This new technique for the treatment of epistaxis is a method of nerve block. The block is performedby the trans-oral approach, through the mid-point of retromolar pad with an angled long needle and nfiltration of 2 ml of 2% Xylocaine to the superior carotid triangle. It attempts to block the parasympathetic nerve plexus. After the block, the nasal bleeding will be controlled immediately. Locally, dryness of nasal mucosa, oral mucosa, retropharyngeal mucosa, lips and tongue was observed. This method is indicated .also for the treatment of bleeding in the oral cavity, hiccough and esophageal spasm. The block was done on 88 cases and the results showed 80.7% of these cases with sucessful effect, 13.6% with partial effect and 5.7% failure.

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Branchial fistulas are commonly believed to be congenital abnormality arising from the remnants of branchial clefts in the embryonic life. A various cases of cervical fistulas have been reported by many in the fields of surgery and otorhinolaryngology. Few reports however have been made in the field of oral surgery. Furthermore, reports on cases of bilateral cervical fistulas are very rare in the literature of this country. We have recently experienced a case of congenital fistula occurring symmetrically in the bilateral neck of a girl aged 9. In this case, the fistulas of the bilateral neck were evident at birth. The complaints were swelling of the neck and intermittent drainage from a small orifice in the neck. The cutaneus orifice is located in the inferior carotid triangle and on a line along the anterior border of the sternomastoid muscle. The tracts are imcomplete (with an end each closed) and run from the external opening through the subcutaneus tissue, the platysma muscle, and to the superficial layer of the deep fascia. They then take a course upward along the internal jugular vein until they reach the deep structures around each hyoid bone. Pathohistological examinations revealed that columnar and stratified squamous epithelium lined the tract wall and that tract was composed of lymphoid tissue, salivary gland and muscle. Judging from the foregoings, the fistulas are considered to have originated from the second inner branchial groove in the embryonic life.

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We have treated four patients with odontogenic phlegmon of the oral floor. Two of the four had diabetes mellitus, and one had suffered a mandibular fracture during tooth extraction.
The four patients did not respond to antibiotic therapy, but symptoms were significantly relieved by incision and drainage.

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A rare case of carcinoembryonic antigen (CEA)-producing branchiogenic carcinoma is reported. A 56-year-old man was referred to our clinic, because of a painless swelling in the right side of the neck. A branchial cyst was diagnosed from the clinical and radiological findings. The serum CEA level at presentation was above the normal range. The cyst was removed surgically. Histological findings showed a well differentiated squamous cell carcinoma arising from the branchiogenic cyst wall. Radiotherapy and chemotherapy were given, followed by surgical treatment. A squamous cell carcinoma was recognized in the right platoglossal arch 10 months after the cystectomy. The tumor was resected surgically, and supurahyoid neck dissection was performed bilaterally. The patient has been well without recurrence for 6 years since the second operation. The serum CEA level fluctuated parallel to development of the tumors. Immunohistochemical findings showed that the branchial tumor cells exhibited CEA in the cytoplasm.

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In 1971 an ectopic solid thymus gland of the neck was first reported in Japan. Since then only a few individual case reports have been published. This article presents one such patient who was recently found and reviews the literature. The embryology of ectopic solid thymus glands and thymic cysts in the neck is also discussed.

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We report a case of lipoma arising in the parotid gland. A 62-year-old man presented with a swelling in the left preauricular region, which had persisted for two months. The tumor was soft and the size of a hen's egg, with no tenderness. Sialography revealed a so called ball-in-hand appearance, which suggested a benign tumor. CT scan demonstrated a clear-cut low density area showing -104.3 Hounsfield units. The tumor was extirpated easily. The diagnosis of lipoma was made histologically.

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A 53-year-old female complained of a growth in the left side of the neck. A tumor was found at the carotid triangle. It was elastic soft and measured approximately 3.0×3.2cm in size. Ultrasound scan confirmed the mass, which was well demarcated, solid, and with a complex echotexture. CT scans revealed that the tumor was located inside the sternocleidomastoid muscle and showed partly high-density-area suggestive of calcification.
The tumor was removed en bloc and showed no connection to the thyroid. The macroscopic appearance more closely resembled thyroid tissue than cervical lymph node. Pathohistologically, it was normal thyroid tissue with thyroid follicles of varying sizes. There was no evidence of malignancy.

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【背景と目的】体幹筋群は浅層に位置するグローバル筋群と深層に位置するローカル筋群とに分類される。近年、従来行われてきたグローバル筋群へのアプローチに加え、ローカル筋群に注目した脊椎の分節的安定性のためのアプローチが注目されている。頚部においては、ローカル筋群に分類されている頚長筋が、脊椎の安定性に重要な役割を果たすことが指摘されている。臨床上、頚長筋の機能を把握することが重要ではあるが、従来の筋力検査法を用いて評価する事はできない。本研究では、超音波画像から非侵襲的に頚長筋の機能評価を試みることを目的とした。
【対象と方法】健常成人6名〔男性3名、女性3名、平均年齢：25.2±5.4歳（22-36歳）、平均身長：165.7±10.7cm、平均体重：57.17±10.7kg〕を対象とした。研究の主旨と方法に関しての説明を十分に行ったあと、被験者の承諾を得て実施した。被験者を背臥位とし、超音波診断装置（東芝社製Powervision-8000）のプローブ（8MHz）をの胸鎖乳突筋上部に位置させ、体表面から胸鎖乳突筋、総頸動脈、頚長筋の三層構造をイメージングした。口頭指示にて頭部を屈曲するようにして頚長筋を収縮させたときの各筋の超音波イメージをBモードにて記録し、それぞれの筋腹幅を計測した。また、SieScapeモードにて記録可能な超音波診断装置（シーメンス社製Sonoline-Antares）を用いて頚部の連続画像を記録した。
【結果】記録された超音波画像上において、浅層から深層へ向かって胸鎖乳突筋、総頸動脈、頚長筋の三層構造を明確に捉えることが可能であり、各筋の作用を動画上での変化として捉えることが可能であった。典型例における頚長筋の筋腹幅は、安静時5.8mm、収縮時8.1mmであり、安静時と比較して収縮時に著明に増加した。
【考察】頚長筋の機能評価の試みとしては、比較的簡便な方法に頚長筋の作用時の体表面の変化を圧バイオフィードバック装置により圧変化として捉える方法がある。しかし、この方法では他の筋による代償運動をチェックする高度なスキルが要求される。これに対して今回試みた方法では、頚長筋の機能を非侵襲的かつ動的に捉えることが可能であり、必要に応じて画像解析による定量的評価が可能である。

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Cervical necrotizing fasciitis is a rare, severe soft tissue infection. It is usually a polymicrobial infection characterized by rapidly spreading diffuse necrosis of the subcutaneous fatty tissue and fascia. We report a case of odontogenic cervical necrotizing fasciitis in an 80-year-old woman. Despite repeated surgical drainage and antibiotic therapy, severe complications, including coma, ARDS, and DIC, developed, and the patient died of acute renal failure in spite of intensive care.

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A case of relatively large lipoma of the right neck is reported and thirty-three cases of lipomas treated in our department from 1965 to 1986 are reviewed.
A 64-year-old man was admitted to our department complaining of a right neck swelling. The preoperative diagnosis was lipoma based on clinical findings as well as the image findings of CT scan and echogram. The tumor was excised through a cervical skin incision under general anesthesia. It lied between the platysma and the superficial layer of the cervical facia. The enucleated yellow and soft specimen was 12×7×6.5cm in size, and covered with a thin fibrous capsule. The histopathological diagnosis was lipoma. The prognosis has been good for about one year. From our statistical study the distribution by site of 33 lipomas is as follows: eleven cases in the check, five in the lower lip, five in the tongue, three in the submandibular region, two in the gingiva, the floor of the mouth, the soft palate, the preauricular portion each other and one in the neck.Males are more affected than females.76% of the patients are over 40 years of age.

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Idiopathic carotidynia is a rare disease of unknown origin characterized by unilateral cervical pain of carotid-sheath origin and soft-tissue infiltration surrounding the carotid sheath on imaging examination. Herein, we report the case of a 65-year-old male who presented with the chief complaint of left cervical pain. Otorhinolaryngological examination showed mild swelling and tenderness of the left carotid sheath. A plain CT showed soft-tissue infiltration surrounding the left carotid sheath at the level of the left hyoid bone. Laboratory test results were normal. These clinical manifestations and the findings of CT were consistent with a diagnosis of idiopathic carotidynia. The above symptoms were relieved by one-day treatment with an anti-inflammatory drug. Although soft-tissue infiltration of the carotid sheath of in cases of carotidynia on contrast-enhanced CT has been described in previous reports, it was observed on plain, non-contrast CT images in this patient, which allowed avoidance of any anxiety from the point of view of potential contrast medium allergy in our case. From the reports in the literature and data from our own case, we propose a revised classification of carotidynia, dividing it into five categories (i.e. idiopathic, migrainous, arteriosclerotic, drug-induced, and others).

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Inflation of the eustachian tube is often applied in the treatment of exudative otitis media and obstruction of the eustachian tube. However, complications following treatment have been occasionally reported and we encountered a rare case which developed a swelling in the neck, dyspnea, and hemorrhage in the deep neck, following application of inflation of the eustachian tube. A finding suggestive of bleeding was obtained by CT and MRI of the neck. Nasopharyngeal fiberscopy revealed extensive submucosal hemorrhage near the tubal orifice.
Treatment with steroids, antibiotics and hemostypic was based on initiated immediately. The symptoms remitted on the next day. Anatomical relationships and earlier reports of similar cases, the internal carotid artery and its branches were considered to be the source of hemorrhage. The route of out flow was estimated accordingly. Although such a complication often results from carelessness in treatment, this patient had diabetes mellitus and osteoporosis as underlying diseases. A diabetic vascular disorder was suspected to be involved in the development of extensive hemorrhage. This case was presented to point out the importance of recognizing the coexisting basic disease, in cases such as this.

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