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Intramusucular hemangioma is a benign neoplasm frequently arising from the skeletal muscles of the trunk and extremities. Involvement of the head and neck by this tumor is rare, even though the majority of such tumors originate from the masseter and the trapezius. Preoperative diagnosis is very difficult because of the rarity and the distribution of these tumors in the deep space. We report on a rare case of intramuscular hemangioma, involving the posterior cricoarytenoid muscle. A 82-year-old female patient with an abnormal sensation in her throat, was found to have a tumor in the left piriform sinus. Thus we performed biopsies twice, but the pathology was not confirmed, with a report of just normal mucosa. However we speculated that the tumor was benign and so performed a lateral neck exploration. The tumor was completely removed. Histological examination revealed it to be an intramuscular hemangioma of the skeletal muscle. Based on the intraoperative findings of the tumor, we diagnosed it as an intramuscular hemanginoma originating from the posterior cricoarytenoid muscle. As the posterior cricoarytenoid muscle opens the glottal space, the left vocal cord was fixed medially after the surgery. Nevertheless its tonus appeared fine and phonetic function remained normal.

Primary tracheal cancer is very rare and a tumor obstructing the airway is an emergency difficult to manage. We report a case of primary tracheal cancer requiring surgery using percutaneous cardiopulmonary support (PCPS). A 68-year-old man was referred of severe dyspnea and squamous cell carcinoma obstructing the subglottic laryx found in bronchoscopy. Computed tomography (CT) showed a tumor extending from the cricoid cartilage to the third tracheal ring. We diagnosed tracheal cancer because most of the lesion was in the tracheal wall. Because dyspnea was getting worse, we performed emergency surgery. PCPS was established before tracheostomy for airway management. We performed total wide-field laryngectomy with the inferior margin located at the seventh tracheal ring. Using PCPS helps keep the operation uneventful and successful. Despite postoperative chemoradiotherapy, mediastinal lymph node and lung metastases 8 months post-operatively led to the man's death 15 months later. PCPS is very simple and easy to control, and has proven very effective in cases of severe airway stenosis.

The incidence of tuberculosis in Japan, including tuberculous otitis media, has increased alarmingly. Predisposing factors remain, however, to be clarified—particularly in view of how clinical features have changed—with the use of effective antitubercular therapy and improved economic and social conditions. Otolaryngologists must thus be aware of tuberculous in chronic otitis media and its varied manifestations. We report the two cases of tuberculous otitis media and its presentation and clinical manifestation. Tuberculous otitis media diagnosis was corroborated by pathohistological, microbiological, and molecular biological tests.

We report a rare case of giant cell tumor of bone arising in the 1st thoracic vertebra, which was successfully resected by a lower cervical approach. The patient was a 16-year-old female who presented with a cervical mass and dyspnea. Imaging study revealed a mediastinal mass arising in the 1st thoracic vertebra, extending upward into the lower neck. After repeated open biopsies, a diagnosis of giant cell tumor of bone was made. Curative surgery was performed by orthopedic and head and neck surgeons. Surgical exposure of the tumor was performed mainly by head and neck surgeons using a lower surgical approach without a median sternotomy. The postoperative course was uneventful and the patient is doing well without recurrence.

We report a case of maxillary cancer that caused a marked systemic inflammatory reaction including leukocytosis and high blood levels of C-reactive protein. The production of Granulocyte-colony stimulating factor (G-CSF) by tumor cells was demonstrated by immunohistochemical staining. Despite the reported poor prognosis of G-CSF producing tumors, chemoradiotherapy was highly effective and all of the inflammatory indexes settled to within normal limits. The patient is under close follow-up and has been in complete remission for eleven months after the completion of chemoradiotherapy.

Change and its significance in the treatment of the hypopharyngeal carcinoma (HPC) are discussed, chiefly based on the author's experiences. In the nineteen-seventies and eighties, the prognosis of HPC was poor, and the 5-year over-all survival was only 24% in 173 patients. Locoregional recurrence was the most serious problem. To improve locoregional control, we introduced extended surgery with reconstruction using a free jejunal graft, in which a safety margin of 3cm or more was secured at the primary site while bilateral retropharyngeal and paratracheal dissections were added to bilateral radical neck dissections. This treatment achieved a disease-specific 3-year survival of 64% for patients with advanced (stage III, IV) HPC, which was significantly better than that of patients treated by previous methods. Furthermore, postoperative radiotherapy was introduced for advanced HPC treatment, in which a 50Gy dose was basically used to irradiate the bilateral neck and a 10Gy dose was locally added when a retropharyngeal lymphnode metastasis was histopathologically identified or the number of lymphnode metastasis was three or more. In the recent five years, the disease-specific 3-year survival reached 81% in 39 advanced HPC patients. During this period, we endeavored to conserve in laryngeal functions for patients with early (stage I, II) HPC by performing a radiotherapy or partial pharyngectomy. In 14 early HPC patients, there was no recurrence and the larynx was well conserved in eleven. We also developed a new method of reconstruction after partial laryngopharyngectomy, in which aspiration was well prevented by reconsfructing the supraglottis and hypopharynx using hyoid bone attached to sternohyoid muscle and free forearm flap. Progress in surgical reconstruction techniques and radiotherapy changed the treatment of HPC, providing a better prognosis for advanced HPC patients and a better life quality for early HPC patients.

Hereditary hemorrhagic telangiectasia (HHT, Osler-Weber-Rendu disease) is a systemic disorder of blood vessels. The most common manifestation of HHT is recurrent epistaxis, occurring in almost 90% of patients. Management of epistaxis is usually difficult and many types of treatment have been advocated. Of all these treatments, intranasal dermoplasty is considered the most effective one. It reduces the frequency of epistaxis by removing the telangiectasic mucosa and replacing it with a split thickness skin graft.We report a 55-year-old woman with HHT and recurrent epistaxis who was treated with intranasal dermoplasty. Postoperatively, she has shown considerable reduction in the frequency and severity of her epistaxis.

Aneurysms of the superficial temporal artery are infrequent, and most of them are traumatic aneurysms located on the superior temporal line. We present a rare case of preauricular aneurysm of the superficial temporal artery. The patient was an 81-year-old woman who had a pulsating mass in the preauricular lesion. It was successfully removed by surgery. Histopathologically, it was suggested to be an aneurysm of the superficial temporal artery caused by atypical arteritis. She has not had active inflammatory findings, but follow-up is needed.

A 50-year-old male had severe tracheal stenosis by a mediastinal goiter. The narrowest trachea part was 2mm in diameter. Therefore we scheduled the use of percutaneous cardiopulmonary support (PCPS) during tracheal intubation. By this method, we could perform tracheal intubation safely and lt-hemithyroidectomy. PCPS is a useful technique for managing severe tracheal stenosis before maintenance of the airway.

Thirty patients with primary hyperparathyroidism (PHPT), who were all surgically treated with a parathyroidectomy, were retrospectively studied. Ultrasonography was the most useful preoperative imaging. Pathological findings revealed 28 adenomas, 1 hyperplasia, and 1 carcinoma. In all cases, only one swollen gland was removed, and values of serum calcium and parathyroid hormone were normalized after surgical treatment. There were no significant postoperative problems. The suggested treatment for PHPT is the extirpation of one swollen gland, which is detected with preoperative imagings.

After a partial laryngectomy on patients with laryngeal cancer with unilateral vocal cord fixation, we reconstructed the widely removed arytenoid region with a part of the thyroid cartilage or the hyoid bone. To maintain the sufficient blood flow, the sternothyroid and thyropharyngeal muscles were conserved when the thyroid cartilage was utilized. The sternothyroid muscle was preserved when the hyoid bone was utilized. The cartilage or bone was directly and firmly fixed to the cricoid cartilage. The inside of the cartilage or bone was covered with a local skin flap from the anterior neck.In two patients, the lateral half of the thyroid ala on the affected side was used in reconstructing the arytenoid. In one patient, the half of the hyoid bone on the unaffected side was used. The supraglottic tissue including the epiglottis was simultaneously removed in two of the three patients. After surgery, the functions of phonation, respiration and swallowing were conserved satisfactorily without recurrence of the cancer in all three patients.

A rare case of thrombophlebitis of the external jugular vein is reported. The patient was a 66-year-old male and complained of cervicodynia of the right side and lockjaw. Swelling and redness were observed on the right side of his neck. Despite treatment with antibiotics cervicodynia and lockjaw worsened. On C T scan, the wall of the right extra jugular vein was thickened and circulation in the vein was obstructed. Resection of the right extra jugular vein was performed and the symptoms disapeared immediately after surgery. The resected vein had a thick wall containing a thrombus. The patient has remains well any evidence of disease 6 months following treatment.

Occasionally the air flow rate during phonation is inadequetely improved by endoscopic microsurgery for vocal cord polyps, nodules and Reinke's edema. To clarify the factors influencing the air flow rate after surgery, we studied severity of the laryngeal lesion and the improvement of hoarseness in patients with inadequete flow rate.1) In patients with polyps, the large and/or bilateral lesions appeared to cause inadequete improvement of the flow rate. There was no relationship between improvement of the flow rate and hoarseness after surgery.2) A patient with vocal cord nodules and little improvement of the flow rate had red vocal cords before surgery and no reduction of hoarseness.3) In a patient with Reinke's edema, good relief of hoarseness was obtained regard less of little improvement of flow rate which did not relate to severity of the laryngeal lesion.

Three cases of so-called tripod malar fracture were treated by maxillary antrostomy for reduction and zygomatico-palatal Kirschner wire fixation (Matsunaga1)). Under general anesthesia, a mucosal incision was made in the gi.ngivobuccal sulcus, and the anterior surfaces of the maxilla and zygoma were exposed. The bulk of the malar bone was reduced by an elevator and then fixed by the Kirschner wire driven from its lateral aspect aimed obliquely through the antrum towards the hard palate. The wire was left in place for four to five weeks and then removed under local anesthesia through a small skin incision made over the wire. Reduction and fixation were satisfactory in all three, and the facial scar was minimum.Zygomatico-palatal Kirschner wire fixation is considered to be a safe and simple method of treating malar bone fractures.