Congenital abnormality of the course of the facial nerve, which was though to berarein the past, has been reported sporadically. Our encounter with such a case was reported here. The cervicallyn-iphnodes, heart, lungs, small intestines, uterus and vagina. As well cautioned in the literatures, good number of sarcomas mimic the so-called progressive gangrenous rhinitis in symptomatology. It was emphasized that this disease should beevaluated with great care.
Peritonsillar abscess is one of the frequently encountered dseases and can be treated with relativeease, using antibiotics and other chemotherapeutic agents. Our patient was a 64 year-old male, who had peritonsillar abscess with dysphagia and pharyngeal pain. The patient was treated by incisi ondrainage followed by postoperative antibiotics and was discharged. In two days after his dis charge, he suddenly developed nausea, vomiting and abdominal pain, for which he was readmitted in poor condition. Vomitus was of coffee-like. In spite of aggressive treatments, the patient diedo furemia on 6th hospital days before GI series and esophagoscopy were performed. Auto psyrevealedan abscess extending from posterior wall of the hypopharnx to the mediastinum, and agastriculcer. Large amount of free blood was in the intestin es. It was presumed that the I & Dand the use of antibiotics cured the peritonsillar abscess but an abscess developed in poste riorwall of the hypopharynx and descended down to the mediastinum. This abscess remained unnoticed since his temperature was normal. Only GI symptoms became do minant. The aged patients often fail to manifest typical symptoms because of the poor body response. Therefore such patients should, be followed closely even after the patientsare improved.
In the field of Otorhinolaryngology, Neurinoma (neurilemmoma, Schwannoma) is well known as a acoustic tumor. patient was a 17 year-old male, who denied any head injuries in his past. Inspection and other examination failed to reveal any sign and symptom of Osteogenesis imperfecta. During operation he was found to have abnormal course of the facial nerve invertical segment of the temporal bone with a little posterior displacement. Kettel in 1909 recorded 4 segments, where abnormalities located. And he classified these segments as follows: Type 1 Abnormality in labyrint hsegment Type 2 Abnormality in horizont alsegment Type 3 Abnormality in pyramid alsegment Type 4 Abnormality in vertica lsegment Therefore our case belongs to Type 4 according to his classification. The exposed portion of the facial nerve was covered by the temporal fascia. On the 3rd postoperative day t hepatient developed facial paralysis but it disappeared in 4 weeks. It was thought that our case was one of the so-called asymptomatic auditory organanomaly Takahara without visible malformation of the temporal bone.
A eight year-old boy was first seen in our Clinic in May, 1966. He was involved in traffic accident in April, 1964 sustaining cointusion of the frontal head. Following this accident he had 7 episodes of the suppuative meningitis by Feb. 1966 accompanied by increased dischage of thecerebral fluid (the liquor). with use of anibiotics during each episode, nesal leak of the cerebra lfiuid became less in amount. Extranasal ethmoid sinus exploration was scheduled because a bone defect was suspecte dpreoperatively. In operation a bone defect was confirmed. The defect, size of index finger tip, involved the lamina cribriformis and tegmentum of the posterior ethmoid sinus, and the cerebra lfluid was found to be leaking through this defect. The defect was closed using bone wax and Aaron alpha (adhesive polymerizer) after the adjacent bone was exposed removing all granulation tissues. In 2 months postoperatively, the patient developed a recurrence of the leak which last edfor a week. It subsided spontaneously. He has been doing well ever since. It was presumed that the bone defect was closed primarily by bone wax and then reen for cedby the graulation tissue. The leak of the cerebral fluid, caused by fractured base of the skull, can be epected moreoften, as the traffic accidents tend to in crease. There are many operative procedures vailable for these patients, but in some cases the simple procedure such as ours is believed to be an operation of choice. Though neurinomas occuring in the nasal cavity or the pharynx have been reporte dspora-dically, it rerely originates in the middle ear and mastoi dregions. Our case reported here is 40th in the World and 4th in the Japanese literatures, toour best know le dge. Patient was a 5-year-old girl, who was brought to our Clinic on January 7, 1967 with right sided facial paralysis and hearing hardness. A tumor involving the external ear canal and mastid was removed. Gross and pathologic findings were ompatible with the facialneurinoma. Her postoperative course was uneventful.
A case of the so-called progressive gangrenous rhinitis was encountered. Initially, patient developed signs and symptoms of the allergic rhinitis. In spite of aggressivee treatments, thepatient deceased in a year and three months. Autopsy revealed reticulum cell sarcoma originating from the nasal septal mucosa on right side, and multiple metastatic lesions were found in the
Maxillary sinusitis of dental origin is caused by suppurative extension of the tooth supporting tissues which locate adjacent to the maxillary sinus, or rarely it can be caused when a chronically infected root is impacted into the maxillary sinus with tooth extraction. To establish diagnosis of this type of sinusitis, the orally taken X-ray films give sval uable informations. Findings of the films are not final for the diagnosis but they should be considere dalong with other informations. Currently two types of films are available, the dental and the occlusal films. For adequate reading of the orally taken X-ray films, several points should be kept inmind. First in the oral technique, it is to be reminded that the films are not placed parallel to the tooth, but are placed so that actual length of the tooth is projected on the films. Therefore direction of the main X-ray beam and its relation to other structures should be well kept in mind with film reading. Secondly, in reading the dental roots and the adjacent areas, on should be meticulous about whether or not transparency around apex legion is present, whether or not the black lining of periodontium is normal in width and whether or not the defect of periodontium is visible around the lining of period on tium. These must be carefully observed on the X-ray films to rule out the suppurativelesions of the tooth supporting tissues. Then their relation to the maxillary sinus base is re-evaluated on t he films. All these informations should be available for the final diagnosis.