Ibuki Hayashi

Sleep Apnea and Sleep-related Breathing Disorders in Patients with Craniofacial Synostosis

Seventeen patients with craniofacial synostosis (CFS) have been treated at the Department of Plastic and Reconstructive Surgery at Osaka Medical College during the past 10 years. Six patients were thoroughly evaluated at the Department of Otolaryngology by polysomnography (PSG), cephalometric X-ray and nasopharyngoscopy during sleep. In 4 of the patients PSG showed obstructive sleep apnea syndromes (OSAS). Heavy snoring without apnea and paradoxical respiration were noted in the other 2 patients. Thus, all of the patients had sleep-related breathing disorders (SRBD). It is assumed that the incidence of SRBD in CFS is high. Cephalometric analysis and profilogram showed maxillomandibular hypoplasia in each patient, and it was assumed that the main cause of SRBD in CFS was stenosis of the upper airway tract caused by maxillo-mandibular hypoplasia. Nasopharyngoscopy was performed during sleep in 2 patients with OSAS secondary to CFS. One patient with adenotonsillar hypertrophy had nasopharyngeal obstruction and another patient whose posterior airway space (PAS) on cephalometric radiograph was 3 mm (normal value: 11 mm) had obstruction at the tongue base.

Stereoscopic Display of a Three-Dimensional Image of the Larynx Using High-Speed Helical Scanning

To evaluate the usefulness of stereoscopic images of larynges using helical CT in stereo mode, a retrospective review of the characteristics of stereoscopic viewing of larynges was made. The subjects were 3 patients with laryngeal cancer, 1 patient with laryngeal leiomyosarcoma and 1 patient with an advanced tongue carcinoma whose formalin-fixed larynx was extirpated. The larynges were scanned by high-speed helical CT using 1- to 2-mm slices. The reproduction of stereographic images was performed by the manipulation and rotation of three-dimensional structures around the y-axis on the computer display. The three-dimensional images of the complex structures, such as the arytenoid cartilage, aryepiglottic fold and pyriform sinus, were better observed by binocular images (stereograms) than by monocular images. Stereoscopic views of the larynx are useful in producing three-dimensional images of the unseen inner surface of the human body.

The Early Detection of Occult Metastasis from Oral Cancer

We examined occult metastasis to cervical lymph nodes in ten cases of early oral and oropharyngeal (uvula origin) cancer. In all ten cases, partial excision alone was performed, without performing prophylactic neck dissection. Ultrasonic echo was carried out once every few month after the initial cancer treatment, and tried to detect occult cervical metastasis early. Metastatic lymph node was defined as showing a minor axis/major axis >0.5, and a minor axis >6mm on ultrasonic echo. The period from primary treatment to detection of metastatic lymph node ranged from 4 to 16 months. The average size of the lymph nodes at diagnosis of metastasis was 16×11mm. Pathological diagnosis of metastatic lymph node was detected by FNA in nine cases and excisional biopsy in one case. Although there was a case in which the observation period was short, seven cases survived and the results were better than the previous reports. It is important to perform ultrasonic echography after the initial treatment for early oral cancer in which prophylactic neck dissection was not performed. These results suggest that early detection of occult metastasis from oral cancer by ultrasonic echo can be expected to improve prognoses in cases of occult metastasis.

Le Fort I Osteotomy for Giant Juvenile Nasopharyngeal Angiofibroma.

Angiofibromas are histologically benign tumors, but clinically they often appear to be malignant because of their rich vascularity, so that massive bleeding may occur during surgery. Therefore, it is necessary to select a surgical technique with only slight bleeding and with a wide view enabling resection of the tumor en bloc.A 13-year-old male patient with a giant angiofibroma involving his nasopharynx, pterygopalatine fossa, and infratemporal fossa was treated here. We tried to resect the tumor en bloc without a skin incision. Le Fort I osteotomy was performed after embolization of the feeding artery of the tumor. The tumor was resected en bloc with little bleeding. There were no postoperative complications. We think that Le Fort I osteotomy is the most desirable technique for resecting angiofibromas with a wide view of the operative area.