Kaneaki Haraguchi

Necrotizing Fasciitis of Cervicothoracic Region after Treatment for Tonsillar Carcinoma.

Necrotizing fasciitis is a rare disease characterized by cutaneous necrosis, suppurative fasciitis, and vascular thrombosis. The disease commonly causes a rapidly progressive toxic systemic illness (i. e. toxic shock-like syndrome) in which the mortality has been reported to be between 20 and 36%.Necrotizing fasciitis of the neck and chest occurred in a patient with tonsillar carcinoma one month after treatment with surgery and radiotherapy. The patient was admitted to our hospital ICU in renal and respiratory failure, septic shock and DIC. He recovered after treatment which included debridement of necrotized tissue in the cervicothoracic region. Streptococcus pyogenes was solated in blood cultures. We speculated that the bacterial infection might have entered through the incision for tumor resection.The recent literature concerning necrotizing fasciitis is reviewed. It is important for otolaryngologists to be aware of this disease since early excision of necrotic tissue and high dose intravenous antibiotics are necessary for patient survival.

Palatine tonsils visualized by ultrasonic tomography.

With ultrasonic tomography palatine tonsils (p.t.) and the paratonsillar regions were imaged in viva. The longitudinal and transverse measurements in 65 tonsils were compared with actual size of these tonsillar tissues after tonsillectomy. We also analyzed the images of the tonsils in 165 normal subjects and in 43 patients with palatine tonsillar diseases (39 with recurrent tonsillitis, one with acute tonsillitis and one each with peritonsillitis, peritonsillar abscess and paratine tonsillar tumor).An ultrasonic apparatus, SSD-256 (Aloka Co. Ltd), and a 7.5MHz probe which were commonly used to examine the carotid arteries were employed. After setting the probe on the submandibular area, we analyzed the images of the p.t. The tissue of the p. t. appeared as a low density shadow, and the plugs in the p. t. as high density spots. In the paratonsillar region, the tongue, the superior constrictor muscles of the pharynx, and the tonsillar branches could also be demonstrated ; the images of the tongue and the sup. const. muscle of the pharynx were high density shadows, while the tonsillar branch appeared as a low density shadow.There was a significant correlation between the ultrasonic measurements and the actual longitudinal and transverse diameters in the 65 tonsils.In normal subjects, images of plugs were not visible or were very faint.Patients with recurrent tonsillitis had many plugs, and the image of the tonsillar capsule was wide and clear from the inferior pole to the superior pole.The image of a localized abscess was clear in the patient with peritonsillar abscess, and that of invasive tumor in the patient with tonsillar tumor.Ultrasound imaging is expected to be useful in the diagnosis and therapy of palatine tonsillar disease.