Practica Oto-Rhino-Laryngologica

Proteinases Related to the Bone Destruction and those Inhibitors in Human Cholesteatoma of the Middle ear

Takeshi Kusunoki, Kiyotaka Murata

2006 Volume 99 Issue 5 Pages 345-352
Published: May 01, 2006
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.99.345

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Objective: We examined metalloproteinase-1 (MMP-1), cathepsin L, and inhibitors (tissue inhibitor of metalloproteinse-1 (TIMP-1), cystatin A, and Cu- and Zn-containing superoxide dismutase (Cu, Zn-SOD)) in human cholesteatoma of the middle ear. Using the above data, epithelia and subepithelial granulation was discussed.
Method: Cathepsin L activity in the cholesteatoma epithelium, granulation tissues in cholesteatoma, or granulation tissues in noncholesteatoma were measured using Barrett's method. Cystatin A expressions were observed by Western blot analysis. Moreover, MMP-1, TIMP-1, cathepsin L, and Cu, Zn-SOD were examined immunohistochemically.
Results: Although, MMP-1 and cathepsin L immunohistochemically showed both epithelial and subepithelial granulation, the mean cathepsin L activity was higher in subepithelial than epithelial granulation. Subepithelial granulations with high cathepsin L activity resulted in extensive bone destruction in cholesteatomas. Cystain A and Cu, Zn-SOD with inhibitors of MMP-1 and cathepsin L were more strongly positive in epithelial regions than in subepithelial granulation tissues.
Conclusion: These results suggest that the area related to bone destruction in human cholesteatoma is subepithelial granulation rather than epithelia.

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A Case of Amelanotic Malignant Melanoma in Oral Region

S. Tominaga, [in Japanese], [in Japanese]

2006 Volume 99 Issue 5 Pages 354-355
Published: May 01, 2006
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.99.354

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Middle Ear Bleeding from Aneurysm in Aberrant Internal Carotid Artery

Ken Hozumi, Keisuke Araki, Kenji Noguchi, Satoru Takebayashi

2006 Volume 99 Issue 5 Pages 357-360
Published: May 01, 2006
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.99.357

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We experienced right middle ear bleeding from an aneurysm in an aberrant internal carotid artery in a 68 year-old female. Her chief complaint was a slight right ear hemorrhage and mild hearing loss. She had a past history of cirrhosis and hepatocellular carcinoma, and was treated at the department of internal medicine in our hospital. On first examination, slight pulsation was observed in the inferior quadrant tympanic membrane of her right ear. High jugular bulb and glomus jugulare tumor were not revealed by computed tomography. Brain angiography was performed and the rupture of an aneurysm in an aberrant internal carotid artery in the middle ear was suspected as the cause. The observation was done because of the impaired liver function. However, transcatheter embolization was planned because of the massive successive bleeding episodes. Almost 100 percent embolization was obtained. After the operation, the aneurysm disappeared and there were no severe side effects except for slight sensorineural hearing loss. Pulsation of the tympanic membrane disappeared. Although it is a very rare disease, it is important as a cause of extensive bleeding from the middle ear.

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A Case of Nasopharyngeal Angiofibroma

Hitoshi Tsujie, Akihito Watanabe, Masanobu Taniguchi

2006 Volume 99 Issue 5 Pages 361-365
Published: May 01, 2006
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.99.361

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Nasopharyngeal angiofibroma is a benign tumor occurring mostly in youth. Despite being a benign tumor, it is an invasive lesion, recurs, frequently, and bleeds easily. Therefore, surgeons find it difficult to excise.
A 18-year-old man consulted our hospital complaining of nasal obstruction for 6 months. Rhinoscopic examination demonstrated a smooth red mass in the left nasal cavity. We excised the mass via the maxillary sinus using a contact YAG LASER. Nasal endoscope was used to assist in identifying the expansion of the tumor. MRA was useful to identify the feeding artery. The volume of bleeding was 700ml. Seven years after surgery, and the tumor has not recurrented. The YAG LASER, nasal endoscopic assist and MRA was useful to reduce blood loss.

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Revision Endoscopic Sinus Surgery for Chronic Rhinosinusitis

Masako Masuda, Tatsuya Honda, Eiji Yumoto

2006 Volume 99 Issue 5 Pages 367-371
Published: May 01, 2006
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.99.367

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Endoscopic sinus surgery (ESS) has become one of the most common surgical procedures for otolaryngologists. Published success rates are very good, but there have been some unsuccessful cases requiring revision surgery. We investigated 29 patients who underwent revision ESS.
Most patients were found to have an obstructed middle nasal meatus with polyps or scaring. Revision ESS has been performed with attention to widen the middle nasal meatus, especially to prevent lateralization of the middle turbinate. We attempted intentional adhesion of the middle turbinate and nasal septum in some cases. All patients were followed-up for more than six months after revision surgery, and most patients underwent postoperative computed tomography (CT).
There was no case of postoperative obstruction of the middle nasal meatus. Success rate by CT examination was 58.5%. Reasons for revision surgery failure were the recurrence of massive polyps (14.6%) or scarring at the frontal recess following recurrent obstruction (26.8%).
The problem of middle nasal meatus obstruction was overcome by revision surgery. As a result, the recurrence of polyps could be controlled by postoperative care in half of the cases.

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A Case of Transitional Cell Carcinoma of the Frontal Sinus

Kazunori Fujiwara, Kei Nakahara, Katsuyuki Kawamoto, Hiromi Takeuchi, ...

2006 Volume 99 Issue 5 Pages 373-376
Published: May 01, 2006
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.99.373

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A case of transitional cell carcinoma (TCC) of the frontal sinus is reported. An 83-year-old man complained of left exophthalmos and nasal obstruction. On examination, the nasal cavity was blocked with a polypoid swelling. Computed tomography and magnetic resonance imaging demonstrated tumor in the frontal sinus and mucocele in the paranasal sinus. The mass in the left frontal sinus was excised and diagnosed as TCC. The treatment was performed by a linear accelerator. The prescribed dose was 70Gy. Irradiation was performed without effect, and the patient died 1 year later. Previous reports of TCC in the paranasal sinus are reviewed and discussed.

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Medial Protrusion of the Lamina Papyracea: A Case Report

Yukiko Mochizuki, Takayuki Mochizuki, Ritsuko Yoneda, Hajime Hirose, M ...

2006 Volume 99 Issue 5 Pages 377-379
Published: May 01, 2006
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.99.377

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Medial protrusion of the lamina papyracea into the ethomoid sinus has been described as a cause of orbital complications during endoscopic sinus surgery (ESS). The reported rate of the abnormal ranges from 0.5-6.5%.
We encountered a male patient with nasal bleeding. A nasal tumor in right nasal cavity was found and medial protrusion of the lamina papyracea into the ethmoid sinus was confirmed by preoperative CT examinations. The patient was successfully treated by ESS without orbital complications.
We emphasized that appropriate CT examinations before ESS are very important for preoperative evaluation of the anatomical relation among adjacent critical structures.

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Usefulness of Three-Dimensional CT Scanning for Preoperative Diagnosis of Postoperative Paranasal Sinus Cysts

Kenzo Tsuzuki, Yasuyuki Hinohira, Naoaki Yagnagihara, Kazuomi Yamada, ...

2006 Volume 99 Issue 5 Pages 381-386
Published: May 01, 2006
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.99.381

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The surgical strategy for postoperative paranasal sinus cysts (POSC) is often difficult, even with helical CT and MRI images. Not only the number and location, but also the hardness (bony or soft) of the POSC wall is an important factor to determine surgical approaches. The existing instruments may be unable to resolve the problems above-mentioned.
We have tried to decide on the best surgical strategy for POSC in such difficult cases, using the new three-dimensional CT scan (3D Accuitomo^®, Morita, Inc., Kyoto), that provides high resolution sagittal, coronal and axial slice views of complex postoperative structures of the paranasal sinuses. 512 frames of X-ray pictures are taken by 3D-CT, and transmitted to a personal computer (PC) as digital data, where the data are stored as mass volume data. Without being time-consuming, the mass volume data can easily be sliced in parallel in selected planes to obtain the best CT images of interest on the PC. And we can therefore choose appropriate surgical approaches, such as an endoscopic endonasal or transantral method.
Between October 2004 and April 2005, 8 patients with POSC were operated on with the aid of the 3D-CT scan. The CT was very helpful for preoperative diagnosis of the disease.

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Salivary Duct Carcinoma in the Submandibular Gland: A Case Report

Hidetaka Shirouzu, Hideki Chijiwa, Keiichi Chijiwa, Tadashi Nakashima, ...

2006 Volume 99 Issue 5 Pages 387-390
Published: May 01, 2006
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.99.387

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Salivary duct carcinoma is an uncommon tumor and was first described by Kleinsasser et al. in 1968. Its histological features resemble ductal carcinoma of the breast. We experienced a 72-year-old male with salivary duct carcinoma of the submandibular gland with neck metastasis. The tumor was resected with the surrounding tissue and selective neck dissection was performed. Histological examination revealed that the tumor presented with cribriform and papillary patterns of the intraductal growth with comedo necrosis. Postoperative radiation of 50Gy and chemotherapy (CDDP, THP, CPA) were performed. The patient is alive without any evidence of recurrence at 30 months after surgery.

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Post-tonsillectomy Hemorrhage

A Retrospective Study of 503 Operations

Ryoji Ishida, Satoshi Nakamura, Tomohito Fuke, Hiroyuki Yamada

2006 Volume 99 Issue 5 Pages 391-395
Published: May 01, 2006
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.99.391

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This study evaluated the risk factors of post-tonsillectomy hemorrhage. We reviewed 503 patients who underwent tonsillectomy in our hospital between 1998 and 2002 in relation to the age of the patients, indications for tonsillectomy, operative experience of the surgeon and BMI. The number of postoperative hemorrhage was 14 (2.7%), and 13 cases required a second general anesthesia to stop the bleeding. Postoperative bleedings occurred more than 5 days after tonsillectomy in 13 cases and occurred most frequently in cases of habitual angina, older age, with a history of previous peritonsillar abscess, with obesity.

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A Case of Kikuchi's Disease with Cervical Lymph Node Swelling and High Fever

Yoshifumi Yamamoto, Tadashi Kitahara, Takeshi Kubo

2006 Volume 99 Issue 5 Pages 397-401
Published: May 01, 2006
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.99.397

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Cervical lymph node swelling and high fever are common in patients presenting to the Department of Otolaryngology. Kikuchi's disease is an idiopathic necrotizing histiocyte lymphadenitis with the main clinical feature being adenopathy, generally in a cervical location. The disease is relatively rare and often misdiagnosed as lymphoma or lupus and inappropriately treated, potentially causing numerous medical consultations without relief of symptoms. The case described is that of a 28-year-old female with persistent cervical lymphadenitis and fever who presented to our department without an appropriate diagnosis at previous hospitals. All symptoms were quite resistant to antibiotics or NSAIDs. Laboratory results showed WBC decrease and AST/ALT increase, although common viral infectious diseases were denied. Finally, left cervical lymph node biopsy was performed under local anesthesia and the patient was diagnosed as having histiocytic necrotizing lymphadenitis or Kikuchi's disease. Since Kikuchi's disease is sometimes recurrent and coupled with collagen disease, long-term follow-up should be required.

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A Case of Benign Symmetrical Lipomatosis

Makoto Miyamoto, Singo Kakimoto, Tosiya Inoue, Motoki Nagata, Toshio Y ...

2006 Volume 99 Issue 5 Pages 403-407
Published: May 01, 2006
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.99.403

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Benign symmetrical lipomatosis is a rare condition characterized by symmetrical deposition of adipose tissue in the neck, sholder, and arm area.
About 200 cases have been reported in the medical literature, primarily from Europe. A 54-year-old man presented with masses in the neck, shoulders and arms. He underwent surgical treatment based on cosmetic reasons. Histopathologically, subcutaneous tumors were composed of mature adipose tissue. we report this case with a review as the literature.

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Three Cases of Kimura's Disease Treated with Post Operative Administrarion

Yukiyoshi Hyo, Toshihiro Tachi, Yukitake Mori, Teruhito Aihara, Kazuya ...

2006 Volume 99 Issue 5 Pages 409-414
Published: May 01, 2006
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.99.409

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Kimura's disease is a chronic benign inflammatory disease with eosinophilia in peripheral blood and often involves the cervical lymph nodes and parotid gland. However, decisive therapy has not been established in the head and neck region.
We report three cases of Kimura's disease. All patients were male and ranged in age from 45 to 58.
All were initially diagnosed with a malignant tumor on imaging findings (MRI, CT), but accurate diagonoses were finally established by biopsy. We treated these patients with steroid (prednisolone) per oral along with steroid (dexamethasone) local injection. All patients showed remarkable improvement. Therefore, we emphasize that these routes of administration made a good combination.
However, since it has been reported that this disease often recur after a long period, further follow-up is necessary.

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Histological Quantitative Examination of Viral Neuritis in Mice with Facial Nerve Paralysis Induced by Herpes Simplex Virus Type 1 Infection

Hisashi Kohno

2006 Volume 99 Issue 5 Pages 415-422
Published: May 01, 2006
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.99.415

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In this study, mice with facial paralysis induced by herpes simplex type 1 (HSV-1) inoculation were investigated histopathologically to quantitatively analyze the histological changes in the facial nerve in order to elucidate the disease process in the facial nerve of Bell's palsy. The mice were divided into three groups: group 1; no facial palsy seven days after saline injection into the auricle, group 2; facial palsy seven days after HSV-1 injection into the auricle, group 3; facial palsy 14 days after HSV-1 injection into the auricle. All mice were sacrificed, and the facial nerve on the right (inoculated) side was removed for histological examination. Light microscopy of both the labyrinthine and horizontal portion demonstrated that the facial nerve filled the fallopian canal in all three groups. The ratio of interstitial (other than axonal filament) area/whole nerve area was larger in groups 2 and 3 than in group 1. The numbers of axonal filaments were lower in groups 2 and 3 than in group 1. Histogram of the area of axonal filament showed disorder of the larger axonal filaments. However, there were no significant differences between group 2 and group 3 on toluidine blue stained cross sections using new analysis software. These findings suggested: 1) Viral neuritis in the paralyzed nerve caused increased pressure within the fallopian canal, and the nerves became entrapped then edematous. This study provided evidence of increased pressure in the fallopian canal caused by neural edema. 2) The histological findings in groups 2 and 3 suggested that histological changes in the nerves were unrelated to the development of paralysis, and thus it is thought that the main cause of paralysis is demyelination.

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Focal Tonsillar Disorders, up to Date

K. Fujihara, [in Japanese]

2006 Volume 99 Issue 5 Pages 424-425
Published: May 01, 2006
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.99.424

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