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前身誌
108 巻, 4 号
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論説
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羽藤 直人2015 年 108 巻 4 号 p. 257-263
発行日: 2015年
公開日: 2015/04/01
ジャーナル 認証ありBell’s palsy is one of the most common causes of facial nerve paralysis, usually on one side of the face, that has no known underlying cause. The natural course of this disease is generally favorable, and approximately 70% of patients recover completely without treatment. The pathogenesis of Bell’s palsy involves herpes simplex virus infection, inflammatory changes, secondary edema, and entrapment neuropathy in the narrow fallopian canal. Steroids and adjunctive antiviral agents are the treatment of choice. However, approximately 10% of patients do not respond to conservative treatment and experience profound denervation leading to severe sequelae. The treatment strategy for severe paralysis is acceleration of recovery by preventing further worsening of nerve degeneration in the early phase of the incident. Facial nerve decompression surgery is indicated in cases of Bell’s palsy suspected to have a poor prognosis, usually within 2 weeks of onset. Since Ballance and Duel first reported decompression of the facial nerve at the distal mastoid segment in 1932, several treatment procedures have been proposed; however, there only very low quality evidence exists, based on which an informed decision could not be made as to whether an operation would be helpful or harmful for patients with Bell’s palsy. Currently, most patients are treated medically, and decompression surgery is rarely undertaken. Decompression more than 2 weeks after the onset of paralysis is particularly rare because the surgical procedure is unlikely to facilitate nerve regeneration. However, the history of, the evidence for, and the procedure of facial nerve decompression surgery are still interesting for neuro-otologists who have to treat patients with severe Bell’s palsy, therefore those must be described in detail.抄録全体を表示PDF形式でダウンロード (794K)
カラー図説
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瀬尾 徹2015 年 108 巻 4 号 p. 264-265
発行日: 2015年
公開日: 2015/04/01
ジャーナル 認証ありPDF形式でダウンロード (373K)
臨床
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鬼頭 良輔, 森 健太郎, 宇佐美 真一2015 年 108 巻 4 号 p. 267-272
発行日: 2015年
公開日: 2015/04/01
ジャーナル 認証ありRecently, the gradual acceptance and performance of intratympanic (IT) steroid therapy for idiopathic sudden sensorineural hearing loss (ISSHNL) has been reported in Japan, but it has not yet become popular.
We report herein on our results of IT steroid injections as initial therapy and salvage therapy for patients with ISSHNL.
Methods:
One hundred and thirty-four patients with ISSHNL treated in our institution were enrolled and analyzed. For the analysis of the effect of salvage therapy, patients showing poor response (hearing improvement <30 dB) to initial systemic steroid therapy were enrolled.
Results:
Fifteen patients were treated with IT steroid injection as initial therapy.
In these patients, hearing improvement >10 dB and >30 dB were 86.7% and 60%, respectively. This hearing recovery was slightly better compared with the recovery of the patients on systemic steroid therapy as initial therapy.
Seventy-eight patients were enrolled for the analysis of the effect of salvage therapy. Thirty-nine patients were treated with IT steroid injection as salvage therapy, 14 patients were treated with systemic steroid therapy, and in 25 patients no additional steroid therapy was performed. Compared with the latter two groups, patients in the IT steroid group achieved significantly better hearing recovery, especially those receiving IT steroid therapy within 3 weeks.
Conclusions:
IT steroid therapy for ISSHNL was considered an effective treatment as both initial and salvage therapy.
There was a high degree of variability in the IT steroid therapy regarding frequency and intervals and the total number of injections across studies. Future studies are therefore required to elucidate the optimum protocol for IT steroid therapy.抄録全体を表示PDF形式でダウンロード (385K) -
岡 愛子, 大野 恒久, 岩永 健, 佐藤 進一2015 年 108 巻 4 号 p. 273-277
発行日: 2015年
公開日: 2015/04/01
ジャーナル 認証ありFacial nerve schwannomas may occur in any segment of the facial nerve, from the cerebellopontine angle to the parotid gland. Extracranial facial nerve schwannomas are uncommon, and tumors around parotid grand may be misdiagnosed as parotid tumors, such as pleomorphic adenoma or Warthin’s tumor. Facial paralysis should be borne in mind as a complication of surgical treatment for facial nerve schwannoma. We encountered a case of extratemporal facial nerve schwannoma that was preoperatively diagnosed as a parotid tumor, but intraoperatively confirmed as a facial nerve schwannoma.
A 35-year-old female was referred to us because of a slight swelling in the anterior part to the right ear. The swelling was slightly tender, but there was no facial paralysis. Physical examination revealed a mass measuring about 3 cm in diameter, that was elastic in consistency and freely mobile. Magnetic resonance imaging (MRI) showed a solid tumor anterior to the parotid grand, visualized as a hypointensity on T1-weighted images and as a well-circumscribed hyperintensity on T2-weighted images. Fine-needle aspiration biopsy revealed class I cytology. Based on these findings, a parotid tumor was suspected, and surgical resection was undertaken. The intraoperative histopathology revealed a schwannoma with an influx of peripheral facial nerve fibers. The postoperative clinical course was good, and there has been no facial paralysis or recurrence during the 10 months since the surgery.
The preoperative diagnosis of facial nerve schwannoma is difficult because of the lack of dindistinctive MRI findings and the low diagnostic sensitivity of fine-needle aspiration biopsy. If the tumor is diagnosed as schwannoma preoperatively or intraoperatively, its location and the pre-operative facial nerve function can affect the decision on the surgical treatment. While functional preservation should be an important goal of surgical treatment, complete removal is also important, as subtotal resection has been shown to be associated with unacceptably high recurrence rates in the long term.抄録全体を表示PDF形式でダウンロード (468K) -
立石 碧, 瀬野 悟史, 清水 猛史2015 年 108 巻 4 号 p. 279-283
発行日: 2015年
公開日: 2015/04/01
ジャーナル 認証ありCavernous sinus syndrome may become fatal if it is misdiagnosed and its treatment is delayed. We report herein on the case of 42-year-old woman with sphenoid sinusitis who developed cavernous sinus syndrome and hypopituitarism. She presented to our hospital with a history of continued headache and swelling of the right eyelid. She was diagnosed as having hypopituitarism based on blood examinations, and computed tomography (CT) imaging revealed right sphenoid sinusitis. Magnetic resonance imaging (MRI) showed local meningitis, right orbital cellulitis and inflammation of the right cavernous sinus.
Endoscopic sinus surgery (ESS) was performed immediately and broad-spectrum antibiotics were administered intravenously before and after the surgery. The patient’s condition improved postoperatively, and she was discharged without any complication after 6 days. The pituitary function returned to normal in 1 month without hormonal support.
For the management of cavernous sinus syndrome, enhanced MRI is useful to reveal important intracranial and sinus findings. Although cavernous sinus syndrome is rare, delay in diagnosing may lead to serious complications such as meningitis, brain abscess, visual disturbance and hypopituitarism. Immediate surgical drainage is essential for the treatment of cavernous sinus syndrome caused by sinusitis.抄録全体を表示PDF形式でダウンロード (731K) -
石川 徹, 武井 聡, 藤峰 武克2015 年 108 巻 4 号 p. 285-288
発行日: 2015年
公開日: 2015/04/01
ジャーナル 認証ありWe report a case of malignant melanoma in the submandibular region. The patient was a 67-year-old man, who presented with the chief complaint of swelling of the submandibular region on the right side. CT demonstrated a cystic lesion adjacent to the submandibular gland, and the result of fine-needle aspiration cytology was Class III. Submandibular glandectomy was performed, and pathological examination revealed features consistent with metastasis from a malignant melanoma. We attempted to identify the site of the primary lesion, but failed. We suspected that a primary lesion in the head or neck may have disappeared spontaneously, or that there was no primary lesion to begin with. As partial biopsy of a malignant melanoma in the head and neck region may worsen the patient’s prognosis, it is important to consider complete biopsy of a mass in the head and neck region suspected to be a carcinoma of unknown primary.抄録全体を表示PDF形式でダウンロード (599K) -
山野 貴史, 宮﨑 健, 坂田 俊文, 中川 尚志2015 年 108 巻 4 号 p. 289-293
発行日: 2015年
公開日: 2015/04/01
ジャーナル 認証ありHerein, we report the results of evaluation of the swallowing functions by video fluorography in three patients who had undergone an extraction procedure to remove a foreign body lodged in the laryngopharynx. Prolongation of the “laryngeal elevation delay time (LEDT)” and dysfunction of pharyngeal clearance were commonly observed in all the cases. Dysphagia, which is a common cause of accidental lodging of a foreign bodies in the laryngopharynx, in addition to other underlying disease and a history of intake of medications for conditions such as schizophrenia.抄録全体を表示PDF形式でダウンロード (545K) -
田畑 貴久, 若杉 哲郎, 三箇 敏昭, 北村 拓朗, 永谷 群司, 鈴木 秀明2015 年 108 巻 4 号 p. 295-300
発行日: 2015年
公開日: 2015/04/01
ジャーナル 認証ありLaryngeal cancer is the third most common of the head and neck cancers in Japan. We retrospectively analyzed the data of 112 newly diagnosed patients with laryngeal cancer who were treated at our department between 2005 and 2012. The subjects consisted of 102 males and 10 females, ranging in age from 40 to 88 years (average, 69.2 years). The follow-up period ranged from 1 to 95 months (median: 33 months).
Our treatment protocol was as follows: Patients with T1a glottic or T1 supra/subglottic cancer were administered radiotherapy alone at 60 Gy/30 fractions. Patients with T1b glottic or T2 cancer received hyperfractionated radiotherapy with concurrent daily carboplatin (25 mg/m2). Responders at 30–40 Gy continued receiving chemoradiotherapy up to a total of 64.8 Gy, whereas nonresponders underwent surgery. For patients with T3 or T4 cancer, 1–2 courses of induction chemotherapy (docetaxel 60 mg/m2 (day 1), cisplatin 60 mg/m2 (day 1), and 5-fluorouracil 600 mg/m2 (days 1–5)) were administered. Responders among the T3 patients were given hyperfractionated radiotherapy with concurrent daily carboplatin, whereas all T4 patients and nonresponder T3 patients were treated by surgery after induction chemotherapy.
The overall 5-year crude survival, disease-specific survival and laryngeal preservation rates as determined by the Kaplan-Meier method were 73.5%, 81.9% and 64.2%, respectively. The survival rates were significantly higher in patients with stage I/II disease than in those with stage III/IV disease (stage I: 93.8% (crude)/100% (disease-specific), stage II: 93.3%/100%, stage III: 62.1%/80.8%, stage IV: 24.2%/31.2%). The laryngeal preservation rate was significantly higher in patients with T1/2 disease than in those with T3/4 disease (T1: 89.7%, T2: 92.0%, T3: 19.3%, T4: 0.0%). The survival rate of patients with stage IV disease and the laryngeal preservation rate of patients with T3 disease were somewhat low and unsatisfactory as compared to previous reports.
These results indicate the importance of early detection and the need for improvement of the treatment protocol for stage IV/T3 cases.抄録全体を表示PDF形式でダウンロード (467K) -
鈴木 久美子, 佐藤 慎太郎, 門司 幹男, 倉富 勇一郎2015 年 108 巻 4 号 p. 301-305
発行日: 2015年
公開日: 2015/04/01
ジャーナル 認証ありEpithelial-myoepithelial carcinomas (EMCs) are classified as a low grade malignant tumor arising from the salivary gland and comprises approximately 1% of all salivary gland tumors. We report herein on a patient with EMC arising from the deep lobe of the parotid gland who presented with facial nerve paralysis as an initial symptom, and then developed otalgia and glossopharyngeal pain, and finally presented multiple cranial nerve disorders.
A 76-year-old woman was referred to us because of right otalgia lasting for 2 years and abnormal lesions in her mastoid cavity seen on magnetic resonance imaging (MRI). She had developed right facial nerve paralysis 6 years before the first visit to us. On otoscopic findings, her right tympanic membrane appeared normal. MRI revealed multiple lesions in the right mastoid air cells and along the glossopharyngeal nerve, and there was suspicion of a faint shadow in the deep lobe of the parotid gland. Medical treatments for the glossopharyngeal neuralgia showed little effect. The patient developed right laryngeal paralysis, and then developed right soft palate and accessory nerve paralyses six to eight months after the first visit. A mastoidectomy was performed which revealed multiple tumors in the mastoid air cells without bone destructions. Histologically, the tumor was diagnosed as an epithelial-myoepithelial carcinoma arising from the parotid gland. Positron emission tomography revealed a metastatic lesion in her cervical spine and, therefore, she underwent carbon-ion radiotherapy. Eighteen months after the treatment, the tumor size was stable. It was presumed that the tumor developed in the deep lobe of the parotid gland, and then invaded the mastoid cavity causing the facial nerve paralysis, and finally infiltrated medially along with the internal jugular vein giving rise to multiple cranial nerve (IX～XI) disorders.抄録全体を表示PDF形式でダウンロード (787K) -
木谷 有加, 山本 馨, 平間 真理子, 折舘 伸彦2015 年 108 巻 4 号 p. 307-310
発行日: 2015年
公開日: 2015/04/01
ジャーナル 認証ありA 55-year-old man was referred to our hospital with the chief complaint of difficulty in opening his mouth and dysphasia. His breathing stopped on fiberscopic examination and cardiopulmonary resuscitation was performed. Based on the symptoms and history of trauma, he was clinically diagnosed as having tetanus. Respiratory care, debridement surgery of a wound bed, anti-tetanus immunoglobulin injection, and administration of penicillin G were required. He was discharged from hospital without any untoward sequelae. The number of patients contracting tetanus is decreasing. However the rate of deaths from this disease is 15–40%, so a tetanus vaccination is required. It should be noted that a patient having tetanus could visit otolaryngology clinic due to their trismus and that a prompt diagnosis based on clinical manifestations is required.抄録全体を表示PDF形式でダウンロード (350K)
薬物
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平位 知久, 福島 典之, 宮原 伸之, 三好 綾子, 有木 雅彦2015 年 108 巻 4 号 p. 311-316
発行日: 2015年
公開日: 2015/04/01
ジャーナル 認証ありGastroesophageal reflux disease (GERD) has been known to cause pharyngeal symptoms such as globus pharyngeus, cough, hoarseness and swallowing disturbance. Non-erosive reflux disease (NERD) is thought to be more difficult to treat than erosive reflux disease (e-GERD) due to the high prevalence of proton pump inhibitor (PPI) resistance. Mosapride citrate improves gastrointestinal peristalsis by promoting the acetylcholine isolation in the gastrointestinal nerve plexus.
We administrated mosapride citrate for 4 weeks in 22 patients with NERD who were diagnosed with the laryngoscope and upper gastrointestinal endoscopy, and the subjective symptoms were assessed on a frequency scale for the symptoms of GERD (FSSG). The overall symptom improvement degree was 68.2%, which was approximately equal to other reports. Mosapride citrate improved both the acid reflux-related scores and the dyspeptic symptom scores on FSSG.
We concluded that mosapride citrate is effective on some patients with NERD.抄録全体を表示PDF形式でダウンロード (393K)
総説
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松塚 崇, 鈴木 政博, 西條 聡, 池田 雅一, 大森 孝一2015 年 108 巻 4 号 p. 317-322
発行日: 2015年
公開日: 2015/04/01
ジャーナル 認証ありElastography is a new ultrasonic technique that characterizes the conditions of lesions in greater detail than B-mode ultrasonography. Elastography is based on two major imaging techniques: the first method is strain elasticity imaging, also called static elastography, and the second method is acoustic stress elasticity imaging, or dynamic elastography, including acoustic radiation force impulse imaging, which applies a short-duration acoustic radiation force to the region of interest, and this method can enable qualitative visual and quantitative value measurements. By measuring the time to peak displacement at each lateral location, a quantitative implementation named virtual touch quantification (VTQ) can calculate the shear wave velocity within the tissue. Virtual touch imaging quantification (VTIQ) is a new form of two-dimensional shear wave imaging and displays a color-coded image using up to 256 spatially distributed ARFI push pulses and detection pulse sequences.
In our study, 77 normal salivary glands (parotid gland: 42, submandibular gland: 35) were examined, the mean values of VTQ and VTIQ were 1.9 and 2.0 m/s, respectively. The VTQ and VTIQ values were correlative, and there were no statistical differences in each mean value between the normal parotid glands and submandibular glands. Some reports have described the mean VTQ values of breast tissue (3.3 m/s), liver (1.6 m/s), pancreas (1.4 m/s), spleen (2.4 m/s) and kidney (2.2 m/s), and the mean VTIQ values of normal breast tissue (3.2 m/s) and fatty tissue (2.5 m/s). By measuring normal quantitative values, these methods could be utilized to provide information for evaluating patients’ conditions and detecting malignant tumors.抄録全体を表示PDF形式でダウンロード (821K)
研修ノート
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坂口 博史2015 年 108 巻 4 号 p. 324-325
発行日: 2015年
公開日: 2015/04/01
ジャーナル 認証ありPDF形式でダウンロード (306K)
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