspected tonsillar focal infection and was positive in 42.2% of patients with chronic tonsillitis.
2) After tonsillectomy, improvement of secondary disease occurred in 88.2% of patients who tested positive to suspected tonsillar focal infection . According to the parameters of the tonsillar provocation test, patients who tested positive to exacerbation of secondary diseas were mostly improved (92.9%).
3) In 5 patients with suspected tonsillar focal infection, secondary disease was improved after tonsillectomy and results of the postoperative tonsillar provocation test was negative. It proved that stimuration by electrovibrator certainly provoked the focal tonsil.
4) Of the 5 normal cases, the tonsillar provocation test was positive in 3 cases (60%). In the provocation test by electrovib rator, it was suggested that false positive cases were included in cases testing positive to parameter of temperature and WBC.
We are certain that the tonsillar provocation test by electrovibrator is useful. We should synthetically judge the clinical course, findings of the tonsil and tonsillar provocation test, and diagnose tonsillar focal infection.

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Aged people who experience the feeling of dryness in the mouth usually take various kinds of medicines. We considered that the side effects of these medicines might be one of the causes for a dry mouth in aged people. Some medicines had an influence on salivation under stimulation, and salivation quickly improved after people stopped taking medicines. Various kinds of medicines that might cause dry mouth are known, but the effect varies depending on the medicine. Therefore, we investigated the medicines by allocated scores according to the frequency of reports of side effects. We gave a score of 3 to the medicines that cause a dry mouth in more than 5% of people, a score of 0 to medicines that don't cause a dry mouth, and scores of 1 or 2 to other medicines in between depending on the frequency of dryness. Each medicine score represents the mean of all responses. The number of medicines that each patient takes and the medicine score were highly correlated. The more the patients take medicines, the more the function of the salivary glands fails, hence causing more dryness in the mouth. When some patients inevitably needed many kinds of medicines, we chose the lowest score among the medicines.

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We surgically treated fifty-nine cases of major salivary gland tumors between 1991 and 1996. Based on each patient's past history, physical examination, and images in ultrasono graphy and CT scan, cases were classified into three classes, such as “surely benign”, “probably malignant”, and “surely malignant” tumors.
Then, we compared the preoperative diagnosis with the postoperative pathological diagnosis. Thirty-five fine needle aspiration biopsies were performed.
Preoperatively, there were ten “probably malignant” tumors, but they were all benign. Of these ten cases, eight were pleomorphic adenomas and two were adenolymphomas. Images of benign pleomorphic adenomas in ultrasonography and CT scans often showed a malignant pattern.
There were three cases in which the preoperative diagnosis and the postoperative diagnosis were different. Two cases were false positive and one case was false negative. Every results of fine needle aspiration biopsy on these three cases was class III. Fine needle aspiration cytology was very useful for predicting malignancy of major salivary gland tumors.

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During the past 19 years, 476 patients with parotid tumors were treated surgically at the Department of Otolaryngology Head and Neck Surgery, Kansai Medical University.
Eighty-three of the 476 patients had Warthin's tumors consisting of 66 men and 17 women, with an overall man-to-woman ratio of 4: 1. The average age was 61.6 years, with ages ranging from 35 to 89 years old. Warthin' s tumors were found in multiple lesions in 10 of 83 patients. Eight of those 10 cases had multiple tumors manifested in the unilateral parotid region. We investigated the usefulness of Tc-99m pertechnetate imaging. Out of 39 patients with Warthin's tumors, 18 patients showed a typical pattern of high-activity in part of the tumor, 13 showed the same activity compared to the normal gland, and 8 showed decreased activity.

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One hundred and three hospitalized cases of benign tumors in the oral cavity and the pharynx were examined clinicopathologically. Sixty-nine cases were in the oral cavity and 34 cases were in the pharynx. The mean duration from which patients first noticed tumors until the the time of the first hospital visit was 32 months for the oral tumors, and 14 months for pharyngeal tumors. The mean diameter of the oral tumors was 2.9 cm and that of the pharyngeal tumors was 3.9 cm.
Histologically, pleomorphic adenoma was the most frequently seen tumor (28/103) followed by hemangioma (25/103). These two histological types were the predominant tumors of the oral and pharyngeal benign tumors.
Total resection is the best way to treat benign tumors. Partial resection, however, should be done if the total resection causes severe cosmetic deformity and loss of function such as swallowing, mastication, and articulation. The longstanding prognosis of these patients is pretty good.

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Tonsillectomy was performed in 34 cases with tonsillar focal infectional skin disease who were observed postoperatively for between 3 months to 164 months, with an average period of 101 months. 17 cases became disease free, and 7 cases were improved. The effective ratio of tonsillectomy was 70.6%. In 25 cases for more than 5 years, the effective ratio after 1 year was 76.0%, but although observation the ratio was 68.0%. We conclude that it requires at least 1 year to estimate the effect of tonsillectomy on skin disease.

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A retrospective review of 46 patients with parotid cancers treated in our department between 1978 and 1995 is presented. All of them were treated with surgery and some cases received added postoperative irradiation. Local recurrence of disease was more frequent in Tla-T3a vs. cervical lymph node and distant metastasis was in T3b-T4b. Histologically, recurrence was more frequent in adenocarcinoma, squamous cell carcinoma and undifferentiated carcinoma patients. Three of 12 patients, who received partial parotidectomy without facial nerve involvement and who were diagnosed malignant by postoperative histological examination, developed local recurrence of disease. These patients had adenocarcinoma and squamous cell carcinoma of T2 or T3. Postoperatively, high-grade histologies, except Ti, needed re-excision after the initial operation. The five-year and ten-year cumulative survival rate was 71.4% and 54.2%, respectively. To prevent recurrence of disease, it is considered necessary to improve the sensitivity and specificity of the preoperative diagnosis.

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The effect on myoepithelial cells in submandibular glands of the rat after treatment with acetylcholine chloride was visualized under laser scanning confocal microscopes using FITCphalloidin, a fluorescent stain for filamentous actin. Acetylcholine chloride, a cholinergic agonist, caused hypertrophy of acini and abundant salivation in the rats. In the presence of acetylcholine chloride, actin bundles in the myoepithelial cells seem to be thicker and denser. Hence, we conclude that myoepithelial cells can help the outflow of saliva by changing the arrangement of filamentous actin when secretion of acetylcholine chloride is activated.

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A 64-year-old female visited our hospital complaining of an abnormal sensation in her pharynx over a long period of time. The right side of her posterior pharynx was markedly swollen. CT and MRI examinations revealed a clearly demarcated tumor in the right parapharyngeal space. Blood test findings were all within normal limits. Ultrasonography revealed multiple swelling of the lymph nodes in the right upper neck region. Thus we suspected that this case was a neoplastic lesion with metastasis to the cervical lymph nodes. An incision biopsy showed that the parapharyngeal mass lesion was an inflammatory tumor. Its cause is unknown as yet. The tumor has remained unchanged for one year after the open biopsy was performed. This kind of inflammatory tumor originating in the parapharyngeal space is rare.

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Salivary duct carcinoma is an uncommon malignant tumor that occurs mainly in the parotid glands of elderly men. The tumors were first described by Kleinsasser et al. in 1968. Since then, approximately 130 cases have been reported.
A case report and a review of the literature are presented. A 51-year-old man had complained of swelling of the right submandibular region. He visited a local hospital and underwent a biopsy and entered our hospital with a diagnosis of metastatic adenocarcinoma. An enhanced CT showed a tumor within the deep pole of the right parotid gland. After chemotherapy, a total parotidectomy and radical neck dissection were performed with a free anterolateral thigh flap.A hard yellow-white mass was found in the parotid gland with an irregular, infiltrating margin. Histopathological examination revealed tumor cells arranged in cribriform, papillary and solid growth patterns. The tumor cells had eosinophilic cytoplasm resembling apocrine epithelium. In many ducts there was central necrosis termed so-called “comedo necrosis”. Lymph node metastases were observed macroscopically and microscopically. The histo-pathological diagnosis was salivary duct carcinoma of the right parotid gland. The postoperative course was uneventful, but local recurrence of tumor was observed in the subcutaneous region 15 months after initial treatment. Therefore, we performed super selective intraarterial chemotherapy with irradiation. There was an objective response in the partial region, but the tumor gradually invaded the subcutaneous region of the neck and head, and he died 30 months after the initial diagnosis . There was no autopsy. Salivary duct carcinoma is the highest-grade malignancy among salivary gland tumors, and radical surgery followed by radiation therapy is necessary in an attempt to control the disease.

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Information obtained from the fungiform papillae of the tongue can be a sensitive and useful indicator of diabetic complications. Typical fungiform papillae from normal young subjects show a papillary shape with well-branched and looped capillary. Serum type IV collagen is reported to be a useful marker for the assessment of the progression of diabetic microangiopathy, and type IV collagen also occurs in the thickened basement membrane of the capillary of the fungiform papillae.
In diabetic patients, the incidence of papillae with a spotty, or even “disappeared”, capillary appearance increases in relation to diabetic complications. The incidence of fungiform papillae with “disappeared capillary appearance”, classified as “type E fungiform papilla”, closely reflects the progression of diabetic complications. To evaluate its clinical significance as a quantitative indicator, the incidence of type E fungiform papilla and serum type IV collagen concentrations were simultaneously determined in non-insulin dependent diabetes mellitus patients (n=26). The incidence of type E papilla was significantly higher in the group with neuropathy (p<0.05), preproliferative or proliferative retinopathy (p<0.05), or overt proteinuria (p<0.05) than in the group without these complications. The serum type IV collagen level was significantly higher in the groups with preproliferative or proliferative retinopathy (p<0.05), or overt proteinuria (p<0.01). However, elevation of serum type IV collagen was not significant in the group with neuropathy. Thus, our findings suggest that the incidence of type E fungiform papilla is a useful quantitative indicator for the assessment of the progression of diabetic complications.

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A case of epidermoid cyst occurring in the soft palate of a 6-week-old male newborn was reported.
This patient, whose parents noticed dyspnea during crying and sucking, was referred to our clinic. He had an approximate 10mm whitish oval mass attached to the surface of the pharynx site of the soft palate, and X-ray examination revealed no particular abnormality. Regarding the mass as benign, we removed it easily under general anesthesia, and the clinical course was uneventful. A histological examination showed an epidermoid cyst.
Dermoid and epidermoid cysts of the head and neck regions occur generally on the floor. of mouth and orbital. It is rare to find such cysts in the soft palate, and such cysts can cause dyspnea in infants. We discuss this case from the perspectives of clinical features, pathogenesis and treatment.

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