Jumpei Nota

Facial nerve decompression surgery using bFGF-impregnated biodegradable gelatin hydrogel in patients with Bell palsy.

Objective. Basic fibroblast growth factor (bFGF) promotes the regeneration of denervated nerves. The aim of this study was to evaluate the regeneration-facilitating effects of novel facial nerve decompression surgery using bFGF in a gelatin hydrogel in patients with severe Bell palsy. Study Design. Prospective clinical study. Setting. Tertiary referral center. Subjects and Methods. Twenty patients with Bell palsy after more than 2 weeks following the onset of severe paralysis were treated with the new procedure. The facial nerve was decompressed between tympanic and mastoid segments via the mastoid. A bFGF-impregnated biodegradable gelatin hydrogel was placed around the exposed nerve. Regeneration of the facial nerve was evaluated by the House-Brackmann (H-B) grading system. The outcomes were compared with the authors’ previous study, which reported outcomes of the patients who underwent conventional decompression surgery (n = 58) or conservative treatment (n = 43). Results. The complete recovery (H-B grade 1) rate of the novel surgery (75.0%) was significantly better than the rate of conventional surgery (44.8%) and conservative treatment (23.3%). Every patient in the novel decompression surgery group improved to H-B grade 2 or better even when undergone between 31 and 99 days after onset. Conclusion. Advantages of this decompression surgery are low risk of complications and long effective period after onset of the paralysis. To the authors’ knowledge, this is the first clinical report of the efficacy of bFGF using a new drug delivery system in patients with severe Bell palsy.

Laryngeal Giant Cell Tumor: A Case Report and Review of the Literature

Giant cell tumor (GCT) is a benign neoplasm arising most commonly in the long bones. GCTs of the larynx (GCTL) are relatively rare, and only individual case reports are documented in the literature. Patients with such tumors may present with hoarseness and anterior neck swelling. We present a 59-year-old man with hoarseness and enlarging anterior neck mass for 3 months. A fiberscopy revealed a submucosal swelling of the left subglottic trachea. Computed tomography and magnetic resonance imaging of the larynx demonstrated a large, well-defined, inhomogeneous enhancing mass at the left thyroid cartilage, which was obstructed entirely. The anterior neck mass was biopsied for histopathological analysis, which showed multinodularity with intervening vascularized connective tissues. The mass was made up of mononuclear cells and distributed multinucleated giant cells. The mitotic activity of the mononuclear cells was as high as 6 per 10 high-power fields. Pathologic consultation resulted in a diagnosis of giant cell tumor. The patient underwent total laryngectomy and, postoperatively, he did well without recurrence or metastasis for two and a half years.

Safety and efficacy of adenotonsillectomy for obstructive sleep apnea in infants, toddlers and preschool children.

OBJECTIVE To investigate and compare the safety and efficacy of adenotonsillectomy (AT) on obstructive sleep apnea (OSA) in infants and toddlers (IT) with preschool children (PS), and charts of 147 children between the ages of 11 months and 6 years were reviewed. METHODS Harmonic Scalpel (HS) was introduced into AT to reduce the operative duration and intraoperative hemorrhage. Preoperative and postoperative apnea-hypopnea indices (AHI) values obtained by the type 3 portable monitoring device, and the change achieved by AT were statistically compared between IT group (N=50) and PS group (N=97). The mean operative duration, the mean amount of intraoperative hemorrhage, the incidence of postoperative hemorrhage, the frequency of abnormal postoperative chest X-ray findings, and the length of hospital stay were also compared between the two groups. All statistical analyses were conducted using either the Students t test or Fischers exact test, and p-values <0.05 were considered statistically significant. RESULTS In the IT group, the mean preoperative AHI value was 13.5±7.1 and decreased to 4.7±3.4 postoperatively. In the PS group, the mean AHI value changed from 16.0±10.2 to 4.4±2.4. There were statistically significant differences between the preoperative and postoperative AHI values in both the IT and PS groups, but there were no statistically significant differences between the IT and PS groups. The mean operative durations in the IT group for tonsillectomy and adenoidectomy were 12.8±6.7 min and 19.5±8.1 min, respectively. The corresponding values in the PS group were 14.5±6.6 min and 22.9±9.7 min, respectively. The mean tonsillectomy durations were comparable, but the adenoidectomy duration was statistically shorter in the IT group. In the IT group, the mean amounts of intraoperative hemorrhage during tonsillectomy and during adenoidectomy were 6.0±5.1 and 18.9±10.6 g, respectively. The corresponding values in the PS group were 6.4±5.4 g and 26.2±13.4 g, respectively. The mean tonsillectomy blood loss was comparable between the groups but was statistically less during adenoidectomy in the IT group. There were no statistical differences between the two groups in the incidence of postoperative hemorrhage and of abnormal findings in the postoperative chest X-ray, and in the length of hospital stay. CONCLUSION AT in IT can be performed without major perioperative complications and should be considered the primary treatment of OSA from infancy to early childhood. Ultrasonic devices may contribute to increasing the safety of this surgical treatment.

Treatment of Neural Anosmia by Topical Application of Basic Fibroblast Growth Factor–Gelatin Hydrogel in the Nasal Cavity: An Experimental Study in Mice

IMPORTANCE A new treatment of neural anosmia. OBJECTIVE To investigate the effects of basic fibroblast growth factor (bFGF)-gelatin hydrogel on recovery of neural anosmia in mice. DESIGN Anosmia was induced by intraperitoneal injection of 3-methylindole, 200 mg/kg. One week later, the animals underwent 1 of the following 3 procedures bilaterally: (1) group A: single-shot intranasal drip infusion of phosphate-buffered saline, (2) group B: single-shot intranasal drip infusion of bFGF, and (3) group C: placement of bFGF-gelatin hydrogel in the nasal cavity. The olfactory function of the animal was evaluated by the odor-detection test (ODT) 2 and 4 weeks later. Following the testing, the animal was killed, the thickness of the olfactory epithelium was measured, and the number of olfactory marker protein (OMP)-positive cells was counted. SETTING Research installation. PARTICIPANTS Mice. INTERVENTION The placement of bFGF-gelatin hydrogel in the nasal cavity. MAIN OUTCOMES AND MEASURES An ODT, thickness of olfactory epithelium, the number of OMP-positive cells RESULTS The ODT proved that neural anosmia recovered in group C but not in groups A and B. Histologically, olfactory epithelium became thicker and the number of OMP-positive cells increased in group C, while such functional and histologic recovery was poor in groups A and B. These findings suggested that placement of bFGF-gelatin hydrogel in the nasal cavity was an efficient way to facilitate recovery of neural anosmia. CONCLUSIONS AND RELEVANCE As a gelatin hydrogel degrades slowly in the body, bFGF is gradually released around the site of the lesion; thus, it constantly exerts its effects on neural regeneration.

Facial Nerve Decompression Surgery with Gelatin Containing bFGF

Objective: Basic fibroblast growth factor (bFGF) promotes the regeneration of denervated nerves. Our experimental study suggested that bFGF-impregnated biodegradable gelatin hydrogel facilitates regeneration of the facial nerve in guinea pigs due to the sustained release of bFGF. Clinically, this therapeutic regimen may be useful for facial nerve decompression surgery. Method: Twenty-five patients with severe facial paralysis were treated with the new procedure. The facial nerve was decompressed tympanic and mastoid portions via mastoid. A bFGF-impregnated biodegradable gelatin hydrogel was placed around the exposed nerve. Regeneration of the facial nerve was evaluated once per month by observing the facial movement. Results: Patients were followed until complete recovery occurred, or for more than 6 months in cases with a poor prognosis. All patients with severe Bell’s palsy and Ramsey Hunt syndrome showed early recuperation and milder sequelae compared to conventional decompression surgery. Recovery from the palsy was defined as House-Brackmann grading 1 and 2. The rates of recovered patients with novel surgery and conventional surgery were 92.0% (n = 25) and 70.7% (n = 58), respectively; the former was significantly better than the latter (P < .05). Conclusion: This is the first study to reveal the efficacy of a bFGF-impregnated biodegradable gelatin hydrogel as a drug-delivery medium in the paralyzed facial nerve surgery. Advantages of this decompression surgery are low risk of hearing impediment and long effective period after onset of paralysis.