The efficacy of the facial nerve decompression was investigated in 21 surgical cases and 143 nonsurgical cases. Having used retro auricular transmastoid approach for decompression, we did not open the internal ear canal. Results are summarized as follows. Electroneurography was the most useful in determining the indication of the operation. When degeneration of fibers of the facial nerve was estimated at more than 95%(less than 5% in electroneurography), operation had to be considered. Recovery of surgical cases was better than that of nonsurgical cases, whose prognosis had been considered to be as poor as the former before the treatment. From the standpoint of the timing of operation, the earlier the decompression operation was carried out, the better the recovery was. Authors propose that otologists decide the indication of operation at least within 3 weeks, preferably 2 weeks after the onset of palsy when the prognosis is considered to be poor.
A statistical observation was made in a total of 1, 520 cases consulted at the emergency outpatient service of the department of otorhinolaryngology during the one year period from April 1, 1982 to March 31, 1983. Patients' ages covered a wide range, but the incidence of children was especially high. Therefore, as to diagnosis, acute otitis media and nasal bleeding were observed with high incidences. No seasonrelated changes were observed. However, most of the patients were brought to us on holidays or on the previous day of holidays. The number of patients who came to us on such days was higher than the annual mean number of patients per day. Two hundred and fifty-four (16.7%) patients were brought to us in an ambulance, the commonest diagnosis in them being nasal bleeding and acute otitis media. As to the residence of patients, most of them lived near our hospital. Out of these, 2.2% patients were hospitalized. In this study characteristics of diseases of these patients were analyzed and results are reported. From the results obtained, the following were revealed. 1) Diseases of the pediatric otorhinolaryngological field were pervailing, 2) Observed symptoms were mild in nature in most of the patients, and 3) Most of the patients had emergent illness which required no hospitalization.
In the treatment of fractures of the mandibular condyle caused by a motorcycle accident, operative reduction was performed with the following results: 1. Two cases of fractures of the condyle were treated with operative reduction with favourable results. 2. Risdon's approach by which an incision is made along the inferior mandibular margin was found to be safer than a preauricular incision and to cause no intraoperative side effects. 3. When treated by the transosseous wiring fixation method which consists of making a sulcus on the surface of the mandibule and burying a wire along the sulcus, no protruded area was left in the osseous surface. Moreover, this method did not cause any disturbances in articular movements and was then said to be a good method. The above described devices for operationcould minimize disadvantages associated withoperative reduction. This treatment method wasmore useful than the closed reduction.
A 49-year-old man with a past history of several frontal sinusectomies was seen to have a large swelling in the frontal area. During surgery an elastic tissue from the swelling was submitted for pathological examination, which showed the mass to be a traumatic neuroma due to previous operations. The neuroma was resected radically without entering into the frontal sinus. No recurrence is seen after one year.
In 9 patients with recurrent tympanic membrane perforations after tympanoplasty, the perforations were closed with sclera or lyophilized dura alone using fibrin sealant. Thirteen patients underwent tympanoplasty using fibrin sealant between sclera or lypophilised dura and fascia. In 4 of them, ceramic ossicular prosthesis was fixed to the stapes with fibrin sealant. Fibrin sealant was also used in skin grafting within the mastoid cavity and in canal plasty in patients with atresia of the external auditory canal and for prevention of liquorrhea in tympanoplasty. The results revealed that fibrin sealant (Tisseel) was useful for these plastic procedures.