We report 6 cases in which emergent operation was performed for organ of vision disorder impairment induced by a posterior paranasal sinus (posterior ethmoid and sphenoid sinus) cyst. Cases 1-3 had paropsis, and cases 4-6 had external ophthalmoplegia. Although the vision in one case of paropsis in which the duration from the onset of the visual symptoms to the operation was less than 24 hours recovered completely, the remaining 2 cases in which the disease duration was beyond 1 month were not cured completely. All the three cases presenting with only external ophthalmoplegia recovered completely, irrespective of the disease duration. We discuss the prognosis and urgency of treatment of cases with organ of vision disorder impairment induced by posterior paranasal sinus cysts, and suggest that as compared with patients with optic nerve disorder, treatment of these cases presenting with only external ophthalmoplegia may not be so urgent.

View full abstract

We observed the vocal folds and performed recordings in 3 patients with bilateral vocal fold paralysis caused by extensive organic brain disorder. Some common findings were observed, as follows. 1) The vocal folds of both sides were fixed in the median position. 2) During expiration, no tension was observed in the vocal folds. 3) During inspiration, the vocal folds became tense, and a marked wheeze was heard. 4) During coughing/expectorating, the vocal folds became externally rotated. In patients with this disorder, early recovery of the vocal fold movements may be difficult, and early airway management by methods such as tracheotomy is necessary.

View full abstract

We present the case of a 3-year-old child with esophageal foreign bodies. In the preoperative X-rays we mistook a 5 yen coin overlapping a 1 yen coin for only a 5 yen coin. One yen coins made of 100% aluminum can be easily missed on X-ray images. In the diagnosis of an esophageal foreign body by X-ray therefore, we must bear in mind the possibility of the presence of a radiolucent foreign body and radioopaque foreign body at the same time. Furthermore, it is also important to obtain lateral-view X-rays in addition to posteroanterior-view X-rays, in order to obtain optimal information from X-ray images.

View full abstract

We report a patient with a glomus tumor in the left nasal cavity. A 58-year-old male visited our department due to repeated nasal bleeding. A mass occupying the left nasal cavity and nasopharynx, that bled readily, was observed on examination. CT, MRI and angiography were performed, and selective microembolization of the vessel feeding the tumor was performed. After this operation, the tumor decreased in size, and was resected by endoscopic endonasal surgery. The bleeding volume was slight. Pathological examination of the resected tumor showed the features of a glomus tumor. At present, the patient has no symptoms suggestive of recurrence, and is being observed on an outpatient basis.

View full abstract

We encountered a patient with Tornwaldt's disease, in whom a retropharyngeal abscess was initially suspected. We discuss the case herein, with a review of the pertinent literature.
A 3-year-old.boy developed a fever of 38 to 39°C with cough around the end of January 2007. He was seen at a nearby pediatric clinic. Treatment with clarithromycin was started on an ambulatory basis at that clinic, but no symptomatic improvement was noted. The patient was referred to the pediatric department of this hospital for a further checkup on February 3, 2007. The patient was followed up with antibiotic therapy at the outpatient service, but he still remained febrile and developed swelling of the left retropharyngeal wall. Therefore, the patient was admitted to the pediatric ward of this hospital on February 7.
On February 8, a computed tomographic (CT) scan of the neck demonstrated a cyst in the left nasopharyngeal-to oropharyngeal region, which was strongly suggestive of a retropharyngeal abscess. On February 9, the abscess was incised and drained under general anesthesia.
A bacteriological examination revealed methicillin-resistant staphylococcus aureus (MRSA) and α-hemolytic streptococci. The patient was therefore switched from clindamycin at 1, 200mg/day and meropenem at 1g/day, which had been prescribed during the postoperative course, to vancomycin at 1g/day and gentamicin at 15 mg/day. A CT scan was repeated on February 15 because leukocytosis was noted, and an abscess was found again ; therefore, on February 16, the abscess was totally excised by electrocautery outside the thickened cystic wall under general anesthesia. The excision was carried out under direct visualization of the nasopharynx, while the oropharynx was retracted using a Nelaton catheter passed through both nostrils. No recurrence of the disease has since been observed, and the final follow-up was conducted on May 8.
The patient presented with no symptoms peculiar to a retropharyngeal abscess, such as dyspnea, although the formation of a giant abscess was evident on the CT scans. Therefore, the abscess was finally considered to be a type of Tornwaldt's disease with intercurrent inflammation rather than a retropharyngeal abscess.
The present case suggests that a careful clinical evaluation is necessary to accurately differentiate a retropharyngeal abscess from Tornwaldt's disease.

View full abstract

[in Japanese]

View full abstract