Deep neck infection (DNI) is a serious and potentially life-threatening infection that spreads in the spaces surrounded by the cervical fasciae. It is divided into 3 stages, lymphadenitis, cellulitis and abscess, which can substantially be differentiated by contrast-enhanced computed tomography (CECT). CECT is also useful in evaluating the extension of DNI, which gives efficient information on determining treatment. The successful management of DNI depends on an understanding of the anatomy of the neck fascial planes and spaces, antibiotic therapy, and potential complications. The mainstays of treatment of DNI are antibacterial therapy and surgical drainage. Cellulitis and lymphadenitis can be treated with IV antibiotic therapy alone. In contrast, abscesses are mandated with surgical drainage, because it has been reported that only 10 to 25% of abscesses may be successfully treated with antibiotics alone. There are many types of surgical approaches. Irrespective of type of approaches, the surgical incision must be large enough to amply expose the entire abscess cavity. Percutaneous needle aspiration as a substitute for surgical incision and drainage is recommended for experts who have full experience of the latter procedure.
A 5-year-old girl with unilateral total deafness suffered from recurring meningitis. High-resolution computed tomography of the temporal bone revealed dysplasia of the bony labyrinth and enlarged fundus of the internal auditory canal (Mondini dysplasia). In the operation, anomaly of the stapes and leakage of cerebrospinal fluid were found. Intralabyrinthine obliteration with the temporal muscle fascia and auricular cartilaginous chip was performed after removal of the stapes. No sign of meningitis has occurred after the operation.
We reported a case of nasopharyngeal cyst (Tornwaldt's disease) found from otitis media effusion. A 49-year-old woman showed hearing loss and left ear fullness since December, 2000, and was hospitalized at our related hospital on February 3rd, 2001. Otitis media effusion of bilateral ears were identified by an otoscopic exam. Her mean hearing level was 40.0dB on the right side (A-B gap 12.5dB) and 56.3dB on the left side (A-B gap 35.0dB). The finding of the tympanogram was B type on both sides. By fiberscopic examination, a smooth and slightly reddish globular mass was found in the center of the nasopharynx. No apparent stenosis of the pharyngeal opening of auditory tube and lesions on the other upper air-ways were identified. On enhanced brain CT, a round and uniform inner low density area was identified in the middle of the nasopharynx, adjacent to the front of bilateral musculus longus capitis. It was low on enhancement. On an MRI T1 enhanced image, an inner uniformly low intensity area was identified at the center of nasopharynx, and on a T2 enhanced image, a uniformly high intensity area was identified. From the above-mentioned findings, we diagnosed it as a nasopharyngeal cyst supposed to be Tornwaldt's disease that caused otitis media effusion, according to the infection on the remains of the nasopharyngeal bursa of the embryonic period.
We clinically studied the effectiveness of nasal nebulizer therapy with cefmenoxime hydrochloride (CMX) and nasal drops of povidone iodine for acute rhinosinusitis in children. We evaluated the results using the standard for new antibiotics of the Japanese Society of Chemotherapy. The subjects were 50 children with acute rhinosinusitis. By the standard for total evaluation, consisting of clinical and bacteriological study, the cure rate of the CMX nebulizer group was 68%, that of the group using nasal drops of povidone iodine was 23.1%, and that of the controls was 38.5%. The cure rate with nasal drops of povidone iodine was not higher than that with CMX nebulizer therapy. However, with the nasal drops of povidone iodine, in 2 of 3 cases, PISP (penicillin intermediately resistant S. pneumoniae) disappeared and in 2 of 2 cases, MRSA (methicillin-resistant S. aureus) disappeared. The nasal drops of povidone iodine were found to be effective for drug-resistant organisms such as PISP and MRSA.
MALT (mucosa-associated lymphoid tissue) lymphomas are caused by chronic inflammation in the stomach and lungs, nodal extravasating organs such as salivary glands and thyroid gland in which lymphoid tissue originally does not exist. Decisive therapy has not been established for the parotid gland region. We report five cases of MALT lymphoma in the parotid gland which were treated by radiotherapy, chemotherapy and operative therapy. There was no local recurrence in any case in which radiotherapy or operative therapy was administened. The two patients for whom combined chemotherapy and radiotherapy were applied responded completely. We concluded that radiotherapy and operative therapy are effective for local control and that chemotherapy may be effective in preventing the dissemination.
A clinical study was performed on 139 patients with major salivary gland tumors initially treated in our hospital from 1991 to 2000. Benign tumors were observed in 117 patients (male: 54; female: 63) and malignant tumors in 22 patients (male: 12; female: 10). The five-year survival rate was 43.4% in the whole malignant tumor group, 80.0% in the stage I, II group and 12.7% in the stage IV group. The factors influencing prognosis were stage IV status, local pain, and facial palsy. Our findings suggested that postoperative radiation and/or chemotherapy are useful.
Sialolithiasis is often found in the submandibular gland, but rarely in the parotid gland. In most cases sialoliths tend to exist in one side. We encountered a very interesting case who had 67 sialoliths in both sides of the parotid gland. A 70-year-old woman underwent an intraoral operation to remove the stones, two large round stones in the right cheek and 65 small stones in the left cheek. The post operation course was uneventful.
A 50-year-old male had severe tracheal stenosis by a mediastinal goiter. The narrowest trachea part was 2mm in diameter. Therefore we scheduled the use of percutaneous cardiopulmonary support (PCPS) during tracheal intubation. By this method, we could perform tracheal intubation safely and lt-hemithyroidectomy. PCPS is a useful technique for managing severe tracheal stenosis before maintenance of the airway.
We retrospectively reviewed our series of 390 consecutive patients operated on for Graves' disease from 1983 through 2002 at Tenri Hospital. Of the 390 patients, twelve (Group A) were found to have thyroid carcinoma, eleven papillary and one follicular, for an incidence of 3.1%. In 58% of these cases the tumors were less than 1cm in diameter and only one patient had recurrence in the cervical lymph nodes. All patients are alive without disease. There was no correlation between the TSH-binding inhibitory immunoglobulin titer and the progression of their carcinomas. Ninety-seven (Group B) patients who had been surgically treated for differentiated thyroid carcinoma from 1999 through 2002 were selected for comparison. The mean age at operation in Group A was 38.8 years, younger than that of Group B, 55.2 years. However, there was no difference in tumor size, and intrathyroidal, lymphatic and distant metastasis between the two groups. Our results suggest that Graves' disease is not associated with increased or rapid growth of concurrent thyroid carcinoma.
We report a case of cervical thymoma in a 59-year-old woman. She visited our hospital for an anterior neck mass. Ultrasonography revealed a mass in the right lobe of the thyroid gland, and it was diagnosed as a thyroid tumor. The tumor was resected, and the histopathological diagnosis was cervical thymoma.
A case of iodoform toxicity is presented in a patient after the treatment of neck gas gangrene. Although iodoform has been widely used for the treatment of wounds, there are few case reports about its side effects, such as headache, consciousness disturbance, delirium and tachycardia. We describe a 56-year-old blind male who under-went hemodialysis for chronic renal failure, with neck gas gangrene. Nonclostridial gas gangrene of the deep neck was improved by surgical drainage and wide debridment of necrotic tissue in combination with conservative treatment. Four kinds of anaerobic gram-positive bacteria including Peptostreptococcus micros were detected in pus. After surgical treatment, we used iodoformgauze (0.22g/day) in the open wounds of the neck. Two days after the iodoform application, he became confused, then delirius. Total serum iodine concentration was high (7440μg/dl; normal range, 4.0 to 9.0μg/dl). To our knowledge, this value of iodine concentration is the highest of the previous patients reported as having iodoform poisoning. We stopped iodoform use and performed direct hemoperfusion, which was considered effective to reduce total serum iodine. The patient became conscious, and was discharged 46 days after hospitalization.
Aneurysms of the superficial temporal artery are infrequent, and most of them are traumatic aneurysms located on the superior temporal line. We present a rare case of preauricular aneurysm of the superficial temporal artery. The patient was an 81-year-old woman who had a pulsating mass in the preauricular lesion. It was successfully removed by surgery. Histopathologically, it was suggested to be an aneurysm of the superficial temporal artery caused by atypical arteritis. She has not had active inflammatory findings, but follow-up is needed.
We reported a very rare case of tiger bite injury. The patient was a 57-year-old male who was a keeper at Asahiyama zoological park in Asahikawa city. He was attacked by an Amur tiger which seriously injured upper half of his body, including intracranial trauma. We performed an operation to save his life. There was severe bleeding from the cervical wound because the left internal jugular vein was severed, therefore, it was clamped and occluded with ligatures. We treated his many wounds, but the intracranial bleeding was not relieved. We considered that ascending intracranial pressure by occlusion of the left internal jugular vein caused the bleeding. Left internal jugular vein reconstruction was performed by neurosurgeons. They used an artificial graft initillay, and then used the greater saphenous vein as a graft. We considered the patient's left internal vein as the dominant side.
Effectiveness and safety of olopatadine hydrochloride were studied in 30 patients with cedar pollenosis by administering the agent before and after cedar pollen began to disperse. After receiving a pre-scription for olopatadine hydrochloride 5mg twice a day, patients recorded nasal symptoms, any hindrance in daily activities, itching of the eye and compliance daily from the first day of treatment to the eighth week after pollen began to disperse. Patients were divided into two groups; one group of patients started the agent before pollen began to disperse (the pre-dispersion group, n=15) and the other group of patients started after pollen began to disperse (the post-dispersion group, n=15). Symptoms and findings were compared between the two groups. All scores for runny nose, nasal obstruction, severity of hindrance in daily activities, itching of the eyes, severity of symptoms and symptom-medication were lower in the pre-dispersion group than in the post-dispersion group. In the post-dispersion group, the minimol sectional area of the nasal cavity and the capacity of the nasal cavity tended to increase following administration of olopatadine hydrochloride. Olopatadine hydrochloride could be sufficiently effective for cedar pollenosis, even when administration started after pollen began to disperse. However, it seemed that when administration started before dispersion, the onset of nasal symptoms was delayed and exacerbation of symptoms was decreased. In addition, the agent seemed to be more effective for relief of itching eyes and preventing hindrance in daily activities.