Recent advances in neurosurgery and reconstructive surgery have provided the widespread of the skull base surgery using both intracranial approach and extracranial approach, for head and neck tumors involving the skull base. Subtotal temporal bone resection is a surgical technique to eradicate the cancers of the ear with en bloc fashion. At present, subtotal temporal resection is performed in the limited institutions in this country, partly due to the rarity of the cancers involving the temporal bone. In this paper, our surgical technique of subtotal temporal resection is presented. Selection of patients, preparation for surgery, postoperative management, complications are also described.

View full abstract

We compared the clinical course of patients with eosinophilic sinusitis and eosinophilic otitis media and patients with eosinophilic sinusitis unassociated with eosinophilic otitis media and assessed the association between the two and changes in the middle ear lesions after endoscopic sinus surgery. The subjects were 175 patients with eosinophilic sinusitis, in 19 (10.8%) of whom, 34 ears, it was associated with eosinophilic otitis media, with 3/4 exhibiting lesions in both ears. The CT images, endoscopic findings, nonspecific total IgE level (RIST method), antigen-specific IgE level, and ECP concentrations in blood and the surface layer of the mucosa of the middle nasal meatus were compared. However, no clear differences were found between the groups with and without eosinophilic otitis media, and thus no association was found between the severity of eosinophilic sinusitis and eosinophilic otitis media. At 4 months after endoscopic sinus surgery, both middle ear mucosa and eustachian tube function had improved in parallel with the improvement in the sinus mucosa, and maintaining the paranasal sinuses in good condition was shown to be efficacious in improving the pathology of eosinophilic otitis media. However, when more than a year had passed since surgery, viscous otorrhea developed in the cases in which deterioration of the mucosa of the ethmoid sinus was observed, and eustachian tube function tended to deteriorate. Based on these results, repeatedly performance of local therapy that favorably maintains sinus lesions whenever eosinophilic sinusitis worsens appeared to be important as a means of controlling eosinophilic otitis media long-term.

View full abstract

We report the case of a 75-year-old man suffering from Wallenberg's syndrome and dysphagia who was treated using a cricopharyngeal myotomy followed by a gastrostomy.
A videofluorographic study showed an impairment in cricopharyngeal muscle relaxation resulting in aspiration during swallowing. Consequently, bilateral cricopharyngeal muscles were resected. After the cricopharyngeal myotomy, a second videofluorographic study showed good relaxation of the cricopharyngeal muscle, however, the patient repeatedly suffered from aspiration pneumonia and eventually received a gastrostomy.
Wallenberg's syndnome is characterized by an infarction of the lateral medullary oblongata. The lateral medullary oblongata consists of a nucleus ambiguus, nucleus tractus solitarius, and parvocellular reticular formation. The motor nucleus of the vagus which controls the pharyngeal muscles, including the cricopharyngeal muscle is located in the nucleus ambiguous. In addition the tractus solitarius and the parvocellular reticular formation also contain swallowing-related neurons. Therefore, dysphagia as a result of Wallenberg's syndrome cannot be improved by cricopharyngeal myotomy alone.

View full abstract

A 92-year-old woman reporting of visual disturbance and photophobia was diagnosed with a rare recurrence of a meningioma. CT and MRI showed bone loss at the base of the frontal skull and a giant meningioma invading the nasal cavity. Intranasal endoscopy under local anesthesia involved pathological biopsy and reductive surgery. The meningioma was diagnosed histopathologically. This patient had been treated previously for meningioma originating from the olfactory nerve, and we surmise that the second meningioma was a recurrence of the earlier tumor, with subsequent invasion of the nasal cavity, gradual tumor enlargement, and oppression of the optic nerve leading to visual disturbance.

View full abstract

Immunotherapy has been widely used to treat allergic disorders and has been shown to be effective for the treatment of nasal allergies. The purpose of this study was to elucidate the clinical efficacy of immunotheraphy for the treatment of perenial rhinitis and pollinosis. Thirty-one patients with rhinitis caused by house-dust, Japanese ceder pollen or dactylis glomerata allergies were enrolled in the study. The average period of Immunotherapy with house-dust was 2 years and 10 months, while that for pollinosis was 2 years and 1 month. More than 80% of the patients with, house-dust allergies exhibited an improvement in nasal symptoms. In the case of pollinosis, more than 60% of the patients showed an improvement by the following season and this percentage continued to increase as the season progressed. We concluded that immunotheraphy was well tolerated and clinically effective for the treatment of allergic rhinitis.

View full abstract

[in Japanese]

View full abstract

[in Japanese]

View full abstract

[in Japanese]

View full abstract