Objective : To develop and evaluate the voice outcomes of an approach to arytenoid adduction (AA) for unilateral vocal cord paralysis through fenestration of the thyroid ala.
Study design : Thirty-two patients with unilateral vocal cord paralysis underwent laryngoplasty using an approach to AA performed through fenestration of the thyroid ala combined with type I thyroplasty.
Patients and methods : Thirty-two patients with unilateral vocal cord paralysis were treated between October 2004 and February 2008. In all cases, maximum phonation time (MPT) and mean airflow rate (MFR) were measured before and after the operation. The voices were analyzed using shimmer and jitter.
Surgical procedure : Two surgical windows were made in the lower part of the thyroid ala. The anterior one was for typical type I thyroplasty and the posterior one was for arytenoid adduction (AA). The locations of the two windows were determined based on three-dimensional computer tomography (3DCT) data. AA was performed by muscular process through the posterior window without releasing the cricothyroid joint. The operations were performed under local anesthesia with sedation. Vocal cord medialization was confirmed endoscopically during the operation.
Results : Twenty-nine of the 32 patients achieved an MPT of over 10 s after surgery. The other 3 cases, whose MPTs were 9 s after the operation, had low breathing capacity because of lung disease and normal side vocal cord sulcus. The MFRs, which ranged from 236 to 1908 ml/s before the operation, improved to under 200 ml/s except in 3 patients, whose MFRs were 210 ml/s , 214 ml/s and 216 ml/s. Jitter and shimmer improved significantly after the operation. Perceptual evaluation using the GRBAS scale also improved significantly.
Conclusion : Our new procedure simplified the combination of AA and type I thyroplasty because the two treatments can be performed in the same operating field, obtaining good voice improvement. Determination of the surgical approach using 3DCT and endoscopic vocal cord observation may contribute to the results.

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We investigated the medical records of vocal fold paralysis cases from 1990 to 2005 at the voice and bronchoesophageal outpatient clinics of the University of Tokyo Hospital. We evaluated the etiology of paralysis, and compared our results with those of the previous study by Hirose at our clinics from 1961 to 1989.
We investigated 797 patients during the period. The mean age was 55.1 years old. The postoperative group consisted of 466 patients (58.5%), and the non-surgical group of 331 (41.5%) patients. In the postoperative group, the most common causes were post-thyroid and post-aortic aneurysm operations. In the non-surgical group, idiopathic paralysis formed the majority, with the next most common causes being lung cancer and cerebrovascular disease.
Compared with the previous study at our clinic spanning from 1961 to 1989 as reported by Hirose, our current report shows an increase in postoperative cases, which may be caused by increasing adoption of operations for many diseases, due to progress in medical techniques in recent years. The report also shows a decrease in idiopathic cases. This may be related to advances in diagnostic devices.

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Between 1998 and 2007, we performed voice rehabilitation with indwelling voice prosthesis for 30 patients after total laryngectomy. The purpose of this study was to estimate the management of voice rehabilitation using voice prosthesis. Number of replacements of the voice prostheses used, average interval of voice prosthesis replacement, types and frequency of complications, and the course and progress of patients were observed over a period of more than six months. The average interval of prosthesis replacement was 5.4 months. Complications occurred in 18 patients (60.0%). Main complications were loss of voice prosthesis, increased granulation tissue around the TE shunt, and stenosis of the tracheal stoma.
The ratio of patients who use a voice prosthesis for daily conversation was 66.7%, while the voice acquisition rate with voice prosthesis after total laryngectomy was 90%. We should think about appropriate indications and timing of TE shunt operations in consideration of these problems involving complications and management.

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Invasion of thyroid cancer into other organs is an important adverse prognostic factor. Macroscopically, in cases where invasion into the trachea has not reached as far as the tracheal mucosa surface, we perform tracheal surface resection (hereafter tracheal shaving).
We retrospectively investigated local control rates, metastasis rates and survival rates in patients who had undergone tracheal shaving. Our subjects were 22 papillary thyroid carcinoma patients in whom tracheal shaving had been performed at the Head and Neck Oncology Department of the Cancer Institute Hospital between January 1994 and December 2005. In 21 of the 22 patients (95%), the carcinoma was locally controlled;in 6 patients (27%), metastasis was observed. With 2 patients dying from causes other than cancer, 5-year and 10-year survival rates were 93% and 41%, respectively. Currently, 2 of the thyroid carcinoma patients still survive.
Compared to full-thickness resection, following tracheal shaving, patients had a higher QOL and the carcinoma was well controlled locally as long as it had not invaded as far as the tracheal mucosa surface. However, compared with papillary thyroid carcinoma with no tracheal invasion, metastasis is common and invasion of organs other than the trachea is frequent, putting many patients into the high risk group. It is therefore considered necessary to carefully monitor the clinical course of such patients paying particular attention to metastasis to other locations.

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Autologous transplantation of a fascia graft as a treatment for unilateral vocal fold paralysis does not prevent resorption of the implanted material after surgery. Therefore, we attempted implantation between the control-release of the basic fibroblast growth factor (b-FGF), which was impregnated into a gelatin hydro gel sheet, to assess whether or not the autologous fascia may increase the survival rate of the implanted fascia. We used SD rats and implanted these materials into the gastrocnemius muscle. The survival rate of the implanted fascia with b-FGF was significantly higher compared with the implanted fascia without b-FGF at 4 weeks after surgery (p=0.03). The volume of granulation tissue around the implanted fascia with b-FGF was significantly larger compared with the implanted fascia without b-FGF at 2 weeks after surgery (p=0.03). The implantation with b-FGF correlated significantly with the volume of the implanted fascia and the granulated tissue (p=0.019). These results suggest that the presented implantation, intended to interact with the control-release of b-FGF, may protect the implanted fascia in such way that it will be covered by severely granulated tissue and avoid resorption in the body. We believe that this type of implantation could be a beneficial treatment for unilateral vocal fold paralysis.

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Spinal and bulbar muscular atrophy (SBMA : Kennedy-Alter-Sung disease) is a rare clinical entity in otolaryngological practice. We report a 52 year-old male with SBMA who underwent total laryngectomy for continuing dysphagia and respiratory problems. Histological examination of the intrinsic laryngeal muscles revealed neurogenic changes mainly in the posterior cricoarytenoid muscle. In this particular case, the selection of total laryngectomy was considered to be appropriate to improve the patient's quality of life (QOL).

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We reported two cases suffering from slowly developing dyspnea after endotracheal extubation in their infancy. We proposed that their dyspnea was due to redundant mucosa of the arytenoids caused by glottic or supraglottic stenosis, and we therefore excised the redundant mucosa by YAG laser in laryngomicrosurgery. The excision relieved their dyspnea and stridor. Case 1 was a 14-year-old female who received endotracheal intubation due to dyspnea at birth and was diagnosed as having Wilson-Mikity syndrome. Although endotracheal extubation was successful at the age of three, dyspnea due to restriction on bilateral vocal cord mobility continued and had been slowly worsening. Case 2 was a 13-year-old female who received a radical operation for congenital heart disease at six months after birth. She was in cardiopulmonary arrest the day after the operation. She had received endotracheal intubation for 20 days. Although the endotracheal extubation was successful, dyspnea and stridor continued and had been slowly worsening.
We diagnosed redundant mucosa of the arytenoids as one cause of airway obstruction. In both cases, tracheotomies were performed and the redundant mucosa was excised by YAG laser in laryngomicrosurgery. After their dyspnea and stridor had been relieved, the tracheostoma was closed.
In both cases, no abnormal findings of the larynx had been pointed out on performing the endotracheal intubation at the earlier hospital, and their dyspnea and stridor had been slowly worsening. Laryngoscopic findings at our department showed redundant mucosa of the arytenoids drawing into the glottis during inspiration. Consequently, we proposed that glottic or supraglottic stenosis caused high negative inspiratory intraluminal pressures, and these pressures could gradually lengthen the arytenoid mucosa, causing redundant mucosa of the arytenoids to form.

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