Michitoshi Ohno

Laryngomicrosurgery Using a Video-Endoscopic System with a Video-Laryngoscope.

Laryngomicrosurgery has been performed under an endoscopic video-monitoring system (“the endoscopic method”) since November 1996 at our department. This method using the Slimline type of Video-Laryngoscope (KARL STORZ, Model III) was compared with “the conventional method” using a microscope. The endoscope was connected to a TV-system to visualize the surgical field on a large monitor screen.(1) Instruments and surgeons position: An expensive and large microscope, which was required for surgery with the “the conventional method”, was unnecessary for surgery with “the endoscopic method”. As a result, the surgeon could easily insert, handle and fix the instruments in a comfortable position.(2) Surgical field: “The endoscopic method” facilitated excellent visualization and recording of the entire surgical field including the instruments, while “the conventional method” suffers from two kinds of visual field defects and insufficient luminous energy resulted in poor recordings of the surgical field.(3) Laryngeal extension: The vertical outer diameter of the Video-Laryngoscope is greater than that of the conventional smaller laryngoscope. Therefore, laryngeal extension may be more difficult during surgery using “the endoscopic method”.“The endoscopic method” had advantages over “the conventional method” based on (1) and (2) above. I expect that the disadvantage mentioned in (3) will be easily overcome by reducing the vertical outer diameter of the Video-Laryngoscope.

Giant Cell Tumor of the Sphenoid Sinus. A Case Report.

A 26-year-old man presented with double vision and headache. Neurological examination revealed impairment of cranial nerves II, III, VI. Bony destruction of the sphenoid sinus as well as the sella-clival region was seen on plain craniogram X-ray films. CT scan showed an enhanced mass in the sphenoid sinus. MRI showed a clear localization of the tumor which involved the surrounding tissues. The contents of the sphenoid sinus could be removed by curettage via a transseptal approach. The histological diagnosis was giant cell tumor. The cranial symptoms were relieved within a few days postoperatively. He has remained asymptomatic for 24 months since the operation.

Actual situation of balance disordered persons recognized in the Law for the Welfare of Physically Disabled Persons

1) The data published by the Welfare Ministry and the Gifu prefectural office were analyzed with respect to persons with balance disorders. Balance disorders account for only 0.1 percent to 0.2 percent of all physical disabilities.2) The number of, persons with balance disorders living in Gifu prefecture is 81.3) The causes of the balance disorder in these 81 persons were : labyrinth or eighth cranial nerve damage (31), CNS disturbance (42), combined disturbance of the labyrinth and CNS (4), and unknown (4).4) Persons under 18 years or 60 years of age had mainly CNS disturbances.5) The incidence of multiple handicaps, especially balance disorder plus deafness, was higher in the labyrinth and the eighth cranial nerve damage group than in the CNS disturbance group.6) Grade 5 balance disorder was more common than grade 3 in the labyrinth and the eighth cranial nerve damage group. The number of grade 3 and grade 5 balance disorders was approximately equal in the CNS disturbance group.