論文要旨 Bezold膿瘍は中耳炎の頭蓋外合併症として乳様突起 から骨瘻孔を経て頸部膿瘍を形成する病態であり、近年 では稀な疾患となっている。今回、健康保険未加入、生 活保護未申請のため医療費の支払いを心配して医療機関 を受診せずに放置された中耳炎を基礎として3ヵ月後に 発生したBezold膿瘍の1例を経験した。症例は30歳女 性、右頸部腫脹と頸部痛を主訴に当科受診した。頸部超 音波検査で右頸部に膿瘍を疑う領域が認められた。右耳 鏡所見では外耳道壁の腫脹があったが、明らかな耳漏や 鼓膜穿孔は認めなかった。CTでは右頸部膿瘍に加えて 乳様突起と後頭蓋窩の骨欠損を認め、Bezold膿瘍と診 断した。また、HbA1c10%と未治療の糖尿病も認められ た。血糖コントロールを開始し、緊急乳突削開術と膿瘍 腔開放術を施行した。術後はABPC/SBTを投与したと ころ全身状態・混合性難聴共に軽快、第22病日退院と Bezold膿瘍を形成した隠蔽性乳様突起炎の1例
Conclusion We performed ossiculoplasty under conditions preventing inflammation by adopting a planned staged operation, which is suitable for ossiculoplasty using an artificial prosthesis We identified the presence of chorda tympani nerve as a candidate predictive factor for successful ossiculoplasty Objectives We aimed to summarize the outcome of ossiculoplasty and to find factors to improve the success rate Methods This was a retrospective chart review of 96 patients who underwent ossiculoplasty in Kyoto University Hospital from 2001 to 2008 Patients' backgrounds, hearing outcomes, and surgical procedures were analyzed To find predictive factors for successful ossiculoplasty, we performed logistic regression analysis Results The improvement in the mean air conduction level was 12 9 dB The mean postoperative air bone gap (ABG) was 25 0 dB The ABG decreased to within 20 dB in 40 7% of the cases As a result of univariate logistic regression analysis, primary or planned second stage surgery, closed mastoid cavity, and presence of the chorda tympani nerve were identified as favorable factors for successful ossiculoplasty
Squamous cell carcinoma (SCC) of the temporal bones, similar to maxillary sinus cancer, often invades into surrounding bone structure and thus, resistant to radiotherapy. Retrospective study evaluating the efficacy of surgery followed by radiotherapy for the temporal bone SCC revealed poor outcome of advanced cases more than T3 in Pittsburg category. Then, we started to treat such advances cases with supradose intra-arterial chemotherapy and radiotherapy. The local control rate was 80% whereas the local control rate of the previous treatment with surgery and post-operative irradiation was approximately 40%. There was no severe adverse effects attributable to this treatment. This treatment could be served as a treatment choice for locally advanced temporal bone SCC.
