Hiroyuki Kitamura

Submandibular salivary pH as a diagnostic aid for prognosis of facial palsy.

The present paper aims at introducing a new method of testing the function of the chorda tympani with the aid of submandibular salivary pH. This method has several advantages: (1.) it enables the measurement of the function of only the paralyzed side; (2.) it accurately predicts the outcome of facial palsy at an early stage; and (3.) the method is simple and inexpensive.

A Case Report of Neurilemmoma of the Larynx

Neurilemmoma of the larynx is an uncommon lesion. In Japan, the first case was reported in 1948, and since then, only 59 cases have been reported to our knowledge. We recently treated a 22-year-old female with a neurilemmoma of the larynx. She had suffered from hoarseness for 5 years. The lesion was located in the right false cord and vocal cord, and was found to be a submucosal tumor. It was resected by laryngofissure, resulting in improved phonation, and no recurrence has been noted in 13 months of follow up.

Salivary Duct Carcinoma; Two Case Reports.

We present two cases of salivary duct carcinoma in this paper. Both cases were middle-aged men. They were treated with total parotidectomy and postoperative radiotherapy. Both cases have been followed up for 18 and 15 months respectively with no evidence of local recurrence or distant metastasis.Sixty-six cases of salivary duct carcinoma, including ours, have been reported in the Japanese literature. We reviewed the clinical characteristics of this unusual tumor. Most cases were male (90%) and occured in the parotid gland (84%). The average age was 61 years, ranging from 36 to 91. In 44% of patients, parotid tumors are accompanied by facial nerve paralysis. Total parotidectomy or extended parotidectomy followed by radiotherapy was the most common treatment for patients with salivary duct carcinoma in the parotid gland. The prognosis was poor and the 5-year survival rate was 28%.

A Case of Deep Lobe Parotid Lipoma.

Lipomas are common soft tissue neoplasms, but they are found rarely in the region of the parotid gland, and are observed in about 1% of tumors of the parotid gland. Deep lobe parotid lipomas are especially rare tumors. We present a 66-year-old woman with a deep lobe parotid lipoma treated by enucleation. We believe that this is only the sixth report in the literature of a lipoma in this location.Magnetic resonance imaging (MRI) and fine needle aspiration were performed, and findings suggested a pre-operative diagnosis of lipoma. The fat suppression MRI technique suppressed the signal from the tumor and strongly confirmed the diagnosis.

Papillary Carcinoma of the Thyroid Metastasizing to the Parapharyngeal Space ; Two Case Reports

The parapharyngeal space is an anatomically complex region in which a variety of neoplasms can arise. Metastasis of a thyroid carcinoma to the parapharyngeal space is very rare. We recently treated two cases of this disease. The first case was a 66 year-old male with recurrent thyroid carcinoma presenting as a parapharyngeal mass, who had previously undergone a hemi-thyroidectomy and modified neck dissection. The second case was a 61 year-old male with accidental thyroid carcinoma metastasis to the parapharyngeal space during surgery for the treatment of hypopharyngeal and esophageal carcinoma. The possibility of metastatis to this region should be considered in the treatment of thyroid carcinoma.

Cervical Ganglioneuroblastoma; A Case Report.

Ganglioneuroblastoma is composed of both ganglion and neuroblast cells and is a subset of neuroblastoma, which is one of the most popular malignant tumors of children. This type of tumor typically originates from the abdomen and rarely from the neck. We report a case of cervical ganglioneuroblastoma in this article.A 9 year-old girl was presented as having an elastic hard tumor in the left side of her neck. The tumor located behind the bifurcation of the common carotid artery and no blood flow was detected by either ultrasonic study or magnetic resonance imaging. We performed extirpation of the tumor as a neurinoma, and carried out an additional neck dissection after the tumor was diagnosed as a ganglioneuroblastoma by pathologic study of a frozen section of the tumor. Its origin was thought to be the cervical sympathetic trunk.Complete surgical resection is sufficient treatment for cervical ganglioneuroblastoma in children because it can be detected earlier than abdominal tumors and because radiation therapy and chemotherapy have serious side effects on children.

Malignant Transformation of an Inverted Papilloma in the Frontal Sinus; A Case Report.

An inverted papilloma in the frontal sinus is a rare finding. We recently treated an 81-year-old female with malignant transformation of an inverted papilloma in the frontal sinus.We performed the tumor resection with a transfrontal sinus approach and a transnasal approach, followed by radiation therapy.To our knowledge, there have been no previous reports of an inverted papilloma in the frontal sinus undergoing malignant transformation.

Treatment Results for Stage I and Stage II Laryngeal Carcinoma.

Combined therapy, using a Nd-YAG laser and irradiation, for the treatment of stage I and stage II laryngeal carcinoma has been applied at our facility since June of 1990. A total of 18 cases of stage I and 12 cases of stage II laryngeal carcinoma were investigated retrospectively. Among these 30 cases there were 3 cases of stage II supraglottic cancer, 26 cases of glottic cancer (stage I: 17 cases, stage II: 9 cases), and one of stage I subglottic cancer.Preservation rate of the larynx in stage I and stage II laryngeal carcinoma patients has been poor in the past. In the present series of patients, however, the larynx was preserved in 100% of the stage I patients and in 58.3% of the stage II patients. Though these results represent a substantial improvement over the previous preservation rate, preservation of the larynx in stage II patients remained similar to that in other reports.

Clinical Study of Ternelin Therapy and Ternelin and Hydergine Therapy for Tinnitus.

Patients with tinnitus were treated with Ternelin® (tizanidine hydrochloride) alone or in combination with Hydergine® (dihydroergotoxine mesylate). The following results were obtained.1) When overall improvement was assessed at the end of the dosing period, 36% of the 136 patients who received Ternelin and Hydergine® (the combined therapy group) showed moderate or marked improvement, while 61.8% of the patients in this group showed slight, moderate or marked improvement. The combined therapy was rated as moderately or highly useful in 35.3% and slightly to highly useful in 61% of all cases.2) Of the 24 patients who received Ternelin alone (the solo therapy group), 25% showed moderate or marked improvement, and 66.7% showed slight, moderate or marked improvement. Solo therapy was rated as moderately or highly useful in 25% and slightly to highly useful in 66.7%.3) of the 153 patients who received combined therapy (including 17 patients who were only included in the safety assessment), 9 developed adverse reactions (3 cases of drowsiness, and one each of orthostatic syncope, hypotonia, dizziness, gastric pain, constipation and oral thirst). None of the patients given Ternelin® alone showed any adverse reactions.4) The percentage of cases showing marked or moderate improvement was higher in the combined therapy group than in the solo therapy group, although this difference was not significant. In the ombined therapy group, the reduction in tinnitus peaked 2 to 4 weeks afterr the start of treatment. In the solo therapy group, the number of patients responding to the drug increased gradually with time, and more time was needed to obtain maximal effects than that in the combined therapy group.

Post Irradiation Maxillary Sinus Sarcoma; A Case Report.

Radiation-induced cancer of the head and neck is well known, but radiation-induced sarcoma is rare. Only nine cases have been reported in the Japanese literature. We treated a patient with post irradiation sarcoma arising in the maxillary sinus. She is now 60 years old and had received radiation therapy for left maxillary carcinoma in 1952. In 1972, left maxillary sarcoma was found and she received postoperative radiation therapy again. Then right nasal carcinoma was found in 1980, and she again received postoperative radiation therapy. Then left maxillary sarcoma was found in 1992. There have been no previous reports of three consecutive radiation-induced malignancies developing in a patient.