Hideki Muraoka

Fibrous dysplasia with cystic appearance in maxillary sinus

Fibrous dysplasia (FD) in the paranasal sinuses is uncommon, and its management may be difficult. We report the case of a 25-year-old female with FD exhibiting a cystic appearance in the maxillary sinus. The patient had been complaining of facial swelling for few years. Imagery study showed a cystic lesion and dense bone changes in the maxillary bone. Inferior meatal antrostomy with a nasal endoscope failed to confirm a histological diagnosis. After a 3-year follow-up, the degree of facial swelling was unchanged, and the patient underwent middle meatal antrostomy and was diagnosed with FD.

Three-dimensional reconstruction of the incudostapedial joint with helical computed tomography.

Three-dimensional images of the incudostapedial joint (I-S joint) were reconstructed using helical computed tomography (CT). The images of the joint were most often reconstructed when threshold values were selected at -500 to -700 Hounsfield Units. These shapes were changed by choosing various threshold values. Histological examinations of the cadaver specimen indicate that these changes are due to structure of the I-S joints. We conclude that these 3-D images may be useful in assessing pathology of the I-S joint.

Three-dimensional imaging of ENT diseases with helical computed tomography

We have employed helical computed tomography (CT) to evaluate ear, nose and throat diseases, and present herein seven typical cases: middle ear surgery, osteoma of the external ear canal, maxillary fracture, tripod fracture, submandibular gland calculus, epiglottic abscess and vocal fold palsy. Helical (CT) facilitates the assessment of these diseases and its high diagnostic value is described.

Three-dimensional imaging of the internal auditory canal in patients with acoustic neuroma

Three-dimensional imaging of the internal auditory canal (IAC) was carried out in 21 patients with acoustic neuromas using helical computed tomography. The IAC was widened in 20 patients, but no irregularities of the canal walls were seen. In addition, the shape of the enlarged IAC corresponded to that of the tumor on magnetic resonance imaging. The data suggest that widening of the IAC in acoustic neuroma patients is due to enlargement of the tumor. Other mechanisms, for example, tumor invasion or destruction caused by release of a specific mediator from the tumor, are unlikely to explain these findings; however, further investigation is needed.Three-dimensional imaging of the internal auditory canal (IAC) was carried out in 21 patients with acoustic neuromas using helical computed tomography. The IAC was widened in 20 patients, but no irregularities of the canal walls were seen. In addition, the shape of the enlarged IAC corresponded to that of the tumor on magnetic resonance imaging. The data suggest that widening of the IAC in acoustic neuroma patients is due to enlargement of the tumor. Other mechanisms, for example, tumor invasion or destruction caused by release of a specific mediator from the tumor, are unlikely to explain these findings; however, further investigation is needed.

Cross-sectional Shapes of the Internal Auditory Canal in Patients with Acoustic Neuromas

Cross-sectional images of the internal auditory canal (IAC) were investigated in 23 patients with acoustic neuroma in order to clarify the widening of the IAC. The area of the IAC and the ratio of areas (neuroma side:normal side) were calculated. The shape of the IAC was fitted by an ellipse to obtain the length of the axes and the direction of the long axis. The area of the IAC was 34.2+/-12.2 mm2 in the neuroma side and 18.1+/-4.8 mm2 in the normal side. The neuroma side was larger than the normal side in all patients, and the mean ratio of areas was 1.9. However, the degrees of cochlear and vestibular damage did not correlate with the ratio of areas. The mean ratio of axes of the approximated ellipse was 1.17+/-0.09 in the neuroma side and 1.14+/-0.10 in the normal side; however, no significant difference was seen between the ratio of axes. The directions of the long axes were not always consistent with the positions of the originating nerves of the tumour. Referring to hypothetical models of enlargement of the IAC, our data suggest that the widening of the IAC in the acoustic neuroma was expansive. The data also indicated that symptoms of the acoustic neuroma were caused not only by compression of the nerves but also by other mechanisms, such as vascular insufficiency to the inner ear.

Helical CT and its three-dimensional image: Application for image-guided surgery in middle cranial fossa approach

SummaryWe describe our method to design a safe approach to the target region in surgery using helical (spiral) computed tomography (CT) and its three-dimensional images. Twenty-five patients with acoustic neuroma in the internal auditory canal underwent helical CT examination before surgery. Three-dimensional images were made and the internal auditory canal was identified. We exposed the internal auditory canal through the middle cranial fossa referring to these images. We also applied this method to four cases of vestibular nerve section. These images permitted safe, accurate image-guided surgery in these 29 procedures. Helical CT enables reconstruction of usable 3-D images and those images help us to perform surgery with minimal invasion.

A case with symptoms of vestibular neuronitis caused by an intramedullary lesion

We report on a patient with an intramedullary lesion who showed only symptoms of so-called vestibular neuronitis. From the neurological aspects and MRI findings, the lesion was thought to be localized to the vestibular nerve in the pons. Cerebrospinal fluid testing and MRI findings suggested a diagnosis of multiple sclerosis (MS), although the clinical features were not compatible with MS. This case may shed some light on the aetiology of vestibular neuronitis.

Ethyl Loflazepate in the Treatment of Tinnitus

Ethyl loflazepate (Meilax®) was administered orally to 91 patients suffering from tinnitus, 58 with tinnitus and sensorineural hearing loss, 27 with tinnitus without hearing loss, and 6 with tinnitus accompanied by sudden deafness. The clinical severity of tinnitus was evaluated every two weeks in terms of loudness, continuity and annoyance. Medication was rate of as effective in 27.5%, moderately effevtive in 33%, slightly effective in 17.6% and not effective in 21.8% at the end of treatment. Effectiveness depend on the duration of treatment. Patients treated for a relatively long period showed greater clinical improvement. Two patients complained of sleepiness as a side effect. It was concluded that ethyl loflazepate is effective in reducing severity of tinnitus.

A New Treatment for Severe Epistaxis.

Patients with severe bleeding from the upper and posterior portions of the nasal cavity are generally treated by Bellocq tamponade, balloon tamponade or surgery, i, e, embolization or ligation of the artery. These procedures cause local pain, headache and nasal obstruction. We tried a new method of treatment in 31 patients with severe epistaxis using oxy-cellulose cotton. The bleeding was controlled adequately in 29 patients, some of whom had been treated by Bellocq tamponade in other hospitals and pleased to be free of the discomfort of their previous experiences.This new method is summarized as follows:1) It is mandatory to recognize the bleeding point, because oxy-cellulose cotton is to be packed at only one bleeding point in the nasal cavity. 2) Oxy-cellulose cotton is divided into small fragments, because the space around the bleeding point is usually narrow and deep within the nose. A piece of the divided contton is dipped in epinephrine or lidocaine solution before use because dry cotton sticks easily to normal nasal mucosa.3) Referred pain is felt in the ear when the cotton is packed on the lateral wall of the inferior meatus, and in the forehead when it is packed in the meatus olfactorius. 4) This treatment never interferes with other treatments for severe epistaxis, and combined procedures with ribbon gauze, Bellocq tamponade, balloon tamponade, etc, can be used when needed.5) Inserted cotton does not need to be removed, because it is absorbed in a few days.

Parapharyngeal Cyst; A Case Report.

A rare case of parapharyngeal cyst arising from the second branchial cleft is reported.Radiologic imaging, especially CT and MRI, were useful in locating the cyst and showing that it extended from the lateral wall of the oropharynx to the base of the skull.A fenestration was made at the bottom of the cyst producing a communication between it and the oropharynx, since it was impossible to remove the cyst completely.Two years later there is no sign of recurrence of the cyst.