This is a supplemental report to the author's article appeared on Otolaryngology Tokyo in 1986. The distortion or structural deformity of the nasal cavity in man can be found not only in the nasal septum but also in the lateral wall of the nasal fossa. The author found that such distortion in the intranasal structure can be found even in advanced anthropoids. The changes become more distinct in primates and even more obvious in man. Such distortion appear to have occurred along the process of evolutional development of the skull in anthropoids, where the original structure of the nasal cavity had been deranged. (evolutional paradox). The state of the nasal cavity can be classified into three types accrding to the findings of deformity of the nasal cavity which was created by the interaction between the maxillofacial bone and cranial bone during their evolutional development. In mammals the interaction of the two bony structures are well balanced, where the nasal cavity maintains proper structure for normal functional performance ; the author termed this stage as three dimensional stage. By taking into account the time factor, which was required for evolutional development, the resulting deformity of the intranasal structure in anthropoids may be considered as four dimensional stage. In evolutional process of man, the major changes were in the brain itself rather than the changes in the shape of the skull. The deformity of the nasal cavity in this stage may be called as five demensional stage. The author discusses the transition and distortion of the intranasal structures from the viewpoint of evolutional development of the craniofacial bony framwork.
The postoperative courses of seven patients with fibrous dysplasia and four patients with osteoma in the paranasal sinuses were observed clinically. The period of the observation was from 1.5 years to 10 years. The subjective symptoms had been improved in all cases. The postoperative enlargements or recurrences of tumor in each case except for two cases of fibrous dysplasia were evaluated by X-ray findings of the paranasal sinuses. The enlargements of the tumor were found in four cases of fibrous dysplasia who had been operated on before 18 years old. Although the rests of tumor at the operation were found in a 34-year-old case of fibrous dysplasia and 23, 29, 58-year-old cases of osteoma, the postoperative enlargements of tumor were not found in these cases. The recurrence of tumor was not found in a 49-year-old case whose osteoma had been removed completely. The operation of fibrous dysplasia in the paranasal sinuses should be performed by taking age of the patient into account. When the patients with fibrous dysplasia and osteoma are operated, especially before adolescence, the postoperative course should be observed carefully and for along time.
We have reported the necessity of obtaining a CT scan in old patients who have recurrent nerve paralysis, even if their routine chest x-ray films and other exminations show normal appearance. In this study, the authors report four cases of the left recurrent laryngeal nerve paralysis caused by small aortic aneurysma in the part of aortic arch. They are all over 60 year-old males. A mass in the aortopulmonary (A-P) window was detected in case 1 and 2 by plain chest x-ray films, and diagnosed as aneurysma by means of enhanced CT scan and MRI-CT (Magne tic Resonance Imaging). A mass was not detected in the A-P window in case 3 and 4 by plain chest x-ray films. On CT scan and MRI-CT examination, a mass was found and diagnosed not as small aneurysma with thrombs but as a metastatic tumor of Botallo's lymphnode. The study revealed the following: 1. CT scan and MRI-CT examination are very useful in diagnosis of the mass in the A-P window 2. CT examination should be obtained in patients over 60-year old who have recurrent laryngeal nerve paralysis, even if their chest xray films show normal appearance. 3. In a case of small aneurysma with large thrombs, enhaned CT and MRI-CT examination were not useful in diagnosis.
Two cases of subdural abcess caused by frontal sinusitis are reported; One was a 44-year-old male and the other was a 22-year-old male. These two cases were successfully treated with neuro surgery. Computed tomography was found to be useful in detecting the intracranial lesions. We emphasize that the intracranial complications from sinusitis continue to be present even to day when antibiotics are available in different froms.
Wegener's granulomatosis manifests diverse symptoms, but the majority of cases presenting at outpatient departments complain of upper respiratory tract conditions, mainly related to nasal disorders. Here, we report our experience of a case who complained of hearing difficulties and whose condition was improved by the administration of a steroid agent and immunological suppressant. In addition, we studied the transition in aural acuity of cases with hearing difficulties that were reported in the past, by classifying them into unilateral, bilateral, conductive, perceptive and mixed deafness. The frequency of cases whose aural acuity was improved by therapy was 1 in 4 cases (25%) of unilateral deafness, 10 in 16 cases (about 63%) of bilateral deafness, 1 in 3 cases (about 33%) of conductive deafness, 2 in 7 cases (about 29%) of perceptive deafness and 6 in 8 cases (75%) of mixed deafness. The causes of deafness identified in these cases appeared to be: 1. Impairment of the middle ear or inner ear caused by granulation 2. Angitis 3. Impairment of the inner ear caused byinfection 4. Autoimmune response.
Rehabilitation for dysphagia were attempted to cases of dysphagia due to cerebral thrmbosis. The first case is a 44-year-old man suffering from dysphagia because of velopharyngeal insufficiency after an attack of cerebral thrombosis. Velopharyngeal plasty was performed four months after the attack, but the result was insufficient and rehabilitation for his dysphagia was started six months after the onset, then his dysphagia was improved and he could eat without any trouble. The second case was a 44-year-old man suffering from dysphagia by cerebral thorombosis, who did not want to undergo operation. His rehabilitation was attempted a year and a half after the attack. Eleven months after the biginning of the rehabilitation, he woke up because he could not swallow saliva at night, but he did not have any other trouble in his dialy life. In The Kanagawa Rehabilitation Hospital there were thirty-nine patients of dysphagia form January 1984 to August 1986. Five of them underwent rehabilitation for dysphagia and two of them were performed both operation and rehabilition for dysphagia, The importance of rehabilitation for dysphagia is stressed.