Impact of sentinel node navigation technique for carcinoma of tongue with cervical node metastases.

We attempted lymph node mapping for clinically positive neck using sentinel node navigation technique. Technetium labeled rhenium sulfide was injected as a radiotracer in 11 patients with squamous cell carcinoma of the tongue. After surgery, the radioactivity and the ratio of metastatic area (RMA) of the removed nodes were measured. Average RMA (57%) of 18 high radioactive metastatic nodes was significantly lower than the RMA (90%) of 16 low radioactive metastatic nodes. Average number of metastatic nodes (4.7 nodes) in the five cases with low radioactive metastatic nodes was significantly larger than that (1.8 nodes) in the six cases with only high radioactive metastatic nodes. There is no accumulation of radioactive tracer if a lymph node is totally or predominantly occupied by metastatic cells. When the sentinel node was mostly occupied by malignant cells, the injected colloid could not flow to the sentinel node and flowed to a different lymph node through another basin. Sentinel node navigation technique can show the actual time of lymphatic flow at the operation of positive neck cases.

Bone destruction resulting from rupture of a cholesteatoma sac: temporal bone pathology.

OBJECTIVE: The purpose of the current study was to research the pathogenesis of bony destruction of cholesteatoma. STUDY DESIGN: We conducted a case report. SETTING: The study was performed at Fukushima Medical University. PATIENTS: The first case involved a 21 trisomy, whereas the second case was cancer of the hypopharynx. Both cases showed cholesteatoma. RESULTS: The following histopathologic findings in the temporal bones of cholesteatoma were obtained. Bony destruction in cholesteatoma was detected in the lesion of the rupture of the cholesteatoma sac. Epithelial debris of cholesteatoma was scattered throughout the rupture of the cholesteatoma sac. Rupture of the matrix was the result of a small abscess. CONCLUSION: Rupture of the cholesteatoma sac was believed to have been a pathway of either endogenous substances from the matrix and/or epithelial debris of cholesteatoma.

Why is otosclerosis of low prevalence in Japanese?

OBJECTIVE: This study aimed to clarify the reasons why clinical otosclerosis, a very common disease among Caucasians, is not prevalent among Japanese. STUDY DESIGN: The incidence, site, activity, and volume of otosclerotic foci were examined in 1011 temporal bone sections from 507 Japanese individuals. SETTING: This study was prepared at the temporal bone laboratory, Fukushima Medical University, Fukushima. RESULTS: Otosclerotic foci were observed in 2.56% of individuals and in 1.48% of the ears. The most common site of involvement was anterior to the oval window region, but this was only in 38.9% of the ears with otosclerotic foci. The otosclerotic foci were not involved in the stapediovestibular articulation or the endosteal layer of the otic capsule in any ears. An active change of the otosclerotic focus was seen in 33.3% of ears with otosclerosis. The volume of otosclerotic foci at the site anterior to the oval window region was less than 0.8 mm3 in 5 out of 7 ears. CONCLUSION: The incidence of histologic otosclerosis among Japanese seemed to be almost the same as that among Caucasians. Three reasons why clinical otosclerosis was not as prevalent among Japanese as among Caucasians are suggested: low incidence of involvement of foci anterior to the oval window, low activity, and small lesion without involvement of the footplate and/or membranous labyrinth of the inner ear.

Anomalies of the auditory organ in trisomy 18 syndrome: human temporal bone histopathological study.

The purpose of this study was to define the histopathological changes in the temporal bone of a fetus with trisomy 18 syndrome, a stillborn due to perosplanchnia. Several anomalies were found including malformation of the auditory ossicles, residual mesenchyme in the middle ear, aberrant tensor tympani muscle, absence of stapedial tendon, aberrant lateral ampullary nerve and wide endolymphatic sinus. The incus body was deformed and separated from the long process by connective tissue and monocrural stapes was noted in the right ear. Three-dimensional reconstruction images provided a clear view of the auditory ossicle malformation. The abnormal findings in our case indicate that ear anomalies in this syndrome might be derived from the component around the first and second branchial arches.

[Sclerotic changes in ossicular ligaments in human temporal bone pathology].

When tympanoplasty is performed for conductive hearing loss due to otitis media, hearing recovery may not be as good as anticipated preoperatively. Sclerotic changes may therefore exist in the conduction system of the middle ear. To clarify the relationship between middle ear inflammation and sclerotic changes of middle ear sound conduction, particularly of the ossicular ligaments, specimens of human temporal bones were studied. Histology of the anterior malleal ligament, posterior incudal ligament, and stapediovestibular ligament was examined in 636 ears from 367 individuals (postmortem) ranging from infancy to 90 years old and without blood disease, neoplasm, anomaly, or cholesteatoma. Only small numbers of acute and subacute inflammatory were identified, but sclerotic changes in ligaments were compared between normal and chronically inflamed ears. In anterior malleal and posterior incudal ligaments, the severity of sclerotic hyalinization and calcification increased with age in normal ears, but sclerotic changes in chronically inflamed ears were more severe than in normal ears and displayed a reduced association with age. Conversely, sclerosis of the stapediovestibular ligament was less severe than that of the anterior malleal and posterior incudal ligaments in both normal and chronically inflamed ears, and displayed a reduced relationship with age. The sclerotic changes apparent in the anterior malleal and posterior incudal ligaments therefore seem to be more readily influenced by inflammation than by age. Sclerotic changes of the stapediovestibular ligament are not as severe as those of anterior malleal and posterior incudal ligaments. For cases in which tympanoplasty of inflamed ears is planned, mobility of the anterior malleal and posterior incudal ligaments should be tested independent of testing of the stapediovestibular ligament. When mobility of anterior malleal and posterior incudal ligaments is not as good as mobility of the stapediovestibular ligament, surgical modification of the anterior malleal and posterior incudal ligaments may be advisable.

[Computer-aided surface area measurement of temporal bone pneumatization: histological sections].

Contention exists on the development of pneumatization of temporal bone. Many techniques to measure the volume of pneumatization have been reported, but no techniques for direct surface area measurement. We measured the surface area and volume of human mastoid air cells. Eight normal temporal bones removed at autopsy were analyzed and fixed in formalin fixative, decalcified, and embedded in celloidin, sectioned at 25 microns and stained with H-E for histological examination. Total surface area and the volume of human mastoid air cells were measured using a personal computer. The surface area of pneumatic spaces for the 8 temporal bone specimens ranged from 36.1 cm2 to 163.0 cm2 (mean +/- SD: 89.1 +/- 34.0 cm2). The volume of pneumatic spaces for the 8 specimens ranged from 1.53 ml to 6.03 ml (mean +/- SD: 4.12 +/- 0.97 ml). The surface area of temporal bone pneumatic spaces we determined could serve as useful basic data for determining the physiology of ventilation for the temporal bone and the function of mastoid cells.

[Temporal bone study of residual mastoid inflammation in ears with normally appearing tympanic membrane].

We examined 395 temporal bones with an intact tympanic membrane to explore the relationship between residual inflammation in the middle ear cavity and development of mastoid pneumatization. Histopathological changes were studied in the middle ear cavity. Mastoid pneumatization was classified as good or poor based on the extent of mastoid tip development to the lateral semicircular canal. Specimens were 344 temporal bones with well-pneumatized mastoid and 51 with poorly-pneumatized mastoid. Otitis media was noted in 119 (34.6%) bones in the good group and 9 (17.6%) in the poor group. In well-pneumatized mastoid, chronic inflammatory changes were frequently observed at the lower portion of mastoid cells, the round window niche, and the tympanic sinus. In contrast, no such incidence of inflammatory change was noted in poorly-pneumatized mastoid. Our findings indicate that an intact tympanic membrane does not always mean freedom from mastoid inflammation, especially when the mastoid is well-pneumatized. This makes it important to check for possible remaining otitis media in patients with a well-pneumatized mastoid, even if the tympanic membrane appears normal.