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Volume 59 (2008)
- Issue 6 Pages 519-
- Issue 5 Pages 439-
- Issue 4 Pages 373-
- Issue 3 Pages 295-
- Issue 2 Pages 77-
- Issue 1 Pages 1-
Volume 59, Issue 3
Displaying 1-11 of 11 articles from this issue
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Original
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Shingo Takano, Miwako Kimura, Takaharu Nito, Ryuzaburo Higo, Niro Taya ...2008 Volume 59 Issue 3 Pages 295-303
Published: June 10, 2008
Released on J-STAGE: June 25, 2008
JOURNAL RESTRICTED ACCESSThere are many approaches to managing laryngeal trauma, depending on the region of trauma, the degree of injury, and the period from the accident. We examined 40 patients of laryngeal trauma who came to our clinic from 1994 to 2005. We used degree classification:Groups 1 to 4 as reported by Trone et al. in 1980.
The patient ages ranged from 19 to 63 years old. The mean age was 34.3. The numbers of patients in Groups 1∼4 were 10, 12, 13 and 5, respectively. Fifteen patients came to our clinic within 14 days after injury, and 4 patients among them received steroid treatment. No patient who came within 14 days received a tracheotomy in our clinic. Twenty-five patients came after 15 or more days from injury, and 12 patients among them received a tracheotomy in another hospital. The numbers of tracheotomy patients in Groups 2∼4 were 2, 5 and 5, respectively. Ten patients were operated on in our clinic. Five received a laryngofissure, and two patients among them continued to have a tracheotomy stoma after treatment. One patient who had undergone cricopharyngeal myotomy and laryngeal elevation also retained a tracheotomy stoma. The three patients were all in Group 4. There were many patients in Groups 2 and 3 who did not need a tracheotomy. It is important to plan operations carefully after evaluation of injury, although it is difficult to manage severe cases or old traumas like those in Group 4.View full abstractDownload PDF (1498K) -
Miwako Kimura, Takaharu Nito, Hiroshi Imagawa, Niro Tayama2008 Volume 59 Issue 3 Pages 304-310
Published: June 10, 2008
Released on J-STAGE: June 25, 2008
JOURNAL RESTRICTED ACCESSMaterial for injection into the vocal folds must be injectable, long-lasting, and well tolerated by the host. Although many materials have been used, including silicone, collagen, fat and fascia, none have successfully met all criteria. Bovine collagen was a useful and easy therapy for glottic insufficiency; however, problems of resorption of injected collagen, allergic reaction and the possibility of rejection limited its use. We performed 121 collagen injections from January 1990 to December 2005 for unilateral vocal fold paralysis. 39 cases treated by collagen over a 2-year period were reviewed for assessment of long-term effects on phonation. No long-term local or systemic reaction to the collagen was seen. The median preoperative maximum phonation time (MPT) and mean flow rate (MFR) improved after collagen injection and the improvement was maintained during the 2-year follow-up term. Preoperative evaluation of voice between the over-2-years follow-up group and the under-2-years follow-up group did not show any statistically significant differences. The long-term results have proved satisfactory.View full abstractDownload PDF (441K) -
Kazuhiro Nakamura, Nobuhiko Isshiki, Tetsuji Sanuki, Hideaki Kanazawa2008 Volume 59 Issue 3 Pages 311-317
Published: June 10, 2008
Released on J-STAGE: June 25, 2008
JOURNAL RESTRICTED ACCESSSeveral options are available for surgical treatment of unilateral vocal fold paralysis, and these are mainly classified into vocal fold injection surgery and laryngeal framework surgery.
When we perform vocal fold injection surgery and laryngeal framework surgery under general anesthesia, intraoperative voice monitoring is impossible.
Laryngeal framework surgery can be performed under local anesthesia, and when performed under local anesthesia, it allows fine adjustment of the surgical procedure by means of intraoperative voice monitoring. For that reason, in our clinic we have traditionally performed laryngeal framework surgery under local anesthesia.
In this article we review the 110 cases in which laryngeal framework surgery was used to treat unilateral vocal fold paralysis between 1994 and 2006 at the Isshiki Clinic of the Kyoto Voice Surgery Center. The patients consisted of 66 men and 44 women with a mean age of 52.9 years. The paralysis was on the left side in 68.2% of the cases and on the right side in the other 31.8%. The causes of the paralysis included thyroid cancer surgery, esophageal cancer surgery, lung cancer surgery, mediastinal surgery, brain tumor, and idiopathic.
Maximum phonation time (MPT) and the alternating current/direct current ratio (AC/DC ratio) were used for pre- and post-operative voice evaluation.
Arytenoid adduction (AA) was added when the glottal space was wide, and thyroplasty type I (type I) when the glottal space was narrow. When vocal fold closure was insufficient, thyro-plasty type IV (type IV) was also performed. Which of these procedures to perform was determined based on the result of intraoperative voice monitoring.
The procedures performed were : type I alone in 45 cases, type I + type IV in 13 cases, AA alone in 6 cases, AA + type I in 39 cases, and AA + type I + type IV in 7 cases.
The mean MPT of the 110 patients was 5.9 seconds before surgery and 13.5 seconds after surgery. The AC/DC ratios of the 42 patients treated since June 2004 were calculated. The mean ratio before surgery was 24.4%, and the mean ratio after surgery was 46.2%.
Among the procedures for unilateral vocal fold paralysis, laryngeal framework surgery under local anesthesia provides definite therapeutic benefit and efficacy.View full abstractDownload PDF (520K) -
Naoya Nishida2008 Volume 59 Issue 3 Pages 318-329
Published: June 10, 2008
Released on J-STAGE: June 25, 2008
JOURNAL RESTRICTED ACCESSAging of the intrinsic laryngeal muscles was investigated in rats by comparing adult and aged animals concerning the number and diameter of the muscle fibers, composition of the myosin heavy chain (MHC), and configuration of the subneural apparatus. Wistar strain rats of 24 months in age were subjected to this experiment as aged animals, while those of 10 to 17 weeks in age were used as the adult control. Histological study showed that in the aged animals the number and diameter of muscle fibers significantly decreased in the cricothyroid (CT) muscle. In the thyroarytenoid (TA) muscle, the number decreased but the diameter remained unchanged. Such changes were not observed in the posterior cricoarytenoid (PCA) muscle. Electrophoretic analysis of the MHCs of the CT muscle proved that the percentage of type IIB decreased and that of type IIA increased with aging. In the TA and PCA muscles, MHC composition did not undergo such change. Configurations of the subneural apparatus in these muscles were observed with a scanning electron microscope. In the aged animals, the labyrinthine type of primary synaptic clefts decreased and the depression type increased in the CT muscle. In contrast, such changes were not recognized in the TA or PCA muscles. In some thin muscle fibers of the aged animals, immature subneural apparatuses were identified exclusively in the CT muscles. These fibers were considered to be in a regenerative process for remodeling.
The present findings indicated that aging of the laryngeal muscles is prominent in the CT muscles, while the TA and PCA muscles are resistive to the aging process. This may reflect the difference in the role of laryngeal function : CT muscles control the tension of the vocal folds, while TA and PCA muscles control airway ventilation and swallowing, which are of vital importance.View full abstractDownload PDF (859K) -
Katsuro Sato, Yutaka Yamamoto, Jun Watanabe, Osamu Hayasaka, Sugata Ta ...2008 Volume 59 Issue 3 Pages 330-337
Published: June 10, 2008
Released on J-STAGE: June 25, 2008
JOURNAL RESTRICTED ACCESSIn this paper, 1,430 patients who visited our phonation clinic during 19 years since 1988, were evaluated clinically. The most common laryngeal disease was vocal cord palsy (18.0%) followed by vocal cord polyp (12.6%), vocal cord nodule (11.7%), sulcus vocalis (12.0%), dysphonia without organic lesion of larynx (9.8%), chronic laryngitis (8.5%), polypoid degeneration (6.1%), and normal cases were seen in 11.5%. Female patients were dominant with vocal cord nodule, vocal cord polyp, and polypoid degeneration. Male patients were dominant with laryngeal cancer, benign laryngeal tumor, sulcus vocalis and vocal cord palsy. Juvenile patients were dominant with vocal cord nodule, middle aged patients with vocal cord polyp and polypoid degeneration, elderly patients with sulcus vocalis and vocal cord palsy. Insufficiency of glottal closure was seen in all the analyzed 5 laryngeal diseases (vocal cord nodule, vocal cord polyp, polypoid degeneration, sulcus vocalis, vocal cord palsy) except for female sulcus vocalis compared with normal cases. Dysfunction of loudness was observed in the patients with vocal cord palsy both male and female, and dysfunction of pitch was seen in the patients with polypoid degeneration in both male and female, and male vocal cord polyp, sulcus vocalis, and vocal cord palsy.View full abstractDownload PDF (468K)
Case Report
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Ryoji Ishida, Masanori Tatematsu, Shinji Seki2008 Volume 59 Issue 3 Pages 338-341
Published: June 10, 2008
Released on J-STAGE: June 25, 2008
JOURNAL RESTRICTED ACCESSAcute epiglottitis is a serious disease because of its potential for sudden fatal obstruction. We reported a case of acute epiglottitis that demonstrated airway obstruction 5 minutes after coming to the hospital. The patient underwent emergency cricothyrotomy and was successfully resuscitated, however subglottic stenosis ensued in 4 days after the cricothyrotomy. Cricothyrotomy is effective when a patient has rapidly progressive stenosis in the upper airway, but has high risk of complications post-operatively. To avoid such outcome, proper examination and properly timed restoration of the airway by tracheotomy or tracheal intubation are required with acute epiglottitis.View full abstractDownload PDF (344K) -
Takeshi Ino, Takashi Masaki, Atsushi Ochiai, Kentaro Ohashi, Makito Ok ...2008 Volume 59 Issue 3 Pages 342-346
Published: June 10, 2008
Released on J-STAGE: June 25, 2008
JOURNAL RESTRICTED ACCESSWe reported on an infant with laryngeal foreign body who required a tracheotomy. The case was a 21-month-old girl with a piece of plastic toy lodged in the subglottis. We undertook a tracheotomy because her breathing worsened while we attempted extraction several times with a Macintosh laryngoscope. After the tracheotomy we extracted the foreign body with a laryngeal surgical microscope. The tracheotomy was thought to be necessary both for keeping the airway open and for carrying out the procedure. After the operation we observed tracheomalacia. The cause was thought to be post-operative bronchitis and trachea weakness. We confirmed the importance of airway management after an infant tracheotomy.View full abstractDownload PDF (404K) -
Hideki Nakagawa, Maki Nagasao, Naoyuki Kohno, Toshiyuki Kusuyama, Hiro ...2008 Volume 59 Issue 3 Pages 347-353
Published: June 10, 2008
Released on J-STAGE: June 25, 2008
JOURNAL RESTRICTED ACCESSThe true incidence of herpes simplex virus (HSV) infections of the pharyngolarynx is unknown. The clinical files of 14 adult patients at Seibo International Catholic Hospital were reviewed. All presented with mucosal lesions in the pharyngolarynx and were diagnosed as HSV infection through detection of viral-specific antigens in the mucous membrane or measurement of titers of anti-HSV antibodies in the serum. Cases of herpetic labialis or herpetic gingivostomatitis, whose lesions were confined to the labia, gingiva or the oral cavity, were excluded. The patients ranged in age from 18 to 45 (mean 29.9) years, seven were male and seven were female. Ten were thought to be primary infection because of a lack of anti-HSV IgG titer at the first visit. High fever around 39°C was seen in all patients. All complained of severe sore throat and swallowing pain. The mucosal lesions were seen not only in the oropharynx including palate tonsils, but also in the epiglottis, the pyriform sinuses and the arytenoids. Laryngeal paresis and epiglottic edema were seen in some cases. Cheilitis or gingivitis, which are considered to be typical signs of HSV infection, were seen in fewer than half of the cases. HSV type 2 antigens were detected in 2 cases by direct immunofluorescence staining for virus antigens. Antiviral agents such as Acyclovir and Valacyclovir were used effectively in the treatment.View full abstractDownload PDF (472K) -
Katsuro Sato, Jun Watanabe, Masahiko Tomita, Sugata Takahashi2008 Volume 59 Issue 3 Pages 354-360
Published: June 10, 2008
Released on J-STAGE: June 25, 2008
JOURNAL RESTRICTED ACCESSA case of cervicomediastinal liposarcoma treated in our department was reported. A 78-year-old male had been treated in the department of thoracic surgery of a general hospital under diagnosis of mediastinal liposarcoma by CT following abnormal shadow on screening chest X-ray at 71 years old. He felt dyspnea during neck rotation when he was 77 years old, and reexamination by CT and MRI showed a huge mass lesion spreading from the neck to the posterior mediastinum. Under diagnosis of liposarcoma based on his clinical course and radiological findings, resection of the mediastinal tumor by right thoracotomy was performed at the hospital. Although the histopathological diagnosis of the resected mediastinal tumor was lipoma, he was referred to our clinic for treatment of the cervical tumor since liposarcoma was still suspected clinically, and upper airway stenosis had occurred. Radiological diagnosis of the remaining cervical tumor indicated liposarcoma, and resection of the cervical tumor was performed by U-shaped skin incision. The tumor located in the retropharyngeal space and multilobular masses adhered with connective tissue. The tumor was extirpated by surgical approach from both sides of the neck. Histopathological diagnosis of the frozen section specimen during the operation pointed to lipoma, but the final diagnosis was revised to well-differentiated type liposarcoma. No recurrence has been observed for 3 years and 3 months after the surgery. Liposarcoma is not invasive to the surrounding tissue generally, and postoperative radiotherapy is effective when sufficient surgical margin cannot be obtained by surgery. For cases with suspicion of liposarcoma in the neck and mediastinum, extirpation surgery preserving the surrounding organs is considered important for the final histopathological diagnosis, oncological treatment, and decision of post-operative clinical strategies.View full abstractDownload PDF (573K)
Glossary
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[in Japanese], [in Japanese], [in Japanese], [in Japanese]2008 Volume 59 Issue 3 Pages 361-362
Published: June 10, 2008
Released on J-STAGE: June 25, 2008
JOURNAL RESTRICTED ACCESSDownload PDF (348K) -
[in Japanese]2008 Volume 59 Issue 3 Pages 363-364
Published: June 10, 2008
Released on J-STAGE: June 25, 2008
JOURNAL RESTRICTED ACCESSDownload PDF (174K)
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