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Volume 52 (2001)
- Issue 6 Pages 431-
- Issue 5 Pages 369-
- Issue 4 Pages 299-
- Issue 3 Pages 229-
- Issue 2 Pages 59-
- Issue 1 Pages 1-
Volume 52, Issue 6
Displaying 1-7 of 7 articles from this issue
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Original
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Hirotaka Hara, Yoko Hashimoto, Naoko Murakami, Hiroshi Yamashita2001 Volume 52 Issue 6 Pages 431-437
Published: December 10, 2001
Released on J-STAGE: August 25, 2008
JOURNAL RESTRICTED ACCESSWe have performed 40 cases of endoscopic laryngomicrosurgery under general anesthesia since 1996. In three out of these 40 cases, it was impossible to perform a traditional laryngomicrosurgery because of insufficient laryngeal extension, but endoscopic laryngomicrosurgery was successfully performed. Endoscopic laryngomicrosurgery allows exploration of the laryngeal regions difficult to observe with the traditional microscopic technique, such as Morgagni's ventricle, subglottic region and the anterior commisssure in the case of insufficient laryngeal extension. In particularlly, for minute observation of the surface of the laryngeal leukoplakia and for a precise definition of the stage of a laryageal tumor, the endoscopic technique was useful. The resection of laryageal polyps, nodules or the biopsy of tumors was relatively simple because the surgeon had an unobstructed visual field. If the endoscope and forceps interfere with the laryngoscope during laryngomicrosurgery, the endoscope should be set a little farther from the vocal cord, a zoom lens used to increase the magnification. When we resect vocal nodules and squeeze Reinke's edema, we also need to set the endoscope a little way from the vocal cords to prevent excessive resection of the true vocal cords.View full abstractDownload PDF (2316K) -
Tetsuyoshi Umeno, Kiminori Sato, Youichi Matsuda, Gengo Ishii, Tadashi ...2001 Volume 52 Issue 6 Pages 438-446
Published: December 10, 2001
Released on J-STAGE: August 25, 2008
JOURNAL RESTRICTED ACCESSA clinicopathological study of stomal recurrence was perform in T3 or T4 laryngeal cancer patients who received total laryngectomy at Kurume University Hospital between 1991 and 1997. There were 70 (glottic 24, supraglottic 46) patients during this period and a pathological study was perform of 63 (glottic 21, supraglottic 42) carcinomas. The results of this study can be summarized as follows:
1) The frequency of metastasis to the paratracheal and prelaryngeal lymphonodes was 19% in the glottic cancers, and 7% in the supraglottic cancers.
2) The frequency of metastasis to the paratracheal or prelaryngeal lymphonodes increased to 50% (glottic cancers) and 20% (supraglottic cancers) of those patients whose tumor extended to the subglottic area of the larynx.
3) Despite the lack of invasion to the subglottic larynx, metastasis to the paratracheal lymphonode was detected in one T3 glottic and one T3 supraglottic cancer. These results strongly indicate the pathologic participation of CA as a route for metastasis.
4) Pratracheal or prelaryngeal lymphonode metastasis was found in 33% of glottic and 17% of supraglottic cancers with invasion to CA even though these patients were free from subglottic extension.
5) There was no metastasis to the paratracheal or prelaryngeal lymphonodes when the examined glottic and supraglottic cancers were free from invasion to both the subglottic and cricoid area.
6) Dissection of the paratracheal lymphonodes as well as postoperative radiation were thought to be highly beneficial for preventing stomal recurrence.View full abstractDownload PDF (976K) -
Yasushi Murakami, Ryo Kawata, Shigeru Nakai, Takayasu Kimura, Susumu M ...2001 Volume 52 Issue 6 Pages 447-455
Published: December 10, 2001
Released on J-STAGE: August 25, 2008
JOURNAL RESTRICTED ACCESSIn order to conclude an indication for neck dissection and select the type of surgery in the treatment of T2-4 glottic carcinomas, neck metastases and their extent to various neck levels were investigated in three groups according to their expression pattern of Type IV collagen: 28 cases with continuous, 12 cases with fragmented and 12 cases with negative expressions. SLI and EGF-R were also examined as factors responsible for neck metastasis.
Conclusions were as follows: 1. They were 33 (63.5%) cases of N- and 19 (36.5%) cases of N+, including 7 cases of cN-N+ and 12 cases of cN+N+. 2. The mean value of SLI and the positive expression rate of EGF-R were lowest in cases with continuous expression, higher in fragmented and highest in cases with negative expression. 3. Neck metastasis was demonstated in all 3 cases of cN- with negative expression, while prospective selection of N+ among cases of cN- with continuous or fragmented expressions was not successful, even with the combined use of SLI and EGF-R, 4. All 28 cases with continuous expression were cN-, and only 2 (7.1%) cases of these were confirmed as N+. Therefore, neck dissection is basically unnecessary, but selective neck dissection with removal of levels III and VI can be indicated prophylactically. 5. Selective neck dissection with removal of levels III and VI is mandatory for cases of cN- with fragmented expression, otherwise strict observation will be necessary. 6. Functional neck dissection preserving the accessory nerve with removal of level VI is indicated for cases of cN+ with fragmented expression, since a positive node was not detected in level V. 7. Metastasis was detected in all cases of cN- with negative expression, but never in level V, and functional neck dissection together with removal of level VI should be done prophylactically. 8. Radical neck dissection with removal of leyel VI is essential, since cases of cN+ with negative expression revealed wide metastasis to many levels, including level V.View full abstractDownload PDF (761K) -
Kiyoaki Tsukahara, Yasuhisa Koyanagi, Tomoyuki Yoshida, Hisashi Inoue, ...2001 Volume 52 Issue 6 Pages 456-462
Published: December 10, 2001
Released on J-STAGE: August 25, 2008
JOURNAL RESTRICTED ACCESSThe incidence of double and triple cancers is evident from the development of diagnostic techniques and therapeutic modalities. We studied the clinical course and the effect of treatments on the esophageal cancer cases that accompanied head and neck cancers. Forty-nine esophageal cancer cases accompanied by head and neck cancers and treated at our department between 1989 and 1998 were analyzed. Of these, 15 cases were triple cancers. For the synchronous double cancers, endomural resection or other surgeries were a mainstay of the treatment. In the esophageal cancers preceded by head and neck cancers, half of the cases were operated on and the other half were irradiated and chemotreated. The results suggest that a periodical follow-up of the upper digestive tract is mandatory, since a majority of the synchronous double esophageal cancers were in the early stage. The high incidence of esophageal double cancer also suggests that a systemized screening strategy for early detection of a head and neck lesion is urgently needed.View full abstractDownload PDF (525K)
Case Report
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Hiroyuki Kuroda, Kiyoshi Doi, Hironori Tanaka, Sadahiro Fujishima2001 Volume 52 Issue 6 Pages 463-467
Published: December 10, 2001
Released on J-STAGE: August 25, 2008
JOURNAL RESTRICTED ACCESSVocal cord dysfunction (VCD) is characterized by the inappropriate adduction of the true vocal cords during inspiration, which causes inspiratory stridor. This inspiratory stridor is commonly followed by upper airway obstruction, which should be diagnosed and treated as soon as possible. In the literature it has been reported that a definitive diagnosis of VCD is established by laryngoscopic findings. Although laryngoscopic examination is widely used by otolaryngologists in Japan, there have been few reports of VCD in Japanese patients. We report here a patient who presented with dyspnea during treatment by a physician, and was subsequently diagnosed as having VCD by otolaryngologists. Laryngoscopical findings showed abnormal motion of the arytenoid region and adduction of the vocal cords during inspiration. From interviews during hospitalization, the 11-year-old female patient reported that she felt stress from her after school activities. Visual feedback therapy, utilizing videolaryngoscopy, was effective. Since a few cases of VCD misdiagnosed as asthma have been reported, it is important for otolaryngologists to participate in the definitive diagnosis of VCD.View full abstractDownload PDF (1226K) -
Ryoji Ishida, Hiroyuki Yamada, Ken-ichiro Fujita, Toshiharu Tokuriki2001 Volume 52 Issue 6 Pages 468-472
Published: December 10, 2001
Released on J-STAGE: August 25, 2008
JOURNAL RESTRICTED ACCESSFrom 1995 to 2000, four patients underwent emergency cricothyrotomy for rapidly progressive airway stenosis at our department. Avoidance of airway obstruction was a success in all cases, and a normal respiration was obtained in all cases after this procedure. On the other hand, post operative complications were observed in all cases. Cricothyrotomy is effective when the patient has the rapidly progressive stenosis in the upper airway. However cricothyrotomy has the high risk of complications post-operatively. To avoid of this procedure, proper examination of airway and safe restoration of the airway at the adequate moment are required.View full abstractDownload PDF (760K) -
Masaaki Kashiwamura, Yoshitaka Nakamura, Shigeki Hiyama, Yasushi Mesud ...2001 Volume 52 Issue 6 Pages 473-480
Published: December 10, 2001
Released on J-STAGE: August 25, 2008
JOURNAL RESTRICTED ACCESSCricotracheal resection with primary thyrotracheal anastomosis (CTR) as a surgical treatment for severe subglottic stenosis in pediatric patients has been reported to have a high success rate since 1993. Thus it has been become a well-established procedure.
We treated a 3-year-old girl who had severe subglottic tracheal stenosis, caused by long term intubation, with this procedure. She was born at 28 weeks of gestational age and had a tracheal intubation immediately after birth because of a bad respiratory condition, which was diagnosed as immature lung and laryngomalacia. After 257 days of intubation, she acquired severe subglottic stenosis and bilateral reccurent nerve paralysis.
We performed CTR and restored the patient's voice. We resected the anterior part of the cricoid and the stenotic part of the trachea. Then, the lower tracheal stump was pulled up and fitted into the residual cricoid ring. Anastomosis was done between the trachea and the thyroid cartilage. We kept the patient sedated after the operation for a week with a nasotracheal intubation for breathing and as a stent.
We considered that a CTR was the most reasonable procedure for the purpose of removing the stenotic part of the trachea. This is a safe treatment as long as proper postoperative care is taken. Considering the fact that dehiscence of anastomosis has been rarely reported and interference with normal laryngotracheal growth is negligible, we concluded that CTR should be reviewed as one of the preferred surgical treatments for severe subglottic stenosis cases.View full abstractDownload PDF (1567K)
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