[Importance of tumor origin determination in selecting suitable surgery for treating inverted maxillary sinus papillomas].

We report the clinical outcomes for 28 subjects treated for inverted maxillary sinus papilloma between 2003 and 2007 involving preoperative imaging determination of tumor origin. Tumor origin often determines whether endoscopic endonasal or transmaxillary surgery is to be done. Endoscopic endonasal surgery was conducted for tumors originating in the posterior maxillary sinus in 17 patients and endoscopic transmaxillary surgery for tumors originating in the anterior maxillary sinus in 11 patients. Recurrence was seen in only 1 whose tumor originated in the superior sinus wall and had spread wide by to the lateral and posterior walls. Endoscopic endonasal resection was initially conducted and the recurrent tumor extracted by endoscopic transmaxillary surgery. The tool essential for successful tumor removal is complete surgical resection so as our study demonstrates, the preoperative determination of tumor origin is important in selecting of the most appropriate surgical procedure.

Preoperative magnetic resonance imaging for localization of the origin of maxillary sinus inverted papillomas.

PURPOSE: It is essential to precisely localize the origin of an inverted papilloma within the maxillary sinus by preoperative imaging so that the lesion can be excised as thoroughly as possible. In the present study, we evaluated the use of preoperative magnetic resonance imaging (MRI) for pinpoint localization of the origin of inverted papillomas. MATERIALS AND METHODS: The subjects were patients with an inverted papilloma of the maxillary sinus. Given the known histopathological features and pattern of growth of this tumor, we obtained preoperative MRIs in an attempt to localize its origin. RESULTS: When different interpretation methods were applied to the preoperative MRIs, there was up to an 85.7% correlation with the surgical results for localization of the tumor origin. CONCLUSIONS: We were able to demonstrate a high rate of agreement between diagnostic imaging and the actual surgical findings in identification of the origin of inverted papillomas.

[A case of laryngeal sarcoidosis difficult to diagnose].

Sarcoidosis is a multiorgan granulomatous disease of unknown cause, named after the characteristic histopathological findings of the disease. In this article, we shall report a case in which biopsy needed to be repeated three times until a final diagnosis of laryngeal sarcoidosis could be made. Since sarcoidosis associated with only a laryngeal pathology may not be associated with any laboratory abnormalities in many cases, first priority should be attached in suspected cases to detect the presence of noncaseating epithelioid cell granulomas. In this case, the results of the first and second laryngeal biopsies did not show non-caseating epithelioid cell granulomas, while the third biopsy showed noncaseating epithelioid cell granulomas with giant cells. Finally, the diagnosis of laryngeal sarcoidosis was made after the results of whole-body imaging became available. Laryngeal sarcoidosis must be borne in mind as a suspected diagnosis in cases where the larynx shows yellowish-white diffuse swelling.

Evaluation of missing fundamental phenomenon in the human auditory cortex.

OBJECTIVE: Harmonic complex tones consisting of four or more continuous harmonics of a certain stem frequency are perceived as the pitch of the fundamental frequency tone, it is referred to as the missing fundamental phenomenon (MFP). It is considered that the MFP is produced in the central auditory system, not in the periphery. However, it remains unclear where and how complex sounds is integrated. Using 306ch magnetoencephalography (MEG), we investigated when and where the MFP was integrated in the auditory cortex. METHOD: We examined six subjects who were selected by MEG in 12 healthy right-handed adult volunteers with normal auditory sensation. Ears were randomly stimulated with five different complex tones consist of fundamental frequency tone and harmonic complex tones. The location and direction of equivalent current dipoles (ECD) were evaluated at P50 and N100 in the right temporal lobe by MEG. Dispersion of the source of ECD was respectively evaluated on their brain MRI. RESULTS: Stimulation of ears with harmonic complex tones and the stem frequency tone revealed the localization of P50 and N100 ECD in the transverse temporal gyrus and their peripheral superior temporal gyrus. Although the sources of P50 ECD for harmonic complex tones and the fundamental tone were varied around the transverse temporal gyrus and superior temporal gyrus, the sources of N100 ECD were almost identical at the transverse temporal gyrus, demonstrating the MFP. This phenomenon were similarly observed, even when dichotic listening were stimulated. CONCLUSION: These findings suggest that the MFP occurs in the transverse temporal gyrus and the superior temporal gyrus, which are the primary auditory cortex, between P50 and N100.