Kunihiro Nishimura

Case of malignant transformation of vagus nerve schwannoma to angiosarcoma

It is known that benign tumors have the potential for malignant transformation. Malignant transformation of vagus nerve schwannoma to angiosarcoma is very rare.

Improved Vision from Severe Compressive Optic Neuropathy by Apical Cavernous Hemangioma.

A 59-year-old woman had a 1-year history of right vision loss. Her visual acuity was then 0.01 OD, and the critical flicker frequency (CFF) was 8 Hz OD. Goldmann perimetry examination showed inferior suppression of the right visual field center. Funduscopic examination revealed normal coloring of the right optic disc. Imaging studies showed an apical oval tumor. The optic nerve was compressed by both the tumor and the superior rectus muscle/levator palpebrae superioris complex. The tumor was dissected from the surrounding tissues and completely extracted. Histopathologic examination confirmed a cavernous hemangioma. The patient underwent three cycles of postoperative steroid pulse therapy. One year after the surgery, her visual acuity and CFF improved to 1.0 and 32 Hz OD, respectively. Her right visual field was within the normal range.

Red blood cell distribution width predicts prognosis in idiopathic sudden sensorineural hearing loss

Abstract Conclusion: Red cell distribution width (RDW) can predict outcome in patients with idiopathic sudden sensorineural hearing loss (ISSNHL). Further studies are required to clarify the potential pathophysiological explanations for these findings. Objectives: RDW is one of the parameters reported in a complete blood count, and is elevated in direct proportion to variation in red cell size (anisocytosis). High RDW values are strongly associated with poor clinical outcomes in various diseases, including inflammatory and thrombotic diseases. To identify a prognostic biomarker that better predicts outcomes after ISSNHL, the association between RDW values at hospitalization and prognosis in patients with ISSNHL was assessed. Method: This study measured RDW and performed hearing assessments in 89 consecutive patients with ISSNHL. Patients were then divided into two groups (‘recovered’ and ‘unrecovered’), according to their response to the treatment, and further analysis undertaken. Results: Mean RDW was significantly higher in the unrecovered group (13.2% ± 1.0% compared with 12.7% ± 0.7% in the recovered group, p = 0.031). After adjusting for potentially confounding factors in a binary logistic regression model, only RDW was associated with recovery from ISSNHL (odds ratio = 2.33, 95% confidence interval = 1.20–4.51, p = 0.012).

Case of partial vertical laryngectomy with vocal cord reconstruction using a thyroid gland flap.

To preserve laryngeal function in early‐stage laryngeal cancer, chemotherapy and radiotherapy are performed more often than surgery as initial treatment. However, in recurrent cases, complex salvage surgery is often required as patients who received aggressive chemoradiotherapy are susceptible to postoperative complications. We report here salvage therapy that preserved laryngeal function in a recurrent case.

Orbital Fat Prolapse Into the Nasal Cavity in Orbital Blowout Fracture.

In this study, the authors describe the first report of 2 patients of fat prolapse into the nasal cavity by orbital blowout fracture. The patients were a 58-year-old male and an 86-year-old female. The patients could not attain binocular single vision in any eye position because of severe impairment of the extraocular muscle motility. Computed tomographic images of both patients revealed orbital blowout fractures with orbital fat prolapse into the nasal cavity. The fractures were reduced under transconjunctival/transcaruncular and endonasal endoscopic approaches. Six months postoperatively, the patients attained a binocular single vision field, including in the primary eye position.

Advanced surgical technique for invasive fungal sinusitis: endoscopic orbit-sinus combined approach

Abstract Background: Invasive fungal sinusitis is usually associated with poor prognosis, but no clear guidelines have been established for surgical treatment. Here, we report the development and application of the endoscopic orbit-sinus combined approach (EOSCA), a novel surgical technique to approach the nasal cavity and orbit concurrently, in patients with invasive fungal sinusitis with orbital infiltration. Material and methods: Two patients with invasive fungal sinusitis infiltrating the orbit underwent EOSCA. Transnasal endoscopy was performed for maximum debulking of tissues infiltrated by fungi in the nasal cavity and orbit, before making an incision into the palpebral conjunctiva. An endoscope was then inserted into the orbit through the incision in the palpebral conjunctiva to remove adipose tissue and muscles that had been infiltrated by fungi from the orbital regions where the transnasal approach was difficult or impossible. Another surgeon assisted the procedure by operating an endoscope concurrently via the nasal cavity (four-hands technique). Results: We were able to remove lesions safely and with precision, preserving visual acuity and a functional eyeball in both cases. Currently, the patients are alive, with no postoperative complications, recurrence, or disfigurement. Conclusions: This novel method shows promise as a safe and reliable surgical procedure for patients with invasive fungal sinusitis infiltrating into the orbit, with no postoperative complications, recurrence, or disfigurement.

Huge Localized Amyloidosis of the Sinonasal Cavity: A Rare Case Report

Background: Amyloidosis is the general term for deposition of fibrous abnormal protein aggregates (amyloid) in organs or tissues that leads to dysfunction of the affected organs. Treatment and follow-up of localized amyloidosis are particularly difficult because its pathogenesis is still unclear. Localized amyloidosis of the head and neck is rare and that of the nose is rarer still. Here, we report a case of localized amyloidosis of the nasal cavity, which affected an area larger than those in previous reports. Case presentation: A 60-year-old woman presented with the chief complaints of headache, proptosis and nasal congestion. There was a lack of response to chemotherapy and endoscopic sinus surgery was performed. As of 18 months after surgery, subjective symptoms have been alleviated and are consistent with the objective findings. There have been no signs of recurrence. Conclusions: Cases of localized amyloidosis of the nasal cavity are rare, and standard treatment has not yet been established. In this case, proactive surgical intervention was successful for this condition.

Invasive Fungal Sinusitis Involving the Orbital Apex in a Patient with Chronic Renal Failure

Abstract An 82-year-old man with chronic renal failure presented with invasive fungal sinusitis involving the right orbital apex. Intravenous liposomal amphotericin B was immediately administered with an intravenous sodium supplement. Subsequently, endoscopic sinus surgery was performed. Aspergillus fumigatus was detected in nasal discharge culture on day 12. Because the patient’s renal function had deteriorated by this time, therapy was changed to nasal inhalation of amphotericin B, which was discontinued after 1 month, and oral administration of voriconazole, which was discontinued after 2 months. During 6-month follow-up, the patient did not show recurrence of sinusitis or further decrease in renal function.

Edema of the interarytenoid mucosa seen on endoscopy is related to endoscopic-positive esophagitis (EE) and is an independent predictor of EE

Laryngopharyngeal reflux (LPR) is defined as the retrograde flow of gastric contents up through the esophagus to the larynx and hypopharynx; this is an extra‐esophageal manifestation of gastroesophageal reflux disease (GERD). Although both LPR and GERD are caused by reflux of stomach contents, their clinical presentations and treatments differ.