Koutou (THE LARYNX JAPAN)
Online ISSN : 2185-4696
Print ISSN : 0915-6127
ISSN-L : 0915-6127
Current issue
Displaying 1-26 of 26 articles from this issue
  • Shigeru Hirano
    2023 Volume 35 Issue 2 Pages 57-61
    Published: December 01, 2023
    Released on J-STAGE: February 02, 2024
    JOURNAL FREE ACCESS

    In the 1970s to 1980s, Japan was a world leader in terms laryngology in terms of basic research on histology, physiology, and pathology, including the body cover theory and laryngeal EMG studies, which improved phonomicrosurgery as well as the understanding of the mechanism of voicing. These basic works contributed to the development of phonosurgery. Framework surgery was also invented in Japan and has since spread throughout the world.

    From the 1990s, Western countries, particularly the USA, began to produce innovative technologies as well as modern basic science using molecular biology and genetics. Innovation in phonomicrosurgey included the development of several new types of equipment, including CO2 and angiolytic lasers, new injectable materials such as hyaluronic acid and calcium hydroxylappatite, new materials for shim in thyroplasty, such as Gore-Tex and titanium, and microflap techniques for vocal fold lesions.

    It is important to always remain informed about new information in the world and to develop innovative technology based on basic research, in order to improve the presence of Japanese laryngology in the future. The greatest advantages of Japan are the spirit of challenge and the scientific environment.

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  • Yoshihiko Kumai
    2023 Volume 35 Issue 2 Pages 64-68
    Published: December 01, 2023
    Released on J-STAGE: February 02, 2024
    JOURNAL FREE ACCESS

    Vocal fold (VF) scarring is one of the main causes of permanent dysphonia and results from injury to the unique layered structure of the VFs. The increased collagen and decreased hyaluronic acid within VF scars lead to a loss of pliability and significantly decreases the VFs’ capacity to vibrate. At present, there is no definitive treatment for VF scarring, and regenerative medicine and tissue engineering have become increasingly important research areas in otolaryngology. Several recent reviews have described the problem of VF scarring and various possible solutions, including tissue-engineered cells and tissues, biomaterial implants, stem cells, growth factors, anti-inflammatory cytokines, and anti-fibrotic agents. However, despite considerable research progress, such technical advances have yet to be established as routine clinical procedures. This review focuses on the emerging techniques for restoring VF pliability using several approaches. We also identified obstacles to advances in research in this field.

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  • Yo Kishimoto, Shinji Kaba, Yoshitaka Kawai, Koich Omori
    2023 Volume 35 Issue 2 Pages 69-72
    Published: December 01, 2023
    Released on J-STAGE: February 02, 2024
    JOURNAL FREE ACCESS

    Vocal fold scarring occurs after inflammation or trauma/injury of the vocal fold mucosa and is histologically characterized by abundant and disorganized collagen deposition. These histological alterations stiffen the vocal fold mucosa, disturbing regular and symmetrical vibrations, and clinically result in severe and intractable dysphonia. There are no established treatment options for the prevention or restoration of vocal fold scarring, making its resolution one of the remaining challenges in the treatment of voice disorders. Recently, it has been shown that tissue fibrosis can be prevented by controlling macrophage phenotypes in some organs, and macrophages are considered master regulators of tissue fibrosis. Research on the prevention or restoration of fibrosis focusing on macrophage polarization in the vocal fold is gradually progressing. Although this is a nonclinical study, we were able to show that controlling the polarity of macrophages with drugs has a preventive effect on vocal fibrosis. In this article, we review studies on vocal cord scarring, focusing on macrophages.

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  • Machiko Ogawa, Shigeyuki Mukudai, Yoichiro Sugiyama, Yosuke Nakani ...
    2023 Volume 35 Issue 2 Pages 73
    Published: December 01, 2023
    Released on J-STAGE: February 02, 2024
    JOURNAL FREE ACCESS
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  • Yoichiro Sugiyama, Mami Kaneko, Shigeru Hirano
    2023 Volume 35 Issue 2 Pages 74-79
    Published: December 01, 2023
    Released on J-STAGE: February 02, 2024
    JOURNAL FREE ACCESS

    Vocal-fold scarring is one of the most intractable diseases that cause hoarseness. Stroboscopy can be used to estimate the severity of vocal-fold scarring. Many animal and human studies have reported on the efficacy of innovative therapies for vocal fold scarring. Voice therapy is one such effective treatment for patients with mild-to-moderate scarring. Regarding surgical intervention for vocal fold scarring, removal of scar tissue with minimally invasive surgery using the microflap technique may be helpful for managing localized fibrosis of the lamina propria. However, regeneration therapy is a better option for managing the vocal fold scar itself. Vocal fold injection of basic fibroblast growth factor is effective for ameliorating vocal fold scarring, particularly mild-to-moderate scarring. In addition, a phase 3 trial of vocal fold injection therapy with hepatocyte growth factor, which may provide significant therapeutic efficacy for severe scarring, is currently underway.

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  • Ryota Yamamoto, Yoichiro Sugiyama, Toshiro Umezaki
    2023 Volume 35 Issue 2 Pages 80-84
    Published: December 01, 2023
    Released on J-STAGE: February 02, 2024
    JOURNAL FREE ACCESS

    Vocalization is controlled by the neuronal networks from the cerebral cortex to the medulla oblongata. The neuronal circuitry of vocalization is closely related to the respiratory neuronal network that controls respiration during vocalization. Laryngeal sensory inputs are transmitted as visceral afferent inputs, primarily to the nucleus tractus solitarius in the medulla oblongata via the internal branch of the superior laryngeal nerve. This signal is then transmitted to the medulla oblongata and cerebral cortex and may be involved in the modulation of vocal motor control as well as that of breathing and swallowing. Animal studies have shown that increasing or decreasing laryngeal sensory input affects the vocal motor patterns and voice quality. However, interferential current stimulation of the neck is a non-invasive method of increasing sensory inputs and is expected to have clinical applications. We encountered a 31-year-old female with hypofunctional dysphonia and a glottal chink during phonation. Interferential current stimulation was performed, and the glottal chink was immediately reduced. Interferential current stimulation of the larynx is a new therapeutic strategy for managing functional dysphonia.

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  • Mami Kaneko, Yoichiro Sugiyama, Shigeru Hirano
    2023 Volume 35 Issue 2 Pages 85-87
    Published: December 01, 2023
    Released on J-STAGE: February 02, 2024
    JOURNAL FREE ACCESS

    It is necessary to understand the pathophysiology of dysphonia in line with the mechanism of vocalization in order to appropriately diagnose voice disorders and consider appropriate treatments. It has been reported, based on animal experiments, that laryngeal sensory inputs affect the vocal control mechanism. However, these experimental methods are difficult to apply in the clinical setting because they use invasive techniques, such as nerve resection or artificial airflow loading with under the tracheostomy. Therefore, we focused on interference current stimulation as an attempt to analyze laryngeal sensory feedback with more natural and non-invasive laryngeal sensory stimulation. In dysphagia treatment, there are therapeutic devices that aim to facilitate the swallowing reflex by applying interference current stimulation to the neck. Focusing on this stimulation characteristic, we are investigating the possibility of voice therapy combined with transcutaneous cervical interference current sensory stimulation. In this paper, we would like to introduce the previous research on the effects of laryngeal afferent inputs for dysphonia and then the results of our own experiments based on this idea.

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  • Takeshi Suzuki, Yosuke Seki, Toyoyuki Hanazawa, Toshitaka Hopp ...
    2023 Volume 35 Issue 2 Pages 88-92
    Published: December 01, 2023
    Released on J-STAGE: February 02, 2024
    JOURNAL FREE ACCESS

    Objective : To investigate the causes of voice disorders associated with laryngopharyngeal reflux disease (LPRD)-related chronic cough.

    Methods : We performed a psychoacoustic evaluation, laryngoscopy (to detect the presence of obvious organic lesions, organic lesions associated with LPRD [subglottic edema and vocal fold edema], and determine the muscle tension dysphonia [MTD] score) for chronic cough patients with LPRD diagnosed by hypopharyngeal multichannel intraluminal impedance.

    Results : Among a total of 24 patients, 11 (46%) patients had voice disorder. However, 7 of the 11 patients (64%) had no abnormalities in a psychoacoustic evaluation. Obvious vocal fold lesions were found in 2 of the 11 patients in the voice disorder group (18%). The score of subglottic edema and vocal fold edema, and the total MTD score (false vocal fold compression [FVF-C] and anterior-to-posterior compression [AP-C]) did not differ to a significant extent (p=0.52); however, the AP-C score of the voice disorder group was significantly higher than that of the normal group (p=0.04).

    Conclusions : The main component of the voice disorder was MTD, especially in AP-C. MTD should be taken into consideration and the possibility of LPRD should be considered in patients with voice disorders when there is a discrepancy between the chief complaint and laryngeal findings.

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  • Naoko Matsubara, Toshiro Umezaki, Ryota Yamamoto
    2023 Volume 35 Issue 2 Pages 93-97
    Published: December 01, 2023
    Released on J-STAGE: February 02, 2024
    JOURNAL FREE ACCESS

    Thirty-one patients with adduction spasmodic dysphonia who had received no treatment or only voice therapy received an injection of lidocaine into their vocal cords on one side. After injection, their conversational voice was evaluated and their larynx was observed by laryngoscopy every 10-60 minutes. All patients were observed to have weakness of the spasmodic motion of the vocal cords with voice improvement. Two patients showed weakness of the spasmodic motion of the vocal cords before the appearance of vocal cord palsy. Lidocaine is an anesthetic that anesthetizes the motor and sensory nerves. Spasmodic movement stopped while the motor nerves were paralyzed. Furthermore, before and after motor nerve paralysis, there was a time when only the sensory nerves were paralyzed. The voice and laryngeal motion improved at this time. The pathophysiology of spasmodic dysphonia may involve the mistakes in the processing of laryngeal sense and an unusual feedback mechanism in the cortex.

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  • Susumu Okano
    2023 Volume 35 Issue 2 Pages 98-101
    Published: December 01, 2023
    Released on J-STAGE: February 02, 2024
    JOURNAL FREE ACCESS

    In addition to the prolongation of survival, preservation of the laryngeal function is one of the most important goals in the treatment of locally advanced head and neck cancer, and is an issue that must be resolved. The impact of total laryngectomy on patients is significant and may lead to various problems other than cancer itself, such as lifestyle restrictions, changes in appearance, loss of communication opportunities, loss of employment in the working-age population, and cognitive decline in the elderly.

    When function-sparing surgery is not possible, radiotherapy is the treatment of choice; however, it is expected to preserve not only the morphology of the larynx but also its function. In the past few decades, radiotherapy, chemoradiotherapy, and induction chemotherapy have been used as curative treatments with unsatisfactory results. Although we are now using our accumulated knowledge and experience to tailor treatment to individual conditions and backgrounds, there is still room for debate on whether optimal treatment is being selected.

    The present article reviews past efforts to preserve the laryngeal function and discusses future prospects through clinical trials using novel agents and immune checkpoint inhibitors to augment the therapeutic effect of radiotherapy.

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  • Takahiro Tsujikawa, Shigeyuki Mukudai, Hikaru Nagao, Yoichiro Su ...
    2023 Volume 35 Issue 2 Pages 102-106
    Published: December 01, 2023
    Released on J-STAGE: February 02, 2024
    JOURNAL FREE ACCESS

    While induction chemotherapy has been serving as a larynx-preservation strategy for laryngeal cancer, the toxicity of docetaxel-cisplatin-fluorouracil (TPF) regimens and their impact on this treatment have become an issue. The paclitaxel-carboplatin-cetuximab (PCE) regimen tends to cause fewer adverse events, including hematologic toxicities, than TPF, and is used as an induction chemotherapy regimen. In this study, we evaluated the safety and outcome of 12 patients with T3 or N2b or higher laryngeal cancer who received PCE induction chemotherapy at our department. The response rate was 83.3%, and the incidence rate of G3 or higher adverse events was 41.7%. Among the four patients treated with chemoradiotherapy, the cisplatin completion rate was 100%. The larynx preservation survival rate was 81.8%. The local recurrence rate differed depending on the response to PCE therapy, and a favorable local control rate was observed in patients with PR or higher, indicating that the PCE regimen-as one of the induction chemotherapy regimens for laryngeal cancer-may contribute to laryngeal preservation. The development of biomarkers to predict the efficacy of induction chemotherapy is a future challenge.

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  • Junji Miyabe, Kazuki Hayashi, Mizuki Korematsu, Koji Kitamura, Tad ...
    2023 Volume 35 Issue 2 Pages 107
    Published: December 01, 2023
    Released on J-STAGE: February 02, 2024
    JOURNAL FREE ACCESS
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  • Daisuke Nishikawa
    2023 Volume 35 Issue 2 Pages 108-113
    Published: December 01, 2023
    Released on J-STAGE: February 02, 2024
    JOURNAL FREE ACCESS

    Photoimmunotherapy (PIT) is a novel cancer treatment. In Japan, it became eligible for national insurance coverage in January 2021, specifically for “unresectable locally advanced or unresectable locally recurrent head and neck cancer.” PIT targets the epidermal growth factor receptor using a conjugate of a photosensitizing agent (IR700) and an anti-EGFR monoclonal antibody (cetuximab sarotalocan sodium), followed by laser light illumination at 690 nm. Two patients with laryngeal and hypopharyngeal lesion were treated with PIT in our institution. Case 1 had a recurrent glottic cancer that persisted despite multiple transoral carbon dioxide laser microsurgeries. The tumor showed shrinkage with each PIT cycle but eventually became uncontrollable. In Case 2, laryngeal and pharyngeal lesions showed a complete response to PIT, enabling normal swallowing and speaking functions without recurrence. However, the applicability of PIT to laryngeal and hypopharyngeal lesions remains challenging due to the difficulty of determining appropriate eligibility criteria and the limitations associated with the illumination approach. Further research and case accumulation are necessary to establish the effectiveness, safety, and optimal treatment strategies for PIT in laryngeal and hypopharyngeal lesions.

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  • Koichiro Saito
    2023 Volume 35 Issue 2 Pages 114-119
    Published: December 01, 2023
    Released on J-STAGE: February 02, 2024
    JOURNAL FREE ACCESS

    The microflap technique is a basic technique used for microlaryngeal surgeries. It enables the removal of diseased lesions/material in the superior layer of the lamina propria without disturbing the intact epithelial membrane of the vocal fold. This surgical option was introduced as a technique suitable for managing diseases including vocal fold polyps, nodules, cysts, and Reinke’s edema. As this technique can also be used to finely detach the epithelial membrane from the deeper layers of the vocal fold, it has been further applied to the management of vocal fold leukoplakia and papilloma located in the membranous vocal fold. In this review, the concept of this technique, as well as the history and anatomy of the vibratory vocal fold, are summarized along with two typical cases.

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  • Koji Matsushima
    2023 Volume 35 Issue 2 Pages 120-125
    Published: December 01, 2023
    Released on J-STAGE: February 02, 2024
    JOURNAL FREE ACCESS

    Laryngeal framework surgery is a surgical method devised and systematized by Isshiki, in which surgical operations are applied to the cartilage of the laryngeal framework according to the disease condition, without operating on the vocal folds. This is a surgery that changes the position and tension of the internal vocal folds and improves symptoms. Laryngeal framework surgery includes type I (lateral compression), type Ⅱ (lateral expansion), type Ⅲ (relaxation/shortening), type Ⅳ (stretching/lengthening), and arytenoid adduction (movement to adduction position and fixation). This time, surgical techniques for type I, arytenoid adduction, and type Ⅱ will be explained.

    Type I thyroplasty : The location of the cartilage fenestration is an important point. If the position of the cartilage fenestration is closer to the cranial side, the expected effect will not be obtained. Be aware of the fenestration in the ventrocaudal position of the affected thyroid cartilage.

    Arytenoid adduction : Various methods have been reported with respect to the method of identification and the direction of traction of the arytenoid cartilage. From an airway perspective, since this is a surgery that narrows the airway, care must be taken to prevent excessive adduction of the arytenoid cartilage.

    Type Ⅱ thyroplasty : Although the concept of this surgery is simple, the surgical effect cannot be obtained unless the midline incision of the thyroid cartilage is made in the area where the anterior commissure tendon is attached to the thyroid cartilage. Therefore, extreme caution is required when making the cartilage incision.

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  • Nobuhiro Hanai
    2023 Volume 35 Issue 2 Pages 126-131
    Published: December 01, 2023
    Released on J-STAGE: February 02, 2024
    JOURNAL FREE ACCESS

    Conservation laryngeal surgery for T1-2 lesions (and selected T3) includes endoscopic resection, transoral resection, and open conservation laryngeal surgery (partial or subtotal laryngectomy). The Japanese guidelines also include total laryngectomy for T2; however, the NCCN (National Comprehensive Cancer Network) guidelines do not include the option of total laryngectomy. T3-4 lesions are rarely candidates for conservation laryngeal surgery, as postoperative irradiation impairs the functional prognosis, and the efficacy of induction chemotherapy before conservation laryngeal surgery has not yet been verified in clinical trials. In clinical practice, partial laryngectomy is often considered for recurrence after definitive radiotherapy. There are few cases in which open conservation laryngeal preservation surgery can be applied as a salvage operation; therefore, the decision should be made carefully. In a surgical technique seminar, I showed surgical videos of vertical partial laryngectomy, horizontal partial laryngectomy, and subtotal laryngectomy (supracricoid partial laryngectomy) and explained tips and the pitfalls associated with each surgical technique. It is important to make appropriate judgments regarding the indications to ensure a good postoperative function. Lung health is an important consideration to be made before surgery. To perform surgery with fewer complications, it is necessary to minimize the extent of undermining, and care must be taken to prevent wound healing failure after salvage surgery.

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  • Noriko Morimoto
    2023 Volume 35 Issue 2 Pages 132-135
    Published: December 01, 2023
    Released on J-STAGE: February 02, 2024
    JOURNAL FREE ACCESS

    Laryngotracheal stenosis in children is an intractable disease that is often caused by long-term intubation in the neonatal period. In recent years, minimally invasive endoscopic treatment has been attempted. If it does not work, laryngotracheal reconstruction (LTR) is often combined with endoscopic treatment. The purpose of this article is a review of the current techniques of these surgical treatment modalities.

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  • Kiminori Sato, Shun-ichi Chitose, Fumihiko Sato, Kiminobu Sato ...
    2023 Volume 35 Issue 2 Pages 136-141
    Published: December 01, 2023
    Released on J-STAGE: February 02, 2024
    JOURNAL FREE ACCESS
  • Naoki Nishio, Tomoki Toda, Kazuhiro Kobayashi, Sohei Mitani, M ...
    2023 Volume 35 Issue 2 Pages 142-147
    Published: December 01, 2023
    Released on J-STAGE: February 02, 2024
    JOURNAL FREE ACCESS

    Laryngectomy still plays an important role in the treatment of head and neck cancer. However, laryngectomized patients experience several difficulties in their lives because of the loss of their original voice. This study aimed to record the original voice before laryngectomy via a recording application or studio recording in patients who planned to undergo laryngectomy (Save the Voice project). In 2021, a multicenter prospective observational study was initiated for patients who planned to undergo laryngectomy in Japan. Before surgery, patients recorded their original voices using a voice recording application or in a recording studio. After laryngectomy, electrolarynx voices were obtained and stored in our database system. The study included 34 patients who were managed in three academic university hospitals (30 males, 4 females; median age at the time of surgery, 69 [range, 46–80] years). The tumor sites were the hypopharynx in 21 patients, esophagus in 6, larynx in 5, oropharynx in 1, and trachea in 1 patient. Among the 34 patients, the original voices were preoperatively recorded via a voice-recording application in 28 patients and via a recording studio in 6 patients. Preoperative recording of the patient’s original voice is essential to regenerate the voice after laryngectomy.

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  • Misato Ameya, Sohei Mitani, Hirofumi Sei, Takashi Kitani, Naoki ...
    2023 Volume 35 Issue 2 Pages 148-154
    Published: December 01, 2023
    Released on J-STAGE: February 02, 2024
    JOURNAL FREE ACCESS

    As an alternative communication method for laryngectomy patients, we introduced a novel voice synthesis smartphone application, referred to as the “speech synthesis app,” alongside conventional alternative speech options. This app employs artificial intelligence technology to generate artificial voices that closely resemble users’ own voices based on recorded samples. While previous research has indicated high satisfaction rates with the speech synthesis app itself, there have been instances where the potential of alternative voices remained underutilized. To investigate the degree of satisfaction with alternative speech via synthetic voices among laryngectomy patients, we conducted a comprehensive assessment utilizing both quantitative and qualitative analyses. The Self-Evaluation of Communication Experiences after Laryngectomy (SECEL), designed to evaluate post-laryngectomy communication, revealed a decline in scores related to speech environments. In addition, through the interview survey, we identified significant needs from both the patients and their families, although these preferences did not always align perfectly with the capabilities of the speech synthesis app. These findings underscore the importance of providing support for patients’ acceptance of this innovative technology, ensuring that it is tailored to individual preferences and convenience. By addressing these challenges, we can further enhance the satisfaction and effectiveness of synthetic voices as an alternative means of communication for patients undergoing laryngectomy.

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  • Makoto Miyamoto, Hideki Nakagawa, Koichiro Saito
    2023 Volume 35 Issue 2 Pages 155-159
    Published: December 01, 2023
    Released on J-STAGE: February 02, 2024
    JOURNAL FREE ACCESS

    The typical symptoms of hypothyroidism are lethargy, cold intolerance, increased weight, constipation, hoarseness, slowing of intellectual and motor activity, reduced appetite, and dry skin. This mechanism is believed to be related to the associated increases in the levels of polysaccharides.

    A 60s-year-old female with hoarseness, dysarthria, and dysphagia was admitted to our hospital. Flexible laryngoscopy findings show normal movement of the vocal folds; however, the redundant mucosa entered the larynx during inspiration. Her acoustic analysis and aerodynamic inspection findings were as follows: GRABS grade of G2R2B1A1S0, fundamental frequency (F0) of 186.6 Hz, voice range of 161.6 - 211.9 Hz, maximum phonation time(MPT) of 21.0 sec, mean air flow rate(MFR) of 182.2 ml/sec, shimmer of 6.512%, jitter of 1.798%, noise-to-harmonic ratio(NHR) of 0.142.

    We confirmed that she had been treated for hyperthyroidism for two years. Her thyroid function tests showed a thyroid-stimulating hormone level of 56.352 mg/dl and a free thyroxine level of <0.4 mg/dl. Based on these findings, chronic thyroiditis was diagnosed. After administration of L-thyroxine, the symptoms rapidly improved, as did the shimmer, jitter, and NHR, and the GRABS grade was G0R0B00S0; however, the F0 and voice range, MPT, and MFR values did not improve.

    Hoarseness and dysarthria may be the main symptoms of hypothyroidism and can be promptly improved after hormone supplementation. However, we noted no significant improvement after treatment in the F0 or voice range.

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  • Shuta Tomisato, Eri Takatsuki, Takeyuki Kono, Hiroyuki Ozawa
    2023 Volume 35 Issue 2 Pages 160-163
    Published: December 01, 2023
    Released on J-STAGE: February 02, 2024
    JOURNAL FREE ACCESS

    Tracheoesophageal shunts performed after laryngectomy for voice acquisition are usually performed on the mucosa of the trachea. We herein report a case in which tracheoesophageal shunting was performed on the skin. The patient was a 67-year-old woman who underwent pharyngolaryngo-neck esophagectomy and free jejunum reconstruction for tracheal cancer. The dorsal side of the permanent tracheal foramen was covered by skin because of the need to remove a large area of the dorsal trachea. Thirteen months after the initial surgery, tracheoesophageal shunting was performed. The tracheoesophageal shunting procedure was performed using almost the same technique as for the mucosa, but a 4-mm skin incision was required when the last proboscis was pulled out toward the trachea. Wound infection developed, and the voice prosthesis was removed on postoperative day 23 because of deviation of the prosthesis from the lumen. Two months after the previous surgery, the patient underwent revision surgery. She was treated with intravenous antibiotics until the postoperative day 7 to prevent infection and discharged from the hospital without any signs of infection. At six months postoperatively, the voice prosthesis was stable and in place, and the patient was able to speak. Two points should be noted when performing tracheoesophageal shunt surgery on the skin: a skin incision is required, and strict postoperative wound infection control is necessary.

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  • Tsunehiro Oka, Shun-ichi Chitose, Mioko Fukahori, Hirohito Umen ...
    2023 Volume 35 Issue 2 Pages 164-169
    Published: December 01, 2023
    Released on J-STAGE: February 02, 2024
    JOURNAL FREE ACCESS

    Posterior glottal stenosis (PGS) is a potentially life-threatening condition associated with bilateral vocal fold immobility (BVFI) that is often difficult to diagnose and treat. We herein report a case of PGS with malformation of the arytenoid cartilage that was successfully treated with arytenoidectomy. The patient was a 20-year-old woman, who had been a very low birth weight infant. She developed pneumonia immediately after birth and underwent prolonged intubation and tracheostomy. She had been diagnosed with BVFI at a previous hospital. As she had no symptoms, the tracheostomy was closed at 19 years of age. However, one year and six months later, she developed inspiratory stridor and hoarseness, and was referred to our hospital. Fiberoptic laryngoscopy and CT tomography revealed suspected PGS. Under general anesthesia, direct laryngoscopy revealed malformation of the right arytenoid cartilage deflecting in the anteromedial direction and excessive anterior mucosa covering the posterior glottis, which led to a diagnosis of PGS. A traction test of the arytenoid cartilage indicated right vocal fold fixation. Subsequently, resection of the anterior excessive mucosa and part of the arytenoid cartilage was performed to widen the posterior glottis by performing laryngomicrosurgery. Postoperatively, her voice and respiratory symptoms improved. For a definite diagnosis of PGS, it is important to confirm the presence of organic lesions in the posterior glottis and the passive movement of bilateral arytenoids under direct laryngoscopy. Surgical treatment for PGS should be performed based on the pathophysiological conditions.

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  • Shinya Fuse, Yoichiro Sugiyama, Nobuhisa Tadaki
    2023 Volume 35 Issue 2 Pages 170-174
    Published: December 01, 2023
    Released on J-STAGE: February 02, 2024
    JOURNAL FREE ACCESS

    A man in his 80s developed convulsive seizures and was intubated for 6 days in the emergency department of our hospital. After extubation, the patient developed dyspnea with inspiratory stridor and underwent tracheostomy. The patient was referred to our department for a further examination and treatment. Laryngeal endoscopy revealed bilateral vocal fold movement disorders, and laryngeal electromyography revealed bilateral vocal fold movement immobility. Posterior glottal stenosis was suspected, and the patient underwent surgery. Thirty days after surgery, he underwent decannulation and was found to have maintained good speech. We believe that aggressive surgical treatment should be performed in elderly patients.

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