Fumio Ikarashi

Treatment of ranula-excision of the sublingual gland versus marsupialization

The purpose of this work is to estimate optimum surgical treatment of ranula according to the type of the lesion. Nine patients with ranula surgically treated between 1989 and 2000 were investigated retrospectively. Six patients had sublingual type ranula and three had submandibular type. In five cases including recurrence cases, the sublingual gland was excised. Marsupialization was performed for four cases, which were superficial, protruded and within 2 cm of diameter. In all cases, histopathological diagnoses were pseudocysts without epithelial lining and there was no recurrence. Almost all ranulas are pseudocysts from the sublingual gland, therefore excision of the sublingual gland is considered to be a reasonable and radical treatment. For the small sublingual type, which is superficial, protruding and smaller than 2 cm in diameter, marsupialization is also a useful modification of surgical treatment of ranula.

The relationship between the degree of chronic middle ear inflammation and tympanic bulla pneumatization in the pig as animal model

The relationship between the degree of chronic middle ear inflammation and pneumatization was investigated in the pig as an animal model, since its tympanic bulla closely resembles the human mastoid air cell system. Ten piglets (sire: Landrace-Hampshire crossbreed; dam: Duroc) were used for this experiment. Four ears of two animals served as the normal control group and 16 ears of eight animals were the experimental group. In this latter group, otitis media was induced by injecting glycerin into the middle ear clefts 1 month after birth, and the degree of inflammation was varied by administering or withholding antibiotics (cefamandole and dibekacin) and adjusting the dosage regimen. The animals were sacrificed 6 months after birth and examined for the relationship between the degree of chronic middle ear inflammation present and tympanic bulla pneumatization. Various degrees of inflammation were successfully induced by injecting the antibiotics: the more severe the inflammation found, the greater was the inhibition of pneumatization. Findings demonstrated that the degree of inhibition of pneumatization produced was directly proportional to the severity of chronic middle ear inflammation.

Pneumatization of the Tympanic Bulla after Blockage of the Ventilation Route through the Eustachian Tube in the Pig

To examine whether gas exchange occurs in the middle ear air cell system independent of the eustachian tube (ET), we occluded the middle ear clefts of piglets, whose tympanic bullae closely resemble the human mastoid air cell system, and investigated subsequent changes in the air cell system. We anticipated that pneumatization and development of the air cell system would continue if gas were exchanged through the mucosa lining the air cell system. If, on the other hand, mastoid air cells depend on the ET, mastoid development would be impaired or arrested. In noninflamed ears, pneumatization was maintained, and development of the air cell system continued after the middle ear cleft had been occluded with an acrylate adhesive and the bullar air cell system was thus excluded from any communication with the ET. These results indicate that the normal middle ear air cell system has the capacity to perform gas exchange independently of the ET, with gas exchange appearing to occur through the submucosal capillary network.

A Case Of Pharyngolaryngeal Stenosis In Behçet's Disease

A rare case of pharyngolaryngeal stenosis in Behçets disease is reported. A 44-year-old female who had Behçets disease for 13 years complained of dysphagia and dyspnea, and was referred to our hospital for treatment in May 1988. The bilateral meso-hypopharyngeal walls were swollen, and the epiglottis was edematously folded, occluding the larynx. Epiglotectomy and thyrohyoidpexia were performed, with dysphagia and dyspnea disappearing after the operation. Two years after the operation, dysphagia and dyspnea recurred because of two stepped cicatricial stenoses at the mesopharynx. An enlargement operation, incising the pharyngeal cicatricial tissue bilaterally and covering raw surfaces with free skins and the pedunculated cervical flap, was performed. Colchicine, corticosteroid, and tranilast (anti-allergy drug) were administered to prevent re-stenosis. Stenosis was not observed for 10 months after the second operation. Two cases undergone surgical interventions have been reported, and this is the first case reporting long term result of the surgical procedure. Because the skin and mucosa of patients with Behçets disease shows hyperreactivity to stimuli, the choice of surgical procedure is controversial and recurrence of stenosis is possible.

Immunohistochemical Study of Pleomorphic Adenoma of the Nasal Septum

A rare case of pleomorphic adenoma of the nasal septum is reported. A 48-year-old man complaining of nasal obstruction and nasal bleeding was referred to our hospital for treatment of a left nasal tumor. The tumor, including the nasal septum, was resected by the modified Denker operation and lateral rhinotomy. The tumor was firm, parenchymatous, pedunculated, and 24 x 22 x 14 mm in size. Pathological examination revealed pleomorphic adenoma with slight cellular atypism. Immunohistochemical observations suggested that characterization of this tumor might be similar to pleomorphic adenoma of the parotid gland.