JIBI INKOKA TEMBO

In cases with severe middle ear disease, transplantation of cultured mucosal epithelium is a useful as a way to promote regeneration of the mucous membrane on the bone surface exposed in middle ear surgery. In clinical practice, the middle ear mucosal membrane can be transplanted with the mucosal epithelium obtained from the nasal or oral mucosa as sampling areas for the epithelial cells. However, whether the transplanted epithelial cells derived from a surrogate tissue will perform as epithelial cells of the middle ear mucous membrane still remains unknown. In the present study, based on the epithelial-mesenchymal interaction, we hypothesized that the phenotype of the nasal and oral mucosal epithelial cells is converted to the phenotype of the middle ear mucosal epithelial cells by the microenvironment produced by the fibroblasts in the middle ear mucous membrane. In this study, we co-cultured epithelial cells and fibroblasts in vitro and performed a gene expression analysis using oligo DNA microarrays and quantitative real-time PCR. The results revealed that each of the epithelial cells has a different phenotype and that this phenotypes approximates to the epithelial cell phenotype of the middle ear mucous membrane upon co-culture with middle ear fibroblasts. In conclusion, it is suggested that the transplanted epithelial cells phenotype might be induced to change to the specific phenotype of the middle ear mucous membrane by the micro-environment.

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We report the case of a 34-year-old woman with an extrapharyngeal foreign body (yellowtail fish bone). The patient complained of soreness of the throat ever since eating a yellowtail fish. Fiberoptic laryngoscopy revealed swelling of the left arytenoid region and a salivary pool in the left pyriform fossa, but no foreign body. CT revealed a fish bone in the left arytenoid region, with abcess formation around it. The extrapharyngeal foreign body was successfully removed by laryngeal microsurgery.

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We report a case of spontaneous cerebrospinal otorrhea occurring in an adult.
An 83-year-old male complained of hearing loss on the left side and fluid was detected in the left middle ear. The middle ear fluid was positive for glucose, suggesting that it was cerebrospinal fluid. CT revealed a bony defect in the temporal bone and a slight effusion in the left mastoid. At the first operation, the site of leakage could not be confirmed and only granulation was found. Therefore, we judged that the ear discharge was associated with chronic otitis media. However, a few days later, fluid in the wound appeared again, and we diagnosed cerebrospinal fluid otorrhea, and performed a second operation. When the part that seemed to be defective was carefully observed, a small amount of leakage was confirmed. The defect was repaired by packing with fascia, bone and fatty tissues with fibrin glue.
No recurrence has been observed for 1 year after the surgery.

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Objective: For skull base tumors, Gamma knife surgery (GKS) is effective to control them. However, it is not possible to treat large tumors which compressed brain stem with GKS alone. Needless to say that microsurgical resection must be considered. We propose that precise preoperative treatment design and intraoperative image supporting system are crucial for them. We developed a system by incorporating a technique for Gamma Knife surgery to design a treatment plan before and during surgery.
Methods: Magnetic resonance imaging was performed without a stereotactic frame before treatment. Image data was imported to Leksell GammaPlan (LGP) to obtain 3D localization in order to understand anatomical relationship between the tumor and surrounding vital structures.
Results: For skull base meningiomas, the dura maters from which tumors arose were identified on LGP. Certain parts of the tumor should be spared by GKS, because there are the most important vital structures such as cranial nerves. Other parts should be then surgically removed as much as possible to be the best decompression in the tumor. For acoustic tumors, we identified facial and acoustic nerves as much as possible using this simulation technique. It can provide the best knowledge of anatomical relationship to neurosurgeons before and during surgery. Most of patients would not have experience with neurological deficits.
Conclusions: Sophisticated 3D computerized image data in LGP enabled us to perform surgery just as planned preoperatively. This new and simple treatment system will be a precursor of future surgical treatment strategies.

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