Hideo Omori

Clinical factors that influence the prognosis of facial nerve paralysis and the magnitudes of influence.

Objective: To show the significance of various factors when predicting the outcome of facial nerve paralysis.

Immunohistopathological Investigation on Unspecific Chronic Sclerosing Sialadenitis of the Submandibular Gland (Küttner Tumor)

An immunohistochemical investigation was conducted on infiltrating lymphocytes in submandibular glands removed from three cases with unspecific chronic sclerosing sialadenitis of the submandibular gland (unspecific CSSS) which has been described for the first time by Küttner. A high degree of lymphocyte infiltration was recognized and formation of lymphatic follicles was observed. In particular, activated B cells were predominantly observed in that part of the lymphatic follicles which was equivalent to germinal centers. In the T cell subset, the helper/inducer T cells displayed significant dominance over suppressor/cytotoxic T cells, and were distributed in the dark peripheral zone of the follicles. The distribution pattern of these lymphocytes seemed to be similar to antigenically stimulated lymph nodes and it was recognized that the unspecific CSSS could be a site of exceedingly active local immune responses. The authors believe that these findings support the view that unspecific CSSS (Küttner tumor) is an immune disorder.

Intravascular hypercoagulability in patients with recent Bell's palsy

Eighty-four patients were examined for blood coagulability during the acute phase of Bells palsy. Abnormally high levels of thrombin-antithrombin III complex (TAT) and α-2 plasmin inhibitor-plasmin complex (PIC) were found, with these increases statistically significant. Values tended to be higher in patients within 3 days after occurrence of the palsy when compared to values in patients 4 days or more later. Abnormal TAT and PIC levels in the acute phase then tended to become normalized during the convalescent phase of the disease. These findings indicated that activation of intravascular coagulability had occurred, with patients entering a temporary clot-forming state. Among the several hypotheses for the etiology of Bells palsy, our findings support a circulation disorder as an influential factor.

A Report of Two Cases with Nasal Tuberculosis.

We treated two patients with nasal tuberculosis. One was a 58-year-old female who visited our clinic because of right nasal obstruction and bleeding. Mild swelling of the inferior turbinate and a bloody nasal discharge were observed. Mycobacterium tuberculosis was cultured from the nasal discharge. Biopsy of the mucous membrane of the inferior turbinate showed a granuloma with epithelioid cells. The other was a 59-year-old female who visited us with complaints of right nasal obstruction, purulent nasal discharge, and frontal headache. Granulation, bleeding and crust attachment were observed on the right concha nasalis inferior and the nasal septum. Mycobacterium tuberculosis was cultured from the nasal discharge. Both patients had strongly positive Mantoux tests. Chest X-ray films showed evidence of old tuberulosis but no active pulmonary tuberculosis. Both patients were treated mainly with streptomycin and other anti-tuberculous drugs with satisfactory results.

Activation of intravascular coagulation in Bell's palsy.

Although the causes of Bell’s palsy are still unknown, it is more or less the unanimous view that ischemic hypothesis and viral hypothesis constitute the main factors. With regard to ischemia, it has been believed that such factors as embolism which occur in vasa nervorum distributing to the facial nerve, or as vasospasm which is induced by dysfunction of the autonomic nervous system, cause ischemia. When considering embolism, it is easily understood that the coagulation functions of individuals are involved in such an abnormality. However, very few studies have so far been made on the functional state of coagulation in patients with facial paralysis. We made a study on the condition of coagulation functions in the acute phase of Bell’s palsy based on the clinical examination centering on the thrombin-antithrombin III complex (TAT), and plasmin-α2 plasmin inhibitor complex (PIC), which have recently attracted much attention as indexes of hypercoagulability. Relationships between the coagulation and the fibrinolytic systems, TAT and PIC, are shown in Fig. 1.