嗄声から食道癌を見出した4症例

抄録

It is strongly emphasized in this paper that every laryngologist should suspect presence of esophageal carcinoma whenever clinical diagnosis of recurrent laryngeal nerve paralysis was made. One hundred and thirty-eight cases with chief complaints of hoarseness were diagnosed as unilateral recurrent laryngeal nerve paralysis at the Department of Otolaryngology, Mitsui Memorial Hospital. Those investigations were carried out over the periods of recent 6 years. Among them, 4 cases with unilateral recurrent laryngeal nerve paralysis were found to present esophageal carcinoma of either cervical or thoracic portion. Those 4 cases commonly did not show any type of dysphagic problem throughout their clinical courses. Only problem they disclosed at the time of initial visiting our clinic was hoarseness rather than dysphagia.
The recurrent laryngeal nerve is located anatomically close to the esophagus so that if carcinoma of the esophagus develops externally outside the esophagus to involve the recurrent laryngeal nerve, hoarseness may be the earliest symptom to suggest presence of esophageal carcinoma. On the contrary, if carcinoma of the esophagus grows internally inside the esophageal tract, dysphagia may be a starting symptom. All 4 cases we experienced in our institution revealed carcinoma of the esophagus extending outside it to paralyze the recurrent laryngeal nerve. Cobalt therapy was provided for 3 cases of them. Complete recovery of paralyzed vocal cord was noted in 1 case whose carcinoma was located in the limited area of pyriformis sinus. However, other 1 case resulted in no recovery of paralyzed vocal cord even on the process of radiotherapy. Among remaining two cases, one was lost for follow-up and the other was surgically treated in terms of total laryngoesophagectomy with permanent creation of tracheostoma.