Mutsuo Amatsu

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.

A one stage surgical technique for postlaryngectomy voice rehabilitation.

A new one‐stage surgical technique for postlaryngectomy speech was applied to 30 patients and its results are described. The essential part of this technique consists of the construction of a tracheoesophageal shunt using the posterior part of the trachea exposed at the time of the laryngectomy to reestablish an air communication between the trachea and the esophagus.

A new one-stage surgical technique for postlaryngectomy speech.

SummaryA new one-stage surgical technique for the postlaryngectomy speech applied to the 17 patients and its results are described herein. The essential part of this technique consists of the construction of a tracheo-esophageal shunt using only the remainder of the trachea obtained at the time of laryngectomy to reestablish an air communication between the trachea and the gullet.Fourteen patients of the 17 patients thus operated upon developed conversational abilities equivalent to the normal subject, except that they use a finger during the speech for the occlusion of the tracheal opening. This technique can be applied to almost all candidates for total laryngectomy with or without neck dissection.The initial speech was developed in 25 days after operation in average. The inflow of the salivas and/or fluids into trachea is not problematic in these patients.

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.

Epithelial migration on the tympanic membrane and external canal

SummaryAn ink dot staining method was used to examine epithelial migration in normal ears, in pathologic tympanic membranes, and in external auditory canal cholesteatoma. The direction of the epithelial migration was found to coincide with that of the vessels in normal ears. This suggested that epithelial migration was controlled by the vessels which supply the epidermal layer of the tympanic membrane. In pathologic tympanic membranes and external auditory canal cholesteatomas, epithelial migration was disturbed to various degrees and depended on the local conditions. In these pathologic conditions, the tympanic membrane showed less vascularization. Based on our findings, we believe that a poor blood supply is the major etiologic factor for the epithelial migratory disturbances of the tympanic membrane.An ink dot staining method was used to examine epithelial migration in normal ears, in pathologic tympanic membranes, and in external auditory canal cholesteatoma. The direction of the epithelial migration was found to coincide with that of the vessels in normal ears. This suggested that epithelial migration was controlled by the vessels which supply the epidermal layer of the tympanic membrane. In pathologic tympanic membranes and external auditory canal cholesteatomas, epithelial migration was disturbed to various degrees and depended on the local conditions. In these pathologic conditions, the tympanic membrane showed less vascularization. Based on our findings, we believe that a poor blood supply is the major etiologic factor for the epithelial migratory disturbances of the tympanic membrane.

Primary tracheoesophageal shunt operation for postlaryngectomy speech with sphincter mechanism.

This paper describes a primary voice restoration technique designed to eliminate the problem of aspiration commonly encountered in rehabilitation procedures following laryngectomy. This technique, utilized in 16 patients, consists of a unique combination of tracheal flap for voice production and bilateral esophageal constrictor muscle flaps to prevent aspiration. Fourteen patients developed satisfactory tracheoesophageal speech; of them 12 had normal deglutition without problems of aspiration. On radiographic examination, the bilateral esophageal muscle flaps, in combination with the dilatation and elevation of the cervical esophagus, provide a sphincter mechanism that prevents tracheal reflux during deglutition.

Distribution and impact of lymph node metastases in oropharyngeal cancer

Conclusions. In the treatment of oropharyngeal cancers, possible metastases to retropharyngeal lymph nodes (RPLNs) should be taken into account, especially in tumors arising in the lateral wall and/or posterior wall. Patients with multiple positive neck nodes must have intensified adjuvant therapy, especially when they have extracapsular spread (ECS). Objective. To develop optimal treatment strategies for oropharyngeal cancers, we retrospectively analyzed the lymph node metastases of oropharyngeal squamous cell carcinoma. Patients and methods. Between 1988 and 2003, 77 patients with previously untreated oropharyngeal squamous cell carcinoma underwent neck dissections. Results. Among the patients with tumor arising in the lateral wall or posterior wall, retropharyngeal nodes were involved in 29% (11/38), while RPLN metastasis was not observed in patients with tumors arising in the superior wall or anterior wall. The survival rate of patients with two or fewer positive lymph nodes was significantly better than that of patients with three or more positive lymph nodes (p<0.05). The survival rate of the patients who had ECS was significantly worse than that of the patients who had lymph node metastases but not ECS (p<0.05). There was no significant difference between the survival rates of the patients with and without RPLN metastases.

Primary Tracheojejunal Shunt Operation for Voice Restoration following Pharyngolaryngoesophagectomy

A primary tracheojejunal shunt operation was performed for voice restoration following pharyngolaryngoesophagectomy with free jejunum reconstruction for advanced hypopharyngeal cancer. A fistula was created between the membranous part of the trachea and the lower part of the transplanted jejunum. The membranous part of the trachea was tubed to construct the tracheojejunal shunt. All three patients who had the tracheojejunal shunt operation retained phonatory function. Pitch formation was seen in the voice waveform with use of the tracheojejunal shunt. No leakage was seen at all during deglutition and a swallowing function was obtained in all patients who had the tracheojejunal shunt.

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.