Search

We report an endoscopically assisted total diverticulectomy for Zenker's diverticulum. Skin incisions were made at the anterior axillary line, the center of the sternum, and the neck as portals for endoscopical instruments. The skin was retracted with hooks which provided an excellent view of the working space. The diverticulum was fully exposed and resected by using a multifire endoscopic stapler. This approach is minimally invasive in comparison with the conventional open cervical approach.

We analyzed 14 patients who showed a further progression of hearing loss after an initial examination of 214 patients with sudden deafness. They were divided into 2 groups based on the type of hearing loss progression. Group I consisted of six patients who displayed a rapid progression after increased hearing loss had begun. Group II consisted of eight patients who showed transient hearing improvement before an increase in hearing loss. The clinical features of the 14 patients were from a earlier visit to the clinics experiencing dizziness and/or vertigo with less recovery of hearing loss than the other patients. However, more than 60% of the 14 patients showed complete recovery or a marked hearing improvement. The predominant type of hearing loss was high tone loss at the initial audiological assessment in both groups. The flat type hearing loss was usually noted at the time when the patients experienced their greatest hearing loss. Although the details of the etiology of hearing loss progression remain unclear, group I was thought to be the slow type sudden deafness, whereas the deterioration of hearing loss in group II may be due to a circulatory disturbance of the inner ear.

Nasolacrimal duct obstruction is normally treated with extranasal dacryocystorhinostomy, but nasal endoscopic dacryocystorhinostomy has recently become more common due to the development of nasal endoscopy. The subjects of the study were 23 patients who underwent nasal endoscopic dacryocystorhinostomy between December 2001 and July 2005 at Kohka Public Hospital, and who were followed for 6 months or longer. The presence or absence of lacrimal canaliculus obstruction was examined in a lacrimal probe test before surgery, and lacrimal contrast XP and CT were performed. During surgery, a Nunchakutype silicon tube was indwelled usually. The silicon tube was removed 3 months after surgery, and the success of the surgery was evaluated based on the improvement of subjective symptoms. The success rate was 88%, but obstruction recurred in 3 patients. Nasal endoscopic dacryocystorhinostomy was repeated in all recurrent cases, and obstruction recurred again in 1 patient. Pus was retained in the lacrimal sac in the recurrent cases, suggesting the involvement of infection.

The patient was a 64-year-old man with an infra-auricular mass. Since the tumor was strongly adherent to the angle and the posterior aspect of the mandible, part of the medial pterygoid muscle, masseter muscle, and parotid gland, it was bluntly dissected and resected en bloc. The resected tumor was measured 65×50×13 mm, and weighed 31 g. The tumor was histopathologically diagnosed as an intramuscular lipoma, presumably arising from the sternocleidomastoid or masseter muscle. The reported recurrence rate of non-infiltrating lipoma is less than 5%, whereas that of infiltrating lipoma ranges from 3 to 62.5%. Since intramuscular lipoma is characterized by an infiltrating growth pattern, it cannot always be completely resected. To reduce its recurrence, it is necessary to perform a wide en-bloc resection of the adjacent normal muscle, while considering the degree of residual muscle dysfunction, including muscle weakness.