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107 巻, 11 号
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論説
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三輪 高喜2014 年 107 巻 11 号 p. 849-857
発行日: 2014年
公開日: 2014/11/01
ジャーナル 認証ありSmell dysfunction is a common complaint among patients presenting to ENT clinics. Patients with a smell disorder are evaluated by detailed interview, physical examination using a nasal endoscope, CT imaging and olfactory function tests. Olfactory function tests include psychophysical measurements and objective tests using measurements of brain activity, but the latter is less established in routine clinical practice. T&T olfactometry is a standard olfactory function test in Japan. Although its good point is that it can evaluate both thresholds and identification ability of the patients, it is not conducted at clinics because of the associated complicated procedure and bad smell. Accordingly some techniques to evaluate the patient’s olfactory function are shown herein, a self-administered odor questionnaire, visual analog scale, and newly developed olfactory identification tests for Japanese subjects. The newly developed procedures, measurement of olfactory bulb volume with MRI and olfacto-scintigraphy using SPECT-MRI as objective tests are presented.抄録全体を表示PDF形式でダウンロード (586K)
カラー図説
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小林 正佳, 坂井田 寛2014 年 107 巻 11 号 p. 858-859
発行日: 2014年
公開日: 2014/11/01
ジャーナル 認証ありPDF形式でダウンロード (685K)
臨床
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木村 俊哉, 水越 彬文, 曾我美 遼, 市丸 和之, 大野 恒久, 小田 直治, 平海 晴一, 玉木 久信, 伊藤 壽一2014 年 107 巻 11 号 p. 861-866
発行日: 2014年
公開日: 2014/11/01
ジャーナル 認証ありA case of bilateral cholesteatomas which caused a cerebellar abscess is reported herein. The patient was a 38-year-old male who had bilateral otorrhea and hearing loss from childhood. He presented with fever, a headache, and vertigo which had started in the summer, and he visited our hospital 2 months later because the symptoms did not improve. At the first visit, nystagmus was not present. CT images revealed bilateral cholesteatomas, and there was a lateral semicircular canal fistula with expansion of the cochlea and the posterior semicircular canal in the right ear. There was no bone defect of the middle- and post-cranial fossa. At first, we regarded the vertigo as peripheral, and planned a radical operation on the right middle ear. But, after hospitalization, the patient collapsed with a tendency to somnolence and Bruns’ nystagmus. MRI revealed an abscess in the right cerebellar hemisphere. To treat obstructive hydrocephalus and the cerebellar abscess, trepanning ventricular drainage and brain abscess drainage via a craniotomy were carried out. After treatment with antibiotics, the patient’s general state improved. Accordingly, a mastoidectomy with labyrinthectomy was performed on the right ear, and a staged tympanoplasty was carried out on the left ear. There has been no recurrence for 3 years until the time of writing. We presume that the infection route of this case was the internal auditory meatus. A cerebellar abscess secondary to cholesteatoma is rare, but early examination and treatment are necessary, because the fatality rate in these cases is higher when a brain, especially cerebellar abscess occurs.抄録全体を表示PDF形式でダウンロード (675K) -
清水 重敬, 小川 恭生, 大塚 康司, 稲垣 太郎, 鈴木 衞2014 年 107 巻 11 号 p. 867-873
発行日: 2014年
公開日: 2014/11/01
ジャーナル 認証ありWe often encounter clinical cases with nystagmus or abnormal eye movements that are suspected to be associated with central vertigo. However, imaging techniques such as magnetic resonance imaging (MRI) may not always yield abnormal findings for such cases. For 2 patients who were suspected as having central vertigo on the basis of oculomotor testing but had normal MRI findings, we identified the lesion site using the results of neuro-otological tests. (1) Since direction-changing positional nystagmus was observed, with inhibited optokinetic nystagmus or saccadic pursuit, we suspected cerebellar or brain stem lesions. (2) Caloric testing yielded a normal response. Hence, the vestibular nucleus, abducens nucleus, oculomotor nerve nucleus, and medial longitudinal fasciculus were considered to be lesion-free. Visual suppression was also normal; this allowed us to rule out the pons, cerebellar flocculus, and nodulus as lesion sites. Moreover, preserved saccadic speed indicated no damage to the pons or midbrain. (3) Because hypermetria was observed during the saccade, we suspected damage to the cerebellar fastigial nucleus. Further, drift to the median during the saccade and gaze-evoked nystagmus were observed, suggesting a lesion in the nucleus prepositus hypoglossi, which is a neural integrator. Both our patients showed poor laterality; therefore, they were thought to have a degenerative disease. From the above-mentioned findings, we propose that MRI cannot reveal any abnormalities during the very early stages of spinocerebellar degeneration.抄録全体を表示PDF形式でダウンロード (1322K) -
平川 治男, 西 康行, 多田 誠, 渡部 泰輔2014 年 107 巻 11 号 p. 875-882
発行日: 2014年
公開日: 2014/11/01
ジャーナル 認証ありJuvenile angiofibromas represent a rare vascular tumor of the deep part of the face occurring in adolescent males. This tumor typically arises from the sphenopalatine artery. The surgical approach for the tumor requires consideration for both complete removal of the tumor and preservation of the facial appearance.
We applied the hemifacial degloving approach in a 12-year-old boy with a unilateral juvenile angiofibroma staged IIIA according to Radkowski (1996). We performed this approach twice on this patient because we had missed the residual tumor inside the base of the right pterygoid process at the first surgery. He has had no evidence of recurrence of the tumor and no surgical marks on the face over three years after the second surgery. Hemifacial degloving is a more suitable approach than midfacial degloving for exclusively unilateral tumors.抄録全体を表示PDF形式でダウンロード (860K) -
竹本 洋介, 御厨 剛史, 橋本 誠, 山下 裕司2014 年 107 巻 11 号 p. 883-888
発行日: 2014年
公開日: 2014/11/01
ジャーナル 認証ありSinusitis is commonly found, but lesions localized in the sphenoid sinus are rarely associated with sinusitis. We report herein on 21 cases of isolated sphenoid sinus disease (ISSD) treated surgically at the Department of Otolaryngology, Yamaguchi University, Graduate School of Medicine between March 2008 and March 2012. Diagnosis was made on the basis of history, clinical signs, nasal endoscopy, and imaging techniques with CT/MRI. The final diagnosis of ISSD was established after histopathological examinations of the excised surgical specimen. The pathologies included fungal diseases (48%), sphenoid sinusitis (28%), sphenoid cysts (19%), and tumorous tissue (5%). The initial symptom was headache (62%), followed by rhinorrhea (19%). An endoscopic sphenoidectomy was performed through the nasal septum in 15 patients and was useful for total removal of the lesion.抄録全体を表示PDF形式でダウンロード (646K) -
大森 良彦, 都築 建三, 児島 雄介, 雪辰 依子, 三代 康雄, 阪上 雅史2014 年 107 巻 11 号 p. 889-893
発行日: 2014年
公開日: 2014/11/01
ジャーナル 認証ありWe experienced a patient with sphenoid sinus metastasis from prostatic adenocarcinoma. A 75-year-old man suffering from diplopia for one month was diagnosed as having left abductor paralysis by an ophthalmologist. He was referred to our department, because the cause of the left abductor paralysis was suspected as being due to opacification at the bilateral sphenoid sinus seen on CT imaging. We performed a nasal septoplasty and endoscopic sinus surgery (ESS) under local anesthesia. A reddish brown tumor in the sphenoid sinus was bilaterally observed during surgery. The tumor was histologically diagnosed as an adenocarcinoma metastasized from prostatic cancer. The left abductor paralysis gradually improved following treatment by medical oncologists after chemotherapy using docetaxel. Sinonasal CT imaging also showed a reduction of the tumor volume in the sphenoid sinus lesion. However, the patient re-presented with right facial palsy in the seventh month after surgery. Finally, he died of respiratory dysfunction caused by metastatic cancer to the lung.抄録全体を表示PDF形式でダウンロード (1018K) -
東谷 敏孝2014 年 107 巻 11 号 p. 895-899
発行日: 2014年
公開日: 2014/11/01
ジャーナル 認証ありActinomycosis is a chronic suppurative granulomatous infection caused by the Actinomyces genus comprising filamentous and gram-positive bacteria that can cause chronic inflammatory granulomas. Actinomyces genus are bacteria resident in tooth sockets or the tonsils. Therefore actinomycosis occurs most commonly in the head and neck region, and in the other cases occurs in the chest and the abdomen.
We report herein on a case of a 66-year-old woman who was diagnosed as having actinomycosis involving the soft palate based on data reported hereunder. Her main complaint was a sore throat. We found a mass-related lesion with a white moss-like substance to the right side of the soft palate. Based on the biopsy findings revealed the histological diagnosis was actinomycosis. We gave her amoxicillin for three weeks, and she was cured. In the six months to time of writing, no recurrence has been noted.
Actinomycosis is an inflammatory mass-forming disease, and diagnosis is difficult when based only on the clinical evidence.抄録全体を表示PDF形式でダウンロード (510K) -
中尾 芳雄2014 年 107 巻 11 号 p. 901-905
発行日: 2014年
公開日: 2014/11/01
ジャーナル 認証ありTraumatic retropharyngeal hematomas are rare but potentially life-threatening conditions. I present herein on the case of a 75-year-old man with a traumatic retropharyngeal hematoma and upper airway obstruction. While driving a car, he fell into a river from a height of 1.5 m, and his face struck the steering wheel, causing bruising. He received anti-platelet therapy, but suddenly complained of severe dyspnea. Computed tomography of the neck showed a large retropharyngeal hematoma so an emergency tracheostomy was performed. Moreover, I treated him with antibiotics and high calorie infusion. The hematoma disappeared after 51 days with close observation. We should keep in mind that retropharyngeal hematomas can occur in elderly trauma patients who are receiving anti-platelet therapy.抄録全体を表示PDF形式でダウンロード (534K) -
渡部 泰輔, 平川 治男, 西 康行, 多田 誠2014 年 107 巻 11 号 p. 907-912
発行日: 2014年
公開日: 2014/11/01
ジャーナル 認証ありArytenoid cartilage dislocation (ACD) is sometimes caused by tracheal intubation or laryngeal injury. A current treatment for ACD is rigid-laryngoscopic closed reduction under general anesthesia. However, hospitalization is usually required for this treatment. Abe (2007) reported fiberscopic baloon reduction under local anesthesia (FBR) for anterior ACD. FBR can be performed repeatedly on outpatients because it is simple and minimally invasive. Our original idea for FBR is using Tiemann catheters (with the curved tip). The insertion procedure into the glottis when FBR is indicated became much easier with the use of a Tiemann catheter, because we can control the position of the tip by turning the axis of the catheter. We report herein on 2 cases of anterior ACD treated with FBR using a Tiemann catheter.抄録全体を表示PDF形式でダウンロード (573K) -
坂本 進, 大野 恒久, 宮崎 拓也, 千代田 朋子, 佐藤 進一2014 年 107 巻 11 号 p. 913-917
発行日: 2014年
公開日: 2014/11/01
ジャーナル 認証ありSome cases of squamous cell carcinoma (SCC) arising in free flaps have been reported by several authors. We report herein two cases of squamous cell carcinoma arising in free flaps after oral reconstruction.
The first case was a 76-year-old woman. Nine years before admission, she received resection of a left buccal mucosal SCC and left radical neck dissection. The defect was reconstructed with an anterolateral thigh flap. On a routine examination, a new SCC was noted in the center of the anterolateral thigh flap. The tumor was simply resected. After resection of the SCC, there has been no recurrence for 15 months.
The second case was a 70-year-old woman. Nineteen years before admission, she received resection of an SCC of the right tongue after radiotherapy, and the defect was reconstructed with a forearm flap. She subsequently received tumor resection of an SCC of the left tongue. Four years before admission, right SCC was found in the lower gingival tissue, and she received both radial neck dissection and mandibulectomy. The defect was reconstructed with an anterolateral thigh flap. On a routine examination, a new SCC was noted between the left tongue and the anterolateral thigh flap. The SCC was resected with safety margin. After resection of the SCC, the patient is alive no recurrence for 9 months.
Long-term follow up of these patients demands careful examination of the mucosa of upper digestive tract and the surface of the flap used for reconstruction.抄録全体を表示PDF形式でダウンロード (567K) -
井内 寛之, 黒野 祐一2014 年 107 巻 11 号 p. 919-925
発行日: 2014年
公開日: 2014/11/01
ジャーナル 認証ありMalignant myoepithelioma is a rare tumor that occurs in about 0.2% of the salivary gland tumors. We report herein on a case of malignant myoepithelioma which presented in the hard palate.
The patient was a 54-year-old woman, who visited our outpatient clinic with a complaining of nasal obstruction. Rhinology showed an elevation of the nasal cavity floor, and a 15 mm mass lesion was observed in hard palate.
The presence of tumor was confirmed by CT imaging on which a large solid mass occupying part of right maxillary sinus, hard palate, and nasal cavity were observed. There were no palpable neck lymph nodes. The pathological diagnosis of a biopsy taken from the nasal cavity floor was malignant myoepithelioma. Immunohistochemical studies showed positive staining for keratin and p63, and partial positivity for S-100 and GFAP.
The patient underwent subtotal maxillectomy of the right maxilla and partial maxillectomy of the left maxilla.
In a 2-year follow up after the surgery, there has been no evidence of recurrence.抄録全体を表示PDF形式でダウンロード (1179K) -
小野 麻友, 柴山 将之, 神前 英明, 竹澤 公美子, 大脇 成広, 清水 猛史2014 年 107 巻 11 号 p. 927-933
発行日: 2014年
公開日: 2014/11/01
ジャーナル 認証ありWe describe a case of deep neck infection with descending necrotizing esophageal and gastric muscularitis in a 78-year-old woman. She complained of a sore throat and dysphagia. Computed tomography revealed a gas-forming abscess in the parapharynx extending into the esophagus and gastric cardia. Esophageal and gastric fiberoscopy revealed no mucosal damage, but the esophageal mucosa was showed exogenous constriction, and thoracoscopy demonstrated an intermuscular abscess of the esophagus. The patient was successfully treated with surgical drainage of the deep neck abscess and antibiotic therapy. The postoperative course was uneventful.抄録全体を表示PDF形式でダウンロード (956K)
研修ノート
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小林 一女2014 年 107 巻 11 号 p. 934-935
発行日: 2014年
公開日: 2014/11/01
ジャーナル 認証ありPDF形式でダウンロード (903K)
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