Takayuki Mochizuki

Cephalometric Analysis in Patients with Obstructive Sleep Apnea Syndrome

Cephalometry is useful as a screening test for anatomical abnormalities in patients having obstructive sleep apnea syndrome. In this study, various conventional parameters in cephalometry, such as the distance and angles determining the oropharyngeal space, and the areas of the soft palate, oral cavity, tongue and pharynx in both posterior-anterior and lateral view X-ray films, were measured before and after surgery in order to evaluate the preoperative predictability and usefulness of uvulopalato-pharyngoplasty and/or midline laser glossectomy (MLG) for the purpose of preoperative assessment and evaluation of surgical treatment. As test subjects, American adult patients with disturbed respiration in sleep observed at Oakland Otology and Apnea Clinic during 1989-1992 and Japanese patients with the same problems observed at Kitasato Univ. Hospital during 1992-1994 were used. The results were as follows: i) cephalometry revealed morphological abnormalities in the skull, and the measurement of soft tissue in the oropharynx provided useful anatomical data to assess the space of the upper airway in each patient before operation; ii) the areas of the soft palate, the whole tongue and the lower half of the tongue were significantly enlarged, and the lengths of MPH, SPL and PNS-H were longer in the apnea group than in the snoring group; iii) in MLG patients, increases in the area of the oral cavity and pharyngeal cavities and a decrease in the area of the upper half of the tongue were observed.

Surgical Approaches for Antrochoanal Polyp of the Maxillary Sinus

Antrochoanal polyps mostly arise from the maxillary sinus and show a relatively high incidence in children and young adults. The base of the antrochoanal polyp is often found on the lateral or posterior wall of the maxillary sinus and extends toward the choana through the nasal cavity. The most important point during surgery for antrochoanal polyp is to remove it completely from its base. For this purpose, endonasal sinus surgery (ESS), combining middle meatal and inferior meatal approaches, is considered the most suitable. In this paper, we report 2 pediatric cases demonstrating antrochoanal polyps successfully treated by combined ESS approaches.

Medial Protrusion of the Lamina Papyracea: A Case Report

Medial protrusion of the lamina papyracea into the ethomoid sinus has been described as a cause of orbital complications during endoscopic sinus surgery (ESS). The reported rate of the abnormal ranges from 0.5-6.5%.We encountered a male patient with nasal bleeding. A nasal tumor in right nasal cavity was found and medial protrusion of the lamina papyracea into the ethmoid sinus was confirmed by preoperative CT examinations. The patient was successfully treated by ESS without orbital complications.We emphasized that appropriate CT examinations before ESS are very important for preoperative evaluation of the anatomical relation among adjacent critical structures.

A Case of Deep Neck Infection Secondary to Peritonsillar Abscess Extending to the Upper Mediastinum

Deep neck infection is still a relatively common emergent condition in otolaryngological practice. We recently experienced a case of 57 year-old male who developed neck swelling with mild dyspnea and dysphagia after perioral administration of antibiotics by an internist for peritonsillar abscess. ENT examinations revealed a painful neck swelling with severe peritonsillar swelling extending to the hypopharynx in the left side. CT examination indicated abscess formation with gas in the neck extending to the upper mediastinum. Peritonsillar drainage was begun on an emergency basis, followed by tracheotomy and cervical drainage. The neck incision was kept open, and the patient was treated with intravenous antibiotics together with human immunoglobulin. The postoperative course was uneventful, and the mediastinal abscess was absorbed without direct drainage. We considered that immediate cervical drainage was essential for the treatment of acute deep neck infection. For the evaluation of the effect of treatments, CT examination and the measurement of CRP and WBC count appeared to be most useful.