Temporal bone with low middle fossa tegmen is one of the causative factors of troublesome complications in cholesteatoma patients.
One hundred and thirty-five consecutive patients with acquired cholesteatoma, who visited Mitsui Memorial Hospital between 1993 and 2004 for ear surgery, were studied with a retrospective case series study design (75 males and 60 females, age ranging from 12 to 75 years old (mean 49), total 144 ears: 105 attic type and 39 pars tensa type).
Thirteeen cases were with low middle fossa tegmen, 33 cases had inner ear fistula, and facial nerve exposure was seen in 23 cases. Although there was no statistically significant difference compared to cases with normal attic space, the risk of complications was twice as high in cases with low middle fossa tegmen: inner ear fistula was seen in 38% (5/13 ears) and facial nerve exposure was seen in 31% (4/13 ears). We conclude that extra attention and fine procedure are necessary in mastoidectomy in such cases.

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Fibrous dysplasia involving the temporal bone is unusual. The most common initial findings are stenosis of the external auditory canal and conductive hearing loss. We report a case of monostotic fibrous dysplasia of the temporal bone. The patient was a 66-year-old man, who complained of hearing loss in the left ear and swelling of the left temporal region of the head. The left external auditory canal was stenotic, so an audiogram demonstrated a conductive hearing loss. A plain skull roentgenogram and CT scan showed swelling of the left temporal bone with ground-glass appearance and bony stenosis of the left external auditory canal. Canalplasty and cranioplasty were performed by a doctor of otorhinolaryngology and plastic surgery. The left external auditory canal was opened and hearing loss was improved, and this condition was maintained for one year after the operation at our hospital. Fibrous dysplasia is one of the benign and chronic proliferations of fibrous tissue and bone. Although it produces tumorous masses, not all authors agree that the process is truly neoplastic. Most cases involve a single bone, but about 20% of patients have polyostotic involvement and often with extraosseous abnormalities. This disease produces widely variable radiographic images. Often, there is a ground-glass appearance with a density similar to that of the surrounding cancellous bone, but lacking a trabecular structure.

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Cartilage is a very useful material in tympanoplasty. It is easily formed into suitable shapes and remains alive for a long time in the middle ear. We used auricular cartilage plates to reconstruct the tympanic membrane in five patients, including one with tympanic reperforation after tympanoplasty, one with advanced cholesteatoma with large defects of the tympanic membrane and tympanic mucosa, and three with adhesive otitis media. Hearing results and appearance of the tympanic membrane were good in all five patients. All patients were satisfied with the post-operative results. Our results suggest that the cartilage plate is a good material for reconstruction of the tympanic membrane to treat tympanic reperforation, which is difficult to close, and adhesive otitis media.

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We analyzed 20 cases of sinonasal inverted papilloma, in which surgical approaches were determined by preoperative staging by MRI. Endoscopic sinus surgery (ESS) was performed in one T1 case. ESS was selected in six of eight T2 cases, a combined approach with ESS and Caldwell-Luc (C-L) procedure was selected in one case, and an external lateral rhinotomy (LR) approach was selected in one recurrent T2 case. In 10 T3 cases, five were treated by the LR approach, three by ESS + C-L, and two by ESS only. ESS followed by radiation therapy was performed in one T4 case. These results indicate that surgical approaches other than ESS are required in some T2 cases, and a less aggressive approach than external LR, such as ESS or ESS + C-L, can be applied in selected T3 cases.

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Malignancy of the lacrimal sac is rare, and primary malignant melanoma in this region is extremely rare. Its current management consists of surgical excision, chemotherapy, and radiation therapy, but its prognosis is poor. We present a case of malignant melanoma of the lacrimal sac that masqueraded as chronic dacryocystitis. The patient underwent resection and radiotherapy (3OGy). The patient died because of distant metastasis nine months later.

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We report here a retrospective study of 54 patients with malignant parotid tumor who underwent facial nerve section at the Kurume University Department of Otolaryngology Head and Neck Surgery. The facial nerve was sectioned at the main trunk in 34 out of the 54 cases and was sectioned at its division in 20 cases. As for the breakdown of the 54 cases, 29 cases were no repair, 22 cases were simultaneous reconstruction (nerve graft: 18 cases), and 3 cases were two-period reconstruction. As for the mean scores of facial paralysis, each technique for reconstruction showed scores of 30/40 in the nerve graft technique, 20/40 in the temporal muscle rotation technique, and 18/40 in the static reconstruction with thigh fascia transplantation, respectively. Fifteen cases of nerve graft were followed up for 1 year. Of these cases, 5 cases showed scores over 30/40, 3 cases of which underwent radiotherapy. The paralysis score of the postoperative radiotherapy group was 28/40 on average, and for the non radiotherapy group was 30/40 on average, showing no significant difference in improvement of paralysis.

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Eight cases of salivary duct carcinoma in the parotid gland are reported. Neither fine-needle aspiration biopsy nor frozen section was an effective tool for diagnosis before or during surgery. Radiation therapy and/or chemotherapy did not show preventive effects on cancer relapse. Although surgical operation was performed for all eight cases, only three were cancer-free when we traced the cases at 2.8 years after surgery. Even enlarged total parotidectomy allowed distant metastasis after surgery in the cases of preoperative facial nerve palsy. Therefore, it is conceivable that en-block extirpation including tumor, parotid gland, and facial nerve is appropriate for those cases to decrease the scattering of tumor cells during surgery. Further studies of diagnosis, surgical procedure, radiation therapy, and chemotherapy are needed to improve the prognosis of SDC.

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A rare case of basal cell adenoma in the bilateral parapharyngeal space is reported. A tumor in the left parapharyngeal space was bluntly enucleated by the cervical-parotid approach and two tumors in the right side were enucleated by the cervical approach. Pathological diagnosis of all three tumors was identical to basal cell adenoma. Multiple occurrence of this benign tumor in the bilateral parapharyngeal space required a careful follow-up because the differential diagnosis of basal cell adenoma between basal cell adenocarcinoma and adenoid cystic carcinoma is usually highly confusing.

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The Easculap Company provides the Frankfurt retraction system for thyroid surgery. We applied this retraction system to 14 patients with thyroid cancer from February to September 2004. We retrospectively checked the duration of surgery, blood loss, complications and length of stay and compared these parameters with those of a control group who underwent the same surgery without this retraction system from May to December 2003. No statistically significant difference was noted between the two groups (paired t-test). We observed that there were no increases in the complication rate using this device. We can educate young doctors in surgical techniques using this device with both hands free to maneuver. We conclude that this retraction system is useful for thyroid cancer surgery.

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