Practica Oto-Rhino-Laryngologica

Ossiculoplasty in Patients with Chronic Otitis Media

Etsuo Yamamoto

2003 Volume 96 Issue 2 Pages 97-103
Published: February 01, 2003
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.96.97

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Classification and nomenclature of the reconstructive method of the middle ear sound-conducting system proposed by the Otological Society of Japan were outlined.
Ossiculoplasty and postoperative hearing results in our clinic were presented. Autogenous materials, such as ossicles, cortical bone chips and bone paste, were recommended as columella materials. More stabilized columella and better postoperative hearing results were obtained when the columella was interposed between the malleus (if present) and the stapes. In cases of total incudostapedial disruption, bone chips and paste was placed on the defective area between the long process of the incus and the head of the stapes. This new method achieved remarkable postoperative improvement of hearing.

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Three Cases of Abnormal Sensations in the Throat with Laryngeal Disease

T. Ogoshi

2003 Volume 96 Issue 2 Pages 104-105
Published: February 01, 2003
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.96.104

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Two Cases of Glomus Jugulare Tumor

Rieko Goto, Hiroshi Hoshikawa, Nozomu Mori

2003 Volume 96 Issue 2 Pages 107-114
Published: February 01, 2003
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.96.107

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The clinical results in two patients with glomus tumor recently treated in our department are reported. The first case involved a mixed type of glomus tympanicum tumor and glomus jugulare tumor, while the second case showed glomus jugulotympanicum tumor. These were both classified as class C1 according to Fisch's classification. Both cases were treated surgically by an infratemporal fossa approach. Preoperative embolization diminished bleeding. The first case underwent partial tumor removal with postoperative radiotherapy using a γ-knife. The second case underwent total tumor removal.

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Giant Cell Tumor of the Temporal Bone

Takao Imai, Mahito Ito, Yoshifumi Yamamoto, Norimasa Izumi, Takuyu Tak ...

2003 Volume 96 Issue 2 Pages 115-120
Published: February 01, 2003
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.96.115

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Giant cell tumor is a relatively common neoplasm most often affecting the epiphysis of long bones, especially the distal femur, proximal tibia, and distal radius. Involvement of the skull is uncommon, comprising less than 2% of giant cell tumors of bone. When the skull is involved, the sphenoid and petrous portions of the temporal bone are preferred sites. Giant cell tumors are generally considered benign, although some can exhibit very aggressive behavior. We experienced a case of giant cell tumor of the temporal bone. This 17-year-old woman showed symptoms such as serous otitis media and had been treated for serous otitis media for about 2 years. There were no lesion in the nasopharyx. It had become impossible for her to walk straight due to dizziness. Therefore, MR images of the head were obtained. MR images showed a mass in the temporal bone. On auditory tests, she showed results suggesting serous otitis media, but she also showed a very strange spontaneous nystagmus. Ablative surgery was performed under general anesthesia. Histologically, the lesion was highly cellular, composed of spindle-shaped to oval stromal cells among which numerous multinucleated giant cells were evenly dispersed. At five months follow up, there was no recurrence detected radiologically. This case emphasizes that when we encounter refractory serous otitis media without nasopharyx lesion in adults, tumors in the temporal bone should be ruled out.

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Sinonasal Malignant Melanoma; Clinical Analysis of 14 Cases

Masamitsu Hyodo, Hidemitsu Sato, Takahiko Yamagata, Naohito Hato, Hiro ...

2003 Volume 96 Issue 2 Pages 121-126
Published: February 01, 2003
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.96.121

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Malignant melanoma arising from the mucosa of the nasal cavity and paranasal sinuses is a rare disease with a generally poor prognosis. Clinical data on 14 patients were analyzed in a retrospective manner. They consisted of 4 males and 10 females, and their mean age was 63.6 years (range 46-74). All patients complained of recurrent epistaxis. Primary tumor sites were the nasal cavity in 12 patients and paranasal sinuses in 2. Immunohistochemical staining for HMB-45, S-100 protein and vimentin was considered necessary for differential diagnosis, especially in amelanotic melanoma. In 12 patients, treatment involved radical surgery with or without adjuvant chemotherapy. However, all 12 patients developed local recurrence. The disease-specific survival was 38.5% at 2 years, 20.5% at 5 years, and 10.2% at 10 years. Eight patients died of distant metastasis and 4 died of local failure, suggesting distant metastasis as the limiting factor for long-term survival. Patients who underwent craniofacial surgery for local disease had significantly better survival than those who did not. Repetitive chemotherapy tended to improve the prognosis, however, the difference was not significant. This study shows that wide local resection appears to have the best efficacy in managing sinonasal melanoma, and adjuvant chemotherapy and radiotherapy may have benefit for increasing disease control.

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Clinical Study of Maxillary Sinus Mycosis

Norimasa Morita, Hisaki Fukushima, Takeshi Akisada, Tamotsu Harada

2003 Volume 96 Issue 2 Pages 127-132
Published: February 01, 2003
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.96.127

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This paper describes 22 cases (6 males and 16 females) with maxillary sinus mycosis treated in our hospital between January 1986 and December 2001.
None of the patients received long-term treatment with cortisone or antibiotic agents. Only 2 of the 22 cases had a chronic debilitating disease, namely diabetes and autoimmune disease, respectively.
CT scans were performed in 11 cases, and ostiomeatal obstruction or stenosis was found in 10 cases. Antral irrigation was performed in three cases, radical antrostomy of the maxillary sinus in 14, and endoscopic sinus surgery in 5. All patients were completely cured and there was no reccurence of symptoms in any patient on follow-up examination.
Fungal infections of the paranasal sinuses are associated with anatomical abnormality of the sinonasal tract rather than with immunocompromised states. In treatment, it appears to be important to improve ventilation of the maxillary sinus in surgery and to remove the fungus completely.

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A Case of Radiation-Induced Osteosarcoma of the Maxilla

Rie Tanaka, Ryo Asato, Shinzo Tanaka, Yasuyuki Hiratsuka, Juichi Ito

2003 Volume 96 Issue 2 Pages 133-137
Published: February 01, 2003
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.96.133

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Radiation-induced osteosarcoma in the head and neak region is very rare. A 68-year-old female, who had been treated with radiation for malignant lymphoma of the right maxillary sinus, presented with right cheek swelling. Imaging examinations demonstrated a huge mass occupying the right nasal cavity and paranasal sinuses. Total maxillectomy was performed, and the tumor was histologically diagnosed as osteosarcoma. Diagnosis and treatment for radiation-induced osteosarcoma in the head and neck is discussed.

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Clinical Study of Parotid Tumors

13-Year Statistical Analysis of 91 Cases

Wataru Shimbashi, Shoji Watanabe, Miki Azuma, Ayuko Munemasa, Atsuto E ...

2003 Volume 96 Issue 2 Pages 139-145
Published: February 01, 2003
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.96.139

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Between 1990 and 2002, 91 cases underwent excision of parotid tumors at St. Marianna University School of Medicine. The most prevalent tumor among benign parotid tumors was pleomorphic adenoma (52.8%), followed by Warthin's tumor (33.3%). Malignant tumors (20.9%) consisted of 4 adenocarcinomas, 3 metastases, 2 carcinomas in pleomorphic adenoma, 2 squamous cell carcinomas, and 2 undifferentiated carcinomas. Tumors that were accompanied by spontaneous pain or facial nerve palsy were frequently malignant. It is important to diagnose parotid tumors by the history, symptoms, and local findings. Ultraysound examination and MRI showed a high accuracy rate (73-80%). The incidence of facial palsy was 4.1% in benign tumors and 10.5% in malignant tumors.

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Sweet's Syndrome; Case Report

Takashi Masaki, Toyota Ishii, Takako Nakayama, Isao Hoshino

2003 Volume 96 Issue 2 Pages 147-150
Published: February 01, 2003
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.96.147

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A 68-year-old male was admitted to our hospital complaining of a sore throat and fever persisting for a few days. The characteristic skin rash, laboratory findings and stomatitis apthosa indicated a diagnosis of Sweet's syndrome. Antibiotics were ineffective for the treatment of Sweet's syndrome, but predonisolone and potassium iodide were effective. Sweet's syndrome is understood to be a tonsillar focal infection. Tonsillectomy has been reported as effective for the recurrence of Sweet's syndrome. We have been following up the patient without tonsillectomy because of non-recurrence of Sweet's syndrome.

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Aspiration Treated by Surgical Closure of the Larynx

Teiji Tanahashi

2003 Volume 96 Issue 2 Pages 151-154
Published: February 01, 2003
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.96.151

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Surgical closure of the larynx was conducted to prevent aspiration in 10 cases of severe pharyngeal dysphagia associated with intractable aspiration. The condition was due to brain stroke in 6, ALS (Amyotrophic Lateral Sclerosis) in 3 and head trauma in 1. Closure was achieved by laryngofissure in 8 cases and by bilateral vocal cord suturing under endoscopy in 2. Although a small fistula resulted in the glottic section in one case of each surgical procedure, the original objective of preventing aspiration was successfully achived in all. The decision for laryngeal closure should not be based on the dysphagic symptoms alone: the patient's systemic motor functions, intellectual disability, and even societal conditions should also be taken into consideration.

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Total Laryngectomy for Misswallowing in Patients with Advanced Disease

Takeshi Akisada, Tamotsu Harada, Shigeo Hirai, Hisaki Fukushima, Katsu ...

2003 Volume 96 Issue 2 Pages 155-159
Published: February 01, 2003
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.96.155

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Over the past 9 years, total laryngectomy was performed on 12 patients advanced disease involving misswallowing after full discussion with the rehabilitation department. The patients were 10 men and 2 women aged 56 to 83 years (mean 71.1 years). The primary disease was cerebrovascular disorder in 7 cases, the post-treatment of head and neck carcinoma in 3, postoperative lung carcinoma in 1 and post generalized burn in 1. Aspiration pneumonia was observed preoperatively in 10 patients, 9 of whom had multiple episodes. All patients had undergone tracheotomy and found it difficult to speak. The duration of illness ranged from 5 months to 15 years. The surgery was simple total laryngectomy through a cervical median incision. The average duration of surgery was about 2 hours and 34 minutes. The average volume of blood loss during surgery was 131.5ml and there were no complications noted intraoperatively. Except for one patient who was transferred to another hospital, all the patients were postoperatively capable of oral ingestion and 8 of them were able to take rice gruel, achieving the operative goal. The patients' satisfaction with surgery in response to a questionnaire was favorable. Total laryngectomy is a surgical procedure that should considered in severely ill patients with advanced vocal and speech dysfunction complicated by misswallowing.

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Percutaneous Ethanol Injection Therapy for Lateral Cervical Cysts

Katsunari Yane, Hiroshi Hosoi, Hiroshi Miyahara

2003 Volume 96 Issue 2 Pages 161-164
Published: February 01, 2003
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.96.161

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Eight patients with lateral cervical cyst were successfully treated with percutaneous ethanol injection therapy (PEIT) under ultrasonographic guidance. Ethanol (range, 2-8ml) was injected after complete aspiration of the cyst. Several cysts required more than one injection and an interval until at least 2 months before remission. The main complication was local and transient pain at injection. There were no severe or permanent complications encountered. A therapeutic effect, when the cyst diameter was decreased to less than 1-2cm, was obtained in all patients. There was no recurrence during a follow up of more than 2 years. The results suggest that PEIT using ultrasonography is a useful therapy for lateral cervical cyst.

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Two Case Reports of Parathyroid Cyst

Shinji Takebayashi, Tomoyuki Haji, Hideaki Maeda, Ryusuke Hori, Atsush ...

2003 Volume 96 Issue 2 Pages 165-170
Published: February 01, 2003
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.96.165

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Microcysts of the parathyroid gland are a common occurrence in the general population, but macroscopic parathyroid cysts of the neck are rare clinical entities. We report two cases of parathyroid cyst that extended to the mediastinum. Parathyroid cysts are classified as nonfunctional and functional. We discuss the clinical features of nonfunctioning and functioning parathyroid cyst. Fine needle aspiration biopsy with ultrasonography is a very useful technique for diagnosis and treatment. In the future, we would like to attempt extirpation of mediastinal tumor from the neck by endoscopy without thoracotomy.

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Storm-Like Symptoms after Thyroidectomy for Hyperthyroidsm

Shinji Suzuki, Kazuhiko Shoji, Shin-ichi Takagita, Yasutaka Kawata, To ...

2003 Volume 96 Issue 2 Pages 171-175
Published: February 01, 2003
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.96.171

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Between 1993 and 2001, 144 patients underwent subtotal or total thyroidectomy for hyperthyroidism (Grave's disease) in Tenri Hospital. Storm-like symptoms such as fever, tachycardia and nervousness were observed in 3 patients. All of them showed minor toxicity, and were treated by hydration, application of cold, intravenous hydrocortisone and oral β-blockers. Since the levels of thyroid hormones did not rise in these cases, we considered these post-operative complications were due to high-sensitivity against thyroid hormone. The likelihood of patients' weathering post-operative toxicities can be predicted retrospectively by their response to preoperative treatment. Patients who were difficult to control with low-grade fever and tachcardia suffered minor crises after subtotal-thyroidectomy.

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Descending Necrotizing Mediastinitis; A Report of Three Cases

In Surgical Approach

Miki Azuma, Shoji Watanabe, Hirotsugu Kinoshita, Hiroya Iwatake, Atsut ...

2003 Volume 96 Issue 2 Pages 177-186
Published: February 01, 2003
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.96.177

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Descending necrotizing mediastinitis (DNM) resulting from oropharyngeal abscess, is a serious and life-threatening infection. However, surgical management, by transcervical, mediastinal drainage or aggressive thoracotomic drainages remains controversial. Recently, we encountered three cases of DNM at our institution. Case 1 was a 65-year-old male with sore throat, marked neck swelling and difficulty in swallowing. CT demonstrated an abscess, extending from the right parapharyngeal and retropharyngeal space to the vascular visceral and prevertebral space, transcervical and mediastinal drainage was performed. Case 2 was a 78-year-old male who complained of neck swelling after dental treatment. CT demonstrated gases in the parapharyngeal and retropharyngeal space. Only antibiotics were given. Surgery was not performed. Case 3 was a 54-year-old male with severe sore throat, neck swelling and dyspnea. CT demonstrated several abscess, ranging from parapharyngeal and retropharyngeal space in the neck to the vascular visceral and prevertebral space at the level of the sternum. Transcervical, mediastinal and thoracotomic drainage was performed bilaterally. In cases 1 and 3, drainage and irrigation of the neck and mediastinal abscess were performed in combination with antibiotic treatment. All cases recovered. CT was very useful for determing whether to perform surgery, including transcervical, mediastinal and thoracotomic drainage. In some cases, it may be appropriate to drain the abscess during the early stage.

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Inverted Papilloma in Nasal Cavity and Paranasal Sinus

H. Kawauchi

2003 Volume 96 Issue 2 Pages 188-189
Published: February 01, 2003
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.96.188

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