Yuichi Tomidokoro

Superselective intra-arterial infusion chemotherapy administered through the deep lingual artery and concomitant radiotherapy: ―舌深動脈からの動注―

Superselective intra-arterial infusion chemotherapy administered through the deep lingual artery and concomitant radiotherapy : Yuichi Tomidokoro1), Nobumitsu Honda1), Sohei Mitani1), Taro Takagi1), Eriko Nishihara1), Koshiro Nakamura1) and Toru Ugumori2). 1)Department of Otolaryngology-Head and Neck Surgery, Ehime Prefectural Central Hospital, 2)Department of Otolaryngology-Head and Neck Surgery, Ehime University School of Medicine

Three Cases of Sphenoid Sinus Mycosis

Mycosis in the paranasal sinus is commonly found in the maxillary sinus, but rarely in the sphenoid sinus. In this paper, three cases of sphenoid sinus mycosis are reported and the clinical feature are compared with the 25 other cases reported in Japan since 1968. Our three patients had complained of headache and eye pain, which were thought to be characteristic symptoms in the 25 previous cases. One of the three patients had onset with a background of rheumatoid arthritis and needed steroid medication, but the other two patients had no improvement with medication for sinusitis. By CT scanning and MRI, a localized sphenoid sinus lesion was detected as a characteristic findings for paranasal sinus mycosis, showing irregular mosaic contras on CT scanning and low intensity signal on T1 and T2 MRI imaging. The definite diagnosis was made by means of histological examination for a block age in the affected sinus cavity. Endoscopic sphenoidectomy was performed through the parsnaslis of the anterior wall of sphenoid sinus and was usefull for total removal of the lesion.

A Case of Acute Mastoiditis with Associated Laryngeal Paralysis.

A 58-year-old man visited our hospital with complaints of temporal headache, hoarseness, dysphagia and left hearing loss. Palsy was noted in the left soft palate, vocal cord and sternomastoid muscle. And also hyperesthesia was noted in the first branch of the left trigeminal nerve and hypoesthesia in the other branches of the nerve. His left hearing was reduced to total deafness. Enhanced CT scan and MRI showed signs of acute mastoiditis with internal jugular vein thrombosis and inflammation around the sigmoid sinus (sinus phlebitis). The mastoiditis had resulted from infection of MRSA; methicillin resistant Staphylococcus aureus. Mastoidectomy was performed, as the antibiotic therapy with Vancomycin did not work for the mastoiditis. At the time of the operation, inflammatory mucous membrane in the mastoid cavity and the bone defect on the lateral semicircular canal were observed, but neither granulation nor abscess was observed. Two days after the operation, redness around the ear was noted, so the wound was opened. Thereafter, curettage of the granulation with irrigation in the mastoid cavity was repeated. The palsy of the left soft palate improved, and the inflammation decreased. When the MRSA turned to Pseudomonas aeruginosa, the antibiotic drug was changed to Imipenem. However, the temporal headache was not relieved and the inflammation increased again. Therefore, further mastoidectomy with tympanoplasty was performed. At the time of the second operation, a fracture on the middle base of the skull and a fistula on the lateral semicircular canal were observed. Postoperatively, the temporal headache and the inflammation improved. A month after the operation, the palsy of the left soft palate, sensation in the face and the sternomastoid muscle functions recovered. Eleven months after the operation, movement of the vocal cord has been improving gradually.