Practica Oto-Rhino-Laryngologica
Online ISSN : 1884-4545
Print ISSN : 0032-6313
ISSN-L : 0032-6313
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Volume 103, Issue 9
Displaying 1-16 of 16 articles from this issue
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Editorial
  • Diagnosis and Therapy for Parotid Carcinoma
    Ryo Kawata
    2010 Volume 103 Issue 9 Pages 789-803
    Published: 2010
    Released on J-STAGE: September 01, 2010
    DOIhttps://doi.org/10.5631/jibirin.103.789
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    The incidence of parotid carcinoma is lower than that of squamous cell carcinoma of the head and neck. Parotid carcinomas are rare, representing about 2% of all head and neck malignancies. In addition, there are many histological types differing in the grade of malignancy. We have employed specific strategies to diagnose/treat parotid carcinoma over the past 20 years. Many reports support that prognostic factors for parotid carcinomas are TNM, local invasion, histologic differentiation (grade), perineural invasion, and facial palsy. In these factors, it is generally accepted that stage and histological grade are the most important factor. Therefore, planning of therapy should be carried out according to each stage and histopathologocal type because each has different tumor activity. Fine needle aspiration biopsy of the salivary gland is an accepted, sensitive and specific technique in the diagnosis of the tumors. However, its accuracy is generally poor, especially in low/intermediate grade carcinoma. Since it is difficult to diagnose histopathological type in each case, we attempt to classify parotid carcinoma into three groups, low, intermediate, and high grade carcinoma. In case of the same group, we can perform almost the same operation planning. In the neck dissection for N0 patients, elective neck dissection (END) may not be necessary in low-grade patients. However, currently, END should be performed in all parotid carcinoma patients because of the low accuracy of grade diagnosis. It was previously thought that cancer of the salivary gland was radioresistant. However, more recent reports suggest otherwise. Postoperative radiotherapy is superior to that for surgery alone. Indications of radiotherapy are the following: high grade cancer, perineural spread of tumor, node metastasis, positive surgical margin, and aggressive cancer.
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Original articles
  • A Case of Chondroblastoma in the Temporal Bone
    Akiko Sakaguchi, Yasuo Mishiro, Osamu Adachi, Hirokazu Katsura, Masafu ...
    2010 Volume 103 Issue 9 Pages 807-812
    Published: 2010
    Released on J-STAGE: September 01, 2010
    DOIhttps://doi.org/10.5631/jibirin.103.807
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    We report a case of temporal-bone chondroblastoma. A 58-year-old man was seen for a sense of fullness and hearing loss in the left ear. The left ear canal was found to have a smooth tumor. An audiogram showed conductive hearing loss and computed tomography (CT) showed a soft-density tumor with left temporal bone destruction. Complete mastoidectomy under general anesthesia yielded a final pathological diagnosis of a rare chondroblastoma. Definitive treatment for chondroblastoma is total removal, but if this is difficult, only curettage may be possible. Radiation therapy remains controversial. Our case involved no further therapy and no sign of recurrence in the 3 years since surgery, but ongoing follow-up is mandaitory.
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  • Nasal Fracture Reduction Using Ultrasonography
    Toshiaki Tsukatani, Takaki Miwa, Tomokazu Yoshizaki
    2010 Volume 103 Issue 9 Pages 813-818
    Published: 2010
    Released on J-STAGE: September 01, 2010
    DOIhttps://doi.org/10.5631/jibirin.103.813
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    The success of nasal fracture healing whether the reposition of nasal bone fracture succeeded or not intraoperatively is only evaluated by the surgeon’s inspection and palpation. We used ultrasonogaphy to confirm adequate bone restoration in 33 subjects with nasal bone fracture. All subjects underwent computed tomography and ultrasonography in preoperative evaluation, then underwent closed reduction. In 2 cases, ultrasonography did not show fractured bone well, so reduction was done without intraoperative ultrasonography. In 31 cases, ultrasonography showed the fractured bone well and were a good surgical reference. Excellent fractured bone reduction judged by ultrasonography was confirmed in 71.0%. Moderate reduction—deformity improved but remained—judged by ultrasonography was 25.8%. Poor reduction—deformity unchanged pre and postoperatively—judged by ultrasonography was 3.2%. Using ultrasonography in closed nasal fracture reduction thus improves accuracy in reduction.
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  • A Case of B-Lymphoblastic Precursor Lymphoma of the Maxillary Sinus
    Yoichiro Tanimoto, Kosuke Sekiyama, Yuichi Kurono
    2010 Volume 103 Issue 9 Pages 819-824
    Published: 2010
    Released on J-STAGE: September 01, 2010
    DOIhttps://doi.org/10.5631/jibirin.103.819
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    Lymphoblastic lymphoma is rare, accounting for 1% of adult malignant lymphoma cases, while lymphoblastic lymphoma derived from B cells comprise only 10% of malignant lymphoma. These lesions occur primarily in head and neck skin, and are frequently associated with bone lesions. We report a case of B-lymphoblastic precursor lymphoma developing in the maxillary sinus of a 29-year-old man initially seen for left buccal pain. Computed tomography showed a homogeneous shadow filling the left maxillary sinus. Based on a diagnosis of acute rhinosinusitis, conservative treatment failed to make any improvement. Suspecting a neoplastic lesion, we opened the maxillary sinus, finding trapped mucopurulent fluid and a granuloma-like lesion was found, which biopsy indicated was malignant lymphoma. More detailed examination yielded a diagnosis of B-lymphoblastic precursor lymphoma, treated as for acute lymphocytic leukemia. Following treatment, the lesion disappeared and no symptoms of recurrence have been seen.
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  • A Case of Renal Cell Carcinoma Metastasizing to the Bilateral Parotid Glands
    Masae Komeno, Shuho Tanaka, Hidekazu Murashita, Akira Hara
    2010 Volume 103 Issue 9 Pages 825-828
    Published: 2010
    Released on J-STAGE: September 01, 2010
    DOIhttps://doi.org/10.5631/jibirin.103.825
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    Parotid gland metastasis from renal cell carcinoma is extremely rare and this case is, to our knowledge, the first presenting such bilateral parotid gland metastasis. A 70-year-old man who had undergone left radical nephrectomy one year before reported painless swelling in the bilateral parotid glands, found in computed tomography, magnetic resonance imaging, and 99mTc pertechnetate scintigraphy to be a vascular tumor of the superficial gland lobe. Superficial parotidectomy preserving the facial nerve were conducted bilaterally under general anesthesia. The histopathological diagnosis was metastatic renal cell carcinoma. Subsequent examination showed multiple metastases to the right kidney, lung, and pancreas, necessitating molecular target drug (Sunitinib) treatment.
    Parotid gland metastasis is found as an initial symptom of renal cell carcinoma or may be found during renal cell carcinoma treatment. Renal cell carcinoma metastasis must thus be considered in the case of a parotid mass.
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  • Hypopharyngeal Cancer Metastasis to Endoscopic Gastrostomy Site
    Mikio Kuwabara, Shinichiro Matsui, Nobuhiko Furuya
    2010 Volume 103 Issue 9 Pages 829-831
    Published: 2010
    Released on J-STAGE: September 01, 2010
    DOIhttps://doi.org/10.5631/jibirin.103.829
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    Percutaneous endoscopic gastrostomy (PEG) tube emplacement is commonly used to feed those with head, neck, or esophageal cancer. An 80-year-old man with hypopharyngeal cancer underwent PEG before chemoradiotherapy.
    After 4 months, tissue granulation extended to the gastrostomy site. The pathological lesion findings showed squamous cell carcinoma, suspected to have metastasized from hypopharyngeal cancer. To avoid cancer cell implantation, it is important to select the type of gastrostomy carefully.
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  • Acute Epiglottitis: Analysis of Factors Associated with Tracheostomy
    Takaaki Murata, Masahiko Muroi, Nobuhiko Furuya
    2010 Volume 103 Issue 9 Pages 833-838
    Published: 2010
    Released on J-STAGE: September 01, 2010
    DOIhttps://doi.org/10.5631/jibirin.103.833
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    Acute epiglottitis causes sudden upper airway obstruction and may trigger death within hours. Intubation is difficult, often necessitating tracheostomy, due to epiglottal swelling. Although appropriate judgment is required for choosing tracheostomy or conservative management with steroids and antibiotics, no guideline yet exists for this disease.
    We retrospectively examined 113 subjects hospitalized with acute epiglottitis, dividing then into two groups—tracheostomy and nontracheostomy. Comparing them for age, gender, common symptoms, clinical aspects, past history, and hospitalization duration, we clarified factors that may determine which is better—tracheostomy or conservative treatment.
    Mean age of the subjects was 49 years (range, 11 to 88 years, mean: 49 years) and the male-to-female ratio was 2.2 to 1.0. The commonest symptoms were sore throat (97%), odynophagia (49%), and fever (44%). Tracheostomy was done 11 cases (10%), but most cases treated conservatively (90%). A 44-year-old man died of cardiopulumonary arrest, despite tracheostomy. All subjects recovered completely. Mean duration from symptom onset to the first medical examination was 0.6 days in the tracheostomy group and 1.9 days in the nontracheostomy group, statistically significant (p<0.01). Other independent factors were the chief complaint of respiratory distress and stridor, 71% and 16% in tracheostomy and 55% and 2% in nontracheostomy. A statistically significant difference was also seen in Katori's grading by endoscopic observation between groups (p<0.01). These four factors may thus be clinically useful in evaluating the necessity of airway intervention.
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  • A Case of Oral and Pharyngolaryngeal Hematoma in Hemophilia A
    Miho Ono, Shu Yamanobe, Teruhisa Suzuki, Koichi Omori
    2010 Volume 103 Issue 9 Pages 839-843
    Published: 2010
    Released on J-STAGE: September 01, 2010
    DOIhttps://doi.org/10.5631/jibirin.103.839
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    Bleeding may occur into the joints, muscles, and internal organs of subjects with hemophilia A where clotting factor VIII is partly or completely missing. Although not curable, hemophilia is controllable by infusing of the deficient clotting factor. We report a case of laryngeal hematoma in a case of hemophilia A. A 15-year-old boy consulting about sore throat and right neck swelling was found to have hematoma of the oral floor, pharynx, and larynx. He was treated by using factor replacement therapy without tracheotomy. We discuss the clinical course and review the Japanese literatures.
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  • Occipital Bone Osteosarcoma and Facial Nerve Palsy
    Mutsuko Hara, Masami Osaki, Osamu Hida, Kazue Hida, Masami Nakajima, S ...
    2010 Volume 103 Issue 9 Pages 845-850
    Published: 2010
    Released on J-STAGE: September 01, 2010
    DOIhttps://doi.org/10.5631/jibirin.103.845
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    While osteosarcoma of the craniofacial bone is rare and therapeutic guidelines are not yet set malignant bone and soft tissue tumors must be considered if facial nerve palsy depends on pathological changes external to the temporal bone.
    A 45-year-old man admitted and treated for right idiopathic facial nerve (Bell’s) palsy experienced complex dysphagia a month later. Bone window computed tomography (CT) showed osteoblastic and osteolytic changes in the right occipital bone and skull base. Magnetic resonance imaging (MRI) indicated tumor compression of the vertical inferior facial nerve without change in the horizontal portion or the geniculate ganglion. Histologically, the diagnosis was osteoblastic osteosarcoma.
    Chemotherapy for a metastatic lung lesion was abandoned however, due to the complications of renal failure, and the man died 6 months after first being seen.
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  • A Case of Recurrent Laryngopharyngofacial Edema Diagnosed as Hereditary Angioedema (HAE) after Long-Term Follow-Up
    Kiyohito Hosokawa, Mahito Ito, Atsushi Hanamoto, Yasumitsu Takimoto
    2010 Volume 103 Issue 9 Pages 851-857
    Published: 2010
    Released on J-STAGE: September 01, 2010
    DOIhttps://doi.org/10.5631/jibirin.103.851
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    The autosomal dominant disorder hereditary angioedema (HAE) causes recurrent subcutaneous or submucosal edema at any body site due to trauma, mental or physical stress, infection, or cold stimulation, making laryngeal edema potentially life-threatening. We report a case of recurrent laryngopharyngofacial edema diagnosed as HAE only after long-term follow-up.
    A 20-year-old woman seen for edema of the face and larynx suffered recurrent acute episodes of the face, throat, and trunk edema and was treated for idiopathic recurrent edema. Life-threatening laryngeal edema a year later resulted in life-saving blind nasal emergency-room intubation. She was eventually diagnosed with HAE based on low serum C1-inhibitor activity and a lower C4 complement 5 years after her first admission. Thereafter, her life-threatening edema necessitated tracheotomy. She is now treated daily with 1500 mg of tranexamic acid for prophylaxis.
    HAE must be detected as early as possible, which necessitates extensive personel interviews with the subject and family members if possible. Greater awareness of HAE among health-care professionals and patients would also be useful.
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  • A Case of a Penetrating Chopstick Foreign Body in the Neck with Vertebral Artery Thrombosis
    Tomohito Fuke, Mamika Araki, Kouhei Fukukita, Toshifumi Tomioka, Takas ...
    2010 Volume 103 Issue 9 Pages 859-863
    Published: 2010
    Released on J-STAGE: September 01, 2010
    DOIhttps://doi.org/10.5631/jibirin.103.859
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    We report the case of a neck-penetrating foreign body. An 81-year-old woman accidently stuck in the neck by a wooden chopstick was found in computed tomography (CT) to have a deep-neck abscess when admitted to the hospital. We incised and drained the abscess, but found no foreign body. Two weeks postoperatively, thin-slice CT and magnetic resonance imaging (MRI) showed the tip of the chopstick remaining in the neck and vertebral artery thrombosis. We removed the foreign body from the intervertebral foramen. After removal, paralysis remained in the segmental C5 areas, but no cerebral infarction occurred.
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  • Status and Satisfaction in Clinic Day Surgery
    Hiroshi Inui, Takashi Inui
    2010 Volume 103 Issue 9 Pages 865-871
    Published: 2010
    Released on J-STAGE: September 01, 2010
    DOIhttps://doi.org/10.5631/jibirin.103.865
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    We report day-surgery status and satisfaction in 308 cases over the last 9 years—endscopic sinus surgery (ESS) in 167 cases, myringoplasty (Yuasa method) in 68, deviatomy in 17, and others in 56. Anesthesia was local, and pharyngeal and laryngeal surgical interventions were excluded. Mean operationing time was under 60 minutes, and 91% of subjects lived within 10 km of clinics taking part.
    Problems included hypotension, bleeding in ESS, and vertigo in the Yuasa method.
    Questionnaire results showed subjects to be satisfied with surgical explanation, surgical risk, and postoperative care. Some subjects experienced preoperative anxiety, but this disappeared in postoperative care.
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Original articles
  • Flexible Nasopharyngeal Fiberscope Cleaning and Sterilization
    Keiji Fujihara, Akihisa Togawa, Masashi Ogami, Shin Takei, Yorihiko Ik ...
    2010 Volume 103 Issue 9 Pages 873-879
    Published: 2010
    Released on J-STAGE: September 01, 2010
    DOIhttps://doi.org/10.5631/jibirin.103.873
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    To compare conventional and automatic flexible nasopharyngeal fiberscope (NFS) sterilizer effectiveness and required time, we studied the NFS handle and tip before and after sterilization in clinical use in 9 cases each. Two bacterial strains were infused into 6 NFS channels then washed them with each method, recording all required cleaning and sterilization time and steps.
    Automatic sterilization yielded no bacteria on the NFS handle, tip, or channnel of the scope in any case. Conventional sterilization yielded bacteria on the handle in 5 of 9 cases, although none on the channel or tip. Average automatic sterilization took 12 minutes 43 seconds, significantly shorter than the conventional 23 minutes 7 seconds.
    We found automatic sterilization to be more bactericidaliy effective and efficacious than conventional sterilization.
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Original articles
  • Use of Microporous Polysaccharide Hemispheres (MPH) for Endoscopic Sinus Surgery
    Satoru Kodama, Tomoyo Okamoto, Masashi Suzuki
    2010 Volume 103 Issue 9 Pages 881-886
    Published: 2010
    Released on J-STAGE: September 01, 2010
    DOIhttps://doi.org/10.5631/jibirin.103.881
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    Endoscopic sinus surgery (ESS) now widely conducted in nasal and paranasal sinus surgery uses one of the excellent bioabsorbable and comfortable hemostatic agent available obviating the need for packing following ESS. We report the use of microporous polysaccharide hemispheres (MPH), an absorbable hemostatic powder produced from purified potato starch, following ESS in 12 subjects with sinonasal disorders treated in 2009. ESS under general anesthesia on 17 sides was conducted by the same surgeon. The series consisted of 5 inflammation, 2 mucoceles, and 5 benign tumors. Treatment was successful in all cases, with MPHs used hemostatically at the end of surgery. No postoperative hemorrhage was seen and the postoperative course was uneventful in all cases. Acting as a molecular sieve by osmotically extracting fluid from blood, MPH particles concentrate platelets and other formed elements, promoting fibrin clot formation. MPH is rapidly cleared within 24 to 48 hours. Our initial experience suggests that MPH is a useful hemostatic agent following ESS.
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