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Volume 60 (2009)
- Issue 6 Pages 457-
- Issue 5 Pages 373-
- Issue 4 Pages 309-
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- Issue 2 Pages 55-
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Volume 60, Issue 6
Displaying 1-11 of 11 articles from this issue
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Original
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Takashi Nasu, Shuji Koike, Daisuke Noda, Akihiro Ishida, Masaru Aoyagi2009 Volume 60 Issue 6 Pages 457-463
Published: December 10, 2009
Released on J-STAGE: December 25, 2009
JOURNAL RESTRICTED ACCESSBetween 1998 and 2007, we treated 64 patients with stages III or IV laryngeal cancers. This study evaluated the long-term results of treatment in these 64 patients and indications for laryngeal preservation in patients with stages III and IV laryngeal cancers. The 5-year survival rates of stage IV, supraglottic carcinoma and laryngeal preservation cases were 62.3%, 65.2% and 54.2%, respectively. These rates were significantly lower than those for stage III, glottic carcinoma and patients undergoing total laryngectomy. In patients with laryngeal preservation, those with preoperatively detected cervical lymph node metastasis from supraglottic carcinoma showed a significantly poorer prognosis than those with glottic carcinoma who received curative therapy. In the assessment of mortality, patients with preoperatively detected cervical lymph node metastasis and those with supraglottic carcinoma require total laryngectomy and neck dissection, and countermeasures against distant metastasis should be taken. T3 glottic carcinoma cases showed a good prognosis, and laryngeal preservation is indicated for such patients.View full abstractDownload PDF (548K) -
Takahito Kondo, Kazuhiro Nakamura, Kiyoaki Tsukahara, Gou Hasegawa, Ma ...2009 Volume 60 Issue 6 Pages 464-469
Published: December 10, 2009
Released on J-STAGE: December 25, 2009
JOURNAL RESTRICTED ACCESSThe clinical effects of postoperative chemoradiotherapy with cisplatin for high-risk patients with locally advanced head and neck squamous cell carcinoma have been recognized worldwide. There are several papers reporting that this type of chemoradiotherapy improves the 5-year survival rate. However, to date there have been only a few reports in Japan. Here we report the safety of postoperative chemoradiotherapy with cisplatin infusion compared with radiation therapy alone for high-risk patients with locally advanced head and neck squamous cell carcinoma. We analyzed 18 cases that received radiotherapy postoperatively. There were 8 cases treated with chemoradiotherapy by CDDP infusion, and 10 cases treated with radiotherapy only. Both groups completed radiotherapy according to the planned schedule. In both groups, there was no significant difference in total irradiation amount, number of sessions, or total days. The completion rate for the treatment with CDDP infusion was 6 of 8 cases, or 75.0%.In both groups, there was no significant difference in the rate of detrimental event occurrence. In the CDDP infusion group, there was a tendency toward increased leukocytopenia. We continue to apply this treatment modality, planning to study the local control rate and 5-year survival rate.View full abstractDownload PDF (1020K) -
Hiromu Kato, Miwako Kimura, Yuzuru Kumagai, Niro Tayama2009 Volume 60 Issue 6 Pages 470-475
Published: December 10, 2009
Released on J-STAGE: December 25, 2009
JOURNAL RESTRICTED ACCESSSurgical tracheotomy techniques are classified into tracheotomy and tracheal fenestration, according to the method of suturing the tracheal wall to the margin of the skin incision. In tracheotomy technique, the inferior based tracheal flap is sutured to the inferior margin of the skin incision using only several stitches, or the tracheostoma is not sutured to the margin of the skin incision. In tracheal fenestration technique, the tracheostoma is sutured to the margin of the skin incision to create a circumferential mucocutaneous junction. The former is performed to achieve relatively short-term airway management. The latter is performed to achieve long-term airway management, with risk of accidental decannulation, etc. We investigated 79 cases who had undergone surgical tracheotomy at the Department of Otorhinolaryngology, Tracheo-esophagology, International Medical Center of Japan from Feb. 2002 to Aug. 2007. In 24 cases, the patients underwent tracheotomy, and 55 patients underwent tracheal fenestration. There were 52 males and 27 females, and their mean age was 57 years (range : 1-89). The most common indication was bilateral vocal cord paralysis in the tracheotomy group, and long-term endotracheal intubation in the tracheal fenestration group. The mean operation time for tracheotomy was 35 minutes and for tracheal fenestration 42 minutes. Patients required airway management by tracheostoma during more than 1 month in 72.2%of the tracheotomy group, and in 100%of the tracheal fenestration group. We found low rates for both early and late complications when comparing tracheal fenestration to tracheotomy.
We conclude that if long-term airway management by tracheostoma will be necessary, we should choose the tracheal fenestration technique.View full abstractDownload PDF (692K)
Case Report
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Etsuyo Tamura, Hiroyuki Fukuda, Yasuhiko Tabata, Shinya Okada, Masato ...2009 Volume 60 Issue 6 Pages 476-482
Published: December 10, 2009
Released on J-STAGE: December 25, 2009
JOURNAL RESTRICTED ACCESSIntroduction : Autologous fat augmentation of the vocal folds has become widely adopted as a means of rehabilitation to treat deficiency of the glottal closure. However, it has been difficult to avoid decreased effectiveness due to absorption after injection and also to determine the injection quantity. In animal experiments using dogs, it was confirmed that the decreased effectiveness caused by absorption after injection can be reduced by administration of low-concentration fibroblast growth factor. Clinical applications were then carried out after acquiring approval from the Institutional Clinical Review Committee.
Method : Basic fibroblast growth factor (b-FGF) was mixed in autologous fat tissue and injected into the vocal folds, and the results were evaluated over time. Also, a study was undertaken to evaluate the complications after injection and the duration of effectiveness.
Cases : Case 1:33-year-old male patient with sulcus vocalis. Case 2:62-year-old male patient with recurrent laryngeal nerve paralysis after operation for esophageal cancer.
Results : More than one year after operation, voices are in stabilized condition in both patients. Assessments using CT images revealed that the decrease in volume of the injected fat tissue was smaller in the cases of this study compared with cases involving the conventional method. Also, no severe complications were found after injection.
Conclusion : The results of this study suggest that it is possible to decrease the volume of fat tissue loss after injection when it is performed with b-FGF.View full abstractDownload PDF (2319K) -
Hiroshi Suzuki, Ryuichi Mochizuki, Masahiro Kawamoto, Keisuke Yamamoto ...2009 Volume 60 Issue 6 Pages 483-488
Published: December 10, 2009
Released on J-STAGE: December 25, 2009
JOURNAL RESTRICTED ACCESSLaryngeal papilloma is known to be a disease that has a high incidence of recurrence and that in rare cases becomes malignant. The principal treatment for laryngeal papilloma is surgery. In Japan, treatment by CO2 laser is the first choice. We reviewed 12 of the 18 cases of laryngeal papilloma we saw between January 2006 and March 2009 at the Osaka Voice Center : those in which power assisted surgery (PAS) was applied.
We also experienced one case in which the preoperative diagnosis was laryngeal papilloma and the postoperative diagnosis was malignancy after PAS. We found that PAS for laryngeal papilloma was beneficial with respect to quality of voice preservation. Moreover, PAS was provided good results in the malignant case also.View full abstractDownload PDF (1923K) -
Kazuhiro Nakamura, Yusuke Watanabe, Kiyoaki Tsukahara, Ujimoto Konomi, ...2009 Volume 60 Issue 6 Pages 489-495
Published: December 10, 2009
Released on J-STAGE: December 25, 2009
JOURNAL RESTRICTED ACCESSIn our department, a thyro-arytenoid muscle myectomy (TA myectomy) and a type 2 thyroplasty (TP2) are performed for adductor spasmodic dysphonia (SD). The operative method is chosen depending on the case. Here, we report the surgical treatment in an SD patient with gender identity disorder (GID). The case was a 32-year-old female. She had GID associated with underlying disease, and she underwent sex re-assignment surgery in March 2005. Her family register entry was changed afterwards from a man to a woman. For sometime, she was upset by her low-pitched speaking fundamental frequency (SFF). Then several years ago, her voice became spasmodic and she came to our department on August 7, 2007. According to the mora method, her voice was assessed as follows : 11/21, SFF : 133.3 Hz, lowest pitch : 124.2 Hz, highest pitch : 418.2 Hz, MPT : 21 s. The patient was hoping for improvement of her spasmodic voice and a rise in her SFF. With a TA myectomy, both effects can be expected. We usually choose TA myectomy first, and in the event of an unsatisfactory result we add a type 4 thyroplasty (TP4) as a 2nd stage operation. TA myectomy was performed on the current patient on October 4, 2007. After six months, her voice according to the mora method was as follows : 0/21, SFF : 200.1 Hz, lowest-pitch : 151.1 Hz, highest-pitch : 364.1 Hz, MPT : 12 s. She hoped to raise the SFF slightly more, so a TP4 was added and scheduled for May 27, 2008. One month after the TP4, her voice by the mora method was as follows : 0/21, SFF : 244.8 Hz, lowest-pitch : 213.0 Hz, highest-pitch : 322.4 Hz, MPT : 8 s. We performed a second operation for an SD patient who had GID. For SD, TA myectomy was effective, but for the GID-associated low-pitched voice, TA myectomy was not effective. A TP4 was therefore added, and excellent results were obtained. The combination of TA myectomy and a TP4 was effective in the present case.View full abstractDownload PDF (6304K) -
Masaaki Higashino, Michiro Kawakami, Keiko Hasegawa, Akihito Mineharu, ...2009 Volume 60 Issue 6 Pages 496-500
Published: December 10, 2009
Released on J-STAGE: December 25, 2009
JOURNAL RESTRICTED ACCESSWe reported a very rare case in which open injury of the pharynx caused immobility of the tongue. The case was a 39-year-old male who fell into a glass door and cut his neck. At our hospital, an emergency tracheostomy was performed, and the wound was treated. After the injury, immobility of the tongue with gradual atrophy of the tongue muscles caused severe dysphagia and articulation disorder. We undertook rehabilitation for the articulation disorder. As a result, he recovered his articulation and swallowing function.View full abstractDownload PDF (2339K) -
Yoichi Ikenoya, Makoto Nonaka, Ryosuke Usuda, Yuto Kuwasako, Takashi S ...2009 Volume 60 Issue 6 Pages 501-506
Published: December 10, 2009
Released on J-STAGE: December 25, 2009
JOURNAL RESTRICTED ACCESSThe patient was a 66-year-old female who had undergone surgery for acute aortic dissociation, and subsequently for thoracic/abdominal dissecting aortic aneurysms. Tracheotomy was not performed during either operation. However, extubation and oral intubation were repeated 3 times after the second surgery. One month after the second surgery, dyspnea and stridor were noted. The patient was admitted to our hospital, and bronchoscopy revealed circumferential stenosis of the trachea. It was impossible to pass a bronchoscope through the stenotic site. CT showed that this site was consistent with the anastomotic site at the time of great thoracic vessel 3-bifurcation reconstruction. Therefore, cauterization for airway stenosis was not considered to be safe. Initially, the stenotic site was dilated using a balloon catheter for dilatation, and a thin tube for oral intubation was inserted. Subsequently, tracheotomy was performed. A thin cuff-free tube for oral intubation was inserted through the incised site so that it passed the stenotic site. Dyspnea disappeared, enabling the taking of meals. The tube diameter was gradually increased, facilitating the insertion of a silicone T-tube. After discharge, rehabilitation was achieved, with follow-up of 1 year and 2 months after T-tube insertion. The present case demonstrates that balloon dilatation and T-tube insertion after progressively increasing the tube diameter may be safe in patients with airway stenosis after thoracic great-vessel surgery.View full abstractDownload PDF (2434K)
Short Communication
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Masanobu Suzuki, Fumio Ohtani, Michiya Matsumura, Yasushi Furuta2009 Volume 60 Issue 6 Pages 507-511
Published: December 10, 2009
Released on J-STAGE: December 25, 2009
JOURNAL RESTRICTED ACCESSThe Colorado microdissection needle® is a monopolar electric scalpel which has a sharp tip measuring 5 micrometers. It is useful for excision of tissue by sharp dissection, offering excellent hemostatic properties and less tissue trauma. We applied a 17.8 cm long probe in laryngomicrosurgeries for laryngeal cysts, granulomas, hemangiomas, and neoplasmas. The advantage of the Colorado microdissection needle® for laryngomicrosurgeries are as follows : first, it is far less expensive than laser devices; second, it adapts to standard monopolar handpieces. Here we describe our experience with laryngomicrosurgeries using the Colorado microdissection needle® in patients with laryngeal diseases and discuss the usefulness and limitations of its usage for laryngomicrosurgeries.View full abstractDownload PDF (790K)
Glossary
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[in Japanese]2009 Volume 60 Issue 6 Pages 512-513
Published: December 10, 2009
Released on J-STAGE: December 25, 2009
JOURNAL RESTRICTED ACCESSDownload PDF (1338K) -
[in Japanese]2009 Volume 60 Issue 6 Pages 514-515
Published: December 10, 2009
Released on J-STAGE: December 25, 2009
JOURNAL RESTRICTED ACCESSDownload PDF (891K)
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