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Comparison between Electorogustometry of the Soft Palate and Schirmer's Test
Hidetoshi Kawamoto, Minoru Ikeda
1995 Volume 1995 Issue Supplement78 Pages
1-6
Published: April 30, 1995
Released on J-STAGE: November 27, 2012
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We coducted electrogustometry (EGM) of the soft palate as a functional test of the greater petrosal nerve (GPN) in patients with acute peripheral facial paralysis and compared these findings with results of the Schirmer's test.
One hundred fifteen cases,59 males and 56 females were examined. Seventy-eight cases had Bell's palsy,27 cases Ramsay Hunt syndrome and 10 cases zoster sine herpete. Dysfunction of the stapedial nerve was recognized in all cases.
An electrogustometer (TR-5, Rion ) was used for the taste test. The elevation of the threshold more than 6 dB on the affected side was considered abnormal. To evaluate lacrimal function, the Schirmer's test was used. Lacrimal secretion on the affected side was considered abnormal when the secretion was decreased to less than 50% of that on the non-affected side.
The following results were obtained.
1.28.2% of 78 cases of the B ell's palsy showed taste disturbance of the soft palate, and 10.3%showed lacrimal dysfunction. It was supposed that the EGM of the soft palate was more sensitive than the Schirmer's test for evaluating of dysfunction of the GPN in facial nerve palaysis.
2. Only 9 (28.1%) of 32 cases with taste dysfunction also showed lacrimal dysfu nction. It was suspected that the affected nerve fibers differ somewhat in between the sensory and secretory nerve fibers of the GPN.
3. Findings of Schirmer's test were more related with the severity of the facial paralysis and with the prognosis of paralysis than those of EGM.
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Kenichi Aiso, Eiichi Ishiyama
1995 Volume 1995 Issue Supplement78 Pages
7-16
Published: April 30, 1995
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Anatomical peculiarities of the planum semilunatum on the crista ampullaris were studied using 20 pigeons. Animals were sacrificed by decapitation and prepared histologically, for SEM and TEM.
1) On the vertical crista ampullaris The planum semilunatum showed a semilunar distribution on the bilateral vertical crista ampullaris with taller cylindrial cells in the center and cells of decreasing height both in the periphery and running under the angle of the sensory cells in the center portion of the septum cruciatum. The supranuclear region of these cells contained small vacoules and granular materials. Intercellular space demonstrated well developed interdigitation.
2) On the lateral crista ampullaris The planum semilunatum was demonstrated only on one side of the crista, i. e. toward the superior crista ampullaris. This observation was not previously demonstrated. The planum semilunatum running under the angle of the sensory cells, however, did not reach the other side of the crista ampullaris. This observation confirmed the findings of Nomura and Hiraide.
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Ryuichi Kametani, Kiyosi Makiyama, Ken-ichi Hisamatsu
1995 Volume 1995 Issue Supplement78 Pages
17-29
Published: April 30, 1995
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We conducted a nasal provocation test, using house dust as the antigen, on 13 patients with perennial nasal allergy and 6 normal subjects. The test was followed by nasal lavage using 25 ml of physiological saline. Using the nasal lavage fluid immediately before the provocation test as the control fluid, the levels of cytokines (IL-1α, IL-1β TNFα) and chemical mediators (LTB4, LTC4, histamine) were determined in the nasal lavage fluid obtained 30,60,120,240,360, and 480 minutes after provocation, and the sequential change in secretory volume per unit of time was investigated. Simultaneously, sequential changes in nasal resistance were determined by rhinomanometry. In the immediate phase reaction,30 minutes after provocation, significant differences (p < 0.05) were noted in the IL-1α, LTC4 levels in the group with nasal allergy and the normal group. In the late phase reaction,360 minutes or more after provocation, no significant difference was noted in the cytokines or chemical mediators between the two groups. A significant difference (p < 0.05) was noted between the levels of IL-1α, TNFα, LTB4, and LTC4 before provocation and those of the immediate phase reaction. However, in the cytokines and chemical mediators, no significant differences were noted in comparing the pre-provocation levels with those of the late phase reaction. Thirty,120, and 360 minutes after provocation, a significant difference (p < 0.05) was noted in the nasal resistance of the group with nasal allergy compared to the normal group. A significant difference (p < 0.05) was noted between the pre-provocation value and the value during the immediate or late phase reaction. Dual phase changes of the immediate and late phase reactions were noted in 9 of the 13 cases. All 6 cases rated as severe or intermediate with regard to daily nasal symptoms exhibited the dual phase reaction. Many of the cases exhibiting a dual phase reaction in nasal resistance showed a repeated rise in the cytokines and chemical mediators during the late phase reaction.
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Kenji Okazaki, Kiyoshi Makiyama, Ken-ichi Hisamatsu
1995 Volume 1995 Issue Supplement78 Pages
30-38
Published: April 30, 1995
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An acetylcholine sensitivity test for nonspecific hyperresponsiveness of the nasal mucosa was established using a fluorescein-stained thread to measure the volume of nasal discharge. This sensitivity test was useful for detecting nonspecific hyperresponsiveness of the nasal gland using acetylcholine chloride at a low concentration, eliminating trigeminal nerve triggering. Ten μ L of acetylcholine chloride in physiological saline at a concentration of one μg/mL was dripped on the anterior portion of the inferior turbinate after aspirating retained nasal discharge, and the nasal discharge provoked within one minute was measured using a fluorescein-stained thread. The mean dye migration distance was 0.87 ± 4.52 mm in normal subjects (n = 15), which was significantly less than that of subjects with house-dust nasal allergy,11.57 ± 9.25 mm (n = 30). Nasal symptoms and nasal findings of nasal allergy subjects were compared with the dye migration distance. The distance was related to the frequency of nose blowing, severity of nasal symptoms, degree of swelling in the nasal turbinates and color of the nasal turbinates. Acetylcholine sensitivity of the nasal mucosa was higher in nasal allergy subjects and reflected nonspecific responsiveness of the nasal mucosa.
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Nahoko Shimazaki, Kiyoshi Makiyama
1995 Volume 1995 Issue Supplement78 Pages
39-52
Published: April 30, 1995
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For aerodynamic assessment of voice disorders, we used the airway interruption method to measure expiratory lung pressure as well as air flow rate, vocal pitch and intensity. These were 71cases of vocal cord polyp,24 cases of Reinke's edema,28 cases of recurrent nerve palsy,22 cases of laryngeal nodule and 44 normal cases. Among patients with polyp or Reinke's edema, flow rates were within the normal range in many cases, while some cases showed a somewhat greater flow rate than normal. Among patients with laryngeal nodule or recurrent nerve palsy, there were cases with an extremely high flow rate. Some of the male subjects with recurrent nerve palsy showed extremely high pressures. Decrease in the glottal resistance is seen in some patients with recurrent nerve palsy. Some increase in glottal resistance was noted in males with polyp. In females, most of the pathologic cases showed a reduction in glottal resistance. Power of expiratory air flow was defined as the product of the flow rate and pressure. In most cases of the normal group, louder voice demonstrated higher expiratory power. An increase in expiratory power was observed in some cases in both the polyp and recurrent nerve palsy groups. An extreme increase in subglottic power was seen in some cases of recurrent nerve palsy. Aerodynamic assessment provides useful data for evaluating glottal resistance and efficiency in organic voice disorders. At the same time, our present data indicate that the aerodynamic condition of the glottis in organic voice disorders varies considerably in individual cases. The data must be studied carefully, case by case, in relation to other organic findings of the larynx.
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Kenichi Watanabe, Fumio Dohi, Hiroshi Tomita, Ritsuko Takemoto, Gen Mu ...
1995 Volume 1995 Issue Supplement78 Pages
53-62
Published: April 30, 1995
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The topographical anatomy of the chorda tympani nerve (CTn) was investigated macroscopically in 45 ears of Japanese adult cadavers, aged 38-88 yr, with special reference to its topographical relationship to critical structures encountered in otorhinolaryngological practice such as the auditory tube and Wharton's duct. Fifteen cases of the “separated type” of CTn running independently along the posterior margin of the lingual nerve, which were noted in our previous study, were included among the 45 specimens. Major findings considered relevant to clinical practice are described below.
1. The course of the CTn, passing inferiorly and medially in the petrotympanic fissure, was classified into 2 types: that traveling immediately anterior to and parallel with the auditory tube, and the becoming progressively more distant (inferior and anterior) to the auditory tube.
2. Immediately after emerging from the petrotympanic fissure, the CTn cons istently communicated with the sympathetic plexus around the middle meningeal artery, and often issued twigs reaching the otic ganglion area.
3. In cases where the CT n was trapped by tendinous tissue around the lateral pterygoid muscle (17.8%), the nerve merged into the lingual nerve from the medial or anterior aspect, and not from the usual posterior aspect, at the level of the mandibular notch.
4. The lingual nerve sometimes (20.0%) showed a strongl y curved sigmoid course behind the mandibular ramus. Several buccal branches innervating the oral lining, without containing the CTn element, were issued at the anterior projecting protion of the sigmoid course.
5. At the base of the oral cavity, the major CTn element traveled al ong the superior margin of the lingual nerve, therefore the CTn element was located away from the submandibular ganglion.
6. A thick communicating branch on both sides of the lingual nerve was rarely observ ed under the mucous lining or in the mucous layers at the tip of the tongue. These findings suggest that morphological variations of the CTn should be considered during surgical procedures and for understanding the nature of related clinical symptoms.
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Masami Tanaka, Hideto Kitagou, Susumu Ogawa, Eikichi Tokunaga, Minoru ...
1995 Volume 1995 Issue Supplement78 Pages
63-69
Published: April 30, 1995
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Gustatory test results from patients whose chief complaint is glossodynia often show dysgeusia, although these patients may not be aware of it. In this study, we conducted gustatory tests on patents who visited our hospital with glossodynia, and examined (1) the rate of dysgeusia complications in these patients as well as (2) the effectiveness of treatment for glossodynia.
Among patients who visited the Dept. of Otorhinolaryngology, Nihon University Itabashi Hospital between January 1990 and December 1993 and whose chief complaint was glossodynia, we selected 96 patients (15 males and 81 females, mean age: 57.7 years) and conducted gustatory and psychological tests, measured serum zinc and copper levels, and observed lingual papilla using biomicroscopy. Results showed the presence of dysgeuisa in 43 patients (44.8%). Severity was mild in 62.8% of the 43. By giving higher priority to treatment of dysgeusia than to glossodynia, pain disappeared or was relieved, along with improvement in gustatory sensation in 27 (62.8%) of the 43 patients who previously complained of both glossodynia and dysgeusia. Overall, including patients not complaining of dysgeusia, pain in 65 of 96 patients (67.7%) disappeared or was improved.
When treating glossodynia, it is important to accurately diagnose the main cause of pain and give higher priority to treating for the cause. Clinical efficacy of treatment for glossodynia will be improved when the presence or absence of dysgeusia is diagnosed early in the course of treatment.
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Isamu Itoh, Akihiro Ikui, Sohei Endoh, Kaoru Satoh, Minoru Ikeda, Hiro ...
1995 Volume 1995 Issue Supplement78 Pages
70-74
Published: April 30, 1995
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We encountered five cases of Hunter's glossitis following total gastrectomy. Chief complaints were taste disorders and abnormal glossal sensations. In all five cases, smooth red tongue, macrocytic anemia and reduced levels of serum vitamin B12 were observed. Gustometry was performed on four patients and taste disorders were observed.
These patients were treated with vitamin B1 2 which improved local findings of the tongue, results of gustatory tests and subjective complaints.
Hunter's glossitis, which can be easily improved with vitamin B12 administration, may be the cause of the smooth red tongue. We need to consider this possibility.
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Yuki Yamauchi, Minoru Ikeda, Yoichiro Yamada, Eiichi Ishiyama, Kouichi ...
1995 Volume 1995 Issue Supplement78 Pages
75-78
Published: April 30, 1995
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This is a case report of a 14-year-old female who developed gustatory disorder due to an orthodontic wire. Because the wire deviated from the regular fixed position and pierced the right trigonum retromolar, the patient complained of traction pain on the right lower jaw, numbness on the right front half of the tongue, and hypogeusia except for sweet taste. Possible causes of these symptoms were: (1) the wire caused dir e ct mechanical compression of the nerve, or (2) edema developed in the nerve tissues around the wire inducing a circulation disorder.
Although the mechanism which sustained the patient's sweet taste recognition at a normal level was not fully understood, this patient is an interesting case from the view of the transfer mechanism of gustatory sensation.
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Mutsumi Kuga, Nobuo Kukimoto, Hidehisa Nakazato, Yuzuru Abiko, Hidetos ...
1995 Volume 1995 Issue Supplement78 Pages
79-82
Published: April 30, 1995
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We investigated the efficacy of large-dose steroid therapy in 28 patients with Ramsay Hunt syndrome, within 2 weeks after disease onset. Facial paralysis were evaluated as severe in all cases. In one group, large dose steroid (starting with 500 mg of methylprednisolone) and an anti-viral agent (Acyclovir) were prescribed for 12 patients. As a result,10 of the 12 patients were completely healed for a cure rate was 83.3%. In the other group, we prescribed 30-60 mg of prednisolone as the initial dose for 16 patients, and 10 were completely healed (cure rate,62.5%). Overall, clinical efficacy was obtained in 21 (75%) of 28 patients.
We evaluated our findings compared to those of other studies. Generally, studies using largedose steroid reported relatively better clinical results compared to those of conventional dose oral administration. Five hundred milligrams of methylprednisolone was the largest initial dose among the studies compared. We used 625 mg prednisolone, and our cure rate (83.3%) was relatively higher than those of the other studies.
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Kouichi Hiroshige, Yoichiro Yamada, Masami Tanaka, Yuki Yamauchi, Kenj ...
1995 Volume 1995 Issue Supplement78 Pages
83-88
Published: April 30, 1995
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Substantiated treatment methods for sudden deafness have not been established. We administered a batroxobin preparation (DefibraseR) with a steroid to 17 patients with sudden deafness, most of whom were resistant to a steroid therapy regimen in previous treatment, and observed symptom improvements in 17 respective ears. Results showed 76.5% mild or better improvement. Because the majority of the subjects were steroid resistant, this rate can be considered relatively high. No side effects were detected, but plasma fibrinogen levels decreased to 50 mg/dl or below in 8 patients during the treatment regimen. This point remains to be investigated to confirm the drug's safety. Steroid and batroxobin are assumed to act via different modes of action. It is worthwhile to try batroxobin for patients with sudden deafness whose symptoms and disease are intractable when administering steroids.
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Hideo Omori, Minoru Ikeda, Yuki Yamauchi, Mahoko Nakazato, Masahiro Ya ...
1995 Volume 1995 Issue Supplement78 Pages
89-93
Published: April 30, 1995
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This is a case report of a massive mastoid cyst that developed in the middle cranial fossa. The patient was a 69-year-old female, who visited the Dept. of Neurology because of a headache that persisted for several months. At the initial examination, a perforation of the right tympanic membrane and mixed hearing loss were observed, but no other neurological symptoms were detected. This patient had not undergone and kind of surgery for the middle ear. CT scan depicted a ring-enhanced lesion of the right middle cranial fossa. Ti and T2 MRIs depicted a highly intensive lesion starting from the mastoid cells. Therefore, intra-cranial development of a cholesterol cyst from the mastoid cavity was surmised. Surgery was performed using a combined transmastoid and middle cranial fossa approach. The cyst had developed to the middle cranial fossa from the mastoid cavity through the tegmen of the mastoid antrum. Pathological findings showed characteristics of a cholesterol cyst. We also discuss the developmental process of mastoid cyst as related to mastoid air cells development.
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Shinya Yoshida, Hiroshi Tomita, Kumiko Yamada
1995 Volume 1995 Issue Supplement78 Pages
94-97
Published: April 30, 1995
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Recently, the number of patients with allergic nasal polyps has been increasing, and this is associated with an increasing incidences of eosinophil infiltration in nasal polyps. We examined 33patients with nasal polyps and analyzed the histological type as well as the state of eosinophil and plasmocyte infiltration in the polyps. The results were edema type 70%, adenocystic type 24%, and fibrous type 6%. Eosinophil and plasmocyte infiltration were observed in 70% and 73% of the total, respectively. In comparison of 12 allergic nasal polyps to 12 non-allergic nasal polyps, eosinophil infiltration was increased in the allergic polyps. When an anti-allergic drug was administered to 5 patients with allergic nasal polyps for more than 3 months prior to surgical treatment, good postoperative results were obtained. However, the degree of eosinophil infiltration was nearly the same as that of patients who did not receive any anti-allergic drugs.
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Isamu Itoh, Kohei Sueno, Masamichi Iijima, Yugo Noguchi, Michitada Bab ...
1995 Volume 1995 Issue Supplement78 Pages
98-102
Published: April 30, 1995
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We rarely encounter primary paranasal sinus cysts in clinical practice. Recently, we treated 2cases of primary cysts of the frontal and ethmoidal sinuses and 2 cases of anterior ethmoid sinus cysts over a relatively short time span. The cases are presented along with a review of the literature.
For diagnosis, CT examination was very useful. MRI examination is an effective diagnostic tool when the cyst invades the intraorbital or intracranial space or for differentiating cystic mass from tumor.
Surgery is the primary therapeutic modality. Early surgery is highly recommended in patients with complications.
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Takuma Yoshikawa, Akinori Kida, Kouhei Sueno, Fumisada Koizumi, Koichi ...
1995 Volume 1995 Issue Supplement78 Pages
103-111
Published: April 30, 1995
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Specific therapy for dentigerous cyst includes initial extraction of the affected tooth. However, we tried to treat the cyst surgically without initial tooth extraction in 3 cases. In a 27-year-old female and a 45-year-old male, we performed surgery on the cysts while preserving the dental roots. In another 47-year old male, a tooth that was buried in the cyst was removed simultaneously during surgery on the cyst.
No relapse was repo rted in the 3 cases and the post operative courses have been good.
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Akihiro Ikui, Yoshihisa Sasaki, Hiroki Abe, Fumio Dohi, Shin Suzuki
1995 Volume 1995 Issue Supplement78 Pages
112-115
Published: April 30, 1995
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Aggressive fibromatosis in the right maxilla was found in a 43-year-old female. CT scan showed that the tumor originated as a right subdermal maxillary lesion and invaded the right maxillary sinus. Wide local excision was performed to resect the fibroma and it has not recurred during 6years of postoperative follow-up.
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Akinori Kida, Ryo Ajisaka, Tohru Furusaka, Norimichi Nemoto
1995 Volume 1995 Issue Supplement78 Pages
116-122
Published: April 30, 1995
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Eosinophilic granuloma of the maxilla is rarely seen in Japan. Eosinophilic granuloma of the bone is a category of Histiocytosis X, along with Hand-Schtiller-Christian disease and Letterer-Siwe disease. The histiocytic cell common to these diseases is known as the Langerhans-cell. A recent study concluded that the disease would more aptly be named Langerhans' cell histiocytoma, as opposed to Histiocytosis X. Although Histiocytosis X includes eosinophilic granuloma of the bone, Hand-Schiiller-Christian disease and Letterer-Siwe disease, not all cases fall neatly into one of these three categories; some show mixed symptoms. To respond to this issue, a staging system prepared by Greenberger takes the age factor into consideration. Our case involved a seven-yearold girl who retained symptoms in the right maxilla, frontal scalp, umbilicus and vulvar area. She was classified in Greenberger stage II. For treatment, we administered a combination of vincristine and predonine. This was followed by chemotherapy given through 6MP, resulting in a disappearance of the symptoms. It is now three years since the chemotherapy was conducted, and there has been no recurrence of the symptoms.
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Masahide Yasuda, Michitada Baba, Kohei Sueno, Takuma Yoshikawa, Isamu ...
1995 Volume 1995 Issue Supplement78 Pages
123-127
Published: April 30, 1995
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This paper reports a pseudolymphoma that developed in the buccal region of a 47-year-old male. With an indolent swelling in the right cheek as his chief complaint, he was seen at our hospital. A tumor mass was palpable beneath the skin, about 1 cm below the edge of the orbita. A tumor shadow of uniform density was indicated on CT scan. The tumor mass was completely extirpated under local anesthesia. Since there was a pathological diagnosis of pseudolymphoma, which has a tendency to become atypia, it was irradiated postoperatively with a dose of
60Co at 36 Gy. Local recurrence or appearance of the tumor mass in other regions has not been occurred d u ring the follow-up of 4 years and 6 months.
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Mitsuyoshi Ohki, Isamu Itoh, Kanako Ikeda, Fumio Dohi, Minoru Ikeda
1995 Volume 1995 Issue Supplement78 Pages
128-131
Published: April 30, 1995
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Epidermoid cysts can be observed in almost any part of the body, and are considered to originate from displaced epithelial nests at birth or in association with injuries suffered postnatally. A few cases with epidermoid cysts in the head and neck regions have been reported. Most such cysts are located in the base of the oral cavity, and epidermoid cysts in other areas of the head and neck are rarely reported.
Thi s is a report of a patient with an epidermoid cyst in the buccal region. Cases of epidermoid cyst developing in that region are very rarely reported and only 28 cases are known throughout the world.
There are 2 hypotheses for congenital causes of epidermoid cyst generation: (1) aberration of epidermoid tissues in the branchial arches, and (2) abnormal burying of the bilateral cervical sinus. The cyst in this patient was considered generated from the concrescence of the maxillary and mandible processes, and it satisfied the conditions of the aberration hypotheses.
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Yoichiro Yamada, Akinori Kida, Minoru Ikeda, Sohei Endo, Shuntaro Shig ...
1995 Volume 1995 Issue Supplement78 Pages
132-135
Published: April 30, 1995
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Thirty cases of press-through package (PTP) as esophageal foreign bodies were analyzed. The patients were 8 males and 22 females. Patient ages were between 14 and 89 y/o, the average age was 64.2 y/o. Esophagogram or endoscopic examination were performed following plain X-ray exam to confirm the presence of the forein body. The foreign bodies included the following: 10 cases in the first stricture,11 cases in the cervical esophagus,9 cases in the second stricture,3 cases in the third stricture. In 3 cases, there were double foreign bodies. Twenty cases were treated surgically to remove the foreign bodies under general anesthesia, and 10 cases were treated under local anesthesia. If there was a greater time lag in removing the foreign body, more severe mucosal erosion was observed, but the erosion recovered without complication. We observed migration of the foreign body in 5 cases.
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Sohei Endo, Akinori Kida, Tohru Furusaka, Yoichiro Yamada, Hidenobu Ii ...
1995 Volume 1995 Issue Supplement78 Pages
136-146
Published: April 30, 1995
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Primary neoplasms, (n = 37), originating in the minor salivary glands of patients who visited our hospitals during the past 20 years, were investigated. Histologic types were adenoid cystic carcinoma (n = 19), mucoepidermoid carcinoma (n = 14), and adenocarcinoma (n = 4). The sites of origin were the oral cavity (14), the paranasal sinuses (11), the oropharynx (7), the nasal cavity (3), the larynx (1), and unknown (1). Using TNM staging criteria used for head and neck squamous cell carcinoma, there were 3 stage I,7 stage II,14 stage M,10 stage 1V without distant metastasis, and 3 stage 1V with distant metastasis (lung). Accordingly, many patients were in the advanced stages. The major treatment modality employed was radical excision, along with adjuvant radiation when residual tumors were suspected. The overall 5- and 10- year survival rates were 63.8% and 60.9%, respectively. The prognostic factors influencing survival were disease stage, T factor, N factor, histologic grade, site of origin, and degree of therapeutic efficacy.
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Akinori Kida, Chie Enomoto, Hidenobu Iida, Ryuichi Kametani, Nahoko Sh ...
1995 Volume 1995 Issue Supplement78 Pages
147-152
Published: April 30, 1995
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We treated an 81-year old woman with giant pleomorphic adenoma of the parotid gland. Although she was diagnosed with a parotis tumour 20 years earlier, it was not recommended that she underwent surgery because of a heart ailment. Consequently, the tumor was left untreated. The tumor gradually grew and became painful, prompting her to visit our hospital. Upon initial diagnosis, we did not find any facial palsy. Under general anesthesia, we extracted the tumor from the left parotid gland. The extracted tumor was 18 cm x 13 cm x 11 cm and weighed 1000 grams. Following surgery, the patient developed transitional incomplete palsy of the mandibular marginal branch of the facial nerve. but recovered four weeks later. We conducted pathological and histological tests on eight selected points of the tumor. Because the tunica was intact and the cells did not show any heteromorphy, the tumor was determined to be pleomophic adenoma. No malignant changes were found.
In general, tumor must be treated at an early stage, regardless of whether the tumor is benign. Doctors should recommend that patients undergo surgery when a parotis tumor is found.
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Hideo Niwa, Akinori Kida, Sohei Endo, Yoichiro Yamada, Fumitaka Sakai, ...
1995 Volume 1995 Issue Supplement78 Pages
153-157
Published: April 30, 1995
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Cystic lymphangiomas occur as the result of a congenital malformation of the lymphatic system and are histologically benign tumors, with spaces lined by true endothelium. We reviewed our 10years of experience in treating cystic lymphangioma of the head and neck. Magnetic resonance imaging (MRI) was used to assess the size and extent of the lesion and to assist in planning the surgical approach. We performed surgical resection on all patients. A brief discussion of cystic lymphangioma and its management is presented, followed by a review of 8 patients with cystic lymphangioma of the head and neck treated at the Department of Otorhinolaryngology, Nihon University.
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Akinori Kida, Shinichi Hashimoto, Hidenobu Iida, Sohei Endo, Yoichiro ...
1995 Volume 1995 Issue Supplement78 Pages
158-164
Published: April 30, 1995
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Hypopharynx hemangioma is a rare disease. In the four cases we encountered, the hemangioma was localized in the hypopharynx. In all four cases, the hemangioma had a dark red color, and the surface was irregular and broad. Plain CT revealed a low density tumor, while contrast CT revealed a high density mass. The tumor showed hypointensity on T1-weighted spin-echo magnetic resonance image (MRI), and hyperintensity on T2-weighted spin-echo MRI. The tumor margin showed hyperintensity during the early stage of T1Gd-DTPA contrast, while the overall tumor showed hyperintensity during the latter stage. Two cases were treated by tracheostomy and cryosugery under general anesthesia. The other two cases were treated by lateral pharyngotomy and resecting the tumor under general anesthesia. We performed tracheostomy on the cases treated by cryosurgery because we took into consideration the dyspnea caused by laryngeal edema after surgery. However, tracheostomy appeared unnecessary when we discovered only a hemangioma on the piriform sinus of the hypopharynx and the larynx was not frozen during cryosurgery.
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Akihiro Ikui, Minoru Ikeda, Isamu Itoh, Mikio Takeda, Yoshiharu Watana ...
1995 Volume 1995 Issue Supplement78 Pages
165-170
Published: April 30, 1995
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A case report of unilateral paralysis of the X, X and XI cranial nerves without skin lesions is reported. The patient was a 22-year-old male who complained of hoarseness and dysphasia. Physical examination revealed paralysis of the left soft palate, left laryngial paralysis and left sternocleidomastoideus and trapezius muscle impairment. There were neither skin nor mucosal manifestations. No other abnormal neurological findings were noted. The serum antibody titer for varicella-zoster virus was significantly elevated on the 17th day. According to the evidence presented, in IX, X and XI cranial nerve paralysis cases, the serum and CSF antibody titer for varicella-zoster virus should be evaluated.
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Kiyoshi Makiyama, Nahoko Shimazaki, Ryuichi Kametani, Chie Enomoto, Hi ...
1995 Volume 1995 Issue Supplement78 Pages
171-178
Published: April 30, 1995
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A case of chordoma of the jugular foramen presenting a phonatory disorder as the initial symptom is reported. The patient, a 13-year-old girl, sought treatment at the Department of Otolaryngology, Nihon University Surugadai Hospital with a major complaint of difficulty in phonation. At the initial examination, no obvious abnormalities of the larynx were noted. Her voice quality and phonatory examinations were normal. Recurrent nerve paralysis of the left side was discovered 4 months later when the patient retured to the clinic with hoarseness which had developed following a cold. In a subsequent visit to the clinic two months later, the patient was found to have sensory and motor paralysis of the left pharynx and paralysis of the left strenocleidomastoid muscle. An enlargement of the left jugular foramen was detected on a 3D-CT and the presence of a dumbbell shaped tumor was observed on MRI examination. At craniotomy, an encapsulated tumor and the X, X and XI cranial nerves were found at the jugular foramen. The encapsulated tumor was excised and found to be chondroid chordoma. The case is considered unusual because of the considerable time that elapsed between onset and development of jugular foramen syndrome.
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Susumu Ogawa, Masamichi Iijima, Hideo Omori, Sohei Endo, Kenzou Tsuji, ...
1995 Volume 1995 Issue Supplement78 Pages
179-182
Published: April 30, 1995
Released on J-STAGE: November 27, 2012
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Deep cervical abscess is an infection which develops widely in the interfascial gaps of the cervical area, and it sometimes causes serious problems.
This is a report of 4 patients with gas-for ming deep cervical abscess, whose ages ranged from 29-59 years old. One of them was a diabetic. Causes of infection were dental caries in 3 and a fish bone stuck in the hypopharynx in 1. Abscess formation occurred within 3-11 days after pain developed. In 2 patients, phlogogenic organisms were determined. CT scans depicted gas-formations in all patients, and these images were quite useful in diagnosing deep cervical abscess.
In treatment, clindamycin (CLDM) was administered. Two patients concomitantly received large penicillin G (PCG) doses. All patients underwent surgery for incision drainage at a relatively early stage of the disease. Their courses as well as prognose were favorable.
In conclusion, physicians should confirm gas and abscess formation early using image diagnoses, even for patients with mild symptoms, and administration of appropriate antibiotics and incision drainage during the early disese stage are important for a good prognosis.
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