The region of the roof and posterior wall of the epipharynx which makes up the boundary between the nasal fossae and the pharynx and a part of the upper respiratory tract forms a sharp angle and, by nature of its anatomical structure, is subjected to intense irritation and is markedly influenced by mechanical and physical forces as well as by bacterial action. The morphological and histopathologic changes of this region of the pharynx were studied. Gross examination of 191 bleached skulls, consisting of 134 males and 57 females, revealed the presence of a particular form of ossification in this region in 41.4 per cent of the specimens. On closer study of the shape and locality of this ossification, it was concluded that no pathologic process was involved because of the unvarying site of the bone formation, that it was not a senile phenomenon because it was found in all age groups, and that it served no supportive function as its delicate structure crumbled easily on touch. In view of the fact that the crest of this bone formation and the underlying archlike bone seemed to show parallel movements and the fact that the bone formation projected into the epipharynx and was inclined toward the pharyngeal wall, resulting in narrowing of the nasopharyngeal fossa, it was speculated that its formation was related to an adaptative response to respiratory air currents. Next, pathohistological examination of this region in 64 cadavers, consisting of 44 males and 20 females, revealed in general inflammatory findings in each case. Among those in which the histological findings showed strong tendencies toward fibrotic changes, formation of the bony tissue was observed in 31 specimens. As the roof and posterior wall of the epipharynx is continuously exposed to respiratory air currents, dust-laden air and bacteria, incessantly stimulated during upper inflammatory inflammations or naso-sinusitis, which is prevalent in our country, or intermittently to irritation by choanal discharge, the high incidence of bone formation in those with strong fibrosis of this area suggests that the bone formation results from ossification in the fi brous tissue due to the chronic stimulation produced by these conditions.
The primary laryngeal cancers in 43 recurrent cases following treatment by irradiation were clinically classified and graded. Supraglottic cancer was found most frequently, in 22 (51%) of the cases, followed next in frequency by subglottic cancer. Graded as to severity, 33 cases (79%) belonged to T3 or T4, which indicates that the malignant growth was already fairly far advanced before radiotherapy. Macroscopic examination of the excised laryngeal specimens revealed infiltration of the recurrent cancer into the vestibule or the anterior commissure in 30 cases (70%). The overall 5-year-survival rate was 37 per cent. The separate rates for T2, T3 and T4 were 57 per cent, 39 per cent and 17 per cent respectively, showing poorer prognosis with advance in severity of the disease. Histopathological examinations of sagittal sections of the right and left sides and through the mid-line of the excised laryngeal specimens revealed squamous cell carcinoma in each, mostly showing a high degree of differentiation with cornification in 33 cases (77%). Invasion of the malignant growth into the thyroid and cricoid cartilages was observed in 12 cases. Localization of the tumor to only one side was seen in only a small number (30%), most (70%) showing spread to the mid-line or to the opposite side. Findings that appeared to indicate a very early stage of the recurrent cancer were found 1) around the abnormally developed area of cornification, 2) around necrotic areas, and 3) in contracted fibrous tissue. Post-irradiation changes such as ravaged blood vessels, swelling of the intima, disarrangement of elastic fibers of the tunica interna, atrophy of disappearance of glandular cells and degeneration of cartilage were observed.
We experienced very large epiglottic cysts which were removed through lateral pharyngotomy. The first epiglottic cyst of aged 66 years old, male, was hen's egg size, located on the anterior surface of the epiglottic and reached to the root of the tongue of the right side. The second one of aged 57 years old, male, was hen's egg size also, developed from the aryepiglottic fold and the margin of the epiglottic of the right side. These histological studies were epidermoid cyst and they were considered retention cysts depending on inflammatory reaction.
A case, 17-year-old female, involving tuberculosis of nasal mucosa was reported. She had no tuberculous lesion in her other organ clinically except septal mucosa and floor of nasal cavity where her finger was able to come in contact with. She was treated with SM, PAS and INAH, then after 6 months, no pathologic granulation was found in the nasal mucosa.
Gentamicin was administered to 15 patients for treatment of chronic suppurative otitis media in 6 and postoperative infection of the middle ear in 9. Before treatment all 6 cases of chronic otitis media complained of obstinate otorrhea, and Pseudomonas aeruginosa and Staphylococcus aureus were demonstrated in each of these cases. Treatments were markedly effective in 4 (26.6%), effective in 7 (46.6%) and ineffective in 4 (26.6%). Thus an overall effective rate of 73.2 per cent was obtained. No discernible side effects on kidney and vestibular functions were observed with administration of the drug. On the basis of the results of this clinical trial, Gentamicin appears to be as effective as other conventional antibiotics such as Colistin or Polymixin used in the treatment of infections due to Pseudomonas. aeruginosa or Proteus vulgaris.
A method is described for plastic repair of the external auditory canal and mastoid process. after radical operation of the middle ear in cases that show poor healing with persistent otorrhea and moistness of the wound. The method consists of the following steps: 1) A hinge flap made behind the ear and used to repair the posterior wall of the external auditory canal. 2) A fasciomuscular flap for filling the mastoid cavity and to repair the middle ear cavity. 3) The use of pilot sutures to securely cover the portion from the middle ear cavity to the deep part of the external auditory canal with fascia from the fascio-muscular flap. Favorable results have been, obtained with this method in our cases.