The purpose of functional surgery for cancers of the head and neck is to enable the patient to live a normal social life as he did before he was afflicted. Although the final objective of the treatment is complete cure of the disease, the first objective is to prevent the lesion from further extension and metastasis in case it is incurable, and enable the patient to return to his social life, even with microscopic evidence of the lesion present. Close observation and Immediate response to any sign of extension are mandatory to confine the disease at one site and enable the patient to continue his social activities. In the treatment of maxillary carcinoma we found that the extension of cancer could be brought under control and the survival rate increased by a small dose of irradiation when combined with chemotherapy and surgery. Irradiation as small as 1000 R has produced histological damage in the cancer cells of 3rd or fourth degree changes in Shimosato's classifiction in 50% of our cases when combined with local debridement. Some remaining cancer cells may be suppressed by interstitial reaction. The control of cancers of the head and neck could be accomplished by a comprehensive understanding of the disease and the organism. The main objective of functional surgery is the total care of a patient and not simply the disease.
Two cases of aspergillosis of the maxillary sinus are reported. The first case is a 43-year-old female characterized by foul odor, rhinorrhea, toothache and nasal bleeding. The maxillary sinus was opened with suspicon of malignancy, but the sinus was filled with caseous mass, pathological examination of which revealed aspergillosis. The second case is a 52-year-old female who was presented by right nasal obstruction, right otalgia and bloody postnasal discharge. Culture of greenish brown crust in the nasal cavity showed aspergillosis. A search of literature revealed a total of 39 cases of candidiasis of the paranasal sinuses. The authors surmised that structural abnormalities of the nasal and paranasal cavities and susceptibility of the mucous membrane are the important elements for the development of such lesions. The treatment of candidiasis of the paranasal sinus is relatively easy if treated before the lesions becomes invasive.
A 35-year-old male who had been examined at the University Hospital because of a sore throat and otalgia was found to have a tumorous lesion in the nasopharynx. Biopsy of the lesion indicated a lupoid change due to tuberculosis of the nasopharynx. The patient was free from tuberculous lesions at any other site, thus the nasopharyngeal disease appeared to be the primary. The lesion was cured by administering routine antituberculous therapy. The authors report the details of the case together with a review of the literature on such lesions.
The materials which are used as columella in tympanoplasty can be classified as autogenous, homogenous and alloplastic. Merits and demerits of the respective material have been discussed by many researchers. The authors devised a useful columella which is a combination of homognous and allogenic materials, utilizing the merits of the respective material. The authors constructed a columella by inserting a polyethylene tube into the center of a plate of cartilage from the auricle, which was about 4 mm square. Care is taken so that the polyethylene tube does not penetrate the cartilage when it is drilled into the cartilage. Such columella, a combination of autogenous and allogenic materials was found to be easy to use because the length of the strut could be cut to adjust to a given case and, at the same time, showed excellent results during a 3-year postoperative observation period. The neotympanic membranes were less likely to be perforated as the polyethylene tubes were not in direct contact with the membranes.