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Volume 53, Issue 1
Displaying 1-9 of 9 articles from this issue
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Original
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Etsuyo Tamura, Satoshi Kitahara, Naoyuki Kohno, Masami Ogura2002 Volume 53 Issue 1 Pages 1-5
Published: 2002
Released on J-STAGE: October 25, 2007
JOURNAL RESTRICTED ACCESSThere are several surgical techniques used for dilation of the glottis to treat the dyspnea and inspiratory stridor caused by a median fixation of both vocal cords. The method proposed by Ejnell et al. in 1984 is advantageous in that 1) it does not cause a destruction of the normal structure of the larynx; and 2) the surgical technique is easy. This method has recently come to be performed more frequently. Although Ejnell's technique is relatively simple, there has been no study on certain details of the procedure, such as in what position the needle that is inserted into the thyroid cartilage should be placed, or what direction the traction thread should take. Hence, a study on the optimal position of the needle, the best direction for traction on the thread, and a measurement of the degree of lateralization of the vocal cord was performed using cadaveric laryngeal specimens.
When the vocal cord was pulled perpendicularly to the thyroid cartilage wing, the mean glottal area was 106.2% of the same area before traction. When the vocal cord was pulled perpendicularly to the median line of the glottis, the mean glottal area was 112.7% of the same area before traction. The glottal area was therefore about 6% larger when the vocal cord was pulled perpendicularly to the median line of the glottis than when it was pulled perpendicularly to the thyroid cartilage wing (p<0.05; pailed t-test).
Based on an anatomic study of six cadaveric laryngeal regions, a formula was developed to predict at which points needles should be placed in Ejnell's technique for optimal results. Further clinical correlations will be carried out in patients to test the validity of this formula.View full abstractDownload PDF (1066K) -
Yoshihiro Tsuruta, Taro Hasegawa, Tomoyuki Shimizu, Yoshinobu Ogawa2002 Volume 53 Issue 1 Pages 6-12
Published: 2002
Released on J-STAGE: October 25, 2007
JOURNAL RESTRICTED ACCESSSince 1993, we have injected autologous fat into paralyzed vocal cords as an alternative to alloplastic substances for vocal cord augmentation. To determine whether our technique aids in long-term graft survival, we evaluated the long-term effects of our autologous fat injection technique.
Ten patients with unilateral laryngeal paralysis were treated by fat injection. All showed improvement in the maximum phonation time (mean time 4.9 s to 13.6 s). The vocal cords of 2 patients were evaluated by CT imaging. Low density area which suggested existence of injected fat lasted for 46 months and 55 months.
The results of this report show that autologous fat which has not been damaged during harvesting or injection can survive transplantation into the vocal cord.View full abstractDownload PDF (2103K) -
Yutaka Isogai, Hatsumi Hamada, Hiroyuki Fukuda, Toshiyuki Kusuyama, Yu ...2002 Volume 53 Issue 1 Pages 13-20
Published: 2002
Released on J-STAGE: October 25, 2007
JOURNAL RESTRICTED ACCESSFocusing problems during hypopharyngeal fiberscopic examinations are caused by membranes and secretions present at a distance shorter than the fiberscope's minimum depth of field.
To obtain a more distinct image, a hypopharyngeal videoendoscope (PENTAX®) with an effective length of 500 mm has been developed by attaching a clear hood to the tip of an existing laryngeal videoendoscope with a Y-shaped manipulating channel divided into a forceps inlet and a suction nipple.
1. The image of this endoscope is extremely sharp and focusing problems do not occur, except during suctioning.
2. A continuous airflow of 300-500 ml/min facilitates the opening of the inlet of the esophagus.
3. A rotary T-shaped adapter divided into a forceps inlet and a tube inlet for the continuous airflow is attached to the forceps inlet.
4. Since the backflow of liquid towards the airflow tube can occur during water injection or suction, a valve to prevent such backflow was added to the rotary T-shaped adapter.
5. Suctioning in the lumen of the esophagus is still insufficient and must be improved.
6. The hypopharyngeal endoscope must be alternately inserted from either side of the recesses piriformis, because the opposite side cannot be observed when the endoscope is only inserted on the other side.View full abstractDownload PDF (1350K) -
Kiyoaki Tsukahara, Hiroya Yamaguchi, Masaki Furukawa, Seiji Niimi2002 Volume 53 Issue 1 Pages 21-26
Published: 2002
Released on J-STAGE: October 25, 2007
JOURNAL RESTRICTED ACCESSIn general, the swallowing mechanism has been divided into three phases: the oral, the pharyngeal and the esophageal. This study was designed to study the minute mechanism of the transitional movements between the oral and the pharyngeal phase during sucking and swallowing through a fine tube. A flexible fiber scope, ultrasonograph and pressure transducers were used. Subjects were two healthy males. Multi-modal data were recorded simultaneously. Making sure that the equipment was functioning and calibrated properly, trial studies were done, such as the phonation of /ka/ sounds, long /S/ sounds, humming and inspiration and expiration before and after the data acquisition. Results were as follows. In the case of sipping juice, the tongue and the soft palate touched just at the beginning of sucking. After that, the tongue and the soft palate were separated. These findings were observed both in the ultrasound image and in the intraoral and pharyngeal pressure analyses. Further studies with more subjects are required for confirmation.View full abstractDownload PDF (965K) -
Takuma Yoshikawa, Shinya Yoshida, Takeshi Asakawa2002 Volume 53 Issue 1 Pages 27-32
Published: 2002
Released on J-STAGE: October 25, 2007
JOURNAL RESTRICTED ACCESSWe compared the ultrasound (US)-guided, fine-needle aspiration biopsy (FNAB) diagnosis, surgical pathology and isotope findings in 55 cases of thyroid surgery. Our diagnostic accuracy was the same as in other reports. Scintigraphical pattern suggesting malignancy is cold spot for Tc and hot spot for 201Tl in delay image. When FNAB was class 1 or 2, this pattern appeared almost as an adenomatous goiter. If there were no findings of calcification and irregular wall in the ultrasound or the CT examination, class 3 cases were judged benign. Many cases were considered acceptable for a wait-and-see strategy without operation. Ultrasound and CT differential diagnosis was difficult for follicular adenoma and follicular carcinoma. However, we could make a totality diagnosis by cytology, scintigraphy, ultrasound and CT in our study. Adenomatous goiter was seen usually as hot scintigraphy of the 201Tl delay image. If there were no findings of calcification or irregular wall in the ultrasound or CT examination, cases with hot scintigraphy of the 201Tl delay image were almost always adenomatous goiter. This pattern was also considered acceptable for a wait-and-see strategy without operation.View full abstractDownload PDF (452K)
Case Report
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Masatoshi Hirayama, Jun Yamanaka, Mitsukuni Nitta, Takashi Hiroshimaya ...2002 Volume 53 Issue 1 Pages 33-36
Published: 2002
Released on J-STAGE: October 25, 2007
JOURNAL RESTRICTED ACCESSWe report a 53-year-old woman with multiple (three) vocal cord cysts. She visited our clinic complaining of deteriorating hoarseness. Indirect laryngoscopic and laryngofiberoscopic examinations showed a slight swelling in both vocal folds and cyst lesion in the right vocal cord. The patient underwent laryngomicrosurgery under general anesthesia. Through a laryngomicroscope, the three cysts were found to be situated in the center of membranous portion of the right vocal cord. The cysts had a smooth surface and a pale yellowish color and measured 4×2×2, 2×1×1, and 1×1×1 mm. Pathological examination of the surgical specimens showed that they were epidermal cysts. Their etiology was presumed to involve the inclusion of epithelial cells of the vocal cord as a result of repeated mechanical irritation.View full abstractDownload PDF (1249K) -
Youji Kato2002 Volume 53 Issue 1 Pages 37-39
Published: 2002
Released on J-STAGE: October 25, 2007
JOURNAL RESTRICTED ACCESSMumps is common disease and it leads to many complications. But pharyngolaryngeal edema with mumps has not been reported yet. So I report two adult cases of pharyngolaryngeal edema with mumps now. Both patients complained of dyspnea. One needed prophylactic tracheostomy. If a patient with mumps complains of dyspnea, the doctor has to examine not only the lower respiratory airway but also the upper airway.View full abstractDownload PDF (679K) -
Noboru Shono, Keizo Arakawa, Nobuyasu Gama, Hideki Hirabayashi, Koutar ...2002 Volume 53 Issue 1 Pages 40-44
Published: 2002
Released on J-STAGE: October 25, 2007
JOURNAL RESTRICTED ACCESSLingual thyroglossal-duct cysts cause severe dyspnea at infancy. Thus, early diagnosis and early therapy are required. A case of such a cyst in an infant is presented. The baby (gestational age: 40 weeks, normal delivery, birth weight: 3222 g) experienced stridor and difficulty suckling at three weeks of age. The endoscopic examination showed a tumor at the tongue base. Computer tomography (CT), technetium cintigraphy (Tc-C), and ultrasonography (UG) all suggested a cystic lesion. The stridor and dyspnea were worsered and we chose to do a cystectomy under general anesthesia. A tracheostomy under mask anesthesia was performed, since it was impossible to intubate by the nasal or the oral route. The cyst wall was so thick that it was difficult to deliver through the rigid scope. The cyst was finally removed via a neck skin incision. A thyroglossal-duct cyst at the base of the tongue is rare, but is sometimes found during autopsy. Such cysts may present in adulthood or in infancy. In particular, stridor can appear not only at the time of birth, but also at a few weeks after birth, as in this case. Thus, endoscopic examination is required when a baby has stridor at this time. The examination of CT, Tc-C, and UG is required for the diagnosis differentialis of this disease.View full abstractDownload PDF (1284K) -
Masaru Yamashita, Shigeru Hirano, Kenichi Kaneko, Hisayoshi Kojima, Ma ...2002 Volume 53 Issue 1 Pages 45-48
Published: 2002
Released on J-STAGE: October 25, 2007
JOURNAL RESTRICTED ACCESSWe report a 32-year-old woman with a foreign body perforating the cervical esophageal mucosa completely.
Five months prior to coming to our hospital, she felt left neck pain on swallowing after a fish meal. Although she underwent esophagoscopy at another hospital the next day, no abnormal findings were obtained. Since she complained of persistent discomfort on swallowing, radiographic examinations were also undergone at the same hospital. They revealed a foreign body located between the left lobe of the thyroid gland and the esophagus, but she refused to undergo an operation because of her mild symptom.
Five months after the foreign body ingestion, she came to our institution and wanting to remove the fish bone. We approached using a collar neck skin incision, and extracted a fish bone embedded in the esophageal muscle layer without damage to mucosa.
Extraluminal esophageal foreign bodies are very rare, but sometimes their complications are fatal. Therefore, great care is required with foreign bodies, even if the ingestion occurred a long time prior to examination, or if esophagoscopy reveals no remarkable abnormality.View full abstractDownload PDF (961K)
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