It is very difficult to master surgical skills in Otorhinolaryngology because of the anatomical complexixy of the field. There are several ways to gain surgical skills before being involved in surgery on humans, especially for young surgeons.
This paper introduces the concept of surgical dissection in the field of nasal surgery using a human cadaver and points out certain problems with using human cadavers. Future surgical training systems such as computer-simulated surgical training system are also described.

View full abstract

Two cases of acoustic neuroma with the onset of sudden deafness are reported. A patient with middle-tone hearing loss was treated by the intravenous infusion of steroids, and hearing loss improved. The tumor size of the patient was 8 mm. The other patient (tumor size: 20 mm) whose audiogram was off scale received the same treatment. However, his hearing loss showed no improvement. We analyzed the 37 previously reported cases to clarify the relationship between the type of hearing loss and size of the tumor. In patients with acoustic neuroma showing severe hearing loss, the tumor sizes were larger, and the rate of curing was lower than in patients with middle-tone hearing loss.

View full abstract

It is well known that the magnitude of the conductive defect is primarily related to the size of the tympanic membrane perforation. However it is difficult to measure the perforation size. Furthermore if the perforation appears spindle-shaped or irregular, it is even more difficult to measure the size. In this study, we measured the size of traumatic perforation of the tympanic membrane in 24 cases using an image analysis system. The form of the perforation was classified to round form, spindle form and irregular form. The location of the perforation was classified based on the four quadrants of the tympanic membrane. Whether the perforation interfered with malleus function was also indecated. Then we analyzed the effect of the perforation of the tympanic membrane on sound transmission. The results were as follow.
1) The size of the tympanic membrane correlated closely with conductive hearing loss, and this correlation was closer for low frequencies than for high frequencies.
2) Conductive hearing loss was significantly smaller for round perforations at all frequencies.
3) The conductive hearing loss at high frequences was significantly larger for spindle-shaped perforations, anteroinferior perforation, and malleolar perforations.

View full abstract

We report a case of dentigerous cyst in the maxillary sinus with epistaxis. A 55-year-old man complained of recurrent epistaxis on the right side. He also had untreated hypertension. Orthopantomography and computed tomography showed an inverted tooth and dentigerous cyst in the right maxillary sinus. We considered that the cyst was the cause of the epistaxis. Removal of the cyst and extraction of the tooth via the vestibulum oris were performed under general anesthesia. The cyst wall was egg shell-like and bled easily. There were no further episodes of epistaxis after surgery. To the best of our knowledge, no case of dentigerous cyst in the maxillary sinus with epistaxis has previously been reported.

View full abstract

We report a rare case of a 78-year-old woman with metastasis from renal cell carcinoma to the right cheek. The patient had undergone left nephrectomy due to renal cell carcinoma. Four years later, the right cheek appeared swollen. A solitary tumor was resected and diagnosed as metastatic renal cell carcinoma to the cheek on histopathological examinations. We describe the clinical course of this case with a review of the literature.

View full abstract

We report a patient with a sore throat and trismus associated with tetanus. The 71-year-old man had a sore throat and so consulted the hospital. However, no abnormal physical or fiberscopic findings were noted except for a high CPK level (438 U/l) in the serum. CT and MRI did not demonstrate abnormal findings. He showed trismus and convulsion after 6 days, and was then diagnosed with tetanus. Respiratory care involving intubation and the administration of Penicillin G (24 million units/day for 11 days) and human anti-tetanus immunoglobulin were performed, resulting in cure without any sequelae. We should consider tetanus in patients with a sore throat and trismus because one quarter of tetanus patients show no injury history.

View full abstract

We report two cases of retropharyngeal abscess. One patient was a 16-year-old female with pharyngeal swelling and severe neck pain. Local findings demonstrated swelling of the posterior wall on the right side of the pharynx. CT showed low-density mass in the retropharyngeal space. We performed surgical drainage and antibiotic therapy. The other patient was a 19-year-old female with a sore throat and right cervical pain. Local findings demonstrated swelling of the posterior wall on the right side of the pharynx. CT identified a low-density mass with ring enhancement on the right side of the retropharyngeal space. We performed surgical drainage and antibiotic therapy. In both cases anaerobic bacteria were detected.

View full abstract

(Purpose) Cases of peritonsillar abscess (PTA) treated by immediate tonsillectomy were reviewed to determine whether a clinical pathway is applicable to the treatment of PTA patients.
(Subjects) PTA patients treated in the inpatient department between January 2006 and May 2007.
(Methods) The number of PTA patients treated by immediate tonsillectomy, the number of patients who received immediate tonsillectomy based on the clinical pathway, and the incidence of variances regarding hospitalization period, postoperative fever, postoperative ingestion state, postoperative pain, and postoperative medication, were reviewed. The incidence of variance pertaining to PTA patients was compared with that pertaining to patients who underwent an elective tonsillectomy in this hospital during the same period.
(Results) A total of 57 patients were treated for PTA. An immediate tonsillectomy was performed in 53 of these 57 patients. Thirty-three of these 53 (62%) patients received an immediate tonsillectomy based on the clinical pathway. Although there were several variances, there were no dropouts from the clinical pathway due to complications. There were no significant differences in the incidence of variances regarding postoperative fever, postoperative ingestion state, postoperative pain, and postoperative medication, between the immediate tonsillectomy group and the elective tonsillectomy group.
(Conclusion) The clinical pathway was thus found to be appropriate and applicable patients with PTA treated by immediate tonsillectomy. This indicates that immediate tonsillectomy can therefore be an alternative treatment for patients with peritonsillar abscess.

View full abstract

In this report, we describe laryngeal findings in a woman with aphonia due to diminished adduction of the vocal cord caused by rheumatoid arthritis (RA) with bilateral cricoarytenoid joint involvements. One month after treatment with methylprednisolone pulse therapy, bilateral cricoarytenoid joint involvements improved and she was able to speak normally. Although laryngeal involvement has been reported to occur frequently in severe RA cases, complaints due to cricoarytenoid arthritis as initial symptoms are comparatively unusual. There are few patients followed by otolaryngologist. However, some patients with cricoarytenoid arthritis demonstrate abduction or adduction disorder that affects the quality of life. In RA patients, careful observations of laryngeal lesions by a laryngoscope and CT scans are important, and serious laryngeal lesions must not be overlooked.

View full abstract

We clinically studied 15 cases of parapharyngeal space tumor treated between 1999 and 2006, and reviewed operative indications regarding tumor locations. Six cases were present in the prestyloid region, and nine were present in the retrostyloid region. There were two malignant tumors and one tumor complicated with air-way obstruction following intra-tumor hemorrhage in the prestyloid region. Therefore, prestyloid parapharyngeal space tumors should be indicated for surgery. For retrostyloidal parapharyngeal space tumors, there are few cases that show increase in size even if we followed the patients. Considering these facts, we should assess operative indication carefully while examining any change in size and symptoms.

View full abstract

We report two cases of a foreign body in the hypopharynx and esophagus, removed by an external incision in the neck. The first case was a 71-year-old male who complained of a sore throat after eating a fish. No foreign body was detected by pharyngolaryngoscopy, but a CT scan revealed a fish bone in his esophagus, and an abscess formation was detected. The foreign body was removed following transcervical drainage of the abscess. The second case was a 62-year-old female with an extrapharyngeal foreign body due to swallowing a fish bone. A CT scan demonstrated a fish bone in her extrapharyngeal space. The foreign body was successfully removed by lateral neck incision.

View full abstract

Kawasaki disease was first reported by Tomisaku Kawasaki in 1967 and there have been 200,000 cases reported in Japan. It is predominantly a disease of young children, and 80% of the patients are younger than 5 years of age. We report a case of Kawasaki disease that was difficult to diagnose. A 12-year-old boy was referred to our hospital with a fever of 40 degrees Celsius and swelling of the right neck lymph nodes, despite a course of antibiotics. A CT scan of the neck showed multiple swollen lymph nodes and laryngeal-edema. He was hospitalized on the same day. After 10 days of fever, point-like eruptions appeared on his chest and he developed conjuctival congestion. Therefore, he was diagnosed as having Kawasaki disease and was treated with γ-globulin (2 g/kg) and aspirin (40 mg/kg/day). On the day after beginning this treatment, his body temperature fell to 37 degrees Celsius, and the pointed eruptions and conjuctival congestion improved gradually. He was discharged from the hospital after 23 days after on set of fever.

View full abstract