Takeo Kumoi

The Blood Supply of the Facial Nerve in the Human Temporal Bone

The gross blood supply and intrinsic vascular anatomy of the facial nerve in the temporal bone are described, and their significance is discussed. At the vertical part of the facial nerve, the stylomastoid artery lies on its anteromedial side as far as the upper third of the nerve. The artery then loops around the lateral or medial side of the nerve, and divides into several branches. At the convex aspect of the genu, these branches anastomose with one another to form an arterial network, passing to the horizontal part. The petrosal branch of the middle meningeal artery reaches the geniculate ganglion and forms a profuse, fine arterial network. The main arterial trunk extends toward the second bend in the nerve, but it never reaches the vertical part. Studies on the draining veins are also described. Duplication of blood vessels from different sources was seen at the horizontal part of the nerve. This would suggest a special vulnerability of this area to vascular injury, since in our topographical study of Bells palsy within two weeks of its onset, 72 out of 117 cases (61.5%) were found to have suprastapedial lesions.

Subglottic neurofibroma in a child.

Reported here for the first time is a case of subglottic neurofibroma in an infant which was removed by laryngofissure. Neurofibromas are ubiquitous in distribution, but very rare in the larynx and also extremely rare in infancy. Only 9 cases had been reported in children under 9 years of age. In the present case, H.T., a boy aged 2 years and 7 months, complaining of inspiratory stridor since the beginning of December 1985, was admitted to our hospital on Jan. 21, 1986. The tumor was completely removed by laryngofissure and pathological diagnosis showed it to be a neurofibroma. Laryngeal neurofriboma cases are reviewed and discussed.

The Embryologic Development of the Human External Auditory Meatus

During the final period of embryogenesis, a funnel-shaped tube continues medially into the mesenchymal tissue forming a curved path. Although this may sound simple, the development occurring during early fetal life is in fact very complex. At first, ectodermal cells proliferate to fill the lumen of the meatus, forming the meatal plug, and then at 10 weeks the bottom of the plug extends in a disc-like fashion, so that in the horizontal plane the meatus is boot-shaped with a narrow neck and the sole of the meatal plug spreading widely to form the future tympanic membrane medially. At the same time, the plug in the proximal portion of the neck starts to be resorbed. In the 13-week fetus, the disc-like plug begins to show signs of its final destiny; the innermost surface of the plug in contact with the anlage of the malleus is ready to contribute to the formation of the tympanic membrane. In the 15-week fetus, the innermost portion of the disc-like plug splits, leaving a thin ectodermal cell layer of immature tympanic membrane. The neck of the boot forms the border between the primary and secondary meatus, and is the last part to split. In the 16.5-week fetus, the meatus is fully patent throughout its entire length, although the lumen is still narrow and curved. In the 18-week fetus, the meatus is already fully expanded to its complete form.

Hydrogen Peroxide Generation by Eosinophils in Allergic Rhinitis

It was the aim to study the hydrogen peroxide (H2O2) generation by eosinophils in allergic rhinitis caused by house dust which was examined in nasal secretion and peripheral blood. The concentration of H2O2 in nasal secretions was increased after nasal challenge with house dust, and subsided gradually by the increase of peroxidase activity. The population of eosinophils and H2O2 generation which was morphologically detected on the plasma membrane of eosinophils in nasal secretion, were increased with the release of eosinophil chemotactic activity after nasal challenge. Also, in peripheral blood, the number and phagocytic activity of eosinophils in extremely high density 1.102 g/ml were increased after nasal challenge. A high number of eosinophils was found in a density of 1.097 g/ml in the high IgE group, but showed less phagocytic activity than in the lower IgE group. Considering from these findings, H2O2 generation by eosinophils appeared to be an important event in tissue injury and augmentation of allergic reaction.

External septorhinoplasty in the cleft lip nose

When the entire septum as well as the cartilaginous vault are exposed to direct vision by degloving the nasal covering, the complete extent of the deformities in cleft lip nose can be clarified. The septal cartilage is hollowed out leaving an L-shaped anterosuperior portion, whereas the intranasal structures are simultaneously altered to ensure the patency of the nasal airway. An adequate-sized piece is cut from the removed cartilage and is fitted to the anterior part of the remaining cartilage to enforce the columella, which acts as a strut to keep both lower lateral cartilages symmetrical and to create a nasal tip. Thus, a new cartilaginous pyramid with symmetrical nostrils is reconstructed. If the anterosuperior portion of the cartilage is deviated, the concave surface is scored to allow it to be straightened before the strut is fitted. Satisfactory cosmetic and functional results were obtained in most patients with adult cleft lip nose, including those associated with deviation, without any major complications.

Ultracytochemical Study of Ouabain-sensitive K+-dependent p-nitro-phenylphosphatase Activity in Stria Vascularis of Reserpinized Guinea Pigs

In order to clarify the effect of reserpine on the Na(+)-K+ active transport in the stria vascularis we investigated the localization of ouabain-sensitive K(+)-dependent p-nitro-phenylphosphatase (K-NPPase) activity in the stria vascularis of reserpinized guinea pigs using the cerium-based method. The K-NPPase activity in marginal cells differed from cell to cell, and was almost completely absent in some cells. These results are consistent with the previous results and suggest that Na(+)-K+ active transport in the stria vascularis may be inhibited by reserpine administration.

Animal model for ischemic facial nerve paralysis with selective vascular embolization.

An experimental model that reliably and easily produces acute ischemic facial nerve paralysis would be useful for the controlled study of treatment and to improve our understanding of the pathophysiology and treatment of facial nerve palsy. Most documented models that simulate clinical facial nerve palsy cause direct damage to the nerve. We describe an experimental model for ischemic facial nerve paralysis in the cat that employs arterial block of the internal and external maxillary and posterior auricular arteries using embolizing material (Avitene). All animals develop stable acute ischemic facial nerve palsy lasting for approximately 2 months. Electromyographic study of this model revealed that the site of the lesion resulting from selective embolization may be within the temporal bone. This model has the advantages of simplicity of technique, cost-effective use of cats, and reproducibility of facial nerve palsy.

Results of tympanoplasty for congenital aural atresia and stenosis, with special reference to fascia and homograft as the graft material of the tympanic membrane

The surgical management of congenital aural atresia is a challenging, complex procedure, and the risks are great. The otologic surgeon is responsible for keeping a patent external auditory canal and for achieving satisfactory hearing.

Dermoid cyst in the middle ear

A case of a moderate essentially low tone unilateral conductive hearing loss without a previous history of secretory otitis media in a six-year-old female patient is described. The condition was found to be due to a dermoid cyst in the tympanic cavity, which was confirmed by pathological examination of the surgically removed specimen. This is the sixth documented case of dermoid cyst in the tympanic cavity.

Reconsideration on the hyoid syndrome.

In 1975, Christiansen et al.’ reported five cases of elongated styloid process encountered in a single 12-month period. After reviewing the literature on this subject, the authors urged that this conspicuous entity be generally accepted as the cause of the neuralgia.’ Eagle’ presented the first case in which clinical symptoms resulting from an elongated styloid process were noted. In 1962, Eagle3 also reiterated the importance of being aware of this syndrome when treating patients with pharyngeal pain and discomfort, many of whom are cancer-conscious and apprehensive that a malignancy may be present in the throat. Thus, the condition caused by an elongated styloid process came to be known as “Eagle’s syndrome.” However, it is generally less well appreciated that similar or identical symptoms can be produced by other parts of the hyoid apparatus (e.g., hyoid syndrome).‘ According to Kopstein; hyoid syndrome is characterized by symptoms related to any of the parts of the hyoid apparatus, which includes the styloid processes, stylohyoid ligaments, the hyoid bone, and the hyoid-thyroid cartilage junction.’ The human hyoid bone is actually suspended from the styloid process of the temporal bone by the stylohyoid ligaments, which attach to the lesser cornua. It is therefore reasonable to consider all the parts of the hyoid apparatus and the styloid process as a single unit. It is often difficult to clearly differentiate hyoid syndrome from styloid syndrome because of their similar symptoms and the anatomic proximity of these two structures. However, the greater cornu of the hyoid and the lower part of the hyoid bone arise embryologically from the third branchial arch,