Mitsuharu Nonomura

Electrical pacing for dynamic treatment of unilateral vocal cord paralysis. Experiment in long-denervated muscle.

In order to explore the possibility of clinical application of laryngeal pacing as a treatment for unilateral vocal cord paralysis, we examined the reactivity of atrophic muscle to electrical stimulation in dogs whose recurrent laryngeal nerves were damaged by crushing, dissection followed by resuturing, or a 3-cm neurectomy. The threshold level to induce enough vocal cord adduction reached the maximum at 2 weeks after nerve injury, decreased with time, and never surpassed 7 V in each case. On the basis of results of these preliminary probings, laryngeal pacing was conducted on a dog 15 months after resection of the laryngeal nerve. Adduction of the paralyzed vocal cord for synchrony with the intact cord was achieved by 7 V of electrical stimulation of the thyroarytenoid muscle that was triggered by signals from the cricothyroid muscle.

Thyroid gland flap for glottic reconstruction after vertical laryngectomy

A thyroid gland flap was devised and applied in five cases of vertical partial laryngectomy to correct the laryngeal defect. The upper pole of the thyroid gland, dissected along with the superior thyroid artery and vein, was placed in the wound after removal of the tumor to compensate for the loss of bulk, and relined using a cervical skin flap. Good phonatory function was obtained without any disturbance of respiration or deglutition. The thyroid gland flap was adjustable to the size of the defect and easily placed in the larynx. Follow-up study for 6 to 18 months after the surgery revealed that the flap was less likely to shrink than the other flaps because of its abundant blood supply.

Bilateral vocal fold paralysis caused by polyarteritis nodosa.

Polyarteritis nodosa (PAN) causes necrotizing angitis mainly in medium-sized muscular arteries throughout the body, and various clinical signs and symptoms such as fever, malaise, weight loss, skin necrosis, renal failure, cerebral nervous system disorder, heart failure, and myalgia develop in affected patients. However, otolaryngologists rarely encounter patients with polyarteritis nodosa, except those with hearing-impairment or facial paralysis.1-6 A patient with PAN whose first symptom was submandibular swelling, with subsequent necrosis over a wide area of the neck and bilateral vocal fold paralysis, is presented.

Cricothyroid-Lateral Cricoarytenoid Muscle Suturing. Experimental Study.

A new method of dynamic reconstruction by suturing the cricothyroid and the lateral cricoarytenoid muscles was devised for the treatment of hoarseness due to unilateral recurrent laryngeal nerve paralysis.Eighteen adult dogs underwent this method after sectioning of a recurrent laryngeal nerve.Immediate postoperative observation during phonation revealed tension and movement of the affected vocal cord, which was adducted to reach the midline in 17 of 18 dogs. Over four months later, fiberscopic inspection revealed that adequate adduction was still present, and electrophysiological and histological examination showed that the affected lateral cricoarytenoid muscle was reinnervated by the external branch of the superior laryngeal nerve.Since this method is simple, and remobilization and tension during phonation are prompt and persistant, the clinical application of this method may serve as a new dynamic reconstruction for unilateral recurrent laryngeal nerve paralysis.

Rhinolith with Nasal Septum Perforation

Rhinoliths, or nasal calculi, are formed by an unknown process. Most of them are small and unilateral, but some of them grow large enough to cause chronic sinusitis, nasal septum perforation and abscess, and palatal perforation. An unusual case of rhinolith with nasal septum perforation is reported. The rhinolith was removed piece by piece under endoscopic maneuver. Surgical removal of the rhinolith provided a good prognosis.

Laryngeal Tuberculosis; Our Experience of Four Cases.

We have treated 4 cases of laryngeal tuberculosis during the past 6 years. All patients complained of hoarseness. Laryngoscopic findings revealed glanulomatous lesions in the vocal cords and in the false vocal cords. After antituberculous treatments, their local findings markedly improved.It is difficult to diagnose elevated lesions as laryngeal tuberculosis, since local findings and the age distribution of this disease are similar to those of laryngeal carcinoma.Although laryngeal tuberculosis is rare in modern Japan, it is important to be aware that this disease still exists.

Double Vision due to Odontogenic Maxillary Sinusitis. A Case Report.

Inflammation induced from an odontogenic origin rarely develops into orbital complications. We reviewed a patient complaining of double vision with orbital cellulitis after odontogenic treatment.A 58-year-old woman complained of left buccal swelling and symptoms of acute sinusitis following the treatment of caries of her left upper tooth. Exophthalmus and diplopia of her left eye were noted. After emergent surgical and medical treatment, she was relieved of all nasal and eye symptoms.

Two Rare Cases of Thyroid Papillary Carcinoma with Unusual Nodal Metastases.

Clinically, nodal metastases from well-differentiated thyroid papillary carcinoma usually present primarily in the pretracheal, paratracheal, and infraglandular groups of lymph nodes, secondly, along the ipsilateral jugular chain nodes, thirdly in the accessory nodes, and then in the other distant regional nodes such as the submandibular and submental groups.We report two cases of rare metastases of thyroid papillary carcinoma.Case 1: A 72-year-old male was referred to our hospital because of a right neck mass. A CT scan revealed that his right jugular nodes were swollen and involved in the deep cervical fascia, and that a minute calcification existed in the left lobe of the thyroid gland. This was a case of a minute carcinoma which metastasized only to the contralateral jugular chain nodes. No metastatic lymph nodes were found in the left side region. Thyroid carcinomas usually metastasize to the ipsilateral side at first. Metastases to the contralateral nodes without ipsilateral nodal involvement are unusual.Case 2: A 57-year-old female was referred to us because of postoperative vocal cord paralysis, and a thyroid tumor was found by chance. Enhanced CT scan showed a high density mass in the retropharyngeal space. After surgery, this was diagnosed as being a lateral retropharyngeal nodal metastasis of a thyroid papillary carcinoma. Metastases to the lateral retropharyngeal nodes are rare.

Burkitt's Lymphoma of the Parapharyngeal Space. A Case Report.

Although most tumors in the parapharyngeal space are benign, a few malignant tumors have been reported. Malignant lymphomas are very rare, and Burkitts lymphoma in the parapharyngeal space has been reported only once in the world literature. Here we describe a patient with Burkitts lymphoma of the parapharyngeal space.A 63-year-old male visited us because of a rapidly increasing mass at the angle of his mandible. MRI showed a large tumor occupying the parapharyngeal space. The FNA report was probable malignant tumor but perhaps not malignant lymphoma. We suspected carcinoma of the parapharyngeal space and resected it through a neck incision. Histological examination showed Burkitts lymphoma, and the patient was referred to the department of hematology in our hospital.

Interferon-Alpha Treatment of Sudden Deafness.

Seventeen patients (17 ears) with a sudden hearing loss of more than 60 desibels were treated with interferon-alpha (3 million IU/day for 5 days) plus methylprednisolon (tapered from 500mg/day for 9 days) and vitamin B12 (500μg/day for 9 days). In the 15 patients whose treatment started within 14 days after the onset, the response tended to be better than in patients treated with steroids and vitamins alone, but they were not as good as those reported by Kanamaru et al, who administered the same daily dose of interferon-alpha for 10 days. No improvement was noted in the 2 patients whose treatment was started more than 14 days after the onset. The results indicate that alpha-interferon may be effective in the treatment of sudden deafness of recent onset, but that it should be administered for more than 5 days.