Practica Oto-Rhino-Laryngologica
Online ISSN : 1884-4545
Print ISSN : 0032-6313
ISSN-L : 0032-6313
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Volume 102, Issue 6
Displaying 1-15 of 15 articles from this issue
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Editorial
  • Clinical Treatment to a Child with Profound Hearing Impairment
    —\Attempt of Auditory and Cochlear Implant Center of Tokyo Medical University Hospital (ACICTMU)—
    Atsushi Kawano, Michio Hazama, Akira Hagiwara, Nobuhiro Nishiyama, Sac ...
    2009 Volume 102 Issue 6 Pages 415-422
    Published: 2009
    Released on J-STAGE: March 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.102.415
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    Our basic purpose is to answer the question of what hospital or professional institutes should be doing to care for and/or support the upbringing of children with congenital or infant profound hearing impairment. The system which improves listening and language skills of such children is necessary. Unfortunately, there are various problems and there is no comprehensive system at present in Japan therefore, a system must be implemented in the near future. The Auditory and Cochlear Implant Center of Tokyo Medical University Hospital (ACICTMU) was established as a special clinical facility and institute of cochlear implant and hearing aid in April 2008, offering continuous effective medical treatment for hearing-impaired children during whole life. In this paper, clinical treatment of such children will be discussed.
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Original articles
  • A Case of Brainstem Infarction with Paralytic Pontine Exotropia
    Akemi Sugita-Kitajima, Oichi Yamaguchi, Tomoyuki Okada, Izumi Koizuka
    2009 Volume 102 Issue 6 Pages 427-431
    Published: 2009
    Released on J-STAGE: March 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.102.427
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    We encountered a case of brainstem infarction with paralytic pontine exotropia. A 74-year-old male with hypertension, hyperlipidemia and diabetes complained of dizziness on day 1. He developed vertigo on day 5 and came to our hospital on day 7. CT findings were normal, but he showed spontaneous nystagmus to the right and one-and-a-half syndrome in addition to ataxia. On the same day, he was admitted to our hospital and MRI was performed. MRI (T2WI and diffusion) showed a high intensity area on the middle-left side of the lower pons. We considered that he had initially had TIA and developed brainstem infarction on day 7. We suggested that impairment of eye movement was caused by paralytic pontine exotropia, which followed one-and-a-half syndrome. After treatment, ataxia recovered, but impairment of eye movement remained. Neurological examinations are important even in cases showing normal CT findings.
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  • A Case of Facial Stab Wound with Scissors
    Toshihiro Nagato, Taketoshi Fujita, Osamu Oshima, Yasuaki Harabuchi
    2009 Volume 102 Issue 6 Pages 433-436
    Published: 2009
    Released on J-STAGE: March 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.102.433
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    We report a rare case of facial stab wound with scissors. A 25-year-old man was admitted to the emergency room of Asahikawa Red Cross Hospital after his face had been stabbed with scissors. Physical examination demonstrated a small stab wound of the left ala of the nose and right abducens nerve palsy. Computed tomography showed fractures of the nasal septum, anterior and posterior walls of the sphenoidal sinus, and posterior clinoid process. There was no detectable cerebrospinal fluid rhinorrhea on endoscopic sinus surgery. He was treated by mecobalamin for abducens nerve palsy. Right abducens nerve palsy showed gradual recovery and improved 2 months after the injury.
    It is important to carefully examine cases of facial stab wound due to any edged tools including scissors even if the wounds are small.
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  • Optic Nerve Decompression for Traumatic Blindness: A Report of Two Cases
    Shirou Kosaka, Suetaka Nishiike, Masako Uno, Teruhito Aihara, Takeshi ...
    2009 Volume 102 Issue 6 Pages 437-441
    Published: 2009
    Released on J-STAGE: March 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.102.437
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    We treated 2 patients with traumatic optic neuropathy showing complete loss of vision. The optic nerve was decompressed by the endoscopic endonasal approach. Visual improvement was achieved in both patients. Endoscopic optic nerve decompression is a minimally invasive procedure that has no adverse cosmetic effects. This endoscopic technique offers several advantages over other surgical approaches. Immediate surgery is preferable for traumatic optic neuropathy, but the improvement of vision is possible even in cases with delayed surgery or with indefinite optic canal fracture. In surgery, frontal sinus seekers are useful for the removal of a thin bony wall, and a diamond drill burr for dacryocystorhinostomy is useful for the removal of a thick bony wall.
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  • Osteoplastic Maxillary Antrostomy Using Collagen Sponge
    Taisuke Kobayashi, Koshiro Nakamura, Nobumitsu Honda, Hayato Komobuchi
    2009 Volume 102 Issue 6 Pages 443-450
    Published: 2009
    Released on J-STAGE: March 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.102.443
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    Osteoplastic maxillary antrostomy is performed to restore the normal anatomy and physiology of the maxillary sinus. Although endoscopic sinus surgery has been employed since the 1980s, antrostomy through the canine fossa is still required in cases such as an inverted papilloma originating from the maxillary sinus or a blow-out fracture of the inferior orbital floor. Herein, we demonstrate a new procedure using a collagen sponge (Terudermis®, Olympus Terumo Biomaterials Co., Ltd., Tokyo, Japan) to support the free bone flap of the anterior wall of the maxillary sinus. The collagen sponge also promotes epithelialization of the maxillary sinus. We employed this procedure in 11 cases, including five cases involving repair of a blow-out fracture of the inferior orbital floor, two to remove fungal growth from the maxillary sinus, three to remove an inverted papilloma of the maxillary sinus, and one for removal of an odontogenic maxillary cyst. In all cases, the maxillary sinus was epithelialized without infection, except for one recurrent case of papilloma. In seven of the 11 cases, postoperative CT was performed, showing that the bony flap was maintained in the original position. This new method simplifies osteoplastic maxillary surgery and reduces the surgical time.
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  • A Case of Large Dermoid Cyst in the Floor of the Mouth
    Eiju Kanagawa, Osamu Horiike, Makoto Hashimoto, Hiroshi Yamashita
    2009 Volume 102 Issue 6 Pages 451-456
    Published: 2009
    Released on J-STAGE: March 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.102.451
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    A large-sized dermoid cyst of the floor of mouth is rare. We report an 18-year-old woman with a 9.0×4.8 cm cyst in the floor of mouth. Magnetic resonance imaging (MRI) revealed it to be of the sublingual type in the classification of Bergmann-Hagisaki, and we could excise it by employing an intra-oral approach. The symptoms subsequently disappeared. Histopathologically, it was diagnosed as a dermoid cyst. Recurrence has not been observed for 3 months after surgical treatment.
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  • The Effects of Acid Regurgitation and Dyspepsia on the Treatment of Patients with laryngopharyngeal Reflux Disease (LPRD)
    Nobuo Ohta, Takashi Nasu, Tomoo Watanabe, Yasuhiro Abe, Daisuke Noda, ...
    2009 Volume 102 Issue 6 Pages 457-464
    Published: 2009
    Released on J-STAGE: March 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.102.457
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    The clinical effects of Rabeprazole on patients with laryngopharyngeal reflux disease (LPRD) were investigated by comparing the frequency of GERD symptoms (FSSG), laryngopharyngeal reflux symptom score (RSS), and objective laryngopharyngeal reflux finding score (RFS) before and after treatment. We found that the scores after treatment were significantly lower than those before treatment.
    These findings indicate that Rabeprazole is useful for the treatment of LPRD.
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  • Frequency Scale for Symptoms of GERD (FSSG) and the Severity of an Abnormal Sensation in the Throat in Patients with Globus Pharyngeus
    Tetsuo Watanabe, Masashi Suzuki
    2009 Volume 102 Issue 6 Pages 465-471
    Published: 2009
    Released on J-STAGE: March 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.102.465
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    (Purpose) Gastroesophageal reflux disease (GERD) has been known to induce globus pharyngeus. The frequency scale for the symptoms of GERD (FSSG) is a simplified questionnaire for GERD evaluation. To clarify the relationship between an abnormal sensation in the throat and GERD, the value of such an abnormal sensation was compared with the FSSG score in patients with globus pharyngeus.
    (Methods) The subjects comprised 130 globus pharyngeus patients who visited our outpatient department between May 2005 and March 2007. They were all evaluated using the FSSG and questionnaire for the presence of an abnormal sensation in the throat. The patients showing an FSSG score above 8 were diagnosed with GERD. The rate of GERD patients among those presenting with globus pharyngeus, and the correlation between the FSSG score and the value of an abnormal sensation in the throat were reviewed. Twenty-two patients with GERD were administered sodium rabeprazole (proton pump inhibitor: PPI) at a dosage of 10 mg daily for 2 weeks. Their symptoms were evaluated using the questionaire both before and after treatment.
    (Results) Sixty-seven of the 130 (52%) patients showed an FSSG score above 8, and, therefore, were diagnosed with GERD. Although the dyspeptic symptom score of the FSSG showed a weak correlation with the value of an abnormal sensation in the throat, the total FSSG score demonstrated no significant correlation with either. Treatment with PPI was associated with a significant improvement in the FSSG score but not in the value of an abnormal sensation in the throat. The acid reflux-related symptom score of the FSSG showed a more significant improvement than the dyspeptic symptom score after PPI treatment.
    (Conclusion) The FSSG was therefore found to be useful for the evaluation and treatment of globus pharyngeus patients. Factors other than acid reflux, such as dyspepsia, may also have some relationship with the cause of an abnormal sensation in the throat in GERD patients.
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  • A Case of Metastatic Breast Carcinoma of the Thyroid Gland
    Yuzuru Sainoo, Yasuo Osato, Haruo Takahashi
    2009 Volume 102 Issue 6 Pages 473-476
    Published: 2009
    Released on J-STAGE: March 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.102.473
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    Metastatic carcinoma of the thyroid gland is uncommon. A 49-year-old woman visited our hospital for hoarseness.
    Endoscopic examination showed left-sided laryngeal nerve palsy. Physical examination revealed a firm thyroid and several palpable firm lymph nodes on the left side of the neck. Diffuse enlargement of the thyroid with fine calcification was revealed on echo imaging, and computed tomography showed a tumor-like mass of the left breast and enlargement of the left-sided axillary lymph nodes.
    A specimen obtained by fine needle aspiration (FNA) biopsy from the thyroid gland was misdiagnosed as papillary carcinoma of the thyroid gland. However, the pathological characteristics of specimens obtained by FNA from the axillary lymph node and the breast closely resembled those from the thyroid gland. Therefore, we performed incision biopsy of both the thyroid gland and breast for a definite diagnosis.
    Immunohistochemistry revealed positive results for estrogen and progesterone receptors, and negative results for thyroglobulin, HER-2, and p-53 in specimens from the two sites leading to a diagnosis of ductal carcinoma of the breast and metastasis to the thyroid gland.
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  • Experience with Wound Dressings for Surgical Wound Dehiscence and Oropharyngeal Fistulae after Excision of Head and Neck Cancer
    Kaori Kayano, Kotaro Okamoto, Taketoshi Shimada, Hitoshi Bamba
    2009 Volume 102 Issue 6 Pages 477-483
    Published: 2009
    Released on J-STAGE: March 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.102.477
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    We report 3 patients in whom occlusive wound dressings were effective and shortened the healing time during the treatment of surgical wound dehiscence and oropharyngeal fistula formation after the excision of head and neck cancers.
    Case 1 showed carcinoma of the right buccal mucosa. Surgical resection of the tumor was performed, including the involved facial skin, followed by reconstruction with an anterolateral thigh flap. However, a cervical abscess occurred with wound dehiscence between the soft palate and flap, as well as an oro-cutaneous fistula. Drainage and re-suture of the wound was carried out, followed by dressing with SORBSAN® (calcium alginate fiber), DuoDERM® (hydrocolloid) CGF®, and Hydrosite® (aqueous polyurethane) after déridement and washing with physiological saline. The fistula was closed on the 28th day after the operation, and epithelization of the wound was achieved by the 38th postoperative day.
    Cases 2 and 3 had carcinoma of the hypopharyx and larynx, respectively. Total pharyngolaryngoesophagectomy with immediate gastric pull-up and total laryngectomy were performed, respectively. However, a cervical abscess occurred with pharyngeal suture dehiscence, and bilateral or anterior pharyngeal-cutaneous fistulae formed in each case. Drainage and dressing with AQUACEL®Ag (Hydrofiber®dressing: carboxymethylcellulose containing ionic silver) were performed in a similar way, respectively. In case 2, the fistula on the left closed by the 58th day after the operation, while that on the right improved and was closed on the postoperative 89th day with a hinge flap. On the other hand, in case 3, the fistula closed by the 45th postoperative day, while epithelization of the wound was achieved on the 59th day.
    In particular, among the wound dressing materials that we employed this time, AQUACEL®Ag was effective for achieving the closure and epithelization of oropharyngeal fistulae associated with infection, because it has a marked capacity to absorb fluid including saliva without lateral spread through the dressing, while its silver content has bactericidal and sterilizing properties.
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  • A Case of Plastic Bronchitis with Cardiopulmonary Arrest
    Naoki Matsushita, Tomoaki Nakano, Go Uemura, Tsunemasa Aiba, Takeshi K ...
    2009 Volume 102 Issue 6 Pages 485-488
    Published: 2009
    Released on J-STAGE: March 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.102.485
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    Plastic bronchitis is characterized by marked obstruction of the large airways by bronchial casts. The condition is rare but can occur at any age. Asthma or allergy is often the cause of cast production, but in some instances there is no etiology identified. Especially in children, it is difficult to differentiate plastic bronchitis from bronchial foreign bodies. Bronchoscopic extraction of casts benefits some patients. Plastic bronchitis causes acute respiratory failure.
    A 2-year old boy with no history of asthma or allergy presented with severe respiratory distress following a 3-day history of upper-respiratory-tract infection. Chest X-ray showed complete collapse of the left lung with mediastinal shift. Bronchoscopy demonstrated obstruction of casts. The patient improved after bronchoscopic extraction of casts. But in the emergency care unit, this patient became very difficult to oxygenate despite aggressive ventilation and suddenly developed cardiopulmonary arrest. This patient was recovered by CPR, and a complete cast of the bronchial tree from carina to the small airways was removed by repeated bronchosopies.
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  • A Case of a Micro Foreign Body in the Cervical Region
    Fuyuko Shigeta, Masahiko Yamamoto, Tomoe Yoshida, Toshiyuki Nomura, Ri ...
    2009 Volume 102 Issue 6 Pages 489-494
    Published: 2009
    Released on J-STAGE: March 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.102.489
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    A 23-year-old male was sustained a small neck puncture while hammering blocks of iron. An iron splinter was identified on preoperative X-ray examination and CT scan. During surgery, the iron splinter could not be identified macroscopically. In this case, we used intraoperative fluoroscopic guidance to locate and remove the iron fragment.
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  • Day and Short Stay Surgery at Our Clinic
    Yuzuru Kobayashi
    2009 Volume 102 Issue 6 Pages 495-501
    Published: 2009
    Released on J-STAGE: March 04, 2011
    DOIhttps://doi.org/10.5631/jibirin.102.495
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    Objectives: To assess the current status of day and short stay surgery.
    Methods: One hundred and fifteen patients who underwent day surgery and 241 patients who underwent short stay surgery at our clinic were studied.
    Results: There were 4 patients (1.1%) aged under 3 years old, and 44 patients (12.4%) aged over 65 years old. Among 356 patients,315 (88.5%) patients underwent operations under general anesthesia. The operation time was shorter than 30 minutes in most day surgeries, and shorter than 1 hour in most short stay surgeries. Day or short stay surgery was indicated based on each surgical procedure. Peiroperative care was performed based on the clinical path. The rate of complications was 2.6% in day surgery and 13.7% in short stay surgery. One patient (0.8%) was hospitalized emergently in day surgery and 5 patients (2.0%) were re-hospitalized or their discharge was delayed in short stay surgery. The most important complication after the operation was epistaxis due to nasal surgery. Nineteen complications (52%) occurred until one day after operation, and the rate of complications decreased rapidly there after.
    Conclusions: Day or short stay ENT surgery can be performed safely in patients at any age.
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Technical notes
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