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There are a variety of morbid conditions that can cause atrophy of the vocal folds. We performed type 3 thyroplasty (Type 3) for atrophy of the vocal folds, and obtained a favorable outcome in terms of vocal function. This case is reported in this paper. A 47-year-old male patient worked as a voice trainer for professional singers. In February 2006, he underwent emergency surgery for pontine hemorrhage. After discharge from the ICU, he found that his voice was weak and high-pitched. After discharge from the hospital, the patient was referred to our hospital with a chief complaint of difficulty in speaking loudly. At the initial examination, marked atrophy of the bilateral vocal folds was observed. There was no vocal fold paralysis. Before corrective surgery, the patient's speaking fundamental frequency (SFF) was 255 Hz, lowest pitch was 217 Hz. Since a decrease in SFF was recognized on manual testing, the patient was judged as having an indication for a Type 3 procedure. Speech analysis was conducted during surgery, and the SFF and lowest pitch were adjusted to 108 Hz and 103 Hz, respectively. The voice parameters improved, as follows: SFF: 110 Hz, lowest pitch: 73 Hz, respectively, post operatively. We encountered a patient in whom atrophy of the vocal folds as a result of surgery for pontine hemorrhage led to a weak and high-pitched voice. Type 3 procedure was found to be useful as treatment for this patient.

We encountered a rare case of facial nerve paralysis caused by cavernous hemangioma of the facial nerve.The patient was a 47 year-old man with a chief complaint of food leaking from the left angle of the mouth starting in January 2001. He was diagnosed as having Bell's paralysis, and he was treated with stel-late ganglion block (SGB). However, paralysis did not improve. Furthermore, MRI demonstrated a tumor in the left temporal bone. He was referred to our department on April 17, 2001.The facial score was 0/40 points by the Yanagihara method. There was no sign of cranial nerves other than the left facial nerve. CT showed a soft tissue shadow in the attic.Facial nerve schwannoma was suspected, and tympanoplasty was performed on October 16, 2001. The tumor bled easily. A solid tumor about 6mm in diameter was removed en bloc. Pathological diagnosis was a cavernous hemangioma of facial nerve origin.When we diagnose facial palsy, paralysis due to a tumor should be listed in the differential diagnosis. Imaging is essential for the diagnosis.

We report a case of leiomyosarcoma in the nasal cavity of a patient with a history of bilateral retinoblastoma.Leiomyosarcomas account for 7% of all soft tissue sarcomas, and they usually develop in smooth-muscle-rich organs such as the uterus, urinary bladder, and gastrointestinal tract, but they also occur at other sites, including the extremities, retroperitoneal space, mesenteries, kidneys, liver, orbits, pancreas, spleen, femoral veins, and heart. Most malignant tumors of the nose and the paranasal sinuses are carcinomas, and the incidence of sarcoma is low; leiomyosarcoma is even rare among the sarcomas in these regions. To the best of our knowledge, only 27 cases, including our own, have been reported in Japan.The patient was a 51-year-old male with a chief complaint of nasal obstruction. He had experienced nasal obstruction on the left side since about May 2004, and was told of the presence of a tumor filling the nasal cavity when he consulted a local otorhinolaryngologist. A CT scan showed a homogeneous tumor filling the inferior nasal meatus on the left, and the tumor was endoscopically removed towards the end of August. Because leiomyosarcoma was diagnosed as a result of istological examination, extirpation of the tumor was performed via the maxilla in the middle of September. Two cycles of a CYVADIC protocol were given postoperatively as adjuvant chemotherapy. There is no evidence of recurrence or metastasis at present.Retinoblastoma occurs when the Rb1 region is deleted in one of the responsible alleles and point mutation occurs in responsible alleles or when point mutation occurs in both of the responsible alleles. Patients with a history of retinoblastoma are known to manifest other primary tumors secondarily. These tumors are thought to develop because of a mutation in the Rb1 gene caused by irradiation, a genetic mutation or other factors that reduce the tumor suppressing function of the body. Osteosarcoma accounts for as much as 50% of sarcomas in patients with both a retinoblastoma and soft tissue sarcoma, but the incidence of leiomyosarcoma is very low. As far as we have been able to determine in a search of the literature in Japan and abroad, this condition has only been reported in the liver in one case and in the urinary bladder in two cases. Thus, this is the first report of a case in which primary leiomyosarcoma developed in the nasal cavity of a patient with a history of retinoblastoma. Because radiation therapy had previously been used in our case, we suspected that the leiomyosarcoma had developed secondarily to a gene-related abnormality such as that of the Rb gene.