Tomoyuki Kurita

Surgical treatment of labyrinthine fistula in patients with cholesteatoma

Labyrinthine fistula is one of the most common complications of chronic otitis media associated with cholesteatoma. The optimal management of labyrinthine fistula, however, remains controversial. Between 1995 and 2005, labyrinthine fistulae were detected in 31 (6 per cent) patients in our institution. The canal wall down technique was used in 27 (87 per cent) patients. The cholesteatoma matrix was completely removed in the first stage in all patients. Bone dust and/or temporalis fascia was inserted to seal the fistula in 29 (94 per cent) patients. A post-operative hearing test was undertaken in 27 patients; seven (26 per cent) patients showed improved hearing, 17 (63 per cent) showed no change and three (11 per cent) showed a deterioration. The study findings indicate that there are various treatment strategies available for cholesteatoma, and that the treatment choice should be based on such criteria as auditory and vestibular function, the surgeons ability and experience, and the location and size of the fistula.

Effect of tympanic membrane perforation on middle-ear sound transmission.

Tympanic membrane perforation causes a sound conduction disturbance, and the size of this conduction disturbance is proportional to the perforation area. However, precise evaluation of perforation size is difficult, and there are few detailed reports addressing this issue. Furthermore, such evaluation becomes more difficult for irregularly shaped perforations. This study conducted a quantitative evaluation of tympanic membrane perforations, using image analysis equipment.A significant correlation was found between the degree of sound conduction disturbance and the perforation area; this correlation was greater at low frequencies following a traumatic perforation. The conductive disturbance associated with chronic otitis media was significantly greater at low frequencies. Circular perforations caused only minor conduction disturbance. Perforations in the anteroinferior quadrant were associated with greater conduction disturbance. Traumatic spindle-shaped perforations and malleolar perforations were associated with greater conduction disturbance.

A case of myxofibrosarcoma of the maxilla with difficulty in preoperative diagnosis

Myxofibrosarcoma (MFS) is a very rare fibroblast-derived sarcoma that occurs in the head and neck region. Here, we report the case of a 52-year-old man in whom MFS generated from the maxilla and whose beginning of treatment was considerably delayed because he was initially diagnosed as having a benign inflammatory lesion. Because a definite diagnosis was not obtained via 2 independent biopsies, total maxillectomy was used for both diagnosis and treatment. Histopathological and immunohistochemical analyses suggested that the tumor was a low-grade MFS. Because soft tissue tumors in the head and neck region are rare and a definite diagnosis is relatively difficult, surgical excision is indispensable if malignancy of the tumor is suspected.

New silicone tube placement therapy for patients with an anterior glottic web.

An anterior glottic web in adults comprises a bridge of scar tissue commonly formed as a result of iatrogenic laryngeal injury. Traditionally, procedures such as transcervical midline thyrotomy and keel placement have been used to repair this condition. However, we recently repaired an anterior glottic web using a new surgical procedure involving a silicone tube instead of a keel. We herein report this case, in which we placed a silicone tube at the anterior commissure after resection of an anterior glottic web, under endolaryngeal microsurgery, without performing a tracheostomy.

Clinical Assessment of Reconstruction Involving Gastric Pull-Up Combined with Free Jejunal Graft After Total Pharyngolaryngoesophagectomy

BackgroundTotal pharyngolaryngoesophagectomy (PLE) is used as a curative treatment for synchronous laryngopharyngeal and thoracic esophageal cancer or for multiple cancers in the cervical and thoracic esophagus. Gastric pull-up is commonly used after PLE, but postoperative complications are common. The present study evaluated these procedures in patients with esophageal cancer.MethodsFourteen patients (7 with synchronous pharyngeal and thoracic esophageal cancer, 4 with synchronous cervical and thoracic esophageal cancer, and 3 with cervicothoracic esophageal cancer) underwent reconstructive surgery after PLE involving gastric pull-up combined with free jejunal graft between 2004 and 2015.ResultsEsophagectomy via right thoracotomy was performed in 9 patients, and transhiatal esophagectomy was used in 5. The posterior mediastinal route was used in 13 patients, excluding one patient with early gastric cancer. Interposition of a free jejunal graft included microvascular anastomosis using two arteries and two veins in all patients. Anastomotic leakage and graft necrosis did not occur in any of the 14 patients who underwent the above surgical procedures. Tracheal ischemia close to the tracheostomy orifice occurred in 4 patients (28.6%), but none of these patients developed pneumonia. No hospital deaths were recorded.ConclusionsThe results indicate that gastric pull-up combined with free jejunal graft is a feasible reconstructive surgery after PLE. This procedure is a promising treatment strategy for synchronous pharyngeal and thoracic esophageal cancer or multiple cancers in the cervical and thoracic esophagus. Larger series are needed to show the distinct advantages of this procedure in comparison with conventional methods of reconstruction after PLE.

Analysis of the Surgical Treatment for Middle Ear Cholesterol Granuloma

Middle ear cholesterol granuloma is still an intractable ear disease, and its pathogenesis has not been clearly demonstrated. In this study, we evaluated treatment of middle ear cholesterol granuloma.We reviewed middle ear cholesterol granuloma in 16 ears that underwent surgical treatment at Kurume University Hospital between 1990 and 2006.Cases that were healed by ventilation tube insertion only and those combined with other middle ear disease such as cholesteatoma were excluded from this study. We analyzed the relation between preoperative findings of the tympanic membrane and postoperative course. Preoperative findings of the tympanic membrane were grouped into the swollen type or retracted type. The cases that underwent myringotomy more than twice, showed persistent otorrhea from the tympanic ventilation tube, or the ventilation tube was missed were classified as showing a poor postoperative course. Cases without the above symptoms were classified as showing a good postoperative course. The hearing results were analyzed using the Guidelines for Evaluating Hearing Results after Middle Ear and Mastoid Surgery published by the Otological Society of Japan (2000).The postoperative courses of patients with a swollen tympanic membrane were significantly poorer. The postoperative courses of those with a retracted tympanic membrane and those undergergoing ossicular chain reconstruction showed significantly better results. However, 3 of 4 cases showing swollen tympanic membrane achieved a good passage. Such cases underwent posterior tympanotomy with ossicular chain reconstruction.Success rate for hearing improvement at about 14 post operative days was 75%. Yet, beyond 6 months postoperatively, the success rate deteriorated to 62.5%. Cases showing a poor hearing result at 14 postoperative days never showed a permanently improved hearing result.To acquire better postoperative results in patients with swollen tympanic membrane, posterior tympanotomy with ossicular chain reconstruction is highly recommended.