Mitsuhiro Mohri

Acyclovir improves recovery rate of facial nerve palsy in Ramsay Hunt syndrome

OBJECTIVE Although the antiviral agent, acyclovir, is currently employed for the treatment in Ramsay Hunt syndrome, the benefit of acyclovir on facial nerve is still unknown and remains controversial. This study was designed to evaluate the effect of acyclovir in facial nerve recovery in Ramsay Hunt syndrome. METHODS To evaluate drug effect on facial nerve function, evaluation of the facial voluntary movement and nerve excitability testing were performed. We have used an infusion therapy of acyclovir in combination with a high dose of steroid (AS), which was started within 7 days of onset of facial nerve palsy in 91 patients with Ramsay Hunt syndrome. The results were compared with those of 47 patients whose therapy was steroid alone started within 7 days of onset. RESULTS Out of 91 patients treated with AS, nerve exitability was good in 68 (75%), while it was poor in 17 and absent in six. Of 47 patients treated with steroid alone, nerve exitability was good in 25 (53%), while it was poor in 11 and absent in 11. There was statistically significant difference between AS and steroid therapy in the posttreatment degree of nerve function. Complete recovery to grade I in facial voluntary movement was attained in 82 of 91 patients (90%) in the AS therapy, while out of 47 patients treated with steroid alone complete recovery to grade I was attained in only 30 (64%). A statistically significant difference in the recovery rate of facial nerve function was induced between AS and steroid therapy. CONCLUSION The AS therapy was proved to keep good degree of nerve function indicated with nerve excitability testing and improve recovery rate of facial nerve in Ramsay Hunt syndrome. Based on this study, we now believe that the AS therapy is an advisable treatment modality to improve the recovery rate of facial nerve function in Ramsay Hunt syndrome.

Significance of Retropharyngeal Node Dissection at Radical Surgery for Carcinoma of the Hypopharynx and Cervical Esophagus

Objectives To clarify the efficacy of dissection of retropharyngeal lymph nodes (RPLNs) in the surgical treatment of carcinoma of the hypopharynx and cervical esophagus.

Epithelial migration in the healing process of tympanic membrane perforations

SummaryThe healing process in 10 human tympanic membrane perforations after trauma and 20 myringotomies was observed under the microscope and was photographed. The movement of the healing process was from the central portion of the perforation to the periphery and followed the same direction as the drums epitehlial migration. At the central portion of the perforations margin, the keratin layer proceeded to the periphery and was followed by the epidermal cell layer. Only slight movement was observed at the peripheral portion of the perforation. Histopathological examination confirmed these observations. These findings demonstrate that epithelial migration on the tympanic membrane plays a great role in the healing of a perforation.

Retropharyngeal node metastasis from papillary thyroid carcinoma

Papillary thyroid carcinomas commonly metastasize to paratracheal and jugular lymph nodes. Metastasis to the retropharyngeal node is rare for this tumor.

Invasion of the skull base by carcinomas: histopathologically evidenced findings with CT and MRI.

Abstract. The depth and extent of the invasion of the skull base by a tumor are the most critical information for successful en bloc resection of the tumor. The only means available for the evaluation of these factors are CT or MRI images. In order to clarify the ability of these imaging modes to delineate the invasion of the skull base, preoperative images of ten patients who underwent en bloc resection of skull base tumors at Kobe University Hospital were compared with the histopathological findings of the resected specimens. CT proved to be superior to MRI for evaluating bone destruction of the skull base. On the other hand, MRI provided more useful information about intracranial invasion than CT. As a hypertrophic linear shadow on Gd-enhanced MRI represented dural invasion or thickened dura mater adjacent to the tumor, this technique should be taken into consideration to determine the dural resection. We concluded that preoperative evaluation of the depth of skull base invasion by both CT and Gd-enhanced MRI is essential for planning complete tumor resection.

Neoglottic Activity in Tracheoesophageal Phonation

It has been generally accepted that the retropharyngeal wall protrudes into the lumen and forms a prominence during alaryngeal phonation. Although the prominence is thought to be responsible for the vibratory source, the relationship between the vocalization process and the dynamics of the prominence is not well known. This study is undertaken to clarify the above-described relationship during tracheoesophageal (TE) phonation, one of the most common forms of voice restoration following total laryngectomy. Electromyography (EMG) with simultaneous manometry and fiberoptic observation of the hypopharynx were done in 7 subjects who underwent TE fistulization at the time of laryngectomy. Fiberscopy revealed prephonatory closure of the hypopharyngeal lumen, and subsequently, a definite configuration of the lumen where diverted air can escape with mucosal vibration during phonation. The EMG disclosed a characteristic pattern that had two bursts of activity with an intervening quiet period. It may be concluded that TE phonation consists of two steps: The first step, associated with the first burst and regarded as the preparatory stage, consists of the hypopharyngeal closure which forms a small lumen. The second step, associated with the second burst and regarded as the phonatory stage, consists of the vibration of the neoglottis with a definite configuration which is maintained by the hypopharyngeal muscle contraction.

Congenital defects of the vomer.

Six cases of congenital defect of the vomer, a rare nasal anomaly, are reported. All 6 patients visited Kobe University Hospital with other complaints, and the anomaly was incidentally detected. In all cases, the nasal septum showed a defect at the posteroinferior portion that appeared to coincide with the location of the vomer. None of the patients had a past history of nasal trauma, nasal surgery, drug abuse, or infectious disease. This anomaly may be attributable to an embryological disorder based on an immature ossification center of the vomer.

Submucous electrocautery following submucous resecrion of turbinate bone—a rationale of surgical treatment for allergic rhinitis

OBJECTIVE Since the majority of the key elements such as trigeminal nerves, parasympathetic nerves, nasal glands, and blood vessels targeted by histamine and leukotrienes are found in the lamina propria of the nasal mucosa, its selective electrocautery has a rationale to improve the symptoms of allergic rhinitis with preservation of epithelial layer. To achieve the above goal, we performed the submucous electrocautery of the lamina propria (SECLP) following the submucous resection of the inferior turbinate bone (submucous turbinectomy: SMT). This paper discusses the efficacy of this procedure for the patients with persistent perennial allergic rhinitis. METHODS An intranasal initial incision was made along the piriform aperture. The mucoperiosteum was elevated from the inferior turbinate bone followed by its complete resection. The SECLP was performed by applying a high-frequency coagulation current with a ball tip electrode, which was inserted into the mucoperiosteal sack after the completion of the SMT and was drawn forward on the medial surface of the mucoperiosteum with drawing a wavy line. We performed this surgery in 43 patients with perennial allergic rhinitis who were refractory to pharmacotherapy or were reluctant to take medicine. Symptoms, macroscopic intranasal findings, the results of allergic tests, nasal resistance, mucociliary function with saccharin, and the number of mast cells were compared pre- and postoperatively. RESULTS The patients exhibited satisfactory improvement in symptoms only with a few crust formations. The macroscopic intranasal findings and allergic tests improved after surgery. Saccharin transport time remained normal. The number of anti-tryptase positive mast cells significantly decreased in the epithelial layer and in the superficial layer of the lamina propria of the postoperative inferior turbinate mucosa. CONCLUSION The SECLP following the SMT is evaluated to be a useful surgical modality for allergic rhinitis with preservation of the nasal mucosal function.

The clinical features and pathogenesis of myringitis granulosa

SummaryMyringitis granulosa is not a rare pathologic condition of the tympanic membrane. However, the condition can be misdiagnosed as chronic suppurative otitis media, since intermittent purulent discharge is the commonest symptom in both disorders. Although the clinical features of myringitis granulosa have been well described by several authors, its pathogenesis is still obscure. In this study, 40 cases of myringitis granulosa were examined in detail to clarify the clinical features and the pathogenesis present. No drum perforations, no hearing impairments and normal X-ray findings indicated that myringitis granulosa had no relation to chronic suppurative otitis media. The other areas of the affected tympanic membrane, except for the site of granulation, showed such pathologic conditions as atrophy, clouding and calcifications. In these pathologic tympanic membranes, epithelial migration was disturbed to a high degree. We suggest that the granulation process on the tympanic membrane should be divided into two stages: (1) injury reaching the lamina propria of the tympanic membrane; and (2) disturbed epithelization of the tympanic membrane. The disturbance of epithelial migration of the tympanic membrane occurs with both stages.

Significance of tubal resection in surgical treatment of middle ear carcinoma

We successfully carried out total en bloc resection of squamous cell carcinoma of the middle ear in two patients. Both patients have been free of the disease for 32–39 months. In one of the cases, the eustachian tube was resected totally with the temporal bone. Postoperative histopathological examination proved tumor invasion into the cartilaginous part of the tube. We would like to emphasize the significance of total resection of the eustachian tube when neoplastic invasion into the tube is highly suspected. Axial computed tomography is of great value for preoperative evaluation of such invasion. Anterior mobilization of the carotid artery from the carotid canal facilitates resection of the petrous apex and should be done after management of the eustachian tube. The carotid canal is best exposed ventrally, since lateral exposure is at high risk for injuring the bony part of the eustachian tube and may possibly disseminate tumor cells.