In a 60-year-old male, bilateral radical neck dissection and resection of bilateral internal jugular veins were carried out in two stages for metastasis of carcinoma of the larynx to bilateral submandibular lymph nodes following irradiation. Postoperatively, sequelae of operative insult such as facial edema, edema of thehypopharynx and larynx, difficulty in swallowing due to motor nerve paralysis, paralysis of bilateral hypoglossal nerve, and left Horner's syndrome were noted. On the 20th postoperative day, pneumonia due to swallowing occurred, leading to shock-like symptom accompanied by transient disturbance of consciousness. Recoverry was seen through maintenance of the airway. Such complication was considered to be due to anoxemia on account of insufficient gas exchange in the lung, in view of the complete absence of symptoms referrable to intracranial cerebral nerves following recovery from the shock. Subsequently, metastasis to lymph node above the left scapula was noted and this was removed. After the operation, patient fell into shock, without recovery of consciousness, and died on the 11th postoperative day. Among cases subjected to bilateral radical neck dissection, resection of bilateral internal jugular vein is only rarely necessary. According to the statistics of our Department during the part 5 years, this was performed only in 1 case. As regards the justification of the resection of internal jugular vein in bilateral radical neck dissection, various complications due to resection of bilateral jugular vein are discussed through a review of literature.
The authors reported three cases of blood disease that manifested the initial symptoms in the pharynx and larynx. Case 1 was a 73-year-old male whose initial complaint was a sore throat. The patient was first seen by a local doctor who suspected acute pharyngitis. He was transferred to our hospital because of high fever and as the sore throat persisted. The patient was found to have a markedly edematous epiglottis which was incised. Blood examination revealed leucocytes 100/cmm3 with lymphocytes 98%, reticulo-lymphocytes 2%. On the following day of admission, the leucocyte count decreased to 100/cmm3 and the patient died. The diagnosis was agranulocytosia. Case 2 was a 23.year-old female who manifested a sore throat and a fever. A marked epiglottic edema was found and incised. Blood examination disclosed platelets 1.1×104. The patient died on the 7th hospital day after an extensive hormone therapy. The diagnosis was leukemia. Case 3 was a 19.year-old female whose chief complaints were a sore throat and a fever. On examination, the tonsils' were coated with white fur and cervical lymph nodes were palpable. Blood examination revealed a marked leucocytosis. All the symptoms were improved in about 2 weeks. The diagnosis was infectious mononeucleosis.
Hypotensive anesthesia has long been practiced in an attempt to depress the amount of bleeding during operations. The method is considered to be very useful for various surgical procedures in the realm of otolaryngology where routine hemostatic measures are less effective. Excessive bleeding during operations often distorts orientation in the operative field, prolongs the operating time and makes the procedure more difficult. The authors reported on their experience with hypotensive anesthesia with Arfonad during vidian neurectomy.
The authors reported a method of resuscitation used in a 2-year-old child who suffered from a sudden obstruction of the airway at the subglottic space due to a foreign body, a peanut. The patient had been seen at different medical institutions because of repeated pneumonia without the knowledge that the patient had a foreign body in the bronchus. The parent of the patient seeked a laryngological examination and during the examination patient suddenly developed sever dyspnea due to a complete obstruction of the subglottic space by the foreign body. One of the authors blew forcedly his expiration into the mouth of the patient with the nostrils obstructed as in the mouth to mouth breathing. The foreign body was successfully slipped from the subglottic space and dropped into one of the bronchi when the dyspnea disappeared and the patient was resuscitated. The authors proposed that this was a very useful method among other procedures because of simplicity and less chance for complication. The peanut was successfully removed at a later day under general anesthesia.
The authors presented two cases where pathological diagnosis was distorted due to inadequate preparation and handling of specimens obtained in biopsies. In the first case, a specimen from a sebaceous cyst in the external ear was misdiagnosed as adenocarcinoma because of an improper description of the lesion. In the second case a pathological diagnosis of undifferentiated carcinoma was unduly delayed because of inadequate fixation of the specimen. The adequate preparation of the specimen is essential for the pathologist to reach a correct diagnosis. The authors stressed that otolaryngologists should work with pathologists in making diagnosis of complicated cases.