There have been many studies concerning anatomical structures of the tympanic isthmus, but most of which were carried out by inspecting the tympanic isthmus superiorly from the attic after removing the tegmen tympani. Aims of the present study using human temporal bones were to examine the tympanic isthmus anteriorly, and to evaluate the pathway in the tympanum with reference to the mucosal folds in the middle ear. The tympanic isthmus can be seen anteroposteriorly far behind the drum, located between the tensor tympani fold anteriorly and incudal fossa posteriorly, and in front of the facial canal. One of the components of the anterior tympanic isthmus, the tensor tympani fold, was thought to be playing an important role for directing the air flow into the tympanum, since the dye insuffiated from the ostium of the eustachian tube into the tympanic cavity, was deposited significantly both in the oval, and round window niche.
A 53-year-old woman with a tumor in the left maxillary sinus was found to have malignant fibrous histiocytoma, which is a common tumor occurring mostly in the soft tissue, but rarely in the head and neck regions. Repeated resections of the tumor were followed by recurrences. Chemotherapy and cryosurgery were performed without showing significant response. The patient died in two years of the initial diagnosis. The authors presumed that the case belonged to MFH-F type, which usually shows very poor prognosis.
The results of 100 exploratory sinusotomy in reference with the symptoms, radiographic findings, CT findings and histopathological results lead us to conclude that: 1. Exploratory sinusotomy has been useful for an early detection of malignancy and its direction of expansion. 2. Cancer of the maxillary sinus originating in the medial wall tended to present similar symptoms to those of unilateral maxillary sinusitis, which often made the differential diagnosis difficult. 3. Mucopyocele of the maxillary sinus causally relating to previous sinusectomy could be associated with malignancy for which the exploratory sinusotomy has been found to be very useful for an early diagnosis.
Nine cases of fungus infections of the para. nasal sinuses which were treated at Sapporo Medical College during the period from 1976 to 1983 are presented. The main site of the lesion was the maxillary sinus. Radiological findings revealed unilateral cloudiness in all cases, while bony changes were seen in four cases. Seven cases were aspergillosis and two were candidiasis. All patients were treated by surgical procedure and the prognoses were good. The pertinent literature was reviewed.
Forty patients with vertigo but without objective findings are studied. Most of the patients were women over 30 years old. Such patients can be classified into the following categories. 1. Although vertigo was present at the beginning of the disease, it disappeared by the time of examination, leaving the patient only with apprehension of vertigo. 2. The vertigo was attributable to autonomic nerve disturbance 3. The vertigo was psychogenic in origin, and included anxiety neurosis, hysteria and other psychogenic diseases. Of the 20 patients with psychogenic vertigo 13 had previously been diagnosed as having vertigo of unknown origin. Development of vertigo in psychogenic patients may be explained as follows: 1. Vertigo superimposed in patients with psychogenic disease. 2. Vertigenous disease constitutes mental stress, which leads to psychogenic disease. 3. Disturbances in normal life created by a vertigenous disease causes psychogenic reactions. It is often the case that presence of psychogenic disease makes the differenital diagnosis of vertigo difficult. It should be pointed out that vertigo can often be caused by psychogenic diseases such as anxiety neurosis, depression and schizophrenia.
The upper airway stenosis was corrected using a cartilage scaffold in two cases. The first case was a 20-year-old man who sustained tracheal injury involving the cricoid cartilage resulting in tracheal stenosis. In surgical correction, after exposure of the tracheal space, the remaining parts of the cartilage had to be removed because of an extensive necrosis. The wound healed but only after leaving a widely exposed tracheal space. A cartilage scaffold was constructed from the rib cartilage to create a new tracheal space, which was later covered with a D-P flap. The scond case was a 34-year-old woman with pharyngeal stenosis due to Behcet disease. The patient developed tracheal stenosis at the tracheal stoma due to proliferation of granulation. After successful surgery of the oropharyngeal stenosis the trachal stenosis was corrected using a cartilage scaffold in a similar manner as in the first case.