Keizo Fukukita

Congenital stridor caused by redundant arytenoid mucosa

Two cases of congenital stridor caused by merely unusual redundancy of the mucosa covering the arytenoids are reported in this paper. The stridor was noted only when the patients were awake, and was not affected by postural changes of patients. The patients who did not reach their full mental and physical development had congenital abnormalities: cleft palate in one case, and hypertrichiosis, short palpebral fissures of camptodactyly in the other. No abnormalities were revealed in the patients on examinations of chromosomes, thyroid hormones and brains using the techniques of computerized axial tomographic scanning and electroencephalography. The diagnosis of these cases should be confirmed by a direct laryngoscopy or a laryngofiberscopy. Although the etiology of redundant arytenoid mucosa is not known, it may be suggested that this condition is incidental to other congenital abnormalities.

A Case of Rhinogenic Intracranial Complication

Rhinogenic Intracranial infection is a rare complication. Intracranial complication arising from nasal infections, principally afflictions of the accessory sinuses, is a very grave complication. Since the advent of chemotherapy and various antibiotics, its incidence and morbidity has diminished appreciably.A case of rhinogenic spontaneous Intracranial complication is reported herein. The patient was a 16-year-old man with a swelling around the left eye-lid that had existed for two days. There had been headache and high fever. On examination, the spinal fluid was under pressure with a high cell count, consisting mostly of poly-morphonuclear cells. Four days after admission, he went into coma. Rhinogenic intracranial complication was suspected. A radical ethmoid, antrum and frontal sinus surgery was immediately carried out. Ten grams of SB-PC and 200mg of DKB were administered daily, but 12 days after admission, the careful CT scanning revealed that he had a subdural abscess. Drainage of the subdural abscess was carried out. The patient made a complete recovery 7 weeks after admission.

A Clinical Examination of Malignant Tumor of the Palatine Tonsil

From 1961 to 1980, 45 patients with malignant tumor of the palatine tonsil were treated at the Department of Otolaryngology, Mie University Hospital. Of these, 12 patients were cancer and 33 sarcoma.Tonsillar cancer predominantly affected the male, whereas sarcoma was found in the male and female almost equally. The age distribution of tonsillar cancer was uniform, while there were two peaks in the fourth and seventh decades of life for tonsillar sarcoma. Eighty-three percent of cancer was squamous cell carcinoma, and all the sarcoma cases were malignant lymphoma of which 94% were reticulum cell sarcoma. Seventy-five percent of carcinoma were stage III or IV, while 94% of malignant lymphoma were stage I or II at the time of diagnosis. Sore throat was the most commonly encountered chief complaint for both carcinoma and malignant lymphoma. Three patients (25%) of those with carcinoma and four (12%) malignant lymphoma patients complained of a lump in the neck.All the patients with tonsillar malignancy underwent radiation therapy, and chemotherapy was also used in nine patients (75%) with carcinoma and 19 (58%) with malignant lymphoma. Crude survival rates for tonsillar cancer was 64% for 1 year, 20% for 2 years, 11% for 3 years and 0% for 5 years, and for malignant lymphoma of the palatine tonsil it was 45% for 1 year, 40% for 2 years, 37% for 3 years and 22% for 5 years.Although both carcinoma and malignant lymphoma had poor prognosis in this study, the preliminary results of combined radiation and chemotherapy for malignant lymphoma were encouraging. It was found that the total radiation dose of 5, 000-7, 000rads for carcinoma and 4, 000-6, 000rads for malignant lymphoma of the palatine tonsil was satisfactory in this study.

Seven Cases of Malignant Lymphoma of the Nose and Paranasal Sinuses

This paper deals with seven patients with malignant lymphoma of the nose and paranasal sinuses. They included six males and one female aging from 30 to 70 years. Of the seven patients, the maxillary sinus was thought to be the site of origin in four patients, the sphenoidal sinus in one and the nasal cavity in three. The most frequent histopathological type in this series was reticulum cell sarcoma, but one was lymphosarcoma and another was unclassifiable.According to the criteria of the Ann Arbor classification, two patients were in stage I, two in stage II, two in stage III and one in stage IV. Cheek swelling and epistaxis were the most common chief complaints in six patients. They did not present particularly characteristic clinical symptoms. Cobalt-60 or Linac teletherapy was delivered in a total dose of 1600-6000rads. In addition, non-scheduled chemotherapy including 5-FU, COP, BONP or VEMP was given. In five out of the seven, the initial response to this therapy was favorable. In these patients, 83% (five of the six) died within 16 months of diagnosis and only 14% (one of the seven) survived for five years. With this dismal experience in mind, three principles are proposed for the management of patients with malignant lymphoma of the nose and paranasal sinuses. These consist of (1) exact staging of the disease, (2) planned protocol adjusted to the stage for the therapy and (3) irradiation combined with chemotherapy for patients in stage II.

Congenital Choanal Atresia

A case of bilateral congenital choanal atresia is presented. The patient was a 16-year-old girl who had suffered from thick, mucoid discharge and complete nasal obstruction since birth. Although she gradually learned to breathe through her mouth, she often encountered respiratory distress with cyanosis in the early stages of life. A diagnosis of choanal atresia was made when a catheter failed to pass through the nose into the pharynx. The nasopharyngography confirmed the posterior nasal obstruction.Surgical correction was performed by a transpalatine approach under general anesthesia. Following exposure of the posterior choanal region via the transpalatine approach, the membraneous tissue which occluded the choanae was excised. Silicon tubes were left inserted into the opened choanae for 2 weeks. No remarkable complication has been observed postoperatively. The choanae are still open and the patient breathes satisfactorily through her nose.From 1923 to 1979, 45 cases of congenital choanal atresia have been reported in the Japanese literature. These cases are analyzed in terms of sex, laterality, type and concomitant anomalies. Our present report is the 45th case of congenital choanal atresia to be reported in Japan.