Yuko Hata

Congenital Cholesteatoma: Posterior Lesions and the Staging System

Objectives We described the characteristics of congenital cholesteatoma in Japanese patients and assessed whether the staging system is useful for predicting the rate of residual disease, the need for reexploration, and surgical outcomes. Methods We performed a retrospective chart analysis of 23 consecutive patients with congenital cholesteatoma. Results The proportion of cases with anterior-superior quadrant involvement was significantly lower in the Asian group than in Western patients. The total residual rate was 26%, and there was a positive association between stage and residual rate, ranging from 0% in stage I and II to 44% in stage IV. Canal wall–up tympanomastoidectomy was the most frequent procedure (57%), and 61% had reexploration. Conclusions Congenital cholesteatoma in Asia is less likely to involve the anterior-superior quadrant than in Western patients. The 4-stage system was useful for predicting residual rates, even in patients in whom anterior-superior quadrant involvement was less common. Postoperative hearing was significantly related to the stages. A routine second-look procedure may be unnecessary in the early stages, whereas reexploration would be better performed in advanced stages. Endoscopy might reduce residual disease and the need for reexploration in the near future.

Retropharyngeal hematoma from parathyroid hemorrhage in a hemodialysis patient

A case of a spontaneous retropharyngeal hematoma in a patient on chronic hemodialysis is described. A 75-year-old man presented with a 5-day history of throat discomfort and neck swelling. He had been on hemodialysis for chronic renal failure with secondary hyperparathyroidism. Examination showed a massively enlarged neck and bruising on his left neck and anterior chest. Flexible nasopharyngoscopy revealed bluish bulging of the posterior pharyngeal wall, and CT showed widening of prevertebral soft tissue. Hemodialysis reduced the swelling of the posterior pharyngeal wall, and conservative management including steroids and antibiotics was adequate for managing the airway and hematoma. Retropharyngeal swelling of this patient seemed to be derived not only from the hematoma itself, but also from the lymphatic and venous congestion. Follow-up CT and MRI indicated that the enlarged left parathyroid was the bleeding source. To the best of our knowledge, this is the second report of a retropharyngeal hematoma from parathyroid hyperplasia in a chronic hemodialysis patient. Physicians should be aware that rare parathyroid hemorrhage in chronic hemodialysis patients could lead to airway obstruction by retropharyngeal swelling.

Submandibular lymphadenitis caused by root canal filler

We report a case of lymph node swelling caused by dental filler used for root canal treatment. The patient was a 44-year-old woman, who presented with the chief complaint of repeated swelling of the mandibular lymph nodes. On cytological examination, the lymph nodes were identified as class 3, and the possibility of a malignant lymphoma could not be definitively eliminated. She had undergone root canal therapy twice in the right lower front molar teeth, the most recent of which had been performed 4 years before her visit to our hospital. Because panoramic tomographic radiography revealed periapical cyst formation at the teeth, we considered that the lymph node swelling was because of inflammation. After extraction of the teeth, the size of the lymph node slightly decreased but repeated aggravation and relief continued. We performed submandibular glandectomy and lymph node biopsy for diagnosis. Pathological analysis of the samples showed normal submandibular glands and macrophage phagocytosis of a black particle suspected as being root canal filler. To our knowledge, this report is the first to show lymph node swelling caused by root canal filler, which is considered safe for use in humans.

A case of a refractory pharyngocutaneous fistula successfully treated with fibrin glue

Postoperative wound dehiscence, especially after radiotherapy, is often a serious complication and therapeutic challenge in head and neck surgery. We report a case involving a 70-year-old man who underwent a salvage total laryngectomy for recurrent laryngeal cancer with previous radiotherapy and thereafter developed a pharyngocutaneous fistula (PCF). Various procedures, including debridement and reconstruction using a deltopectoral flap, were performed to control the inflammation and develop granulation tissue. However, a pinhole fistula still remained. On the 184th postoperative day, we filled the PCF with fibrin glue, which finally resulted in closure of the fistula. Fibrin glue is simple to use. This case report suggests that filling a small PCF with fibrin glue is an effective treatment method and may be a potential therapeutic option.