An electronmicroscopical study was performed to analyse the current controversy upon the histogenesis of the pleomorphic adenoma of the salivary gland. Morphological characteristics of the pleomorphic adenoma of the parotid gland were studied and were compared with those of the embryonal ductal and myoepithelial cells of the human parotid glands and also with those of the cultured cells of the normal human parotid glands, Morphology of the tumor cells constituting the pleomorphic adenoma is characterized by its diversity but ultrastructurally apparent transition from the tumor cells similar to the typical peripheral duct cells into the chondroid cells are observed. Histogenetically the peripheral duct cell plays the dominant roles in this tumor. But judging from the morphological characteristics of the tumor cells and also from the histoarchitecture of the tumor, the myoepithelial cells are also involved in tumorigenesis. Tumorigenesis from the reserve cells which preserve multipotentiality to develop into the ductal cells and also into the myoepithelial cells may explain these inconsistency. During early developmental stage of the embryonal parotid gland, primitive intralobular duct cells are regularly doubly layered. These cells located in the basal layer are confirmed ultrastructurally to develop into the myoepithelium in the later stage, but it is also assumed possible that these cells are basal cells whhich have a potentialty to developed into the ductal cells simultaneously. By tissue culture of the human parotid gland outgrowth of cells which have morphological characteristics of ductal epithelium are observed. The cytoplasm of most of these cells are characterized by abundant presence of the various filamentous structure. This shows thatenvironmental change can easily influence upon formation of the filamentous structures in the cytoplasm of these cells. The filamentous structures which are commonly observed in the tumor cells of the pleomorphic adenoma are difficult to be definitely discriminated morphologically, whether myofilaments or tonofilaments.
The authors report 4 cases, 3 females and a male, of sinobronchitis. The duration of the disease ranged from 1 year to 33 years. All the cases underwent sinusectomy for correction of the chronic sinusitis. Rhinological findings e. g. intranasal findings, x-ray findings, operative findings, and pathological findings of the antral mucosa have been studied in relation with the lower airway findings e. g. bronchoscopic findings, bronchographic findings, pulmonary funtion test results and pathological findings of the biopsied mucosa of the right bronchus. In two cases the frontal, sinus was lacking and purulent sputum was discerned under bronchoscopy. Sinusectomy in the two cases failed to improve the lower airway symptoms. In the other two cases however, not only the the nasal symptoms but also the lower airway symptoms have improved after sinusectomy. The authors discuss the relationship between the upper and lower airway symptoms.
Department of Otolaryngology, The Jikei University School of Medicine The authors report a case where anastomosis of the trachea succeeded after many difficult trials. A 40-year-old male developed stenosis of the trachea due to granulation proliferation at the end of a tracheal cannula. The granulation had to be removed frequently, which each time was followed by a placement of a stent. Local granulation however, could not be controlled and the stenosis recurred invariably after every procedure. Four tracheal cartilages from no. 2 to no. 5 or 4 cm in length were then excised and was followed by end to end anastomosis. But the scar tissues and adhesions with the surrounding tissues again separated the two ends. The anastomosis finally succeeded after using the laryngeal release by the methods after Montgomery and Dedo-Fishman together with separation of the pharyngeal sphinctors. The postoperative course has been uneventful except mild limitation in extension of the neck and lack of smoothness in swallowing.
A 33-year-old male with a history of bilateral chronic otitis media was seen with complaints of uncomfortable sensation at the retroauricular area and left shoulder. Digital examination of the left pharyngeal wall revealed a bony protrusion with tenderness at the lower pole of the left tonsil. This finding was highly suggestive of an elongated styloid process. Plain X-rays and laminagrams also indicated the condition. Under general anesthesia, an external cervical incision was made between the external ridge of the mandible and anterior ridge of m. sternocleidomastoideus. Submaxillary gland and the lower part of the parotid gland were then exposed. The elongated process was searched between these two glands and extirpated. After the operation the symptoms improved but the patient presented abnormal mandibular movement. Adolfo Bruni and others called this “excellent function of mandible”. The authors attributed this to the injury to the left side of m. stylohyideus, which produced asymmetric movement of the hyoid bone. This abnormal movement improved gradually. The elongated styloid process causes various symptoms in the head and neck area as this affects tissues, nerves, and veins in the parapharyngeal space such as the pharyngeal wall, n. glossopharyngeus, n. hypoglossus, cervical sympathetic nerve ganglia, sympathetic nerves, a. carotis and process itself may form ex. pseudoarthrosis.
The deviated nose can be classified into two, namely, the bony deviation and the cartilaginous deviation. The surgical procedure to the bony deviated nose is represented by lateral osteotomy. The cartilaginous deviated nose can be caused by imbalanced development between the septal cartilage and lateral cartilage. The treatment consists maikly of surgery on the septal cartilage. The author performs the operation on the cartilaginous deviated nose according to the Killian's method as follows: The septal perichondrium is detached bilaterally and the septal cartilage is resected partly as a large piece, which is preserved for later use. The upper part of the remaining septal cartilage is detached bilaterally and made movable. The removed cartilage is worked on a little and inserted again into the nasal septum and mattress sutures are placed for fixation. The present paper introduces a simple method for correcting cartilaginous deviated nose.