Cholesteatoma of the middle ear appearing after surgery is called either recurrent cholesteatoma, residual cholesteatoma or iatrogenic cholesteatoma (Sheehy). The author has encountered such cholesteatomas in 79 cases out of 194 operated cases and classified them as follows: I Recurrent cholesteatoma A) retention cholesteatoma 1. cholesteatoma formations due to retraction of the neo-tympanic membrane into the attic space, 2. cholesteatoma formations due to retraction of the posterior wall skin into the mastoid cavity through a hole in the posterior bony wall. B) invasion cholesteatoma cholesteatoma formations due to migration of the external canal skin into the middle ear after a loss of the grafted membrane II Residual cholesteatoma III Embedded cholesteatoma (iatrogenic cholesteatoma) Recurrent cholesteatoma often appears in cases where the posterior bony wall is preserved during an operation, and, particularly so, when cholesteatoma develops in the attic space. The author feels it is essential to reconstruct the lateral wall of the attic for prevention of recurrent cholesteatoma
Reported is a 19-year-old male, an university student with latent schizophrenia, who had been complaining of disfigurement of the face, protrusion of the cheek bones and nose, for four years, The patient insisted on receiving a cosmetic operation on his face, although the disfigurement was very slight and objectively not significant. Although cosmetic surgery in such cases with latent schizophrenia is considered to be contraindicated, the author performed a very minor surgery as a part of psychological treatment, in which the protruded cheek bones were chiseled slightly. In spite of the slightest changes obtained postoperatively, the patient was elated after operation and showed a very favorable course in terms of the underlying disease
A review of 66 cases of facial paralysis encountered in our clinic during the past two years (1974-1975) was made. Among them, 61 cases were the peripheral facial palsy including 35 cases of Bell's palsy and 11 cases of Hunt's syndrome. Prodromal signs and symptoms that appeared to have been caused by virus preceded the facial paralysis in about 46% of the patients in this series, while taste disorder was associated in 50% of these subjects. The prognosis of Bell's palsy caused by viral infection seemed to be poor. The preliminary results of a controlled study with randomly selected drugs, and those in which a new combination with the usual medicaments (U. M.), such as vitamine B group and tocopherol nicotinate, and Coenzyme Q10 as substitute for ATP in Bell's palsy (18 cases) and Hunt's syndrome (7 cases) during 1975 were reported. The purpose for selecting this new combination with such a drug was to compare the efficacy of Coenzyme Q10 with that of ATP and to search for a much more effective medication for the conservative treatment of f acial palsy. A complete cure was obtained in 83.3% of the patients treated with Coenzyme Q10 plus U. M. and in 66.7% of those given ATP with U. M., showing a significant difference between the two (P<0.05). Based upon these findings, it is concluded that the combined administration of Coenzyme Q10 and U. M. was an effective therapeutic regimen for the treatment of Bell's palsy and also in Hunt's syndrome if performed at an early stage (within two weeks) after the onset of the paralysis.
This 59-year-old male was initially treated by a general practioner under a diagnosis of acute laryngitis because the patient developed hoarseness after an upper respiratory infection. In about one month, the patient was seen by an otolaryngologist who found the cause of his hoarseness was left recurrent nerve paralysis which was considered to be due to viral infection and was treated conservatively for about three months without improvement. The patient visited the authors' hospital three and a half months after the onset of the disease. He was then found to have tuberculous lesions in the upper lobes of both lungs. Culture of his sputum showed a positive result for tuberculous bacilli. The tuberculous lesion was taken into consideration as a possible cause of his recurrent paralysis. Meanwhile, the patient developed severe pain in the chest, which was found to be due to deformans of the cervical spine. Traction of the cervical spine relieved the symptom rapidly. A few months later the patient developed fracture of the left iliac bone, for which canvas traction was used. The patient developed dyspnea one night lasting for about 30 minutes, which was later found to have been caused by bilateral vocal cord paralysis. The patient died due to cardiac arrest two days after a tracheostomy was perfomed. The autopsy revealed concurrent adenocarcinoma of the left lung. It was difficult to identity the true cause of the vocal cord paralysis because the lung tumor was concealed by the pulmonary tuberculous lesion and the patient did not show any significant symptoms suggesting the lung cancer.