Practica Oto-Rhino-Laryngologica
Online ISSN : 1884-4545
Print ISSN : 0032-6313
ISSN-L : 0032-6313
Volume 97, Issue 3
Displaying 1-16 of 16 articles from this issue
  • Changing the Way of Thinking for Prevention of Retraction Cholesteatoma Recurrence
    Hiroshi Hosoi
    2004 Volume 97 Issue 3 Pages 183-192
    Published: March 01, 2004
    Released on J-STAGE: October 07, 2011
    JOURNAL FREE ACCESS
    There has been serious controversy regarding the choice of surgical methods for ears with cholesteatoma. I began to perform tympanoplasty with reconstruction of the soft posterior meatal wall for the prevention of postoperative retraction pocket formation in 1989. Our method is characterized by the reconstruction of the soft posterior meatal wall, non-obliteration with permanent or temporary materials, no use of a Palva flap and the use of fibrin glue for attaching the fascia to the posterior meatal skin. None of the patients experienced postoperative narrow-neck retraction pocket formation, and whenever aeration of the middle ear was disturbed, a balloon-like retraction was observed.
    In this report I discuss the advantages and disadvantages of various tympanoplasty methods in comparison with our method based on the requirements for treatment of cholesteatoma. All other methods of tympanoplasty with canal wall up or canal reconstruction are performed based on the idea of fortification of the posterior meatal wall for prevention of retraction pocket recurrence. I changed this way of thinking and as a result could avoid retraction pocket formation. What I would like to present here is not the material for posterior meatal wall reconstruction but a new way of thinking for prevention of cholesteatoma.
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  • T. Tono
    2004 Volume 97 Issue 3 Pages 194-195
    Published: March 01, 2004
    Released on J-STAGE: October 07, 2011
    JOURNAL FREE ACCESS
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  • Naoki Saka, Osamu Adachi, Mieko Okunaka, Kojiro Tsuji, Masafumi Sakaga ...
    2004 Volume 97 Issue 3 Pages 197-200
    Published: March 01, 2004
    Released on J-STAGE: October 07, 2011
    JOURNAL FREE ACCESS
    A case of bilateral total deafness after mumps infection is reported. A five-year-old boy complained of bilateral deafness after the onset of bilateral parotid swelling. Audiogram showed profound bilateral hearing loss at all frequencies.
    We diagnosed labyrinthisis due to mumps virus. High dose of steroid was administered, but hearing did not recover. Thereafter, he was fitted with a hearing aid, but it provided insufficient assistance. He underwent cochlear implant surgery of the left ear, and he recovered hearing up to 40dB. He is now studying in elementary school.
    We review seven patients (eight ears) with mumps induced hearing loss treated at Hyogo College of Medicine between April 1997 and March 2002. Six patients demonstrated unilateral loss, but one patient demonstrated bilateral loss. The hearing levels in the five patients were scaled out at the initial examination. The antibody for mumps, IgM and IgG, both showed a high titer in six cases. High dose of steroid was administered in six cases, but none of them recovered hearing.
    When bilateral deafness due to mumps infection occurs and steroid therapy is not effective, cochlear implant surgery to recover hearing is recommended.
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  • Fumiaki Nin, Nobuhito Ioka, Kaheita Hirasugi, Susumu Nakae
    2004 Volume 97 Issue 3 Pages 201-204
    Published: March 01, 2004
    Released on J-STAGE: October 07, 2011
    JOURNAL FREE ACCESS
    A case of van der Hoeve syndrome in a 7-year-old Japanese male is reported here. He demonstrated three symptoms: blue sclera, osteogenesis imperfecta and conductive hearing loss.
    Pure tone audiometry showed a 61.7dB hearing loss in the left ear. Tympanogram was type Ad and stapedial reflex was absent. Therefore, dislocation of ossicular chain was suspected.
    At surgery, it was observed that the bilateral stapedial crura had fractured spontaneously, but the stapedial footplate was mobile. Using tympanoplasty IV-i type, we reconstructed the conduction with an artificial ossicle. The patient obtained an improvement in his hearing level in the immediate postoperative period.
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  • Shin-ichi Kanemaru, Tatsuo Nakamura, Magrufov Akhmar, Koichi Omori, Ma ...
    2004 Volume 97 Issue 3 Pages 205-210
    Published: March 01, 2004
    Released on J-STAGE: October 07, 2011
    JOURNAL FREE ACCESS
    The aim of this study was to regenerate the pneumatic air cells and their gas exchange function in the poorly developed mastoid cavities of patients with chronic otitis media.
    Five patients with severe chronic otitis media whose mastoid air cells were poorly developed took part in this clinical trial. Four of 5 patients underwent staged operation of tympanoplasty.
    Honeycomb-like structures made of hydroxyapatite (HA) coated with collagen was used as a framework for artificial pneumatic bones. At the first stage of tympanoplasty, collagen-coated HA was implanted into the newly opened mastoid cavity and was fixed by fibrin glue. After the first operation, recovery of mastoid aeration and regeneration of the pneumatic air cells of the newly opened mastoid cavity were assessed on CT scan images. In 4 of 5 cases, aeration was recovered. The pneumatic air cells were regenerated in 3 cases.
    This study demonstrated that the mastoid air cells could be regenerated with implanted HA in the newly opened mastoid cavity. This tissue engineering method may be a possible treatment for intractable otitis media because it can recover the gas exchange function.
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  • Masahiro Hasegawa, Takeharu Kanazawa, Jun Matsumura, Asano Higa, Shizu ...
    2004 Volume 97 Issue 3 Pages 211-215
    Published: March 01, 2004
    Released on J-STAGE: October 07, 2011
    JOURNAL FREE ACCESS
    A rare case of leiomyosarcoma of the nasal cavity is reported. The patient was a 47-year-old male who complained of recurrent epistaxis and nasal obstruction. CT scans and MRI examinations showed a tumor of the nasal cavity on the right side. The tumor was completely removed via lateral rhinotomy, followed by radiotherapy of 60Gy. According to typical immunohistochemical findings obtained from the resected tumor, the diagnosis was finally decided as leiomyosarcoma of nasal cavity. Thirty-eight months after the operation and radiotherapy, the patient has not exhibited local recurrence or any distant metastasis. Leiomyosarcomas of the nasal cavity are uncommon and have an aggressive clinical behavior. It is difficult to diagnose leiomyosarcoma without immunohistochemical examination, therefore, this procedure should be performed without delay. Furthermore, lateral rhinotony, which exposes a broad surgical field, should be chosen to remove the tumor safely and efficiency.
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  • Satoshi Ohno, Shinzo Tanaka, Yasuyuki Hiratsuka, Ryo Asato, Kouichi Oh ...
    2004 Volume 97 Issue 3 Pages 217-223
    Published: March 01, 2004
    Released on J-STAGE: October 07, 2011
    JOURNAL FREE ACCESS
    Solitary fibrous tumor (SFT) is a rare mesenchymal neoplasm typically arising in the pleura, but it has recently been reported in various extrapleural sites. We report a case of SFT arising in the lacrimal sac.
    A 32-year-old man presented with a 2-year history of slowly progressive right proptosis. Computed tomography demonstrated a well-circumscribed low density mass in the inferomedial orbit. Surgical excision was performed. Immunohistochemically, the tumor cells were stained for CD34 and bcl-2, leading to a diagnosis of SFT. There has been no evidence of recurrence 12 months postoperatively. Because SFT, especially with a high mitotic count, may recur after excision, careful follow-up over a prolonged period is important.
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  • Nanako Tamura, Keisuke Masuyama, Eiji Yumoto
    2004 Volume 97 Issue 3 Pages 225-230
    Published: March 01, 2004
    Released on J-STAGE: October 07, 2011
    JOURNAL FREE ACCESS
    We reported four cases demonstrating severe visual disturbance due to mucoceles of the posterior paranasal sinuses. Two of the four patients also complained of headache and blepharoptosis or retroorbital pain. All patients were referred to our out-patient clinic by a neurosurgeon or ophthalmologist. They underwent emergency drainage surgery. We found a bony defect of the optic nerve canal in all patients. Three patients reported remarkable improvement of visual acuity postoperatively, although the optic disc in one patient appeared pale preoperatively. The remaining patient did not recover visual acuity. In that case, the optic disc was preoperatively edematous and hyperemic, and become atrophic postoperatively. There was bacteria growth found on culture of the contents of mucoceles. All patients had consulted either a local physician or ophthalmologist within two days of symptom onset. However, patients were referred to us five to 11 days (average: five days) after they initially consulted their hospital. Early diagnosis and prompt surgical management are indispensable in the treatment of severe visual disturbance due to mucoceles of the posterior paranasal sinuses.
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  • Naomi Kato, Kazuo Makimoto, Yasuko Fujimoto
    2004 Volume 97 Issue 3 Pages 231-237
    Published: March 01, 2004
    Released on J-STAGE: October 07, 2011
    JOURNAL FREE ACCESS
    We present a case of giant pleomorphic adenoma of the parotid gland. A 59-year-old male had a giant tumor that developed in the left parotid region since more than 15 years. He consulted our hospital with a complaint of difficulty in left field vision when driving a vehicle. Ultrasonography, CT with a contrast agent and MRI (T1-, and T2-weighted) suggested a benign tumor. In Ga-scintigraphy, we noted warm areas in the lower portion of the tumor. Embolization of feeding arteries was performed two days before the surgery, and we were able to preserve the facial nerve in the surgical field. Blood loss during surgery amounted to 450ml. A postoperative histopathology examination revealed a pleomorphic adenoma.
    In this report we discuss the pathology of giant parotid tumor, facial nerve preservation during the surgical procedure and the prognosis after surgery.
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  • Koji Yamada, Tsunemasa Aiba, Takeshi Kubo, Tomoaki Nakano, Tadashi Wad ...
    2004 Volume 97 Issue 3 Pages 239-244
    Published: March 01, 2004
    Released on J-STAGE: October 07, 2011
    JOURNAL FREE ACCESS
    We report a case of clear cell adenocarcinoma of the parotid gland. The patient was a 67-year-old female diagnosed as having sialolithiasis of the left submandibular gland. Computed tomography demonstrated three sialoliths in the left Warthon's duct and a small solitary mass in the right parotid gland. Physical examination showed a small, hard and painless mass in the right parotid gland. Magnetic resonance imaging demonstrated an enhanced, poorly defined tumor. The tumor was completely resected under general anesthesia, and histopathologically diagnosed as clear cell adenocarcinoma. Clear cell adenocarcinoma is a very rare, recently described low-grade malignant tumor of the salivary gland. Twenty cases of this tumor have been reported, the majority have occurred in a minor salivary gland of the oral cavity, and only four cases in the parotid gland have been reported.
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  • Tatsuhisa Hasegawa, Masaya Uchida, Tatsuya Matsunami
    2004 Volume 97 Issue 3 Pages 245-249
    Published: March 01, 2004
    Released on J-STAGE: October 07, 2011
    JOURNAL FREE ACCESS
    We treated two cases of tumors arising from accessory parotid gland and Stensen's duct. The first case was a 30-year-old female with a 10-year history of right cheek tumor. Sialo-CT findings suggested that the tumor detached from the parotid gland and enhancement around the tumor was not remarkable. Fine needle aspiration cytology demonstrated normal salivary gland cells. Therefore, this case was diagnosed as accessory parotid gland tumor and extirpation surgery was performed. The other case was an 86-year-old female with a 4 year history of right cheek tumor. Sialography demonstrated obstruction of Stensen's duct. Based on the surgical specimen, this case was diagnosed as tumor arising from Stensen's duct. We discuss the management of the facial nerve during resection of these tumors.
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  • Katsutoshi Tsuchiya, Takayuki Mochizuki, Yukiko Mochizuki, Hajime Hiro ...
    2004 Volume 97 Issue 3 Pages 251-254
    Published: March 01, 2004
    Released on J-STAGE: October 07, 2011
    JOURNAL FREE ACCESS
    We report a case of subglottal stenosis successfully treated by insertion of a T-tube. A 55-year-old male was referred to our hospital with complaints of dyspnea and aphonia after emergency tracheal intubation.
    The patient had an attack of myocardial infarction, and emergency tracheal intubation was performed for resuscitation. The tube was kept in place for 4 days and then removed. Two months after removal of the tube, the patient developed dyspnea. Although tracheal intubation was again attempted, the insertion failed because of an apparent stenosis at the subglottic level, and tracheotomy was performed. The patient was eventually referred to our hospital after coronary bypass surgery. Laryngeal examinations revealed a granulomatous mass at the subglottal space and the mass was removed under laryngomicroscopy. His postoperative course was uneventful and the tracheal tube was removed 2 weeks postoperatively. However, the patient developed dyspnea again approximately 3 weeks after the closure of the tracheostoma, and was readmitted for another tracheotomy. Fiberscopic examinations at this point revealed recurrence of granulomatous subgottal stenosis. The granulation was subsequently completely removed by laryngotracheal fissure approach and a T-tube was inserted. The T-tube was kept in place for 5 months and removed without any further problems, and the tracheostoma was closed successfully. We speculated that the subgottal stenosis developed due to intubation injury associated with his poor general condition, resulting in local ischemia. The insertion of a T-tube should have been performed in the first stage of removal of granulation mass in this case.
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  • Toshiya Ohno, Hideki Takegoshi, Shigeru Kikuchi
    2004 Volume 97 Issue 3 Pages 255-258
    Published: March 01, 2004
    Released on J-STAGE: October 07, 2011
    JOURNAL FREE ACCESS
    We report a 56-year-old female patient with dyspnea and a giant polypoid vocal fold. The polypoid moved to and fro from the larynx to trachea in synchrony with respiration, and was large enough to cause respiratory disturbance. The polypoid was diagnosed as type III in Yonekawa's classification of Reinke's edema. We secured an emergency airway by tracheotomy. There are very few reported cases of polypoid vocal fold necessitating tracheotomy. It may be appropriate to consider that the polypoid fell into the Rima glottides causing the patient to develop breathing difficulty.
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  • Shoji Arai, Akihiro Kaneko, Naoko Marusasa, Toshio Yamashita
    2004 Volume 97 Issue 3 Pages 259-261
    Published: March 01, 2004
    Released on J-STAGE: October 07, 2011
    JOURNAL FREE ACCESS
    We report a rare case of thyroid papillary carcinoma that was detected by parenchymatous hemorrhage. A 27-year-old female complained of sudden pain and swelling on the left side of the anterior neck. A CT scan demonstrated a mass measuring 3cm in diameter in the left lobe of the thyroid gland. Based on fine needle aspiration biopsy cytology, the tumor was diagnosed as class IV. Thus, the patient was suspected of having thyroid cancer of the left lobe associated with hematoma, and surgery was performed. At surgery, it was ascertained that the tumor in the left lobe was papillary carcinoma of the thyroid with lymph node metastasis. Therefore left subtotal thyroidectomy with modified neck dissection was performed. It is generally thought that cystic thyroid diseases are benign. However, it has been reported that 20 to 45% of malignant thyroid diseases demonstrate cysts. Therefore, physicians must always keep in mind that thyroid disease exhibiting neck pain and hematoma might be malignant.
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  • Aki Taguchi
    2004 Volume 97 Issue 3 Pages 263-270
    Published: March 01, 2004
    Released on J-STAGE: October 07, 2011
    JOURNAL FREE ACCESS
    Age-related functional deterioration of deglutition is a serious problem in the elderly population since it increases the risk of aspiration pneumonia. In the present study, aging effects in the subneural apparatus (SNA) were histologically investigated in the inferior pharyngeal muscle of a rat using scanning electron microscopy. In young-adult group, the primary synaptic clefts (PSCs) of the SNAs in the thyropharyngeal muscle (TP) were predominantly labyrinthine type, whereas, those in the cricopharyngeal muscle (CP) were mostly depression type. The ratio of length to width (L/W ratio) of the secondary synaptic clefts (SSCs) and the ratio of areas of SSCs to those of PSCs (ASC/APC ratio) were larger in the TP than in the CP.
    In the TP, the labyrinthine type of PSC decreased in percentage with age, while the depression type increased instead. However, the CP showed no significant change of PSC typing. The L/W ratio and ASC/APC ratio of the SSC decreased in the TP with age, and those in the CP increased. In the aged group, thin muscle fibers which contained immature SNA were occasionally identified in both muscles. These fibers were considered to be undergoing a regenerating process. Myosin ATPase staining showed age-related decrease of type II muscle fiber and increase of type I fiber in the TP. Similar findings were noted in the CP, although the change was not as great as in the TP.
    These age-related changes of the TP might suggest weakening and slowing of the muscle contraction, and therefore cause a disturbance of food transport into the esophagus during deglutition. In contrast, the CP is less affected by aging. Disturbed function of the TP together with maintained tonic contraction of the CP may work disadvantageously for deglutition, thereby resulting in increased risk of aspiration.
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  • I. Koizuka
    2004 Volume 97 Issue 3 Pages 272-273
    Published: March 01, 2004
    Released on J-STAGE: October 07, 2011
    JOURNAL FREE ACCESS
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