Masahiro Kawana

Treatment of ranula-excision of the sublingual gland versus marsupialization

The purpose of this work is to estimate optimum surgical treatment of ranula according to the type of the lesion. Nine patients with ranula surgically treated between 1989 and 2000 were investigated retrospectively. Six patients had sublingual type ranula and three had submandibular type. In five cases including recurrence cases, the sublingual gland was excised. Marsupialization was performed for four cases, which were superficial, protruded and within 2 cm of diameter. In all cases, histopathological diagnoses were pseudocysts without epithelial lining and there was no recurrence. Almost all ranulas are pseudocysts from the sublingual gland, therefore excision of the sublingual gland is considered to be a reasonable and radical treatment. For the small sublingual type, which is superficial, protruding and smaller than 2 cm in diameter, marsupialization is also a useful modification of surgical treatment of ranula.

Course of IL-1β, IL-6, IL-8, and TNF-α in the Middle Ear Fluid of the Guinea Pig Otitis Media Model Induced by Nonviable Haemophilus Influenzae

To characterize the local response in acute otitis media, courses of interleukin (IL)–1β, IL-6, IL-8, and tumor necrosis factor (TNF) α in middle ear fluid (MEF) of the guinea pig otitis media model induced by nonviable Haemophilus influenzae were investigated with enzyme-linked immunosorbent assay (ELISA) kits. The IL-1β concentration in H influenzae–inoculated ears peaked 24 hours after inoculation. The IL-8 concentration was significantly higher in H influenzae–inoculated ears than in controls 48 and 96 hours after inoculation. The TNF-α concentration in H influenzae–inoculated ears had an initial peak 6 hours after inoculation and had significant late increases 48 and 96 hours after inoculation. The results suggest that IL-1β and TNF-α were produced by middle ear mucosa in the early stage of the experiment by stimulation of bacterial inoculation, which caused subsequent inflammatory cell accumulation, and that IL-8 and TNF-α were produced in the late stage by accumulating inflammatory cells.

Desmoid-type infantile fibromatosis in the mandible: A case report

A 3-year-old boy with desmoid-type infantile fibromatosis arose in the mandible was reported. He was referred to our hospital because of suspected malignant bone tumor of the mandible. Histological examination of an open biopsy specimen was performed followed by tumor resection with marginal mandibulectomy and reconstruction by iliac bone grafting, which caused no functional complications nor mandibular deformity. To treat tumors in the facial skeleton, the surgical procedure should be planned based on the histological diagnosis in order to determine the proper area of resection to prevent functional or cosmetic complications. Especially in children, attention should be taken for benign but clinically resembling malignant rare diseases such as desmoid-type infantile fibromatosis.

Radiological findings of adenolymphoma (Warthin's tumor)

The radiological findings of adenolymphomas (Warthins tumor) treated in six hospitals between 1985 and 1994 were compared with the operative and histological findings and the usefulness of the radiological examinations was evaluated. The total number of patients was 72. The mean age was 61.8 years; 61 were males and 11 were females. All tumors developed in the parotid gland. Tc-99m-pertechnetate salivary gland scanning was performed in 13 patients and an increased uptake of the isotope was observed in only six patients. Even if Tc-99m-pertechnetate salivary gland scanning does not reveal intense accumulation, this tumor should not be ruled out. By computed tomography (CT), ultrasonography (US), and magnetic resonance imaging (MRI), the margin of all tumors was evident; however, the contents of the tumor varied. The contents and multiplicity of the tumors were well demonstrated by MRI, which was found to be the most accurate imaging modality.

MR findings with dynamic evaluation in Riedel's thyroiditis

We reported the findings on MRI in a patient with proven Riedels thyroiditis. The lesion was seen as slightly heterogeneous hypointensity on both T1- and T2-weighted images and had a mild enhancement after administration of gadpentate dimeglumine (Gd-DTPA). Dynamic MR study showed gradual increase in signal intensity of the lesion. These findings were different from those of thyroid neoplasms and were considered to reflect the mixture of inflammatory cells infiltration and fibrosis of Riedels thyroiditis.

Malignant lymphoma in the head and neck associated with benign lymphoepithelial lesion of the parotid gland.

Lymphoepithelial lesion is a benign lymphoproliferative disease occasionally arises in the salivary glands, but association with malignant diseases or autoimmune diseases has also been discussed. We herein present three cases of malignant lymphoma arose in the parotid gland and the lacrimal gland, following parotid surgery for benign lymphoepithelial lesion (BLEL) of the parotid gland. Two cases had mucosa associated lymphoid tissue (MALT) lymphoma in the parotid gland; one arose in the ipsilateral parotid gland as a recurrent swelling, and the other arose in the contralateral parotid gland of the previous BLEL surgery. The third case of malignant lymphoma arose in the lacrimal gland on the ipsilateral side, and the following contralateral parotid gland remained BLEL. All three patients were female, and one patient had a past history of Sjögrens syndrome and Hashimotos disease. All three patients were treated by chemotherapy and one patient received additional radiotherapy. To follow-up lymphoproliferative diseases in the salivary glands such as BLEL, careful observation should be made on the same gland, other major salivary glands, and other organs in the head and neck, especially in females with autoimmune diseases.

Experimentally induced otitis media with effusion following inoculation with the outer cell wall of nontypable Haemophilus influenzae

SummaryPreviously, we extracted lipopolysaccaride endotoxin (LPS) from an axenic culture of Haemophilus influenzae and inoculated it into the middle ears of guinea pigs, inducing temporary serous effusions. In the present study, we tried to clarify whether the immunological mechanism responsible for producing the otitis media following outer cell wall inoculation was persistent. We extracted the outer cell wall from nontypable H. influenzae, using Zollingers method, and inoculated extracts into the middle ears of guinea pigs that had previously received three injections of nonviable H. influenzae in Freunds complete adjuvant. Histological evaluations were performed from day 2 to day 24. Effusions and mucosal changes persisted for a longer time than in the LPS-inoculated model. Hypertrophied mucosae and increased numbers of goblet cells with hypersecretion were visible in the specimens on days 23–24. The condition seemed to show a greater similarity to chronic otitis media with effusion in children than did the LPS-inoculated model. We concluded that both the biological activity of the outer cell wall and immunological mechanisms might induce prolonged otitis media. We speculate that not only single middle ear infection but also general infections and repetitive middle ear infections may contribute to prolonged otitis media.

Evaluation of mastoid air cell system by three-dimensional reconstruction using sagittal tomography of the temporal bone

The mastoid air cell system has been recognized as an important contributor to the pathophysiology of middle ear inflammatory diseases. Various methods of temporal bone imaging have been designed to investigate the correlation between middle ear disease and mastoid pneumatization. In this study, the mastoid air cell system was reconstructed three-dimensionally from sagittal tomographic images of the temporal bone on X-ray films, using a personal computer to evaluate the mastoid pneumatization in a total of 29 patients with chronic otitis media, adhesive otitis media, adhesive-type cholesteatoma, attic cholesteatoma and cholesterol granuloma, and in five normal subjects as controls. Reconstructed three-dimensional images of the mastoid air cell system and its volume were analyzed. The reconstructed images were helpful in recognizing the three-dimensional solid appearance of the mastoid air cell system. The volume of the reconstructed mastoid air cell system was significantly reduced compared with that in the controls in each of the patient groups. Mastoid pneumatization in the patients with adhesive-type cholesteatoma was significantly suppressed compared with that in the adhesive otitis media patients. Interestingly, the adhesive otitis media group showed cell development at the tip of mastoid process, whereas the group of adhesive-type cholesteatoma did not, suggesting a difference in the pathophysiology in the two diseases. We found that three-dimensional reconstruction of the temporal bone using sagittal tomographic images was useful in evaluating the state of mastoid air cell system development in individual cases and in investigating the pathophysiology in middle ear disease.

Early Inflammatory Changes of the Haemophilus influenzae-Induced Experimental Otitis Media

Haemophilus influenzae is one of the most frequent pathogens of acute otitis media. To determine the middle ear response during the early stage of acute inflammation, a small amount of H. influenzae was inoculated into the bullae of guinea pigs through the tympanic membrane. The bullae were harvested at 6, 12, 24, 36, and 48 hours after H. influenzae inoculation and washed with phosphate-buffered saline (PBS). The number of viable H. influenzae and inflammatory cells, the concentrations of myeloperoxidase (MPO) and lysozyme in the washing suspensions were measured, and compared with those in PBS-inoculated control ears. The number of viable H. influenzae increased very rapidly from 6 to 12 hours after inoculation and remained stationary up to 48 hours. The number of inflammatory cells and the MPO concentration were significantly higher in the H. influenzae-inoculated ears than in the control ears from 12 to 48 hours after inoculation. The lysozyme concentration was already significantly higher at 6 hours in the H. influenzae-inoculated ears; the lysozyme was released in the middle ear before the accumulation of inflammatory cells and degranulation of MPO from inflammatory cells. The results indicated that inflammatory reactions were present already at 6 hours after bacterial inoculation, and were rapidly accelerated during the subsequent hours. Consequently, acute middle ear inflammatory responses were seen immediately following inoculation of viable bacteria, and these responses originated in direct responses of middle ear mucosa, and oxidative and non-oxidative neutrophil metabolic products, which may cause tissue injury.

Acquired airway obstruction caused by hypertrophic mucosa of the arytenoids and aryepiglottic folds

Congenital laryngomalacia is the most common condition that causes stridor in the neonate, infant, and child. It is characterized by laryngeal collapse, including: (1) inward collapse of the aryepiglottic fold and enlarged cuneiform cartilage; (2) a long tubular epiglottis, or the so-called “omega-shaped” epiglottis, which becomes curled in on itself; (3) anterior medial collapse of the arytenoid cartilages; and (4) posterior inspiratory displacement of the epiglottis against the posterior pharyngeal wall or vocal cord. These symptoms usually appear within the first 2 weeks of 1ife.l In 1988, Peron et al2 reported 7 cases of redundant aryepiglottic fold in elderly patients as a new cause of stridor. Since then, several reports have investigated acquired laryngeal collapse caused by epiglottis prolapse and edematously swollen mucosa of the arytenoid and aryepiglottic fold in elderly patients.3-6 Most of these patients had sustained severe central nervous system injury, a head and neck tumor, and/or undergone head-andneck surgery. Two elderly patients without such history, but complaining of stridor and inspiratory dyspnea as a result of hypertrophic mucosa of the arytenoids and aryepiglottic folds, were studied.