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Volume 61, Issue 1
Displaying 1-9 of 9 articles from this issue
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Original
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Shunichi Chitose, Sachiyo Hamakawa, Akiteru Maeda, Hirohito Umeno, Tad ...2010 Volume 61 Issue 1 Pages 1-7
Published: February 10, 2010
Released on J-STAGE: February 25, 2010
JOURNAL RESTRICTED ACCESSWhen wide resection and reconstruction for advanced oropharyngeal cancer are performed, we often experience many functional disorders postoperatively; and, in particular, postoperative dysphagia frequently causes tragic results. In this study, we quantitatively analyzed compensatory function after reconstructive surgery for advanced oropharyngeal cancer. Analyses were performed in 52 patients who received radical resection of oropharyngeal cancers with laryngeal preservation and without preoperative radiotherapy. Using lateral views of videofluorography, the anterior bulge of the posterior pharyngeal wall (PPW) at two time points, in rest status and pharyngeal swallow, was measured and calculated as the ratio of PPW movement. These measured values were compared with those of control cases, and were divided into three categories according to over/under 60 years of age, method of reconstruction and presence/absence of nasopharyngeal closure (NC). The mean ratio of PPW movement in the postoperative cases was higher than in the control cases at 3 and 6 months after surgery. There was no significant difference between age categories. Regarding methods of reconstruction, the mean ratio of PPW movement in the pectoralis major myocutaneous flap group was significantly higher than in the free rectus abdominus muscle flap group at 3 and 6 months after surgery. In the comparison of NC, the mean ratio of PPW movement in the NC positive group was significantly higher than in the NC negative group at 6 months after surgery. These results indicate potential for postoperative compensatory function in left oropharyngeal tissues when the contraction in the resected parts becomes weak, and also suggest more remarkable compensatory potential from 3 months after surgery.View full abstractDownload PDF (543K) -
Masanori Komatsu, Junichi Ishitoya, Youichi Ikeda, Osamu Shiono, Toshi ...2010 Volume 61 Issue 1 Pages 8-14
Published: February 10, 2010
Released on J-STAGE: February 25, 2010
JOURNAL RESTRICTED ACCESSThe aim of this study was to evaluate late disturbance of food ingestion and swallowing in patients with advanced head and neck carcinoma after concurrent chemoradiotherapy (CCRT). Patients answered a questionnaire, the Quality of Life Radiation Therapy Instrument (QOL-RTI) for Japanese, and swallowing function was investigated by videoendoscopy (VE) more than 1 year after treatment. The results of patients after CCRT were compared with normal elderly serving as the control group. The total QOL score of the patient group was significantly lower than that of the control group. In terms of the results of the QOL questionnaires, the QOL scores for quantity of saliva, quality of saliva, taste and food swallowing were significantly lower in the patient group. Regarding the VE findings, the control group exhibited almost normal swallowing function, but pooling in the vallecura, laryngeal palsy and pooling in the hypopharynx were observed in the phase of not swallowing. Furthermore, dysfunction of swallowing using the colored water swallowing test was observed in about 40% of the patients. In addition, the factors associated with disturbance of QOL score and swallowing function were analyzed. All factors, i.e., age, T and N classification, stage, duration after treatment, acute toxicity of chemoradiotherapy and order of chemotherapy, had not influence on food ingestion or swallowing. Patients after CCRT might have potential dysfunction of swallowing. The colored water swallowing test is useful for diagnosis of swallowing dysfunction in head and neck cancer patients after CCRT.View full abstractDownload PDF (804K)
Case Report
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Akihito Yamauchi, Miwako Kimura, Miho Hagisawa, Takaharu Nito, Niro Ta ...2010 Volume 61 Issue 1 Pages 15-20
Published: February 10, 2010
Released on J-STAGE: February 25, 2010
JOURNAL RESTRICTED ACCESSWe experienced a case with repeated extensive glottic granulation tissue caused by silicone tracheal tubes. The patient was a 59-year-old female who presented to a nearby otolaryngologist in April 2002 with a 6-month history of progressive hoarseness, and laryngeal fiberscopy revealed left vocal cord palsy and a left-sided subglottic tumor. Laryngeal chondrosarcoma was suspected after repeated tissue biopsy, and she was referred to our department in March 2003 for surgical treatment. She underwent tumor resection along with subtotal crycoidectomy and tracheostomy in May 2003, and was diagnosed as laryngeal chondrosarcoma. A Montgomery T-tube was placed into the tracheal stoma postoperatively. One month later, she had upper airway infection, and globus sensation dyspnea persisted thereafter. Laryngeal fiberscopy revealed granulation tissue of the left glottis. Although the lesion was first expectantly managed with adjustment of the T-tube to minimize mechanical irritation to the glottis, the lesion persisted and was finally removed by laryngomicrosurgery. Her clinical course was favorable with the adjusted T-tube for the following 2 years, until glottic granulation tissue reappeared after upper airway infection in October 2005. Since the lesion appeared suddenly with such extensive distribution throughout the glottis, surgical treatment was soon performed, and the lesion was successfully removed. In January 2007, after she had upper airway infection again, large glottic granulation tissue recurred. This time, the lesion resolved with expectant management. Her clinical course was fairly good thereafter, and the tracheal stoma was successfully closed in June 2007. There are no signs of recurrence of glottic granulation of the chondrosarcoma as of October 2009. On every occasion, granulation tissue was accompanied by upper airway infection, and mechanical irritation by silicone tracheal tubes and inflammation by infection was considered to be causative.View full abstractDownload PDF (3409K) -
Tomonori Terada, Akiko Sakaguchi, Nobuo Saeki, Nobuhiro Uwa, Kosuke Sa ...2010 Volume 61 Issue 1 Pages 21-27
Published: February 10, 2010
Released on J-STAGE: February 25, 2010
JOURNAL RESTRICTED ACCESSMalignant fibrous histiocytoma (MFH) is a rare malignant neoplasm in the larynx. We report a case of MFH arising in the supraglottic larynx.
A 69-year-old male presented hoarseness in May 2006. Endoscopy showed an irregular tumor extending from the right false cord to the epiglottis. There was no lymphadenopathy palpable in the cervical region. A biopsy showed MFH. Chemoradiotherapy was chosen as the initial treatment to preserve the larynx. However, total laryngectomy had to be performed in August 2006 because of residual tumor. The patient has been well, without recurrence or distant metastasis, for 38 months postoperatively.View full abstractDownload PDF (1494K) -
Tomoyoshi Suzuki, Tetsuro Nishikage, Kagami Nagai, Yasuaki Nakajima, K ...2010 Volume 61 Issue 1 Pages 28-33
Published: February 10, 2010
Released on J-STAGE: February 25, 2010
JOURNAL RESTRICTED ACCESSSubglottic stricture has been reported usually as a complication of tracheotomy or orotracheal intubation. However, as a result of recent wide use of mini-tracheotomy instruments such as the MiniTrachTM through the cricothyroid membrane, cases of subglottic stricture after mini-tracheotomy have been reported. We experienced a case of delayed subglottic stricture possibly caused by insertion of MiniTrachTM after radical esophagectomy, followed by wide airway stenosis with tracheal cartilagitis. The cause of subglottic stricture was thought to be injury of the cricoid cartilage, irritation to the tracheal mucosa, or local infection during MiniTrachTM placement. We conclude that gentle handling and early removal of the MiniTrachTM are necessary to prevent subglottic stricture after of MiniTrachTM insertion in order to reduce risk of irritation to the tracheal mucosa and/or infection.View full abstractDownload PDF (2380K) -
Shinya Agena, Kunihiko Nagahara, Sueyoshi Moritani, Takumi Okuda, Keig ...2010 Volume 61 Issue 1 Pages 34-40
Published: February 10, 2010
Released on J-STAGE: February 25, 2010
JOURNAL RESTRICTED ACCESSOpportunities when otolaryngology/head and neck surgeons encounter tracheal cancer are rare. Patients presenting primary symptoms like tracheal stenosis, stridor or bloody sputum are often treated as cases of bronchitis or bronchial asthma. Therefore, diagnosis comes too late and often has an unhappy outcome. Here we report a case of adenoid cystic carcinoma of the trachea found by a health checkup. A 39-year-old woman showed an abnormal thoracic shadow and was referred to the department of respiratory surgery of a university hospital. Tuberous shadows in the anterior mediastinum and right anterior neck were found by chest CT. Using fine needle aspiration cytology, the mass of the anterior mediastinum was diagnosed as thymoma and the mass of the right anterior neck as adenoid cystic carcinoma. Intraluminal tumor invasion between the subglottic space and the seventh tracheal ring was ascertained using NBI (narrow band imaging) fiberscopy. The specimen obtained was also adenoid cystic carcinoma. PET/CT study showed accumulation of FDG in the anterior mediastinum and the dorsal part of the right thyroid lobe. The main tracheal tumor arising from the right wall and penetrating the tracheal rings was clearly depicted on MRI. Curative resection of this tumor started from the lower part of the seventh tracheal ring, where no tumorous lesion was observed under bronchoscopy. However, the ablative margin was positive. The margin was decided by repeating frozen sectioning, but additional resection of three more rings was necessary. The right recurrent laryngeal nerve (RLN) was rolled up in the tumor. The sacrificed RLN was reconstructed by anastomosing the ansa cervicalis nerve to the distal end of the RLN found under the thyroid cartilage. Invasion to the esophagus showed over all layers. However, the esophagus was preserved under microscope by leaving only the mucosal layer for more than 3 cm. Finally, the resection of the airway extended from the bottom end of the vocal cord to the tenth tracheal ring. The trachea was reconstructed in three stages using the deltopectoral flap with nasal septal cartilage embedded. One and half years later, no findings suggested a recurrence. Phonation is excellent, with maximum phonation time of 20 seconds. Deglutition function is also excellent, without any sign of silent aspiration.View full abstractDownload PDF (5614K) -
Noriyasu Chika, Tatsuya Miyazaki, Youzou Yokoyama, Tadashi Kitaoka, To ...2010 Volume 61 Issue 1 Pages 41-45
Published: February 10, 2010
Released on J-STAGE: February 25, 2010
JOURNAL RESTRICTED ACCESSWe herein report a rare case of anorexia nervosa who accidentally swallowed a spoon, also including a review of the related literature.
A 26-year-old female was using a spoon to induce vomiting and swallowed the spoon accidentally. For the past two years, she had been under medical treatment for anorexia nervosa and repeated self-induced vomiting. On admission, abdominal roentgenogram demonstrated a spoon in the stomach. We tried to remove the spoon by an endoscopic procedure using a snare and alligator-jaw forceps under topical pharyngeal anesthesia, but failed. Then, thoracic roentgenogram demonstrated the spoon in the thoracic esophagus, and we tried to remove it again by an endoscopic procedure under general anesthesia. We successfully removed the spoon using a snare and alligator-jaw forceps. The spoon measured about 13 cm × 3 cm. The patient was discharged 12 days after admission without complication.
We suggest that a large foreign body should be removed by endoscopic procedure under general anesthesia.View full abstractDownload PDF (876K)
Glossary
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[in Japanese]2010 Volume 61 Issue 1 Pages 46-48
Published: February 10, 2010
Released on J-STAGE: February 25, 2010
JOURNAL RESTRICTED ACCESSDownload PDF (192K) -
[in Japanese]2010 Volume 61 Issue 1 Pages 49-51
Published: February 10, 2010
Released on J-STAGE: February 25, 2010
JOURNAL RESTRICTED ACCESSDownload PDF (655K)
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