The most serious injury accompanying esophagoscopy would be the rupture of the esophageal wall at the orifice of the esophagus. This complication has been reported by some to occur from 0.3 to 1% of all the diagnostic esophagoscopy. In order to avoid the complication the surgeon must be aware of detailed anatomical as well as histological structure of the region. The authors describe anatomy and histology at the particular area and safe technique of esophagoscopy, and then propose that the junction of the cricopharynge al and thyropharyngeal muscles should correctly be called as “Killian's weak area”.
The authors report a 10-year-old infant with osteomyelitis of the maxillary bone, where computed tomography was very useful in diagnosis, determining the type and time of surgery, and in observation of the postoperative course. Although osteomyelitis of the maxillary bone in new-born infants has once been a life threatening disease, it can now be controlled and treated adequately with surgery and chemotherapy through accurate evaluation of thedisease using computed tomography.
Five cases of adenoid cystic carcinoma of the external auditory canal were treated druing the period of six years from 1976 to 1985. The onset of the disease was usually inconspicous and insidious as the tumor appeared to be a benign swelling at the early stage. The tumor infiltrated into the soft tissue in the external auditory canal without creating a mass. The five cases were treated by extended surgical resection but recurred in three cases.
The authors report six cases of retropharyngeal abscess treated during the past nine years. The study revealed the following: 1. There were more adult cases of nontuberculous retropharyngeal abscess that followed upper respiratory infections than those of tuberculous origin. 2. Bacteriological study showed that streptococcus viridans and Neisseria were more frequently occurred. 3. The majority of the patients complained of dysphagia or sore throat. It was noteworthy that no adult with retropharyngeal abscess developed a high fever. 4. In some cases, incision and drainage could be made under local anesthesia without problems. The authors concluded that the principle of treatment are of incision and drainage even in the days of different kinds of new antibiotics.
Paralysis of the abducens nerve develops in various cancers of the otolaryngological area. A survey of malignancies encountered during the past 10 years revealed that the nerve paralysis can be caused by cancers of the nasopharynx or ethmosphenoidal sinus. Of 38 nasopharyngeal cancers, only three cases showed paralysis of the abducens nerve (8%). The incidence was much greater in cancers of the ethmosphenoidal area where 10 out of 17 cases (59%) developed paralysis of the abducens. In each of the three cases of nasopharyngeal cancer with paralysis of the abducens, the sphenoidal sinus was found to have been infiltrated with tumor on radiological findings. This study indicated that the paralysis of the abducens nerve due to otolaryngological malignancy is brought most often through the involvement of the sphenoid sinus.
There were 200 cases of sudden deafness who were hospitalized at the department of otorhinolaryngology, Kanazawa University in the period of 10 years from January 1975 to December 1984. One hundred and four cases were male and 94 cases were female. The age of the patients ranged from 9 to 75 years old. The age group of 50-59 years included the greatest number of patients. The right ear was affected in 99 cases and the left ear was affected in 100 cases. There was one case occurring simultaneously in both ears. Eighty two point three percent of the patients had visited other hospital before they visited our hospital. The patient visited our hospital in 7.8 days from the onset of the disease on average. Nine patients had a relapse of sudden deafness. The patients were treated with stellate ganglion block, hyperbaric oxygen therapy, steroid, vitamins and vasodilators. Forty-six cases showed a complete recovery, 58 cases showed remarkable improvement, 59 cases showed slight improvement, and 37 cases showed no improvement.
A case of embryonal rhabdomyosarcoma of the ear is reported. A 2-year-old boy was referred to the otorhinolaryngology outpatients department at Syuto General Hospital with a painless rightsided aural polyp. Rentogenograms of the skull suggested a lesion involving the middle ear, external auditory meatus and mastoid. CT-scan of the head indicated an infiltration in the brain. The polyp was excised and was identified as embryonal rhabdomyosarcoma. The patient was treated with combined chemotherapy and radiation therapy, which led to disappearance of the tumor for about one year after the initial diagnosis. But the tumor recurred and the patient died 24 months after the diagnosis. Literature on related subjects is reviewed.
A simple office technique for closure of a perforation in the tympanic membrane was used in ten ears with small central perforation due to otitis media. The perforation was within 2mm in diameter in each case. This technique is characterized by traumatizing the margin of the perforation with a myringotomy knife, and inserting a small pledget of subcutaneous connective tissue into the perforation to promote epithelial growth. Successful closure was attained in 8 of the 10 cases. Factors for success and failure are discussed.