Practica Oto-Rhino-Laryngologica

Change and its Significance in the Treatment of Hypopharyngeal Carcinoma

Shinzo Tanaka

2006 Volume 99 Issue 7 Pages 513-518
Published: July 01, 2006
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.99.513

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Change and its significance in the treatment of the hypopharyngeal carcinoma (HPC) are discussed, chiefly based on the author's experiences. In the nineteen-seventies and eighties, the prognosis of HPC was poor, and the 5-year over-all survival was only 24% in 173 patients. Locoregional recurrence was the most serious problem. To improve locoregional control, we introduced extended surgery with reconstruction using a free jejunal graft, in which a safety margin of 3cm or more was secured at the primary site while bilateral retropharyngeal and paratracheal dissections were added to bilateral radical neck dissections. This treatment achieved a disease-specific 3-year survival of 64% for patients with advanced (stage III, IV) HPC, which was significantly better than that of patients treated by previous methods. Furthermore, postoperative radiotherapy was introduced for advanced HPC treatment, in which a 50Gy dose was basically used to irradiate the bilateral neck and a 10Gy dose was locally added when a retropharyngeal lymphnode metastasis was histopathologically identified or the number of lymphnode metastasis was three or more. In the recent five years, the disease-specific 3-year survival reached 81% in 39 advanced HPC patients. During this period, we endeavored to conserve in laryngeal functions for patients with early (stage I, II) HPC by performing a radiotherapy or partial pharyngectomy. In 14 early HPC patients, there was no recurrence and the larynx was well conserved in eleven. We also developed a new method of reconstruction after partial laryngopharyngectomy, in which aspiration was well prevented by reconsfructing the supraglottis and hypopharynx using hyoid bone attached to sternohyoid muscle and free forearm flap. Progress in surgical reconstruction techniques and radiotherapy changed the treatment of HPC, providing a better prognosis for advanced HPC patients and a better life quality for early HPC patients.

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Microflap Technique for Vocal Fold Polyp

S. Hirano

2006 Volume 99 Issue 7 Pages 520-521
Published: July 01, 2006
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.99.520

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Location of Tinnitus Frequency Examined from the Pure Tone Audiometric Pattern

Hitoshi Okumura, Satoshi Seki, Hitoshi Sato, Sugata Takahashi

2006 Volume 99 Issue 7 Pages 523-530
Published: July 01, 2006
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.99.523

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The relationship between tinnitus and hearing loss has been studied previously. In this paper, we examined the relationship of tinnitus frequencies, pure tone audiometric patterns and diseases causing hearing loss. As a result, we reconfirmed the strong relationship between tinnitus frequency and hearing loss, and considered that analysis of tinnitus frequency, pure tone audiometric pattern, and the disease causing the hearing loss can be used to suggest the lesion location.

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Two Cases of Congenital Cochlear Dysplasia Associated with Meningitis

Masaya Konishi, Yumi Munemoto, Tadashi Doi, Akihiro Kaneko, Masayuki F ...

2006 Volume 99 Issue 7 Pages 531-535
Published: July 01, 2006
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.99.531

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Congenital dysplasia is one of the most important cause of a recurrence of pyogenic meningitis in children. It is difficult to preoperatively recognize congenital deformities of the labyrinth because of the varying degrees of hearing loss associated with these deformities. Radiographic examination, especially computed tomography, is useful for detecting any malformation of the osseous labyrinth and classifying these anomalies precisely. We report two cases of recurrent meningitis due to the development of a fistulous communication between the subarachnoid space and the middle ear cavity, classified as incomplete partition and common cavity type. In both cases, CSF-gusher occurred intraoperatively and the vestibule was then packed with an abundance of fibrofatty tissue in the deformed labyrinth. The patients have not demonstrated meningitis recurrence postoperatively.

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Bilateral Low-Frequency Hearing Loss Following Spinal Anesthesia: A Case Report

Seiji Bruce Shibata, Kohei Kawamoto, Hiromichi Kuriyama, Toshio Yamash ...

2006 Volume 99 Issue 7 Pages 537-541
Published: July 01, 2006
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.99.537

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Spinal anesthesia is a very common procedure that is performed on a daily basis in surgical clinical practice. Well known complications include headache, nausea and vertigo. Hearing loss is also a known yet uncommon complication that is usually transient and seldom presents any problems.
We report a case of bilateral low-frequency sensorineural hearing loss following spinal anesthesia. A 57-year-old-man with a right indirect inguinal hernia underwent inguinal herinoplasty under spinal anesthesia. The following day he complained of post-spinal headache and bilateral tinnitus. On the second post operative day, he reported a feeling of impaired hearing in both ears and was referred to our clinic. We treated the patient with infusions consisting of low-molecular dextran and prednisolone from the day of admission. Four days after therapy hearing loss declined and eight days later the patient showed full auditory recovery in the low-frequency area. This low-frequency sensorineural hearing loss is thought to be caused by endolymphatic hydrops due to the loss of cerebrospinal fluid during the spinal anesthesia procedure. Suggested therapies are bed rest, infusions with low-molecular weight dextran, steroids, vitamin B₁₂ and epidural blood patch.

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Image of the Facial Canal Shown by “3DX Multi-Image Micro CT”

Kazuomi Yamada

2006 Volume 99 Issue 7 Pages 543-554
Published: July 01, 2006
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.99.543

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“3DX Multi-Image Micro CT” is a new three dimensional CT method using limited cone beam x-ray CT technology. A sensitive image intensifier transmits 512 X-ray pictures of a complex bony structure such as the temporal bone in a cylindrical area with a height of 30mm and a diameter of 40mm to a personal computer, where the X-ray data are processed into CT images. Axial (X), coronal (Y) and sagittal (Z) CTs along a desired slice plane are simultaneously displayed on the monitor. The author was able to measure the size of the bony facial canal with an image reconstruction. In 28 normal adult volunteers, the diameters of the bony facial canals were measured at the meatal foramen, the cocleariform process, the stapes, the pyramidal eminence and emerging point of the chorda tympani in the vertical segment. The result showed that the facial canal had two narrow sites; one at the meatal foramen and the other at the level of the stapes. From the meatal foramen toward the geniculate ganglion, the canal gradually enlarged. From here, the canal again became narrower until the level of the stapes, and then it gradually enlarged toward the stylomastoid foramen. There were no significant differences between data of the right and left sides. The same measurements were made in 16 patients with Bell's palsy and 8 with Hunt's syndrome. Abnormal enlargement of the facial canal distal and peripheral to the geniculate ganglion was observed only in the paralyzed side. The abnormality was closely associated with the grade of palsy and denervtion. The results suggested that, in these diseases, the pathologic process involved the bony facial canal beside the facial nerve.

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Isolated Oculomotor Nerve Palsy Caused by Paranasal Sinus Disease: A Report of Three Cases

Minoru Hara, Kenji Takasaki, Kaori Enatsu, Satoru Kaieda, Hidetaka Kum ...

2006 Volume 99 Issue 7 Pages 555-559
Published: July 01, 2006
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.99.555

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We report three cases of isolated oculomotor nerve palsy caused by paranasal disease. All patients complained of double vision but showed no sign of brain aneurysm or diabetes mellitus. These patients had unilateral disturbance of ocular movement and ptosis, but there was no visual impairment on opthalmologic examination. In two cases, computed tomography (CT) demonstrated soft tissue density (STD) in the posterior ethmoid and sphenoid sinuses and also inside the ipsilateral anterior clinoid process (ACP) of the sphenoid bone. In the other case, CT and magnetic resonance imaging showed STD in the ethmoid sinus and pneumatization in the ACP. In all cases, a bony defect was identified at the inferior wall in ACP, adjacent to the superior orbital fissure. We performed endoscopic sphenoidectomy in two cases and conservatively treated the other case with steroid and antibiotics. In all three cases, ocular movement became normal approximately one month later. Since the oculomotor nerve coursed just under the pneumatized ACP in these cases, we speculated that compression and/or inflammation through the ACP might have induced oculomotor nerve palsy.

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Hemangioma of the Sphenoid Sinus: A Case Report

Tadashi Yoshida, Koshiro Nakamura, Taisuke Kobayashi, Yuichi Tomidokor ...

2006 Volume 99 Issue 7 Pages 561-567
Published: July 01, 2006
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.99.561

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Hemangioma is a benign tumor that originates from vascular tissue of the skin, mucosa, bone, muscles and glands. More than half of hemangioma are found in the head and neck regions. Hemangioma of the paranasal sinus is rare, particularly in the sphenoid sinus; only four cases have been previously published in the literature. We report a case of hemangioma of the sphenoid sinus in a 13-year-old boy. CT and MRI demonstrated that the tumor filling the sphenoid sinus extended into the nasal cavity. Following embolization of some feeding arteries, removal of the tumor by the endonasal approach was attempted using an endoscope, however, the procedure could not be completed due to excessive bleeding. The remaining tumor was completely resected by lateral rhinotomy, five months after the previous surgery. Imaging studies such as MRI and conventional angiography play a vital role in the diagnosis of hemangioma. Hemangiomas arising from the paranasal sinus or nasal cavity should be treated by preoperative intervention, such as ligation or embolization of the feeding artery in order to prevent severe intraoperative hemorrhage. Considering the location and size of the tumor, it is important to choose the most appropriate surgical method for the management of hemangioma of the paranasal sinus.

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A Case of Metastatic Renal Cell Carcinoma to the Maxillary Sinus

Kouichi Sakaguchi, Kenji Takasaki, Fujinobu Tanaka, Noriyuki Sakihama, ...

2006 Volume 99 Issue 7 Pages 569-572
Published: July 01, 2006
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.99.569

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We report a rare case of a 44-year-old man with metastasis from renal cell carcinoma to the right maxillary sinus. The patient had undergone a tumor nephrectomy approximately six years previously. Intermittent epistaxis was the first symptom. The solitary metastatic tumor was resected by a maxillectomy with closure of the large cavity using a microvascular latissimus dorsi flap. Additionally, conservative treatment with alpha-interferon was administered. We describe the clinical course with a review of literature.

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A Case of Submandibular Hemangioma

Yoshiya Ishida, Mitsuru Asanome, Yasuaki Harabuchi

2006 Volume 99 Issue 7 Pages 573-579
Published: July 01, 2006
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.99.573

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Most salivary gland hemangiomas have involved the parotid gland, and cavernous hemangioma of the submandibular gland is rare. We have treated a cavernous hemangioma, which had several phleboliths in the right submandibular gland.
A 46-year-old female was referred to our clinic with a swelling in the right submandibular triangle. The clinical features appear to be hemangioma of the submandibular gland. Computed tomography, ultrasonography and magnetic resonance imaging were useful in the diagnosis. Under general anesthesia, the tumor was removed surgically, and the histopathological diagnosis was cavernous hemangioma with several phleboliths. Since surgery, the patient has shown a favorable prognosis and there has not been any sign of recurrence.
Including our case, 25 cases of hemangioma of the submandibular gland have been reported between 1960 and 2005 in Japan. Patient ages range from 6 to 70 years with an average age of 31.4 years. There were 12 males and 13 females and 80% (20/25) of the cases had cavernous hemangioma. Phleboliths were found in about 70% (17/25). Most of the cases (96%, 24/25) were treated surgically.

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Retrograde Approach for the Parotid Gland Tumor

from the Zygomatic Branch of the Facial Nerve

Yo Kishimoto, Kazuhiko Shoji, Satoshi Ikegami, Yasutaka Kawata, Shinji ...

2006 Volume 99 Issue 7 Pages 581-584
Published: July 01, 2006
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.99.581

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Conventionally, partial parotidectomy has been performed for benign parotid gland tumor. In this procedure, dissection and preservation of the facial nerve plays an important role. The conventional approach starting from the main trunk of the facial nerve has generally been used.
However, when we perform partial parotidectomy for tumor in the anterior part of the parotid gland using the conventional approach, it is necessary to dissect the facial nerve long from the gland. In that case, we have been using the retrograde approach starting from the zygomatic branch of the facial nerve. The zygomatic branch can located easily in front of the gland, below the zygomatic arch and the surface of the masseter muscle.
In this method, there is no need to ligate vessels, to use a drain or to cut the great auricular nerve and retromandibular vein. Furthermore, exposure of the facical nerve and parenchyma of the gland is more limited, avoiding facial palsy, frey syndrome and salivary fistula.
Based on advantages described above, a retrograde approach starting from the zygomatic branch should be used more often for surgery on parotid gland tumor.

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Laryngeal Carcinosarcoma Recurring with Innominate Artery Fistula: A Case Report

Daizo Taguchi, Hideyuki Kataoka, Takema Sakoda, Katsuyuki Kawamoto, Ke ...

2006 Volume 99 Issue 7 Pages 585-589
Published: July 01, 2006
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.99.585

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Innominate artery fistulas require a surgical procedure, although the prognosis is usually very poor because of complications such as re-bleeding and infection. A 50-year-old man presented with laryngeal carcinosarcoma (T1a, N0, M0). Partial laryngectomy was performed but there was a recurrence; therefore, total laryngectomy, total thyroidectomy, right radical neck dissection, left functional neck dissection, skin-combined resection and D-P flap were performed. On postoperative day 6, after intense coughing, copious hemorrhage from the tracheostoma was demonstrated. Immediately, bleeding was arrested by pressing the tracheostoma. Fistula of the innominate artery was then repaired using left great saphenous vein, but recurrent perforation of the innominate artery developed. Therefore, innominate artery transection and omentopexy were performed. These results demonstrate that in cases of trachea-innominate artery fistula, innominate artery transection should be performed first.

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Schwannoma Arising from the Pharyngeal Branch of the Vagus Nerve

Akiko Katoh, Takeyuki Fujimura, Takashi Shimizu, Koich Hashida, Takuro ...

2006 Volume 99 Issue 7 Pages 591-594
Published: July 01, 2006
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.99.591

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We report a rare case of schwannoma arising from the pharyngeal branch of the vagus nerve. An 18-year-old woman presented with an egg-sized nontender upper cervical swelling. Computed tomography and magnetic resonance imaging (MRI) revealed a well-defined tumor measuring 50mm in its major axis in the left carotid space. The tumor was moderately enhanced, and showed hypointensity and isointensity on T1- and T2-weighted MRI, respectively. Otorhinolaryngological findings were otherwise normal. A schwannoma was most likely suspected, and she underwent transcervical resection of the tumor. A cordlike strand connected to the cephalad end of the tumor was severed, while both the vagus and hypoglossal nerves were identified and preserved. The histopathological diagnose is schwannoma. After surgery, the patient manifested a curtain sign toward the unaffected side without showing vocal cord palsy or Homer's syndrome, indicating that the tumor had arisen from the pharyngeal branch of the vagus nerve. Clinical characteristics of schwannomas in the carotid space were reviewed.

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A Case of Neurovascular Compression Causing Glossopharyngeal and Vagal Nerve Palsy

Satoshi Takeuchi, Niro Tayama

2006 Volume 99 Issue 7 Pages 595-600
Published: July 01, 2006
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.99.595

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We report a 43-year-old male-to-female transsexual patient with gender identity disorder (GID), suffering from neurovascular compression causing glossopharyngeal and vagal nerve palsy. Cross-sex hormone therapy has been approved for 5 years. He had complained of difficulty inn speaking and singing for 3 years, with symptoms of right soft palate palsy, lower sensitivity of the right pharynx and curtain sign. However, recurrent nerve palsy was not identified so his vocal cord mobility was good. We investigated brain MRI and MRA, and detected dolichoectasia of the right vertebral artery on the medulla. We suspected that the neural symptoms on the same side were caused by the vertebral artery dolichoectasia compressing his glossopharyngeal and vagal nerve on the medulla.

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Diagnosis and Treatment for Myringitis

S. Iwasaki

2006 Volume 99 Issue 7 Pages 602-603
Published: July 01, 2006
Released on J-STAGE: October 07, 2011

DOIhttps://doi.org/10.5631/jibirin.99.602

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