Masanori Sakaguchi

Characterization and management of deep neck infections

A retrospective review was conducted of 91 patients with deep neck infections to determine the pattern of clinical disease and formulate a management plan. The spaces involved, as determined by clinical, radiologic, and operative findings, were the peritonsillar space (72 patients), parapharyngeal space (eight patients) submandibular space (seven patients), retropharyngeal space (one patient) superficial space (one patient), anterior visceral space (one patient), and visceral vascular space (one patient). Of the 19 patients who did not have a peritonsillar space infection the origin of the infection was found in eight; four of these were odontogenic. Thirty-eight patients required surgical drainage of the abscess. Five patients underwent tracheotomy due to increasing dyspnea. One patient with diabetes mellitus and a past history of myocardial infarction died of unknown cause. All other patients had an uneventful recovery without major complications. The combination of early radiologic diagnosis, effective antimicrobial therapy, and intensive surgical management contributed to the good prognosis.

Carotid Resection and Reconstruction for Advanced Cervical Cancer

Patients with advanced cervical cancers often have direct invasion of their carotid arteries. The prognosis for these patients with nonsurgical therapy is extremely poor. Because complete tumor removal is the only therapy that can offer these patients a chance for cure, carotid resection should be performed. We performed carotid resection and reconstruction on nine patients with advanced cervical cancers. Of these patients, none suffered from severe neurologic postoperative complications such as permanent hemiplegia. Three of the nine patients have been disease free for more than 24 months. These three patients would not have survived without carotid resection. Further study will show the usefulness of carotid resection and reconstruction in decreasing the morbidity and mortality in patients with cervical cancer involving the carotid artery.

Computed tomographic findings in peritonsillar abscess and cellulitis

The differentiation of a peritonsillar abscess from peritonsillar cellulitis, although difficult on physical examination, is required in order to determine the appropriate treatment. Peritonsillar cellulitis can be treated with antibiotics alone, while a peritonsillar abscess should be drained. Computed tomography (CT) of the neck is often performed to identify the formation of a deep abscess in the neck, but is rarely used to diagnose peritonsillar infections. We report a patient in whom CT was a useful diagnostic tool for distinguishing peritonsillar abscess from peritonsillar cellulitis.

Epidemiological research into nasopharyngeal carcinoma in the Chubu region of Japan

Although patient death due to nasopharyngeal carcinoma (NPC) is increasing, few epidemiological analyses of NPC in Japan have been conducted since Sawakis report in 1979. To determine the current incidence of NPC in Japan we examined NPC case in the Chubu area from 1986 to 1995. The leaders and reporting representatives of all otorhinolaryngological groups in the area were asked for their support of this epidemiological research. A total of 607 cases (445 male and 162 female NPC patients) were analyzed epidemiologically, histologically, serologically and clinically in this study. The incidence of NPC gradually increased with age. The mean age of the patients was 54.1 years. The age-standardized annual incidence in the Chubu region was 0.28 per 10(5) persons per year. The incidence in prefectures bordering Japan Sea (0.36) was significantly higher than that of prefectures facing the Pacific Ocean (0.21, P<0.05). On the basis of World Health Organization (WHO) histological criteria, 12%) of the cases were classified as WHO I, 54% as WHO II and 34% as WHO III. As for tumor origin, in 58% of the cases it originated posterosuperiorly, in 32% laterally and in 1% inferiorly. Tumor staging showed 4% to belong to stage I, 9% to stage II, 15% to stage III and 72% to stage IV. The positive rates of serum titers of the antibodies to Epstein Barr virus

Changes with aging in head and center of foot pressure sway in children.

To quantitate the development of equilibrium in children, we investigated movements of the head and of the center of foot pressure (COF) in standing subjects, using a cephalograph, a force measuring platform, and a technical computer. We studied 126 subjects, 105 healthy children, aged 4-18 years, and 21 adults, aged 20-28 years. Each subject stood with their feet together on a platform for 60 s each with eyes open or closed. The area and total length of head and COF movements decreased with increasing age, and were significantly greater in children under 12 years than in adults. The ratio of the lengths of head to COF movements was significantly larger in children under 9 years than in adults. The ratio of the anteroposterior to lateral movement of COF was also larger in children under 9 years. These observations suggested that body sway in children was not only larger than that in adults, but different in nature.

Relationship between Head Sway and Center of Foot Pressure Sway

We investigated the correlation between body sway and head sway in 64 healthy subjects who stood on a force-measuring platform. Each subject wore a helmet attached to a cephalograph and was asked to stand as still as possible on a platform with his feet close together for 60 sec. Subjects were asked to do this three times with their eyes closed and three times with their eyes open. We selected the test with the minimum sway for computer analysis of the sway path, sway area, ratio of anteroposterior/lateral components, sway velocity in each direction, averaged divisional frequency, and Romberg quotient. The movement of the head was significantly correlated with the center of foot pressure (COF) for the sway path, sway area, sway velocity, averaged divisional frequency, and the Romberg quotient. Our findings suggest that COF sway can be used instead of head sway to assess those five parameters.

Tympanometric changes following acute otitis media in Japanese children

Using tympanometry we investigated potential changes in both middle ears developing during and after unilateral acute otitis media (AOM) in Japanese children. In 144 children with unilateral AOM, tympanometry was performed at presentation and was repeated at the 1st, 2nd, 3rd, and 4th weeks and then every 2 weeks up to 12 weeks after entry into the study. Type B tympanograms were recorded in 81 (56%) of the affected ears and in 37 (26%) of the unaffected ears at presentation. Twelve weeks after AOM, the type B tympanogram was still observed in 21 (15%) of the affected ears and in 16 (11%) of the unaffected ears. Ears with type B changes at presentation showed a significantly slower recovery of middle ear ventilation than did those with either type A or type C1.

Bilateral carcinomas of the maxillary sinus.

We report a 68-year-old male with a rare case of synchronous bilateral carcinomas of the maxillary sinus. A CT scan revealed a large tumour mass that extruded from the left maxillary sinus; tissue of soft density filled the right antrum which had intact bony walls. A probe antrostomy on the right side disclosed a tumour which was diagnosed histologically as the same poorly differentiated squamous cell carcinoma as that in the left antrum. The incidence and aetiology of this disorder are presented, and its diagnosis and management are discussed.

Neurotological Evaluation of Vertical Semicircular Canal Function in Inner Ear Malformation

A 9-year-old boy with inner ear malformation complained of slight deafness and unsteadiness. CT revealed a normal cochlea despite enlargement of the lateral semicircular canals. The vertical semicircular canals developed more or less normally. The caloric test showed complete canal paresis bilaterally; however, a horizontal rotational stimulus elicited a vestibulo-ocular response, which showed only rightward and downward nystagmus, and their maximal slow-phase velocities were low. In addition, the examination of the vertical semicircular canal function using the head-tilted rotation test revealed a more active response, and the maximal slow-phase velocities were higher than those of a standard horizontal rotational test. These results suggest that the function of the vertical semicircular canal was well preserved and that it may have perceived the horizontal acceleration instead of the lateral semicircular canal.

Acute pharyngitis, an unusual complication of intravenous hyperalimentation

While the numerous complications of intravenous hyperalimentation (IVH) are well recognized, we encountered a unique one. A 60-year-old man developed a sore throat, neck pain and fever seven days after catheterization of the subclavian vein to provide post-operative nutrition. Marked swelling was visible at the right posterior wall of this oropharynx and hypopharynx. X-ray of the neck revealed that the tip of the catheter was positioned in the internal jugular vein, not the subclavian vein as intended. The acute pharyngitis, diagnosed as due to phlebitis of the internal jugular vein due to the malpositioned catheter, subsided within two days of catheter removal.