The problems associated with operative traumatic facial paralysis as acomplication of middle ear and mastoid surgery were described on the basis of experience of treatment of 113 patients by the author during the last 18 years. This figure corresponds to 5.4% of the author's series of 2, 112 patients with facial palsy of various etiologies. While the incidence of the iatrogenic facial paralysis has been decreasing recently, the otologic surgeon has to always keep in mind the possibility of surgical injury to the facial nerve whenever he encounters the following situations: 1) the sclerotic mastoid with microsized antrum, 2) distorted anatomical landmarks either by cholesteatoma or tympanosclerosis, 3) unusually well pneumatized mastoid, 4) dehiscence of the facial canal, 5) anomalous course of the facial canal, and 6) excessive bleeding which frequently occurs under general anestesia. As to the treatment, emphasis was placed on the importance of the immediate re-exploration of the damaged portion and appropriate repair of the nerve. Even in a long-standing case, the nerve should be inspected and repaired before plastic correction of the facial disfigurement is considered because the injured nerve often keeps its regenerating potential for several years.
Since its initial introduction in 1950 to the research of otolaryngology, the electron microscope has been used mainly for the studies of the nasal mucosal epithelium or cilia. Although the importance of the epithelium as a defence organ with such a unique function as mucus transport has been well understood, attention should also be given to the vascular system of the mucosa, which comprises the greatest part of the mucosa and which controls the humidification and heating of the inspired air as well as the capacity of the nasal fossa. The peripheral vascular system of the nasal mucosa has been studied by the light electron microscope since the 19th century. However, the recent introduction of the electron microscope into such research enabled us to observe further details of the mucosal ultrastructure. The author describes the recent knowledge of the vascular bed of the nasal mucosa, which was obtained by means of the transmission electron microscope (TEM) and scanning electron microscope (SEM). The ultrastructure of the fenestrated capillaries was investigated by means of TEM, while collodion casts were prepared for the observation of the vascular structure by means of SEM. The authors detected many capillaries with hair pin curves in the nasal mucosa near the nares.
In the present paper, the electrically induced stapedial reflex (ESR) test has been applied to facial palsy patients in order to study its clinical utilization. There were two reasons why we selected facial palsy patients as the first objects of this study. Firstly, the acoustical stapedial reflex (ASR) test has been used as the diagnostic means, not only for the tonotopic diagnosis but for the prognostic one, and this view is supported by many articles. Secondly, as the ascending pathway of the ESR is partly composed of the somatosensory branches of the facial nerve, we thought that in some patients the reflex pattern would, be different between the ASR and the ESR. We studied 15 patients and in these 15 patients, a different pattern between the ASR and the ESR existed in three patients. In one patient the threshold of the ESR was not different between the healthy and the affected side, but the ASR was diminished on the affected side. On the contrary, in two patients the ESR was absent or diminished on the affected side, while the ASR was not different between the healthy and the affected side. These two patients complained of hypesthesia of the posterior wall of the external auditory meatus. In 12 other patients the ASR and the ESR showed almost the same pattern. We therefore concluded that among the various methods of diagnostic means for facial palsy, both reflexes have almost the same utilization except in rare cases.
Rhabdomyosarcoma is a relatively rare tumor, but it appears most frequently in the region of the head and neck, and is said to be the most malignant of all the tumors which develop in the soft tissue. In step with the improvement of diagnostic methods, the number of reported cases is increasing steadily. Irradiation, chemical and surgical therapies and their combinations have improved the prognosis of the disease, but the cases with remote metastases still have poor prognoses. At present, the chosen therapy consists of a very positive chemotherapy with various kinds of drugs, although such therapy often causes severe sideeffects. Cooperation among the related departments for good team work seems to be essential in the treatment of this disease.
A total of 124 cases with cancer of the maxillary sinus were treated during the period from 1960 to 1980 at the Department of Otorhinolaryngology, the Jikei University School of Medicine. A review of the late 58 cases revealed that the combined therapy consisting of local chemotherapy, irradiation followed by radical surgery was the treatment with the best results. We treated 39 cases of cancer of the maxillary sinus during the period from 1976 to 1980. The main treatment was the combined therapy consisting of local chemotherapy (5 FU), irradiation (4, 000 rads) and radical operation. 3-year cumulative survival rate was as follows: total, 52%, T2 67%, T3 62%, T4 0%. Stage I 80%, II 72%, III 21%, IV 0%. There was an increase in the incidence of anaplastic cancer, which is more likely to metastasize resulting in poor prognosis.
A case with postsurgical stenosis of the external auditory canal is reported. The patient was a 26-year-old female complaining of left progressive conductive deafness, tinnitus, pain in the postauricular region and dizziness of 6 months' duration. Cholesteatoma with intact tympanic membrane was suspected. Tympanatomy revealed tympanosclerosis in the middle ear cavity, especially in the epitympanum. The stenosis of the external auditory canal occurred approximately 2 months after the middle ear surgery. Following the extirpation of the cicatricial tissues of the stenosed lesions, a stent of microporous expanded polytetrafuruoroethylene (EPTFE) was inserted into the opened external auditory canal for approximately 7 months. The external auditory canal remained wide open after removal of the stent. Histopathology of the stenosed lesions showed fibrosis with hyaline degeneration. It is of great interest to note that hyaline degeneration was noted in both the tympanosclerotic tissue of the epitymanic cavity and the cicatricial tissue of the stenosed external auditory canal. A causative relationship may possibly exist between these two lesions.
Over the last four years, we have encountered four cases of cholesterol formation in the nasal polyp in our hospital. These patients had no previous history of nasal and/or paranasal surgery. Cholesterol clefts were noted in the acidophilic fluid of the cystic space of the nasal polyp in three of the four cases. One case was included in which the predominant histological picture was of cholesterol clefts with a surrounding foreign body giant cell reaction and granulation tissue formation. The origin of cholesterol in these lesions was obscure. It is presumed that the relatively insoluble cholesterol was dissociated from the lipoprotein complex derived from fluids and/or destroyed cellular elements in the cystic nasal glands of the polyp. The pathogenesis of the cholesterol granuloma in the nasal polyp was discussed as compared with that of the middle ear.
Video ENT flexible fiberscopy using the ENT flexible fiberscope and video system is described. ENT flexible fiberscopes (ENT US-30S, US-30P) and a xenon light source (RX-500J) were developed by Machida Opt. Co. A video system composed of a video camera (DXC-1850, DXC-6000), video monitor and videocassette recorder was developed by SONY Co. 3/4 inch U-matic video tapes were used. Patients aged from 14 hrs after birth to 77 years were examined successfully. A clear and enlarged view on the TV monitor was sufficiently reliable to evaluate the disorders. The video fiberscopy was especially useful in the case of congenital stridor in the neonatal period. The use of video home system in this method is difficult at present because of insufficient quality in home video equipment. Some problems to be solved were discussed briefly.