Since the introduction of tympanoplasty practice of modified radical mastoidectomy has been greatly reduced. Bondy proposed modified radical mastoidectomy for removal of cholesteatoma without disturbing the tympanic membrane and ossicles in an attempt to preserve the remaining hearing. Although this procedure involves drawbacks inherent in an open method procedure the recurrence of cholesteatoma can be prevented in many cases. Tympanoplasty often requires ossiculoplasty, which in turn may compromise the final hearing results. The author proposed that Bondy's procedure should have its place in the management of cholesteatoma even today.
The authors reviewed the changes in operative treatments of otolaryngological diseases from the data at the Aoto Hospital, The Jikei University School of Medicine. On average, 500 to 600 otolaryngological operations were performed in one year in the hospital during the period. Radical operation of the paranasal sinuses for chronic sinusitis made up about 80% of the total operations, while 90% consisted of nasal surgery each year during the period from 1949 to 1985. The number of conservative sinus operations increased after 1960 and comprised 45% of all nasal operations during the period from 1969 to 1979. The number of radical sinus operations is on the decrease and was responsible for 50% of the total for the same period. The changes in operative treatments are also seen in ear surgery. Radical mastoidectomy, which had comprised 70% of all the ear surgery during the period from 1949 to 1958, decreased to 10 to 20%, while tympanoplasty operations increased to 90% after 1956. The numbers of laryngomicrosurgery and middle ear intubation have increased during the past several years.
The authors reviewed 21 cases of head and neck tumors which occurred in juvenile patients under 20 years of age and summarized the results as follows: 1. The common sites of the tumors are the nasal cavity, paranasal sinuses and nasopharynx. In histological study, malignant lymphoma and rhabdomyosarooma are commonly seen. 2. Punch biopsy often failed to distinguish the histology. A large, careful incisional biopsy under general anesthesia seemed to be better. 3. The recurrent cases numbered 6. Early diagnosis and early treatment were important.
The authors report two cases of long-standing foreign bodies of the frontal area, one in a 45-year-old man with a piece of a chopstick embedded in the frontal bone for 40 years, and the other in a 31-year-old man with a piece of front window glass broken during an automobile accident buied in the frontal sinus for 10 years. Both foreign bodies showed no significant complications and were found accidentally. The authors reviewed 35 other cases of longstanding foreign bodies in the facial area which appeared in Japanese literature.
The infected fistula auris congenita at the base of crus helicis makes its total removal difficult through the preauricular approach because of the location of the main lesion. The fistula sinus is usually located deep behind the auricle. Therefore, it is easier to extirpate the entire lesion through the retroauricular approach than the preauricular approach. The retroauricular approach enables a wider operative field and makes the lesion free easier from the surrounding tissues. The author describes a detailed technique of the retroauricular approach for the infected fistula auris congenita at the base of crus helicis.