We have employed sialendoscopy for salivary gland disease since April, 2012 and we report herein on the results of 13 cases who underwent surgery using sialendoscopes. The aim of this study was to clarify the indication of surgery of the salivary glands using sialendoscopy. The clinical features of these cases including operative methods, diagnosis and calculi size were investigated with retrospective chart study. They included 12 salivary stones of the submandibular gland and one case of sialectasis of Stensen's duct. All cases were operated on under general anesthesia and laser was not used. The preservation rate of submandibular glands was 67% in the 12 cases. Of 16 calculi, 5 were removed by exclusively with endoscopes, 7 were removed with a combined approach and 4 were treated with removal of the salivary gland. The median size in the endoscopically removed group was 3.3 mm, while that in the combined approach or removal of the submandibular gland group was 8.1 mm, demonstrating a significant difference. The largest calculus removed with the endoscope was 6.2 mm in diameter. On the other hand, in a case with stenosis of the duct and another case with many calculi in the duct, endoscopic removal was not removed. No operative complication occurred except temporary swelling of the submandibular glands. In conclusion, calculus of submandibular glands with a largest diameter less than 6 mm could be an indication for endoscopic removal when the laser is not used.
Diseases resulting in acquired perforation or defect of the palate are well known due to some kind of infectious diseases, vasculitis, or malignant tumors. However, an unexplained soft palate perforation occurring in adult patients has not hitherto been reported. We encountered a 68-year-old woman with an unexplained soft palate perforation, who complained of nasopharyngeal regurgitation and rhinolalia aperta. Although, we examined the patient in detail to try and ascertain the cause of the perforation, we were unable to pinpoint the etiology of the perforation. Four months after the close investigations, we performed a push-back procedure to close the perforation. Her symptoms disappeared postoperatively and we are going to perform a long-term follow-up in this patient.
Fish bones as foreign bodies are often observed in everyday clinical practice, and most of them can be easily treated. However, difficult cases are very occasionally encountered. We report herein on three cases of atypical fish bone foreign bodies in 60 cases of fish bone removal experienced over a 4.5 year period. The first case was a decomposed fish bone in the tongue. The second case was a fish bone which had migrated to the dorsal area of the right lobe of the thyroid. The third case was a fish bone in the lingual tonsil removed through an oral approach. It requires more careful work in the case where fish bone foreign bodies are not able to be found by visual examination, and in this situation, CT is a very useful examination tool.
The patient was a forty-four years old female. She had sore throat and left side neck swelling. She was diagnosed as having a left peritonsillar abscess and underwent the incisional drainage at another hospital. Following the drainage, her symptoms were temporarily improved. However, the neck swelling and sore throat were persisted, and she was referred to our hospital. Blood examination showed mild inflammation. The cervical CT and MRI revealed a cystic lesion in the left parapharyngeal space. We suspected a brachiogenic cyst or neurilemmoma, and performed surgical intervention. The cystic lesion was located at the dorsal side of the internal and external carotid arteries, and did not show continuity with the vagal, accessory, hypoglossal, or sympathetic nerve fibers. Histopathological examination showed that the wall of the cyst was composed of squamous epithelium and lymphoid follicles had formed. Thus, we diagnosed a Bailey type-IV brachiogenic cyst.
We report herein on a case of carcinoma ex pleomorphic adenoma with epithelial-myoepithelial carcinoma of the minor salivary gland. The patient was a 66-year-old female who presented with a large tumor of her right cheek with a history of about 40 years without consultation with any medical doctors. The tumor grew very slowly but became the size of a baseball 1 year before the patient came to our hospital. She did not want to receive any aggressive treatment but felt inconvenience in her daily life. The patient finally decided to undergo tumor resection and tracheostomy at our hospital. The tumor was about 10 cm in diameter and the pathological findings were carcinoma ex pleomorphic adenoma with epithelial-myoepithelial carcinoma. Some parts of the tumor showed anaplastic conversion. The tumor recurred so quickly in 6 months after surgery and the patient unfortunately died about 1 year after the first surgery.
We report herein on the case of an 84-year-old man with tetanus. He complained of a 2-day history of sore throat and dysphagia. Fiberscopic examination of the larynx revealed the retention of saliva. A blood examination showed a WBC count of 11200 and a CRP level of 19.33. Antibiotic medical treatment with Tazobactam/Piperacillin (TAZ/PIPC) was started. Trismus and convulsions developed on the 8th day. It was discovered that the patient had been engaged in farming up to three days before the admission, and we diagnosed tetanus in the second stage. He received medical treatment and respiratory care involving nasal intubation, tracheostomy, and human anti-tetanus immunoglobulin. The dysphagia gradually improved and he underwent swallowing training. He was cured without any sequelae. Tetanus must be considered in the differential diagnosis of dysphagia in spite of the lack of any history of injury.
We report herein on a rare case of tuberculosis with a retropharyngeal abscess. The patient was a 27-year-old woman complaining of neck pain, who has immigrated to Japan from Nepal one and a half years previously. She visited Kawakita General Hospital Department of Orthopedics initially and X-ray imaging revealed no abnormal findings. She was then reffered to the E.N.T. department since she also complained of a swallowing pain. The laryngeal fiberscopy showed no tumor growth or inflammation. Three months later, she went to the ER of a nearby hospital with a headache. At that hospital, CT and MRI were performed and the findings suggested a retro-pharyngeal abscess. She was admitted to our hospital and cervical CT showed an erosion of the cervical vertebra without fever or inflammatory findings. We suspected a cold abscess and spinal caries. Chest CT revealed several cavities in the upper lobe of the right lung. Puncture of the retropharyngeal abscess was carried out and the polymerase chain reaction (PCR) technique showed Mycobacterium tuberculosis in the pus. No other samples including sputum or gastric juice showed infection of M. tuberculosis. The patient was referred to a hospital specializing in tuberculosis where and anti tuberculosis medicines were administered for 6 months then the bony lesions were debrided.
Malignant lymphoma is not a rare disease, which is encountered by otolaryngologists in their daily medical practice. The mucosa of the gastrointestinal tracts and salivary glands such as the parotid gland, which are separated from the external environment by a extranodal mucosal membrane, contain aggregations of lymphoid tissue called MALT (mucosa- associated lymphoid tissue). MALT lymphoma is a type of lymphoma originating from MALT and includes B cell neoplasms with cells varying in size from intermediate to medium. MALT lymphoma is characterized by the existence of reactive lymphoid cells intermingled with plasma cells and it is known to be complicated with Sjögren's syndrome. Many reports have reported that preoperative diagnosis of MALT lymphoma failed to detect a specific finding from imaging or blood tests and no treatment has yet been established for the disease. In this paper, we present a case report of a patient with MALT lymphoma, including the clinical characteristics and the treatment plan we provided at our facility.
Chest pain and discomfort are regarded as the hallmark symptoms of coronary disease and the absence of the symptoms are described as atypical. Sometimes, coronary disease patients complain of otolaryngologic symptoms. A rare case of a patient is presented herein with the unusual symptoms of exertional throat discomfort associated with cardiac ischemia. The patient was a 64 years old male. His electrocardiogram was normal but with myocardial scintigraphy, myocardial ischemia was suggested. Coronary angiography (CAG) showed 90% stenosis in LAD, 99% stenosis in LCX and 100% stenosis in RCA. Percutaneous coronary intervention (PCI) was performed and the patient recovered from cardiac ischemia followed by complete resolution of his symptom. Unusual symptoms associated with coronary disease make diagnosis difficult and misdiagnosis may cause an unfavorable outcome. We examined 12 reports (13 cases) of coronary disease with otolaryngologic symptoms to find a clue to the diagnosis, 8 reports in Japanese and 4 reports in English. Burning pain, zonesthesia, acute onset, exertional onset, a previous chest symptom, and accessory symptoms such as nausea, dyspnea and sweating may be clues to the diagnosis of coronary disease.
Rheumatic fever is an inflammatory disease that occurs following a hemolytic streptococcal infection. The major symptoms of rheumatic fever are carditis, polyarthritis, subcutaneous nodules, erythema marginatum and chorea. Carditis is the most important prognostic factor, which can lead to permanent heart damage or fatal heart failure. Rheumatic fever is caused by antibody cross-reactivity that can involve the heart, joints, skin, and brain. Due to the improvement of the general sanitary and medical conditions, rheumatic fever is seldom seen in developed countries. We report herein on a case of rheumatic fever with a peritonsillar abscess and myocarditis. The patient was a 20 years old male, who complained at first of chest pain. He was diagnosed as having myocarditis, and the patient was admitted to intensive care unit (ICU). At the second day of admission, he complained of a sore throat and lockjaw. He was diagnosed as having a peritonsillar abscess and underwent incision and drainage. Group G hemolytic streptococcus was detected in the abscess and the serum concentration of anti-streptolysin O antibody (ASO) was very high. After 9 days of treatment with CLDM (clindamycin phosphate) and CTRX (ceftriaxone sodium hydrate), he completely recovered with no sequelae. Clinicians should be aware that rheumatic fever can develop secondary to streptococcal infections.