Practica Oto-Rhino-Laryngologica

Tracheal Reconstruction after Wide-Excision of Trachea

Tetsuaki Kubota, Yoshiyuki Kadokura

2002 Volume 95 Issue 9 Pages 877-884
Published: September 01, 2002
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.95.877

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Imaging for Navigation Surgery

[in Japanese], [in Japanese], [in Japanese]

2002 Volume 95 Issue 9 Pages 886-887
Published: September 01, 2002
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.95.886

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Herpes Zoster Involving Lower Cranial Nerves; A Report of 2 Cases

Kunio Mizutari, Hideyuki Saito, Hiroyuki Ozawa

2002 Volume 95 Issue 9 Pages 889-892
Published: September 01, 2002
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.95.889

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We report two cases of cranial nerve palsy due to varicella-zoster virus infection. One patient, a 53-year-old woman, was admitted to our hospital complaining of a sore throat, right otalgia and painful vesicle on the right auricle. Herpetic vesicles were present on the right soft palate and arytenoid. She also reported loss of hearing in the right ear but there was no facial palsy. The serum antibody titer for herpes zoster was significantly elevated, and the cerebrospinal fluid showed pleocytosis. She was diagnosed as having herpes zoster involving the vestibulocochlear nerve and glossopharyngeal nerve. She was treated with intravenous acyclovir and satellite ganglion block. She did not have any residual signs.
The other patient, a 44-year-old woman, complained of a sore throat, hoarseness and difficulty in swallowing. She had no skin rash, but there was a single vesicle on the left arytenoid. Physical examination revealed poor elevation of soft palate on the left side, but gag reflex was preserved. The serum antibody titer for herpes zoster was significantly elevated. She was diagnosed as having herpes zoster involving vagus nerve. She was treated with intravenous acyclovir for 7 days. She did not have any residual sign.
In cases of unilateral cranial nerve palsy with pain, herpes zoster should be considered, and serum antibody titer for herpes zoster should be evaluated.

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A Case Report of Middle-Ear Lipoma

Toshihisa Ito, Takehisa Saito, Seita Kubo, Hitoshi Saito

2002 Volume 95 Issue 9 Pages 893-897
Published: September 01, 2002
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.95.893

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Middle-ear lipoma is very rare and it is difficult to differentiate preoperatively from other middle-ear tumors. We report a 5-year-old boy with middle-ear lipoma that was diagnosed preoperatively as congenital cholesteatoma in the tympanic cavity. To date, 5 cases of middle-ear lipoma have been reported in the world. We reviewed this literature, and our lipoma case was compared with those in the other reported cases.

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Endoscopic Adenoidectomy Using Ultrasonically Activated Scalpel

Masashi Hamada, Yozo Washizu, Taizo Takeda

2002 Volume 95 Issue 9 Pages 899-903
Published: September 01, 2002
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.95.899

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Ultrasonically activated scalpel was developed to concomitantly achieve cutting and coagulation, and thereby has a potential to reduce bleeding. We introduced this instrument (Harmonic Scalpel ®, Johnson and Johnson Medical Co., Cincinnati, OH, USA) for adenoidectomy in 14 patients under direct visualization by endoscope.
After the patient was intubated, a sandbag was placed under the shoulders and Davis mouth gag was inserted. Small rubber catheters were introduced to retract the soft palate and a 4-mm 70° rigid endoscope was used transorally to visualize the nasopharynx. The adenoid tissue was initially shaved mostly using a KATANA blade. Thereafter, the residual tissue, especially the choanal adenoid and peritubal tonsil, was removed with a ball coagulator. Finally the nasopharyngeal wound was smoothed for complete hemostasis using the latter blade.
The mean blood loss was 31.6g (range 0-70g) and the mean surgical duration was 37.6 minutes (range 19-57 minutes). Neither postoperative hemorrhage nor regrowth of adenoid tissue was encountered. There were no other complications such as otitis media, hemotympanum and local infection observed.
We concluded that ultrasonically activated instrument combined with endoscopic visualization facilitated a more adequate adenoidectomy.

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Clinical Study of Hospitalized Patient with Recurrent Epistaxis

Makoto Miyamoto, Akihiko Nakamura, Hiroki Ikeda, Manabu Ogura, Toshio ...

2002 Volume 95 Issue 9 Pages 905-909
Published: September 01, 2002
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.95.905

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Sixty-seven patients with epistaxis requiring hospitalization during the past nine years were analyzed statistically. Seven those of 67 patients complained of recurrent epistaxis and were comprisal of an approximately equal number the same of men and women. All patients except one were middle aged or older. Six patients were complicated by systemic diseases, especially hypertension, and were treated with medication. All cases except case 1 showed the same recurrent lesion at the bleeding point. Their treatments during hospitalization included hemostatic medication and tampon. Two cases of recurrent patients underwent brain angiography and arteriovenous malformation was found in one case. We conclude that recurrent epistaxis patients, especially those of the suspected of arteriovenous malformation need to undergo brain angiography recurrent vascular system.

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Maxillary Reconstruction Using a Latissimus Dorsi Myocutaneous (LDMC) Flap with Scapular Bone

Shigenobu Nomiya, Michihiro Nakada, Toru Watanabe, Motoharu Fukazawa, ...

2002 Volume 95 Issue 9 Pages 911-916
Published: September 01, 2002
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.95.911

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Reconstruction after total maxillectomy for maxillary cancer remains difficult. The procedure offers a stable form, preserving the facial figure and several functions closely related to the QOL of the patients. In order to satisfy the demand for three dimensional, anatomical reconstruction, a reliable flap with skin paddles and bone segments is needed. Some functions such as visual acuity, deglutition and smelling, also should be preserved.
The scapular region is well established as an excellent source of expendable skin, fascia, muscle, and bone for use in free-flap reconstruction of defects requiring bone and soft tissue in complex three dimensional relationships. The inferior border of the scapular bone is independently perfused by the angular branch. This vessel originates from the serratus branch or the thoracodorsal artery.
In this article, three cases of reconstruction after total maxillectomy for squamous cell carcinoma using a free latissimus dorsi myocutaneous (LDMC) flap with scapular bone perfused by the angular branch are reported.
Although this technique takes a long time for one stage reconstruction because it is necessary to change the position of the patient, the advantages include the ability to design the myocutaneous flap on a separate vascular pedicle from the bone and minimal donor site morbidity.

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A Case of McCune-Albright Syndrome with Surgical Treatment

Ryuichiro Saijo, Takeshi Shimizu, Syuichiro Hayashi, Takatsugu Tsunoda ...

2002 Volume 95 Issue 9 Pages 917-921
Published: September 01, 2002
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.95.917

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We report a 23-year-old female diagnosed with McCune-Albright syndrome (MCAS), which is a rare disease consisting of polyostotic fibrous dysplasia of the bone associated with brown pigmented areas of the skin and several endocrine dysfunctions. The diagnosis was made at the age of 5. Surgical treatment was performed at the ages of 13 and 17, to correct asymmetric lesions of her face. After the first and second surgery, the resected maxillary bone regrew rapidly for 3-12 months postoperatively. We recommend that surgical treatment should be performed after the arrest of bony growth on CT, arrest of growth in height and in weight and normalization of ALP. Patients with MCAS should be reviewed at 6-12 month intervals.

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Influence of Smoking on Bacillus in Acute and Chronic Sinusitis Cases

Shinnya Takano, Sei Kitajima, Yumiko Okamura, Hajime Aramaki

2002 Volume 95 Issue 9 Pages 923-928
Published: September 01, 2002
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.95.923

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We examined how smoking influenced the bacillus detected from acute and chronic sinusitis cases and the pH of nasal discharge.
There was no significant difference in the bacillus detected in sinusitis due to the presence of smoking.
The pH of nasal discharge temporarily falls during smoking.
The decreased pH of nasal discharge may decrease the bacillus growth inhibition of the normal flora.

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A Case of Delayed-Onset Traumatic Cerebrospinal Fluid Rhinorrhea

Masaomi Moriyama, Takeshi Suko, Masashi Suzuki, Goro Mogi, Kimiko Sato ...

2002 Volume 95 Issue 9 Pages 929-932
Published: September 01, 2002
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.95.929

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We treated a 55-year-old woman with delayed-onset traumatic cerebrospinal fluid (CSF) rhinorrhea. She developed CSF rhinorrhea 17 months after a closed head injury followed by meningitis 24 months after the incident. Fistula of the right lamina was closed with fascia temporalis under endoscopic sinus surgery (ESS) 26 months after the trauma occurred. There was no recurrence of CSF rhinorrhea or meningitis during the subsequent 18-month follow-up. We compared the clinical features of delayed-onset traumatic CSF rhinorrhea with spontaneous CSF rhinorrhea. CT scanning and ESS were useful in determining of the precise location of the fistula.

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Clinical Review of Oral Cancers

Atsushi Yuta, Chikako Kishioka, Masanori Tatematsu, Yuichi Majima

2002 Volume 95 Issue 9 Pages 933-937
Published: September 01, 2002
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.95.933

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Sixty-five patients with oral cancer, treated at Mie University Hospital for 7 years between 1992 and 1998, were reviewed. The average age was 63.7-years-old. Primary site of oral cancer was the tongue in 34, oral floor in 15, buccal mucosa in 8, gingiva in 5, and the hard palate in 3. The 5-year survival rate analyzed by Kaplan-Meier method was 100%, 75.0%, 61.5%, 91.7%, 21.9% and 0%, respectively for stage 0, I, II, III, IVA and IVC. The high survival rate in stage III indicates the effectiveness of therapy by superselective intraarterial chemotherapy combined with radiation. The 5-year survival rate by the site was 59.7%, 53.0%, 62.5%, 50.0%, and 100%, respectively for tongue, oral floor, buccal mucosa, gingiva, and hard palate.

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Two Cases of Peritonsillar Abscess in Children

Tsuyoshi Kitanishi, Takashi Ikeda, Daisuke Nakajima, Kazutomo Kitajima

2002 Volume 95 Issue 9 Pages 939-943
Published: September 01, 2002
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.95.939

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Peritonsillar abscess is the most common deep neck infection in adults. However, pediatric patients have a smaller anatomy and are often unable to cooperate with examination and treatment. This article describes two cases of peritonsillar abscess in children. The first patient (5-year-old boy) complained of sore throat and pyrexia. CT findings suggested a peritonsillar abscess. Emergent transoral drainage was performed under general anesthesia. He was discharged without any complications. The second patient (7-year-old boy) complained of pyrexia and sore thoat. In this case, we also performed the emergent drainage under general anesthesia because of the peritonsillar abscess. Early diagnosis and adequate treatment lead to a considerable decrease in this morbidity. Especially in the pediatric age group, abscess drainage such as surgery under general anesthesia is sometimes required.

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Clinical Analysis of Recurrent Laryngeal Nerve Paralysis following Endotracheal Intubation

Seiji Kawakita, Masamitsu Hyodo, Takahiko Yamagata, Eiji Yumoto

2002 Volume 95 Issue 9 Pages 945-949
Published: September 01, 2002
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.95.945

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Twenty-five cases of recurrent laryngeal nerve paralysis following endotracheal intubation were clinically analyzed. The mean rate of occurrence was 1/2100 cases undergoing endotracheal intubation. Sixtyeight percent of the patients were male and the mean age was 55.6 years. There were no patients younger than 20 years old. These findings suggested that age-related decreased elasticity of the surrounding tissue of the recurrent laryngeal nerve was an important risk factor. The presumable etiology of the paralysis is disturbance of microcirculation for recurrent laryngeal nerve by endotracheal tube cuff and overlying tracheal cartilage. Nitrous oxide might diffuse into the cuffs causing a substantial increase in intracuff pressure. Vocal fold mobility was completely recovered in 88.2% of the paralyzed vocal folds; therefore, physiological conduction block of the nerve was thought to be a pathogenesis with favorable prognosis. Number of nerve fibers distributing to the posterior cricoarytenoid muscle is relatively smaller than those of the laryngeal adductor muscles. This is a possible explanation of delayed recovery of abduction of the vocal folds.

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A Case of Mumps with Edema of Larynx

Kazuhiro Tonouchi, Masahiko Yamamoto, Tomoe Yoshida, Toshiyuki Nomura, ...

2002 Volume 95 Issue 9 Pages 951-955
Published: September 01, 2002
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.95.951

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We report a case of mumps with edema of the larynx requiring urgent tracheotomy.
The patient was a 47-year-old man. Dyspnea appeared secondary to swelling in the parotid division. Swelling of the whole face was apparent. There was trismus, and the tonsil and soft palate could not be observed due to severe swelling of the floor of mouth. The tonsilla lingualis, hypopharyngeal walls, and epiglottis showed progressive swelling. Conservative treatment was performed, but an urgent tracheotomy was required due to aggravation of dyspnea. This case was diagnosed as mumps by the clinical course and virus serodiagnosis. We searched the literature for a combination of mumps and edema of the larynx using MEDLINE for 33 years from 1966 to 2000, then performed a second search from 1987 to 2000, using coalescence retrieval, but could not find a previous report of a similar case. There was a description of mumps with edema of larynx in the Nelson Textbook of Pediatrics. This is the first report of mumps accompanied by edema of larynx in Japan. Edema of larynx seemed to be caused by swelling of the tonsilla lingualis and hypopharyngeal wall which appeared to circulatory disturbance.

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A Case of Postoperative Laryngopharyngeal Edema following Bilateral Neck Dissection

Yoshihiro Hyodo, Yukihiro Masuda, Takehiro Karaho, Tetsuya Tanabe, Sat ...

2002 Volume 95 Issue 9 Pages 957-961
Published: September 01, 2002
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.95.957

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We present a case of postoperative laryngopharyngeal edema following simultaneous bilateral neck dissection with preservation of the left internal jugular vein.
A 66-year-old male underwent bilateral neck dissection for nodal metastasis of mesopharyngeal cancer. Approximately 23 hours postoperatively, dyspnea and stridor appeared. Fiberscopic inspection was performed and advanced upper airway stenosis due to severe laryngopharyngeal edema could be observed. Therefore, emergency tracheostomy was performed and airway was successfully secured.
Thereafter, slight improvement of laryngopharyngeal edema was recognized on the fourth day, and remarkably improvement was noted on the sixth postoperative day.
We were able to successfully close the tracheal stoma on the eighteenth postoperative day.

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Amyloid Goiter that was Difficult to Distinguish from Malignant Tumor

Tomonori Eguchi, Hideo EDAMATSU, Kensuke Watanabe

2002 Volume 95 Issue 9 Pages 963-967
Published: September 01, 2002
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.95.963

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A seventy-five-year-old man consulted our clinic, complaining of a rapidly enlarging mass in the left neck arising over the past one month. A hard tumor in the left thyroid lobe and tumor in the left posterior neck were palpated. CT and MRI showed tumor of the left lobe expanding into the thorax and an isolated mass in the left neck. Thyroid function was normal and there were no other general symptom noted.
Malignant thyroid tumor and metastatic lymph nodes were preoperatively diagnosed. Therefore, left thyroid lobectomy and neck mass exenteration were performed. Pathological diagnosis with Congo red dye established amyloid goiter without malignant cell. Rectal biopsy postoperatively was also positive for amyloid.
This case was thought to be primary amyloid goiter with general extension, and the type of amyloid was AA. The patient's postoperative course has been good without mass recurrence.
Pathological diagnosis of thyroid mass has been very varied, but amyloid goiter seems to be underestimated because of its rare incidence. Amyloid goiter tends to rapidly enlarge and becomes hard in some case. Preoperative distinguishing between malignant tumor and amyloid goiter might be clinically very difficult.
Many amyloid goiters have a good prognosis without serious symptoms, but goiter may sometimes be fatal due to cardiac failure. Therefore, amyloid goiter should be carefully observed postoperatively.

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A Case of Forestier's Disease with Reversible Laryngeal Paralysis

Kouichi Abe, Kousuke Ishii, Masanori Yamamoto, Keiju Tsubaki, Masashi ...

2002 Volume 95 Issue 9 Pages 969-973
Published: September 01, 2002
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.95.969

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A case of Forestier's disease with slight dysphagia and hoarseness in a 68-year-old male is reported. This case presented with reversible unilateral vocal fold paralysis.
In August 2000, another hospital referred this patient to us because of left laryngeal paralysis. However, he did not have laryngeal paralysis on examination in our department, although the hypopharyngeal posterior wall showed a protrusion covered by a normal mucosal surface. Cervical roentgenogram revealed a protrusion of the anterior cervical spine from C4 to C7.
In November 2000, after an observation period, we noted slight symptoms involving left vocal fold paralysis accompanied by dysphagia. Enhanced CT of the neck demonstrated swelling of left pyriform recess, arytenoid mucosa and bony proliferation of anterior cervical spine. In February 2001, vocal fold paralysis recovered without treatment.
We considered that reversible vocal fold paralysis in our case was caused by compression of the cricoarytenoid articulation and posterior cricoarytenoid muscle due to congestion. However, we must follow this patient strictly and consider surgical treatment if that becomes necessary.

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Mastoid Cortex Plasty Using Bone Pate and its Effect on Middle Ear Aeration

Naoaki Yanagihara, Yasuyuki Hinohira, Ryosei Minoda

2002 Volume 95 Issue 9 Pages 975-981
Published: September 01, 2002
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.95.975

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Otologists have generally paid little attention to the bony defect of the mastoid cortex following a mastoidectomy. To prevent ingrowth of retroauricular soft tissue into the mastoid cavity and to restore the aerated mastoid cavity, we attempted to reconstruct the mastoid cortex with bone paste hardened with fibrin glue in intact canal wall tympanoplasty. In 55 patients with middle ear cholesteatoma, the outcome of mastoid cortex plasty was observed during second stage operation. In 40 patients (72.7%), the mastoid cortex was completely reconstructed and soft tissue ingrowth into the mastoid cavity was perfectly blocked. In the remaining 15 patients (27.3%) defects of varying sizes were found at the site of the drainage tube insertion. However, the defect was small enough not to allow soft tissue ingrowth into the mastoid cavity. To determine the effect of the mastoid cortex plasty, thirty-five patients with cholesteatoma treated by staged surgery were randomly divided into two groups. Seventeen patients received mastoid cortex plasty with scutum plasty and the remaining 18 control patients received only scutum plasty. Restoration of the middle ear aeration was assessed using High Resolution CT scans before both the first stage operation and the second stage operation. Mastoid cortex plasty was significantly effective for the amelioration of the epitympanum, and also provided mastoid cavity aeration. Mastoid cortex plasty using bone paste is a valuable adjunct to mastoidectomy not only for prevention of retroauricular dimple but for restoration of better aeration of the middle ear cavity.

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Surgical Approach for Internal Auditory Canal Lesions

[in Japanese]

2002 Volume 95 Issue 9 Pages 982-983
Published: September 01, 2002
Released on J-STAGE: November 04, 2011

DOIhttps://doi.org/10.5631/jibirin.95.982

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