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Volume 61 (2010)
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Volume 61, Issue 5
Displaying 1-10 of 10 articles from this issue
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Special Issue of Surgical Interventions in Pediatric Tracheo-esophageal Diseases
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Masato Takase2010 Volume 61 Issue 5 Pages 415-420
Published: October 10, 2010
Released on J-STAGE: October 25, 2010
JOURNAL RESTRICTED ACCESSVarious diseases and conditions of the larynx and esophagus are discussed in terms of indications for surgical treatment. Congenital anomalies, such as laryngomalacia, tracheal atresia, tracheal stenosis, tracheomalacia, tracheo-esophageal fistula and esophageal atresia are reviewed. Although most of these conditions require immediate intervention after birth, survival rates are gradually improving. An increased rate of antenatal diagnosis may be contributing to this improvement. Neoplastic diseases are rare, and have many variations in terms of histology. Recurrent respiratory papillomatosis caused by human papilloma virus is also noted. Foreign bodies and trauma are also briefly discussed for their possible need for surgery. Laryngotracheal separation along with tracheostomy has been widely adopted to minimize the risk of aspiration in children with severe motor and intellectual disabilities. The procedure is not only life-saving, but also improves quality of life for patients and families. Gastroesophageal reflux disease (GERD) and achalasia are also noted as acquired functional disorders of the esophagus. A consensus on the indication of surgical treatment in children with GERD needs to be reached in the near future.View full abstractDownload PDF (588K) -
Tatsuo Kuroda2010 Volume 61 Issue 5 Pages 421-426
Published: October 10, 2010
Released on J-STAGE: October 25, 2010
JOURNAL RESTRICTED ACCESSCongenital anomalies of the trachea and esophagus in the pediatric surgical field are classified into 2 groups according to embryological background : 1) anomalies caused by disturbed splitting of the foregut, such as congenital esophageal atresia and stenosis, tracheobronchial stenosis, and tracheal agenesis ; and 2) anomalies caused by abnormal lung bud development, such as BPFM. In esophageal atresia, recent improvement in clinical outcomes has altered the risk assessment, and attention is directed to adult problems after esophageal repair in childhood, including carcinogenesis. New operative techniques such as endoscopic repair of esophageal atresia in neonates and slide tracheoplasty for tracheobronchial stenosis have been proposed and accepted widely. Furthermore, innovative surgical techniques for laryngotracheoesophageal cleft and tracheal agenesis are also reported in the recent literature. Congenital anomalies of the trachea and esophagus have become a major topic in modern pediatric surgery.View full abstractDownload PDF (1183K) -
Hiroaki Kitagawa, Hideki Shima, Munechika Wakisaka, Hirokazu Kawase2010 Volume 61 Issue 5 Pages 427-433
Published: October 10, 2010
Released on J-STAGE: October 25, 2010
JOURNAL RESTRICTED ACCESSIntractable aspiration is a life-threatening medical problem in patients with severe motor and intellectual disabilities (SMID). Laryngotracheal separation (LTS) is a surgical procedure for the treatment of intractable aspiration which separates the upper respiratory tract from the digestive tract. One hundred and thirty-eight patients received tracheostomy at our institution over two decades, and half of them were SMID. Over the last three years, our approach has been to avoid intractable aspiration with SMID and we have favored LTS rather than tracheostomy alone. We have performed two types of operation for LTS. The standard diversion procedure connects the upper trachea to the esophagus (diversion). The modified diversion (separation) includes closure of the proximal trachea and avoids tracheoesophageal anastomosis. Laryngotracheal separation was performed on 14 patients. A standard diversion was performed in 10 patients and a separation in 4. There were no operative complications recently. Eleven patients were safely transferred to home-care after their LTS. Twelve patients are still alive and 2 died some months after operation. One patient died from the primary disease and the other died of a tracheo-innominate artery fistula (TIAF). We recently experienced a patient who was at high risk of developing a TIAF. LTS is an effective operation, preventing intractable aspiration in patients with severe motor and intellectual disabilities and also increasing the patients' and families'QOL. The results are similar for diversion and separation, with the procedure chosen being related to the initial tracheostomy. LTS is one of the surgical options available to avoid intractable aspiration in SMID.View full abstractDownload PDF (1482K) -
Koji Fukumoto, Naoto Urushihara, Hiroaki Fukuzawa, Akihide Sugiyama, H ...2010 Volume 61 Issue 5 Pages 434-437
Published: October 10, 2010
Released on J-STAGE: October 25, 2010
JOURNAL RESTRICTED ACCESSLaryngomalacia is the most common cause of stridor in infants. Surgical therapy is necessary in 5% to 10% of cases. We use the classifications and surgical treatment reported by Olney et al. Cases were prolapse of the mucosa overlying the arytenoid cartilage (type 1), foreshortened aryepiglottic folds (type 2), and posterior displacement of the epiglottis (type 3). We performed excision of the mucosa overlying the arytenoid cartilage for type 1, excision of the short aryepiglottic folds for type 2, and suture suspension of the epiglottis to the base of the tongue for type 3.
In this paper, we report the pathophysiology, the diagnosis and the treatment from our experience of laryngomicrosurgery.View full abstractDownload PDF (863K) -
Fumiyo Kudo2010 Volume 61 Issue 5 Pages 438-444
Published: October 10, 2010
Released on J-STAGE: October 25, 2010
JOURNAL RESTRICTED ACCESSAspiration of foreign bodies, especially by small children, is a serious and sometimes life-threatening situation. Of all cases aged 0-15, 70% are children under the age of 2. The most commonly found foreign bodies are peanuts and legumes. The most common clinical manifestations are coughing and stridor. Careful diagnosis by asking questions and chest radiography is important to secure a precise diagnosis. For the final diagnosis we use the flexible bronchoscopy through a laryngeal mask under general anesthesia. In airway foreign body aspiration, more than 95% of patients had a foreign body in the tracheal/bronchial trees/lungs. The extraction method from these areas is rigid and/or flexible bronchoscopy, a procedure requiring general anesthesia. Because in infants the trachea is not so big as to permit use of flexible bronchoscopy with a channel for forceps, we mainly use rigid bronchoscopy. After extraction of the foreign body, postoperative care is important especially in the case of peanuts aspiration.
The type of ingested foreign body varies according to each child's feeding habits and sociocultural features. Around 20 years ago, a common ingested foreign body was coins, but recently ingestion of coins has decreased and cases of ingested printed seals are increasing. It has been reported that 80% of ingested foreign bodies are found in the upper esophagus, and 13% in the middle esophagus. Although there are two methods for extraction, rigid and/or flexible endoscopy, most foreign bodies can be extracted with a flexible endoscope. For foreign bodies with a sharp edge, rigid endoscopy is preferable.
Aspirations into the airway and ingestion of foreign bodies are accidents common in children. Prevention is better than any cure, so more attention and public awareness are necessary by supervising adults in particular.View full abstractDownload PDF (2008K)
Original
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Kazuhiro Nakamura, Yusuke Watanabe, Ujimoto Konomi, Daigo Komazawa, To ...2010 Volume 61 Issue 5 Pages 445-451
Published: October 10, 2010
Released on J-STAGE: October 25, 2010
JOURNAL RESTRICTED ACCESSThe standard operative method for laryngeal disease is laryngeal microsurgery under general anesthesia (LMS). LMS can be performed by a single operator, but general anesthesia and hospitalization are necessary. On the other hand, one-day laryngeal videoendoscopic surgery (LVES) can be performed under local anesthesia at the outpatient department. However, a single operator cannot perform this procedure and an assistant is required. Also, LVES requires a special pair of forceps. LVES was performed by a single operator at our institution with just a regular appliance. We report on this device.
LVES was performed on 50 patients at Mita Hospital from January 2007 to June 2009. During the same period, LMS was performed on 329 patients. The operation was performed under local anesthesia. The pharynx and larynx were anesthetized carefully with lidocaine. After they were sufficiently anesthetized, the operator held the forceps with the right hand and the endoscope with the left hand and completed the surgery. None of the cases required the operation to be suspended ; the successful execution rate of the operation was 100%.
LVES is a simple and easy operation that can be performed by an operator alone using just a regular forceps.View full abstractDownload PDF (2233K) -
Maki Takagi, Ryoji Tokashiki, Mamoru Suzuki2010 Volume 61 Issue 5 Pages 452-457
Published: October 10, 2010
Released on J-STAGE: October 25, 2010
JOURNAL RESTRICTED ACCESSObjective : The purpose of this study was to determine the postoperative pitch range acquired in cases of unilateral vocal cord paralysis treated with surgery, as well as factors affecting outcomes.
Subjects and Methods : We analyzed 39 cases of unilateral vocal cord paralysis in which surgery was performed between January 2006 and January 2009, and for which pitch ranges and the items listed below were measured preoperatively and one year postoperatively. Arytenoid adduction and type I thyroplasty were performed simultaneously in all cases regardless of preoperative severity. The correlation between pitch range acquired postoperatively and the following were examined : (1) pre- and postoperative maximum phonation time (MPT) ; (2) pre- and postoperative mean air flow rate (MFR) ; and (3) preoperative pitch range.
Results : Pitch range increased significantly from 3.0±4.5 half-tones (mean±SD) preoperatively to 17.5±5.8 half-tones postoperatively. Preoperative MPT, MFR, and pitch range did not correlate with the width of postoperative pitch range. Postoperatively, only MPT correlated with the width of postoperative pitch range.
Conclusion : Arytenoid adduction and type I thyroplasty for unilateral vocal cord paralysis significantly expanded postoperative pitch range. We conjectured that there is no correlation between preoperative severity and width of pitch range acquired postoperatively.View full abstractDownload PDF (505K) -
Satoshi Yoshioka, Kazuo Sakurai, Kensei Naito, Shigetaka Suzuki, Naoko ...2010 Volume 61 Issue 5 Pages 458-466
Published: October 10, 2010
Released on J-STAGE: October 25, 2010
JOURNAL RESTRICTED ACCESSA 320-row area detector CT scanner was used to assess foreign bodies in the bronchi of pediatric patients. This system, which employs a detector of 0.5 mm × 320 rows, permits a range of up to 160 mm to be scanned in a single rotation at a maximum scan speed of 0.35 s/rot. This makes it possible to perform imaging with no temporal mismatch between any parts of the acquired images and to acquire consecutive three-dimensional dynamic image data over time by continuous rotation (4DCT).
The subjects were 4 pediatric patients in whom the presence of a foreign body in the bronchi was suspected. The system used was a 320-row CT scanner (Aquilion ONE, Toshiba). Multiplanar reconstruction (MPR) images and three-dimensional CT (3DCT) images were generated. In addition, consecutive four-dimensional dynamic CT (4DCT) images were obtained over time.
With this system, scanning can be completed instantly, permitting examinations to be performed without sedation. In stationary images, artifacts due to respiration and cardiac contraction (which are unavoidable with conventional scanning methods) can be completely eliminated, and the continuity of images as well as the visualization of peripheral bronchi are significantly improved.
This leads to greater diagnostic confidence when evaluating small or multiple foreign bodies. 4DCT permits dynamic observation to be performed easily, which is useful, for example, for detecting the presence of a foreign body in the peripheral bronchi or evaluating incomplete ventilation of a part of the lung. In other words, the CT system can also be used to assess lung function. In addition, the exposure dose can be reduced to within permissible limits. It is therefore concluded that 320-row area detector CT is very useful as a new imaging tool for the evaluation of the bronchi and lungs.View full abstractDownload PDF (4121K)
Glossary
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[in Japanese], [in Japanese], [in Japanese]2010 Volume 61 Issue 5 Pages 467-469
Published: October 10, 2010
Released on J-STAGE: October 25, 2010
JOURNAL RESTRICTED ACCESSDownload PDF (723K) -
[in Japanese], [in Japanese], [in Japanese], [in Japanese]2010 Volume 61 Issue 5 Pages 470-472
Published: October 10, 2010
Released on J-STAGE: October 25, 2010
JOURNAL RESTRICTED ACCESSDownload PDF (370K)
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