Nihon Kikan Shokudoka Gakkai Kaiho
Online ISSN : 1880-6848
Print ISSN : 0029-0645
ISSN-L : 0029-0645
Volume 63, Issue 6
Displaying 1-10 of 10 articles from this issue
Original
  • Yutomo Seino, Meijin Nakayama, Seiichi Hayashi, Makito Okamoto
    2012 Volume 63 Issue 6 Pages 423-429
    Published: December 10, 2012
    Released on J-STAGE: December 25, 2012
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    Objective : To morphologically analyze the three-dimensional (3D) configuration of the neoglottis after supracricoid laryngectomy with cricohyoidoepiglottopexy (SCL-CHEP).
    Patients and Methods : Multidetector-row CT scanning was performed for 17 patients who received SCL-CHEP. The fine-cut CT image was evaluated at a slice thickness of 1.25 mm. Then 3-D models of the neoglottis were reconstructed using INTAGE Realia (KGT Inc) on a Windows computer. In this study, ossification of the cricoid and arytenoid cartilages and the virtual neoglottic airway were visualized on the 3-D images.
    Results : 1) Mobility of arytenoid cartilages : In patients with bilateral arytenoids remaining, mobility of the arytenoids was well preserved. The mobility was even better in patients with only one arytenoid. There were no findings suggesting arytenoid dislocation. 2) Morphology of the airway : Two types of airway configuration, one with a single stream and the other with a combination of several streams, were observed during phonation. There were significant differences between these two groups in terms of VHI analyses.
    Discussion : Because neoglottis morphology is directly related to postoperative phonetic function, 3D images of arytenoid mobility and airway configuration demonstrated useful information related to the post SCL-CHEP neoglottis. This information may be useful for improving the surgical technique so that better laryngeal function can be attained.
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  • Hiroki Mitani, Kazuyoshi Kawabata
    2012 Volume 63 Issue 6 Pages 430-435
    Published: December 10, 2012
    Released on J-STAGE: December 25, 2012
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    Recently CRT, which helps retain the function and shape of the head and neck, has been provided in the field of head and neck cancer treatment. However a few recurrence cases have been reported, and salvage surgery should be performed in such cases. We recorded all complications with salvage surgery and compared CRT cases and simple RT or non-RT cases during the same time frame. We examined a total of 299 cases, including hypopharyngeal carcinoma (189cases), laryngeal carcinoma (82cases), and cervical esophageal carcinoma (28cases), that were given total laryngectomy or total pharyngo-laryngo-esophagectomy between April 2005 and August 2009. We classified them as CRT (22cases), simple RT (31cases) or non-RT (242cases), and subdivided these into 3 types : severe (carotid artery rupture), moderate (major fistula), and light (minor fistula). The results showed that among the CRT cases, 19.2% were severe, 11.5% were moderate, 19.2% were light, and 53.8% had no complications. Among the simple RT cases, 6.5% were severe, 6.5% were moderate, 16.1% were light, and 74.2% had no complications. Among the non-RT cases, 3.3% were severe, 3.3% were moderate, 9.1% were light, and 85.6% had no complications.
    A significant difference (p=0.0003) in frequency of complication development was seen between CRT cases and non-RT cases. Because we can not avoid the risk of the complications developing during salvage surgery, we must offer salvage surgery with an explanation of attendant risks and secure patient agreement in all cases.
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  • Nobuhiro Hanai, Taijiro Ozawa, Hitoshi Hirakawa, Hidenori Suzuki, Yusu ...
    2012 Volume 63 Issue 6 Pages 436-442
    Published: December 10, 2012
    Released on J-STAGE: December 25, 2012
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    Head and neck cancer surgery using the Harmonic FOCUS® (HF) contributes to shortening of operative time, decrease in bleeding, and reduction of operative invasion. We discussed the specific ideas behind and essential points of HF use in procedures total pharyngo-laryngo-esophagectomy (TPLE) and neck dissection.
    In particular, the essential point in primary resection (TPLE) is consecutive performance of procedures 1) from transection of the strap muscles to paratracheal dissection and 2) from division of the thyroid isthmus to Berry's ligament. Operative time was significantly shortened in the operations the writer performed using HF. Also, bleeding and required time decreased even in comparison of neck dissections.
    In the operations of TPLE and neck dissection which we indicated here, HF can be used effectively in various perioperative scenes. Although some cost problems remain unresolved, we believe use of HF, is worth its cost. Head and neck surgery using HF makes a new era in operations, and constitutes one type of minimally invasive surgery because it reduces operative involvement.
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  • Hiroki Ishii, Keisuke Masuyama
    2012 Volume 63 Issue 6 Pages 443-450
    Published: December 10, 2012
    Released on J-STAGE: December 25, 2012
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    The incidence of synchronous or metachronous multiple primary cancers (MPCs) has increased in patients with head and neck cancer. In particular, synchronous or metachronous esophageal cancer has been frequently detected in patients with hypopharyngeal cancer (HPC). There are some cases of synchronous esophageal and HPC in which management of treatment strategy is difficult. A total of 89 patients were diagnosed with HPC between January 2003 and October 2011. We reviewed their clinical data, which consists of the incident sites, timing, and overall survival, retrospectively. A total of 52.8% of the patients with HPC were diagnosed with MPCs ; 24 cases were diagnosed with synchronous MPCs, whereas 23 cases were metachronous. The most common site of the MPCs was esophageal cancer. Overall survivals were 45.1% and 54.7% in the with-MPCs group and without-MPCs group, respectively. There were no significant differences between the two groups. We investigated the over-5-year survival rate of the synchronous hypopharyngeal and esophageal cancer group. The overall survival rate was 11.6% in the synchronous cases, a group having poor survival. To detect early HPC, endoscopic surveillance and long-term follow-up should be performed for patients with either head and neck or esophageal cancer.
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  • Yukiko Hanada, Makoto Ogawa, Kiyohito Hosokawa, Takashi Shikina, Hiden ...
    2012 Volume 63 Issue 6 Pages 451-459
    Published: December 10, 2012
    Released on J-STAGE: December 25, 2012
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    Tracheostomy is a common surgical procedure performed by the otolaryngologist. However, very few reports exist concerning long-term decannulation and survival rates following tracheostomy. The aim of this study was to investigate the association between long-term outcomes of patients who underwent a tracheostomy and the causal diseases at an acute-care general hospital retrospectively. The subjects were 214 (155 male and 59 female) cases who underwent a tracheo-stomy during admission. The state of the tracheostomy tube and mortality were assessed for each case every 4 weeks until 24 weeks after the operation. Decannulation and mortality rates were compared among the causal diseases. The decannulation rate in all cases increased to a plateau of 31.8% 12 weeks after the operation. In an investigation of the individual groups, the group of cases with head and neck diseases, for which tracheostomy was performed because of unstable airway, achieved a 50%decannulation rate. The groups with cases of cardiac, respiratory, or gastrointestinal diseases, for which tracheostomy was performed because of prolonged mechanical ventilation, showed 31.8%,27.7% and 23.1% decannulation rates, respectively. The group of cases with neurological diseases included more than 40% of cases transferred to other chronic-care institutes with unknown outcome. In conclusion, these findings suggest that decannulation and mortality rates in tracheostomized cases at an acute-care hospital are dependent on the causal diseases and indications of the tracheostomy.
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Case Report
  • Takashi Taniyama, Tomonori Sugiyama, Mamika Araki, Kouhei Fukukita, Hi ...
    2012 Volume 63 Issue 6 Pages 460-465
    Published: December 10, 2012
    Released on J-STAGE: December 25, 2012
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    We experienced a case in which thyroid papillary carcinoma invaded the recurrent laryngeal nerve (RLN) and we were obliged to perform reinnervation of the RLN in the larynx. The case was a female 86 years of age. Her major complaints at initial visit were cervical swelling, hoarseness and cough. We confirmed a tumor which occupied the left lobe of the thyroid, and the left vocal cord was fixed. The result of FNA was a suspected class V papillary Ca, and we performed left lobectomy and D1 dissection. We were unable to find the peripheral end of the RLN out of the larynx because of invasion, so we cut part of the thyroid cartilage, found the peripheral end of the RLN inside the larynx, and performed reinnervation with a cervical loop. Gradually the tonus of her vocal cord is increasing and her phonetic condition is improving. In cases when we are unable to find the peripheral end of the RLN out of the larynx, attempting to find it in the larynx was considered an effective method, in addition to secondary phonosurgery such as laryngoplasty.
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Short Communication
  • Ryoji Tokashiki, Hiroyuki Hiramatsu, Shun Inoue
    2012 Volume 63 Issue 6 Pages 466-470
    Published: December 10, 2012
    Released on J-STAGE: December 25, 2012
    JOURNAL RESTRICTED ACCESS
    Injection laryngoplasty is performed for vocal fold paralysis or atrophy. When injection is performed as an office-based surgery under topical anesthesia, the trans-oral needle injection method has been popular. Because the needle is too long, some amount of injection material is left inside the vein. However, some patients cannot endure this procedure because of gag reflex. We perform percutaneous injection laryngoplasty using a curved 23G 60mm Cathelin needle through thyrohyoid approach. This method enables the surgeon to have better access to the whole vocal fold, from anterior to posterior in all directions. This method is very simple and useful and free of technical or medical failure.
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