Shinya Matsunaga

Necrotizing Fasciitis of Cervicothoracic Region after Treatment for Tonsillar Carcinoma.

Necrotizing fasciitis is a rare disease characterized by cutaneous necrosis, suppurative fasciitis, and vascular thrombosis. The disease commonly causes a rapidly progressive toxic systemic illness (i. e. toxic shock-like syndrome) in which the mortality has been reported to be between 20 and 36%.Necrotizing fasciitis of the neck and chest occurred in a patient with tonsillar carcinoma one month after treatment with surgery and radiotherapy. The patient was admitted to our hospital ICU in renal and respiratory failure, septic shock and DIC. He recovered after treatment which included debridement of necrotized tissue in the cervicothoracic region. Streptococcus pyogenes was solated in blood cultures. We speculated that the bacterial infection might have entered through the incision for tumor resection.The recent literature concerning necrotizing fasciitis is reviewed. It is important for otolaryngologists to be aware of this disease since early excision of necrotic tissue and high dose intravenous antibiotics are necessary for patient survival.

Ossifying Fibroma with Severe Nasal Hemorrhage; A Case Report.

Ossifying fibroma is an uncommon fibro-osseous tumor, usually found in the maxilla or mandible. It has been reported that is difficulte to differentiate this tumor from fibrous dysplasia clinically and histopathologically.15-year-old female had severe nasal hemorrhage. CT scans revealed a large and well-circumscribed hard mass with low dencity areas in maxillary and ethmoid sinuses. Biopsy of the tumor showed cavernous hemangioma, but the histological examination on the surgically removed tumor was revealed ossifying fibroma.The maxillary artery, which was suspected to be a feeding artery, was successfully embolized with small pieces of Gelfoam. The clinical, radiological, and pathological characteristics of the disease are discussed, the literature is reviewed.

Clinical and Statistical Studies of Facial Trauma.

We have treated 68 patients with facial trauma from 1979 to 1990 in the otolaryngologic clinic of Kagoshima University Hospital. There were 52 males and 16 females of all ages. The incidence was highest among 10-19-year old males.Traffic accidents caused the most traumas followed by fights and sports accidents. In 62 of the 68, there were facial bone fractures: nasal, maxilla, zygoma and orbital floor in almost equal numbers.Miniplates used for the fixation of maxillo-zygomatic bones were quite useful. Questionaires to the patients showed that post-operative distress was more often a cosmetic problem than functional disability.

Neutrophil adhesion to microvascular endothelial cells in chronic sinusitis.

The adherence of circulating leukocytes to the vascular endothelium is a critical step of inflammatory infiltration. In order to understand the influence of the nasal secretion on vascular endothelium, adherence of neutrophils to monolayers of endothelial cells was assayed using 51Cr-labeled leukocytes and human mucosal microvascular endothelial cells derived from inferior turbinate. Quantitative analysis of interleukin-1α, β and tumor necrosis factor-α were made in the retention fluid of the maxillary sinus of chronic sinusitis and the nasal secretion of nasal allergy using ELISA kit. The vascular endothelial cells acquired adhesiveness for neutrophils after preincubation with maxillary sinus retention fluids of chronic sinusitis. However, no adhesive effect was found in the nasal secretion of nasal allergy. Quantitative analysis revealed the presence of interleukin-1 and the absence of tumor necrosis factor-α in the retention fluids of chronic sinusitis. The adherence inducing effect was heatlabile and almost neutralized by anti-IL-1β antibody in dose dependent manner.These findings suggest that the IL-1 in the para-nasal secretion of chronic sinusitis induce the adherence of neutrophil to vascular endothelium and further promoted leukocytes infiltrates in the paranasal sinuses, playing an important role in persistency of chronic sinusitis.