Yasuyuki Tasaka

Eustachian tube function in OME patients with cleft palate. Special reference to the prognosis of otitis media with effusion.

Eustachian tube function was investigated in two groups of cleft palate patients who had otitis media with effusion. One group consisted of 16 ears that healed after one ventilatory tube insertion, the other consisted of 33 ears that needed repeated tube insertion and did not heal in 2 years. The latter group was characterized by low opening pressure and inability to sustain lower middle ear positive pressure. This decrease force in the Eustachian tube was considered to be related to the prognosis of otitis media with effusion in patients with cleft palate.

A Case of a True Malignant Mixed Tumor of the Parotid Gland.

True malignant mixed tumor (carcinosarcoma) of salivary glands, with carcinomatous and sarcomatous components, is aggressive and extremely rare. We report a case of a true malignant mixed tumor in a parotid lesion.A 58-year-old man had a painless right inf raauricular mass that had been present for about 30 years. A 6×4cm elastic hard nodule existed from the tragus to the angle of the mandible. The patient underwent total parotidectomy with facial nerve preservation. The entire tumor was resected with the surrounding tissues except along the main trunk of the facial nerve. Histologically, the tumor showed a biphasic pattern composed of both carcinomatous and sarcomatous elements. The carcinomatous component was adenocarcinoma with ductal structure and the sarcomatous components varied from unclassified sarcoma to unequivocal chondrosarcoma. Two months later, the patient suddenly complained of right facial paralysis. Magnetic resonance imaging revealed a irregular mass extending to the parapharyngeal space. A radical operation, combined with chemotherapy and radiotherapy, was performed with neck dissection, partial mandibulectomy and facial nerve sacrifice. Despite these intensive therapies, an X ray study showed multiple pulmonary coin lesions three months after the second operation.We emphasize the necessity for radicality in initial operations when dealing with this type of tumor.

Two Cases Showing Dizziness during Recovery from Puffer Fish Poisoning.

Symptoms and neuro-otological test results in two patients with puffer fish poisoning (one severe case and the other mild) were reported. Both patients complained of dizziness one day after revival. The eye-tracking test showed a saccadic pattern in the severe case. The optokinetic pattern test showed overall poor pursuit in the severe case, while poor pursuit was only evident at high speeds in the mild case. The caloric test showed bilateral hypofunction in both cases. Tests results uniformly improved when dizziness disappeared. These observations suggest that tetrodotoxin may affect both the peripheral and central nervous systems.

A Case of Multiple Schwannomas with the Initial Symptoms of a Parotid Tumor.

In 1984, Shishiba et al described 4 cases with multiple cutaneous neurilemmomas as “neurilemmomatosis” which is a systemic disease distinct from neurofibromatosis. Since then, some reports have been published on multiple schwannomas as a systemic disease. In this paper, we report a case of multiple schwannomas with the initial symptoms of a parotid tumor.A 64-year-old man visited our hospital complaining of swelling in the right inf raauricular region. Preoperative CT and MRI examinations revealed a 25×25 mm round tumor in the deep portion of the right parotid gland and two other tumors in the deep right upper neck. A malignant tumor in the parotid gland with lymph node metastasis was suspected. An operation revealed that these tumors originated from the facial nerve, a branch of the accessory nerve and the brachial plexus. There were two independent tumors in the facial nerve. The tumor in the accessory nerve was totally removed, but the others were treated conservatively in consideration of his quality of life. The tumors in the accesory and the facial nerves were examined histologically, and were diagnosed as a mixed type schwannoma.The present case could not be considered to be neurofibromatosis, because the patient did not have dermatological findings, cafe au lait spots, neurofibromas, nor a familial history of neurofibromatosis.

The Effects of Submucous Turbinotomy on Allergic Rhinitis.

The effects of submucous turbinotomy were investigated in 45 patients with perennial nasal allergies caused by house dust, who were resistant to treatment with various medications. Subjectively, all of the patients had reduced nasal obstruction and more than 90% of the patients showed a decrease in both sneezing and rhinorrhea for one year postoperatively. Objectively, the mean nasal airflow value increased significantly. Furthermore, the nasal provocating reaction to specific antigens was weakened in 93.5% of patients.These results suggest that submucous turbinotomy is a useful surgical treatment for severe nasal allergy, as evidenced by the improvements in not only the nasal airflow but also the nasal allergic reaction.Histopathologically, the superficial layer of the submucosa of the turbinate was occupied by fibrous tissues, and the vessels, nasal glands and eosinophils infiltration almost disappeared. These changes were considered to weaken the allergic reaction, and to block both the venous plexus and the secretion of rhinorrhea.

Cavernous Hemangioma of 4th Ventricle; A Case Report.

A 35-year-old woman complained of left facial palsy and a sensation of fullness of the left ear of 3 days duration. Physical examination revealed left abducens nerve palsy and gaze nystagmus. CT scans and MRI showed a well-enhanced tumor in the 4th ventricle. She was treated neurosurgically and both facial palsy and hearing loss were improved. Althouth it is rare for peripheral facial palsy to be caused by a lesion of the brain stem, it is necessary to perform both audiological vestibular examinations to determine the location of the lesion.

Metastasis of Renal Cell Carcinoma to Lingual Ectopic Thyroid; A Case Report.

A 62-year-old female came to our clinic because of oral bleeding. A tumor was found at the base of the tongue. Despite many examinations, including biopsy, we could not determine the nature of the tumor. It was resected, and pathological examination revealed a metastasis from a renal cell carcinoma to a lingual ectopic thyroid.If malignancy is suspected in the head and neck region, the possibility of metastatic tumor, especially from the urogenital tract, must be kept in mind.

Middle ear diseases in patients with congenital velopharyngeal insufficiency.

To clarify the incidence of middle ear disease in patients with congenital velopharyngeal insufficiency (CVPI), we observed the shape of the velopharynx by a videofluorography and the movement of the lateral pharyngeal wall and soft palate with a flexible fxberscope. The findings of otoscopy, audiometry, and tympanometry were also recorded.Otitis media with effusion was the most common findings. The shape of the velopharynx had no relation to the incidence of middle ear disease. On the other hand, middle ear diseases were uncommon in CVPI patients with a good mobility of the lateral pharyngeal wall and soft palate. It was thought that the mobility of the velopharyngeal muscles, such as a levator veli palatini, might have some effect on conditions in the middle ear.

Rhabdomyosarcoma of the paranasal sinus; A case report.

A 24-year-old woman complained of pain of the radix nasi and disturbed visual acuity of 10 days duration. CT scan showed a tumor of the right ethmoid sinus extending into the right maxillary sinus. As much of the tumor was removed as possible through an extranasal approach and Caldwell-Luc operation. A diagnosis of rhabdomyosarcoma was established with special staining techniques.Postoperatively, this patient was treated with irradiation and chemotherapy (VCR, CTX, AMD, ADM). She is now asymptomatic 11 months after surgery, and radiographic or scintigraphic examinations reveal no local recurrence and distant metastasis.