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Ossifying fibroma is an uncommon benign osteogenic neoplasm arising from cells of the periodontal ligament, typically with a slowly progressive enlargement of the affected bone. The neoplasm sometimes presents with hyperparathyroidism, most of which cases are due to familial parathyroid tumours. We report a rare case of ossifying fibroma of the mandible which showed very rapid growth and presented with primary hyperparathyroidism due to non-familial parathyroid adenoma. Despite improvement of parathyroid dysfunction after removal of the parathyroid adenoma, the tumour continued to grow very aggressively. The case required partial mandibular resection for complete resection of the tumour, and fixation of the remaining mandible with a titanium plate.

Hemangioma occurs in every systemic region, and in the head and neck region, it is often found in the tongue, the lip, and the buccal mucosa. However, intramuscular hemangioma in the head and neck region is relatively rare.We treated two cases of hemangioma in the masseter muscle. Both the tumors contained various sizes of phlebolith. Combination of CT and MRI analysis was useful for identifying the tumor localization. Both tumors were excised by external incision, which enabled a secure enough field of operation and a certain extraction. Histologically, they were diagnosed as hemangioma.Here, we report the diagnosis and surgical treatment of hemangioma in the masseter muscle with reference to the literature.

Olfactory neuroblastoma is a relatively rare malignant neoplasm, believed to arise from the epithelium of the upper nasal cavity. Approximately 300 cases of olfactory neuroblastoma have been described in the medical literature since the first case report by Berger and associates in 1924 introduced the tumor entity. To prevent the tumor invading the skull base, a combined transnasal and endocranial approach is essential. In general, the combination of surgery and radiotherapy seems to be the optimum approach to treatment, and its survival at five years is about 65%. We have experienced two cases of olfactory neuroblastoma and report them here with some considerations.Case 1 was a 60-year-old female. She presented with nasal obstruction and magnetic resonance imaging revealed a mass limited to the nasal cavity. She was treated with partial maxillectomy by lateral rhinotomy and followed by postoperative irradiation. She is still alive with no evidence of local recurrence or metastasis about three years after the initial treatments.Case 2 was a 35-year-old male. He experienced left upper neck swelling and computed tomography revealed a submandibular tumor. Tumor resection was performed, and histopathological diagnosis was myoepithelioma. After that he presented with nasal bleeding and left upper neck tumor, and magnetic resonance imaging revealed a mass in the nasal cavity that infiltrated intracranially and a swelling lymph node in the left upper neck. Biopsy was performed and those tumors were diagnosed as olfactory neuroblastoma. After reexamination, the submandibular tumor was histopathologically same as above. En bloc resection by craniofacial surgery and the left neck dissection was carried out with subsequent radiotherapy. The patient shows no recurrence or metastasis during a two-year follow-up.In both cases, we reffered to Hyams' classification to determine treatment planning and found it useful.

The indication and preferred dissection field for prophylactic neck dissection for submandibular gland cancer are controversial and have not been standardized. We reviewed 27 patients who underwent a definitive operation for previously untreated submandibular gland cancer. The 27 patients consisted of 13 patients with adenoid cystic carcinoma, 6 patients with mucoepidermoid carcinoma, 6 patients with adenocarcinoma, and 2 patients with squamous cell carcinoma. The diagnostic accuracies of malignancy and histology with fine needle aspiration cytology were 86% and 56%, respectively. In sixteen out of 21 cases without neck lymph node metastasis, a prophylactic neck dissection was performed and pathological neck lymph node metastases were detected in five cases. On the other hand, in five cases that did not receive a prophylactic neck dissection, latent neck lymph node metastasis was observed in 2 cases. In both cases of neck lymph node metastasis, pathological positive lymph nodes were observed in only level 2 or level 3. The rates of occult neck lymph node metastasis according to the T stage were 0% in TI, 33.3% in T2, 57.1% in T3 and 100% in T4. The rates of occult neck lymph node metastasis according to the histopathology were 46.2% in adenoid cystic carcinoma, 50% in mucoepidermoid carcinoma. 50% in adenocarcinoma, and 50% in squamous cell carcinoma. In conclusion, we believe that supraomohyoid neck dissection is suitable fur NO cases of submandibular gland cancer because of four reasons : 1) rate of occult neck lymph node metastasis in submandibular gland cancer is high, 2) pathological neck lymph node metastasis in No cases and latent neck lymph node metastasis were observed in level 2 and level 3, 3) the prognosis of cases with neck lymph node metastasis was poor, and 4) same skin incision can be used not only for the primary resection but also for the neck dissection.

近年, 頭頸部癌の早期診断と治療法の進歩により, 初発癌の制御が向上し, 続発癌に遭遇する機会が増加する傾向にある。そのため時に, 口腔内に限局して多発し, 診断, 加療に苦慮させられる症例に直面することが少なくない。そこで今回われわれは, 口腔内多重癌に着目し, 主にその治療法について検討を加えた。対象は1960年1月から1998年12月まで39年間に当科を受診した口唇癌を含む口腔扁平上皮癌2169例中, 口腔内多重癌1次症例30例であった。その内訳は, 同時性癌7例, 異時性癌23例であった。初発癌に対する第1次治療としては, 同時性癌では7例中5例で外科的切除が施行されていた。一方, 異時性癌では23例中12例が放射線治療単独であった。外科的切除を施行した18例中14例が制御可能であった。これらのことから, 口腔内多重癌の治療法としては外科的切除が有効であると考えられた。

This study evaluates the use of ultrasonography (USG) to diagnose metastatic cervical lymph nodes. Three-hundred and one lymph nodes were removed from 58 patients with squamous cell carcinomas of the head and neck. None of the patients had received any preoperative treatments for cancer. The lymph nodes were then histopathologically examined: 139 metastatic lymph nodes and 162 non-metastatic nodes were found. USG was then used to evaluate the size, internal echo, and margin of each lymph node. Size was found to be the best criteria for distinguishing metastatic lymph nodes from non-metastatic lymph nodes in all cervical regions (78% accuracy). Superior internal jugular lymph nodes and submandibular lymph nodes larger than 7 mm and mid and inferior internal jugular lymph nodes larger than 6 mm were regarded as metastatic. Internal echoes were classified into five patterns: homogeneous hypoechoic, homogeneous hyperechoic, heterogeneous, eccentric hyperechoic, and centric hyperechoic. Homogeneous hyperechoic and heterogeneous patterns were characteristic of metastatic nodes, while eccentric hyperechoic patterns were characteristic of non-metastatic nodes. Homogeneous hypoechoic patterns were observed in both metastatic and non-metastatic nodes. Regular margins were found in 81% of the metastatic nodes. Of the 22 lymph nodes with irregular margins, however, 91% were metastatic. Evaluations using a combination of USG and clinical feature criteria were compared with evaluations using only thickness as a criterium. Although thickness is the single most important factor in diagnosing metastatic nodes, the combination of USG and clinical feature criteria improved the accuracy of diagnosis to 83%. Thus, diagnostic methods involving a combination of several criteria are more accurate than methods involving only a single criterium.

Background This study was undertaken to analyze the functional results, complications, local control rates, and survival in patients undergoing conservation surgery for squamous cell carcinoma (SCC) of the larynx as a salvage procedure for recurrent tumors after previous radiotherapy. Methods Twenty-one patients underwent frontolateral laryngectomy for radiation failure, T1 and T2 glottic SCC, at the Cancer Institute Hospital, Tokyo, from 1976 to 1991. All patients were men between the ages of 42 and 83 years. The disease-free interval ranged from 1 to 87 months (median, 26 months). The stage at initial treatment was T1 in 17 patients and T2 in four patients. Local recurrence developed in three patients. Results The rate of local control was influenced by a surgical margin of less than 1 mm (p < 0.05). Overall voice preservation was achieved in 86% of the patients. The 5-year and 10-year survival rates following frontolateral laryngectomy were 86% and 70%, respectively. Maximum phonation time after surgery ranged from 4 to 18 seconds (median, 8.1 seconds). Conclusions These results indicate that in carefully selected cases, frontolateral laryngectomy may be used for treating radiation failure stage I or II vocal cord carcinomas with good success. Careful follow-up may be necessary in patients with a close surgical margin. © 1997 John Wiley & Sons, Inc. Head Neck19: 116–120, 1997.

Reconstruction of the tonsillar fossa and soft palate is sometimes troublesome, because of postoperative deglutition and speech disorder. In this study, we reviewed 84 patients who underwent reconstruction surgery of this area at our hospital during the period from 1977 to 1995. As a result, (1) wide resection causes poor postoperative quality, (2) patients after 1990 shows better function of eating and speaking than patients before 1990, (3) free flap reconstruction has more benefit than pedicled flap because trimming of the free flap is quite easy and it can fit any defect of the lesion. One of the most important things during surgery are not to injure the function of nasophayngeal closure and tongue mobility. In these couple of years, we routinely use rectus abdominis M - C flap after wide resection of the oropharyngeal cancer.

We reviewed 79 patients with squamous cell carcinoma of the lateral wall of the oropharynx who received treatment at the Cancer Institute Hospital. Tokyo, between 1971 and 1990. There were 67 men and 12 women, aged 31 to 81 years (average 59.2 years). The tumors could be staged by TNM classification (UICC 1987) as follows: Stage 10 Stage II 12, Stage III 27, Stage IV 40. It must be noted that more than 50% of the tumors were classified as stage IV. As the initial treatment, 50 patients underwent radical radiotherapy, and the remaining 29 were treated mainly by surgery after pre-operative radiation. Some patients underwent adjuvant chemotherapy, but the role of chemotherapy was not considered in this study. The purpose of the present study was to determine the prognostic factors and to determine the survival rate after each treatment modality. The results were as follows: i) Patients with either T4, over N2b or a stage IV tumor had a significantly poor prognosis. ii) Cox multivariate analysis revealed that age, local extension (base of tongue, anterior pillar, soft palate and mid-line), pathological findings (poorly, moderately or well differentiated), tumor type (exophytic or endophytic) were not useful prognostic factors. iii) Radiosensitivity was not reflected in the survival rate judging from the high recurrence rate (44%) after radical radiotherapy. On the other hand, local recurrence after radical resection was seen in 18% of the patients. iv) Analysis of the data supported the recommendation of surgery after preoperative radiation as the treatment for stage III patients. It seems difficult to find the best treatment modality for stage IV patients in order to improve the survival rate, and this is an issue that still remains to be resolved. v) From the study of the surgical specimens, we are unable to demonstrate a significant survival advantage of the patients with a high grade radiation effect, or patients with no vessel involvement.

A case of melanin pigmented oncocytic metaplasia is reported. A 62-year-old man presented with a history of discomfort of the ear of a 2 weeks' duration. Nasoscopic examination revealed a black nodule of about 5mm at the left Eustachian opening, and several black spots were discovered around the bilateral torus tubarius. The nodule was biopsied to determine the histology. Microscopically, there were oncocytic cells with abundant pigmented granules showing glandular pattern. Such a pigmented variant of benign oncocytic lesion is very rare.

In a total of 2083 cases of hollow organ cancer of the head and neck region treated in our institute in the past 20 years, the relative risk of second primary cancers was statistically studied by the person-year approach. The organ association in multiple primary cancers and the relationship between tobacco and alcohol consumption and the development of second primary cancers were also reviewed. The incidence of second primary cancers was significantly (p0.05) higher in patients having a lesion at the tongue (n = 502), mesopharynx (n = 188), hypopharynx (n = 224) and larynx (n = 621) and in the oral cavity (n = 203) than in the general population. With regard to organ association in multiple primary cancers, cancers in the oral cavity, esophagus and at the pharynx were found to occur as second primary cancers of the tongue, oral cavity, meso-hypopharynx and larynx at significantly high rates in males. Male laryngeal cancer was related to the lung. No relation of female lingual cancer to the esophagus was noted. The incidence of second primary cancer was very high in persons who had been heavy smokers and/or heavy drinkers before the occurrence of their primary cancer in the head and neck region. In these people, second primary cancers were found to occur at high rates as cancers related to tobacco smoking and drinking. Otherwise, in cases with head and neck cancers less related to tobacco smoking and drinking, the incidence of second primary cancers was low. From the above results, tobacco smoking and drinking may be closely related to a high incidence of second primary cancer following the first primary cancer in the head and neck region.

1990年6月までに札幌医科大学耳鼻咽喉科で治療した頭頸部原発悪性黒色腫14例 (鼻腔原発11例, 上咽頭原発2例, 歯肉原発1例) を対象として臨床的検討を行った。5年累積生存率は, 全症例で55.1%, 臨床病期Ia (7例) で68.6%, Ib (5例) で40%, II (2例) で50%であり, 鼻腔原発例で60.6%であった。一次治療の内容との関連では, 手術を主体とした症例の方が, 放射線や化学療法を主体としたものより局所制御が良好であったが, 生存率や死亡原因に差は認めなかった。今回の症例では, DAVを主体とした化学療法の併用効果は認められなかった。頻回に局所再発したにもかかわらず, 手術を主体とした局所治療の結果, 長期生存している例が認められた。

We conducted definitive surgery on 45 patients with untreated primary parotid cancer from 1975 to 1995, and evaluated methods of neck dissection and results of treatment. All 14 with clinical neck lymph node metastasis underwent ipsilateral radical neck dissection and only 1 developed neck lymph node recurrence at the peripheral dissected site. Of 31 patients without clinical neck lymph node metastasis, 27 of 19 of 36 with high-grade malignancy and 12 of 24 with T3 or T4 did not undergo prophylactic neck dissection and developed latent neck lymph node metastasis in 2 cases (7.4%). Whereas in most cases we achieved good control of the primary site but neck lymph node recurrences occurred, recurrent sites were observed all around the ipsilateral neck and prognosis were very poor if neck dissection was conducted as secondary treatment. Although histopathological diagnosis was considered feasible for predicting occult neck lymph node metastasis, correct diagnostic with fine needle aspiration cytology revealed only 21.8%. Pathological positive lymph nodes in 15 patients who underwent neck dissection were detected all over (level I to V) the ipsilateral neck and the recurrent positive rate at level II was 100%. Based on the above results, we conclude that (1) in cases with neck lymph node metastasis in preoperative evaluation, ipsilateral radical neck dissection is mandated, and (2) in cases without neck lymph node metastasis, prophylactic neck dissection is not usually needed. When pathological results of frozen section from intraoperative jugulodigastric nodal sampling are positive, ipsilateral radical neck dissection is mandated.

To investigate the clinical significance of p53 and p21WAF1/CIP1 in the advanced squamous cell carcinoma (SCC) of the pyriform sinus, we performed immunohistochemical staining of p53 and p21WAF1/CIP1 on the biopsy specimens from patients with stage III or stage IV SCC of the pyriform sinus. The results were compared with clinico-pathological features, including age, histological grade, TNM classification, number of neck lymph node metastases on histopathological examination (pLN) and prognosis. Specific staining for p53 and p21WAF1/CIP1 was detected in 36% and 32% of the specimens, respectively. Positive staining of p21WAF1/CIP1 was observed not only in the p53-negative specimens but also in the p53-positive specimens. Age (p < 0.05) and pLN (p < 0.001) were regarded as the significant prognostic factors. The 5-year survival rate of the p53-positive patients (55%) was significantly higher than that of the p53-negative patients (26.5%: p < 0.03). However, there is no significant difference between the p53 groups after controlling pLN. Although it was not statistically significant, the 5-year survival rate of the p21WAF1/CIP1-positive patients (58.8%) was higher than that of the p21WAF1/CIP1-negative patients (26.9%). These results suggest that expressions of p53 and p21WAF1/CIP1 are independent genetic alterations that may play different roles in the SCC of the pyriform sinus. Expression of p53 could not be regarded as an independent prognostic factor at this point. Further studies including the molecular biological analysis should be performed in order to determine the clinical role of p21WAF1/CIP1.

The charts of 319 consecutive patients who underwent total laryngectomy at the Cancer Institute Hospital from 1971 to 1994 were reviewed in order to clarify the relationship between pharyngo-cutaneous fistula formation and age, the dose of pre-operative radiation and radical neck dissection, as well as the need for subsequent surgical repair. The patients did not need to undergo reconstruction by flaps at the time of laryngectomy. Radiation sources were limited to X ray radiotherapy and Cobalt 60. Of the 319 patients 204 (63.9%) underwent neck dissection. Both radical neck dissection and modified radical neck dissection were classified as neck dissection. The chi-square test was used to construct a table of the three parameters age, dose of radiation and neck dissection. With respect to age, the incidence of fistula formation was 13.4% (16 patients of 119) in patients at the age of 59 and below, 5.9% (7/118) in those from 60 to 69, and 8.5% (7/82) in those at 70 years and above. Our analysis reveals that the age at the time of surgery is not a predisposing factor for fistula formation in the three age groups (59 and below, between 60 and 69, and 70 and above). Similarly the need for subsequent surgical repair is also not age-related. With respect to radiation, the incidence of fistula formation was 8.0% (4/50) for patients who received radiotherapy less than 20 Gy, 6.3% (2/32) in those who received between 20 and 40 Gy, 2.6% (2/77) in those who received between 40 and 60 Gy, 13.2% (20/152) in those who received between 60 and 80 Gy and 25.0% (2/8) in those who received over 80 Gy. When the preoperative dose of radiation was divided into three classes, that is, less than 40 Gy, 40 to 60 Gy and over 60 Gy, we observed that the incidence of fistula formation increased significantly in the patients who received over 60 Gy. Surgical repair was also indicated more frequently for those patients who received over 60 Gy than for those who received less than 60 Gy. With respect to neck dissection, the incidence of fistula formation was 12.2% (14/115) for the patients who did not undergo neck dissection or those who underwent only lymphadenectomy, 7.8% (9/115) for the patients who underwent unilateral neck dissection, and 7.9% (7/89) for those who underwent bilateral neck dissection. These data reveal that neck dissection, whether unilateral or bilateral, dose not increase the incidence of fistula formation, nor the need for subsequent surgical repair. Fistulae were present in 30 patients (9.4%) for 24 years, and 14 of these 30 patients did not need subsequent surgery. In these 30 patients with fistulae, we did not find patients with systemic disease such as diabetes mellitus prior to the surgery. When the period of 24 years was divided into 4 periods, the incidence of fistula formation was 19.0% (from 1971 to 1976), 6.9% (from 1977 to 1982), 10.3% (from 1983 to 1989) and 2.6% (from 1989 to 1994), that of the latest period was the lowest with gradual improvement. The average dose of preoperative radiation was 57.7 Gy (from 1971 to 1976), 50.8 Gy (from 1977 to 1982), 39.6 Gy (from 1982 to 1988) and 45.7 Gy (from 1989 to 1994) and reduction in dose of radiation seemed to be one of the reasons for the lower frequency of fistula. Several surgeons performed the operations for different patients, but the procedure of laryngectomy was recently directed by an experienced surgeon. The study also indicates that the risk of fistula formation is reduced not only by the dose of radiation but also by improved surgical skill.

Sixteen patients with lymphatic metastases to the neck and a histological diagnosis of undifferentiated carcinoma from an unknown primary lesion were assessed using immunohistochemical staining. The results revealed a non-epithelial tumor in 11 cases (malignant lymphoma in 5 cases) and an epithelial tumor in 3 cases. The patients with malignant lymphoma had a good outcome, but those with other non-epithelial tumors did not. Treatment of patients with an unknown primary tumor, especially undifferentiated carcinoma, should be carefully evaluated based on immunohistological examinations to identify malignant lymphoma.

Case 1. A 34-year-old male complained of pain and numbness of the left cheek. CT scan revealed a left maxillary sinus tumor which had destroyed the medial, posterior and lateral walls. The histopathological diagnosis was malignant fibrous histiocytoma (common type). Case 2. A 74-year-old female suffered from left dental and cheek pain. CT scan revealed a tumor mass which had destroyed the anterior, lateral and posterior walls and invaded pterygomaxillary fossa. The histopathological diagnosis was malignant fibrous histiocytoma (Giant cell type). Both patients were treated with radiation therpy, chemotherapy and surgery. Case 1 remains free of disease 4 year after surgery. Case 2 died of local recurrence and systemic matastasis 2 months the after surgery.Clinical stage of case 2 was more advanced than that of case 1. Giant cell type of malignant fibrous histiocytoma is more malignant than the common type. The early death of case 2 was presumably due to the more malignant histopathological type.

Recently, neck abscess or mediastinal abscess occuring from oral infection is appeared uncommonly. But, it certainly is possible that this disease is fatal if neck swelling due to infection grows rapidly and airway is obstracted progressive. When we have to treat these disease, we get the accurate diagnostic information and immediately start the appropriate treatment.Recently, we experienced 2 cases of cervical abscess and 2 cases of cervicomediastinal abscess occuring from oral infection. Anaerobic infection participated in the all of cases. In two cases, there were diabetes mellitus as the past illness. In all cases, we have done the surgery in combination with appropriate antibiotics. Now they are good in health. In comparison to the case of cervical abscess, drainaged operation was postponed in the case of cervicomediastinal abscess. These cases suggested to us that we had to do accurate and quick treatment in order to guard these patient.

This is a clinical study of 55 patients with maxillary squamous cell carcinoma treated in Sapporo Medical College from 1977 to 1985. These patients were treated with a combination of radiotherapy, regional chemotherapy via a superficial temporal artery and surgery. They were divided into three groups according to their surgical procedures, A) necrotomy, B) reduction operation and C) radical operation, respectively. The cumultive 5-year survival rate was 31% in group A, 30% in group B and 47% in group C. The final local tumor control rate was 27% in group A, 40% in group B and 68% in group C. The patients in group C had lower incidences of local tumor rests and recurrence, but a higher incidence of distant metastasis than those in the other groups. The most frequent cause of treatment failure in the patients with cervical metastasis was the failure of local tumor control. When the maxillary tumor was well controlled by either external radiation or radical neck dissection, the prognosis was not poor even in those patients.

We studied the respiratory oscillations of the nasal mucosa in dogs. Even after temporarily stopping the respirator, intranasal balloon pressure showed respiration-related oscillations (spontaneous nasal oscillations). These spontaneous oscillations were recorded in all 21 dogs. Spontaneous nasal oscillations were not abolished even after thoracotomy, vagotomy and vidian neurectomy. Only cervical sympathectomy could to a large extent abolish the spontaneous nasal oscillations. Furthermore, the spontaneous nasal oscillations were found to be synchronized with the respiration-related fluctuations of cervical sympathetic nerve activities. Rhythms of the spontaneous nasal oscillations were not dependent on the rates of artificial ventilation, but were closely related to the rates of spontaneous respiration before administering the muscle relaxant. On some occasions, we recognized remarkable differences in the height of waves of the spontaneous nasal oscillations between the sides of the body. On eight occasions in 5 dogs, reciprocal changes of the dominant side of bilateral spontaneous nasal oscillations were noted which might be an expression of the nasal cycle.

In this paper, we present a case where radiotherapy was very effective against malignant melanoma. We performed a total maxillectomy as the primary treatment, but the tumor recurred rapidly in the operated wound. Then, the patient was treated with 50 Gy in twenty-five treatments. After that, the tumor disappeared remarkably. On the other hand, this malignant melanoma was of the amelanotic type. We carried out a Fontana's stain and electronic microscopy to provide the criteria for the diagnosis of malignant melanoma. The pathological character of this malignant melanoma was investigated.

We studied the effects of stimulation and acute denervation of the cervical sympathetic nerve and the vidian nerve on the nasal vascular tone, as measured by intranasal balloon pressure. Significant vasoconstriction was found during electrical stimulation of the cervical sympathetic nerve. When the cervical sympathetic nerve was sectioned, causing a transient vasoconstriction due to the stimulatory effect of the nerve injury, then significant vasodilation was found in 23 out of 30 experiments. Significant vasodilation during electrical stimulation of the vidian nerve and slight but significant vasoconstriction after sectioning of the vidian nerve were also found. In addition, we found spontaneous nerve discharges in the cervical sympathetic nerve trunks. These nerve discharges increased after stopping the respiratory pump. Differences in these sympathetic nerve discharges between the sides of the body were also recognized.

We studied the respiration-related movements of the canine nose by examining the respiratory oscillations of intranasal balloon pressure and EMG activities of the dilator nares in dogs. Under spontaneous respiration, balloon pressure decreased and EMG activities increased during the early inspiratory phase. These respiratory movements of the nose differed and changed reciprocally in strength between the two sides of the body spontaneously, after painful stimulation or intranasal histamine administration. When the muscle relaxant was administered and the respiration was controlled by the ventilation pump, the intranasal balloon pressure increased during the inspiratory phase. This phenomenon had a completely inverted pattern compared with that during spontaneous respiration. Furthermore, even when the ventilation pump was stopped, respiration-like spontaneous oscillations of the intranasal balloon pressure were recognized. These were abolished by sectioning of the ipsilateral cervical sympathetic nerve trunk. From these findings, the respiration-related movements of the nose were thought to be controlled not only by the cardiac output and the vagal nerve reflexes but also by respiratory activities in the nervous systems controlling the nose, which might be originated from the medullary respiratory centres.

Malignant melanoma of the nasal cavity is relatively rare, and has poor prognosis. Accord-ing to Gallagher, its mean survival years is 2.6 years. But, the cases with relatively long survival years were also reported. In the present report, a case of malignant melanoma is reported with three recurrences in fourteen years. Cryosurgery to the small local recurrence was performed with effect. Treatment policy for malignant melanoma is not established as yet, but cryosurgery proved itself to be effective to limited local recurrence.