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Volume 64, Issue 1
Displaying 1-8 of 8 articles from this issue
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Review
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Hiroyuki Ito, Akira Shimizu, Kiyoaki Tsukahara, Isaku Okamoto, Takahit ...2013 Volume 64 Issue 1 Pages 1-7
Published: February 10, 2013
Released on J-STAGE: February 25, 2013
JOURNAL RESTRICTED ACCESSRobot-assisted thyroidectomy and transoral robotic surgery using the daVinci surgical robot are minimally invasive treatments for head and neck cancers. To treat neoplastic diseases of the head and neck region, surgery is performed by operating the controller in the remote console and inserting the endoscope and robotic arm through a narrow entrance, such as the axilla or mouth. There is no need for a large incision in the neck, and this method reduces postoperative complications and sequelae compared with traditional surgical techniques.
To enable the use of robotic surgery in clinical applications, we created a set of instructions by dividing the process into four steps and examining the process in detail. Step 1 includes basic training on how to operate the daVinci surgical system (dVSS). Step 2 is preparatory training for the operation using a cadaver. Step 3 is a training course for using the dVSS, which involves performing a cadaver dissection for a head and neck operation with the dVSS, and observing a case. This step includes performing a simulated operation in collaboration with an anesthesiologist and nursing team in the operating room. Step 4 involves establishing standards for patient selection, receiving approval from the hospital ethics committee, and initiating a clinical study.
By following these steps, robotic surgery using the dVSS can be safely performed to treat head and neck cancers.View full abstractDownload PDF (6529K)
Original
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Masaki Nomoto, Ryoji Tokashiki, Hiroyuki Hiramatsu, Rey Motohashi, Eri ...2013 Volume 64 Issue 1 Pages 8-13
Published: February 10, 2013
Released on J-STAGE: February 25, 2013
JOURNAL RESTRICTED ACCESSTwo surgical treatments for adductor spasmodic dysphonia (SD) are thyroarytenoid muscle myectomy (TAM) and type II thyroplasty (TPII). To date, there have been no comparisons of the two surgeries.
In this study, we compared the efficacies of the two types of surgery. A total of 14 cases of SD treated surgically from March 2008 to August 2009 were included. TAM was performed on seven cases and TPII on seven. We evaluated treatment effectiveness using the voice handicap index 10 (VHI10) and auditory impressions of strangulation, interruption and tremor measured before surgery and six months after surgery. All 14 cases showed improvement after surgery. Before surgery, there was no difference in the severity of strangulation or tremor between the two surgeries, but there were differences in interruption and VHI. Interruption and VHI before surgery were more severe in patients who underwent TAM. All patients were significantly improved after surgery with TAM, but improvement of interruption and tremor were not significant with TPII. After surgery there were no significant differences between the two surgeries.
Both TAM and TPII are considered to be useful choices for treating SD.View full abstractDownload PDF (1054K) -
Toshihiko Iwahashi, Ryuichi Mochizuki, Keisuke Yamamoto, Maki Yamashit ...2013 Volume 64 Issue 1 Pages 14-20
Published: February 10, 2013
Released on J-STAGE: February 25, 2013
JOURNAL RESTRICTED ACCESSTuberculosis (TB) patients have been decreasing since 1999. Laryngeal tuberculosis (LTB) accounts for only about 0.2% (50 patients) of all TB cases each year in Japan, and therefore we fear that LTB tends to be overlooked. It is difficult to diagnose laryngeal tuberculosis because there are various types. We compared reports of the past with our own three cases, and reviewed LTB type tendencies and medical considerations.
The patients were 57-, 22- and 48-year-old women. Case 1 had been diagnosed as granuloma. We performed an operation under general anaesthesia, and diagnosed her as LTB. Cases 2 and 3 had been diagnosed as laryngitis. We diagnosed these as LTB based on chest CT and sputum examination.
Today we are able to find small lesions thanks to medical advances, but this ability may make diagnosis difficult. Otorhinolaryngologists assume visiting patients are mild cases, but laryngeal tuberculosis should be immediately suspected for intractable cases. We suggest the need for a concept of a new “swelling type” of LTB. We believe that understanding recent type tendencies, and reconfirming by examination are helpful for diagnosis of LTB.View full abstractDownload PDF (11023K) -
Tomohisa Hirai, Noriyuki Fukushima, Nobuyuki Miyahara2013 Volume 64 Issue 1 Pages 21-26
Published: February 10, 2013
Released on J-STAGE: February 25, 2013
JOURNAL RESTRICTED ACCESSWe examined the usefulness of the reflex cough test using tartaric acid inhalation (RCT-TAI) as an evaluator of patients with dysphagia. The subjects of this study were 149 patients with dysphagia. The RCT-TAI was performed before videofluorography. We investigated the relationship between the level registered by the RCT-TAI and the level of choking with dysphagia. The cases with normal level on the RCT-TAI was 71 cases (48%), moderate level on it was 47 cases (32%) and weak level on it was 31 cases (21%). The cases aspiration were seen in was 62 cases. A strong correlation was found between the RCT-TAI level and silent aspiration. We also examined the relationship between the RCT-TAI level and the existence of onset of aspiration pneumonitis three months after the examinations. Aspiration pneumonitis had been developed in 15 case (10%). As the level on the RCT-TAI were weak, the risk of onset of aspiration pneumonitis became higher and deteriorated cases were often found among cases with weak RCT-TAI scores. We concluded that RCT-TAI was useful in predicting an silent aspiration.View full abstractDownload PDF (904K)
Case Report
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Takashi Kojima, Tomoe Nakamura, Masaru Noguchi, Kouichiro Nishiyama, A ...2013 Volume 64 Issue 1 Pages 27-35
Published: February 10, 2013
Released on J-STAGE: February 25, 2013
JOURNAL RESTRICTED ACCESSWe report a case of a 65-year-old male patient with a vascular leiomyoma in the larynx, a benign tumor that is rare in this organ. Chief complaints were odynophagia and muffled voice. Flexible laryngoscopy revealed a spherical tumor measuring 2.5 cm and covered with normal mucosa on the left aryepiglottic fold. We immediately admitted the patient and performed tracheostomy under local anesthesia. Inspection of images showed the tumor border was regular and was well enhanced by iodinated contrast medium. Laryngomicrosurgery was carried out under general anesthesia. Histological examination resulted in a diagnosis of vascular leiomyoma. A modified transhyoid pharyngotomy procedure was performed. A horizontal incision was made over the hyoid bone, and the suprahyoid muscles were cut at the site of the attachment. We exfoliated the submucosal layer of the tongue root and aryepiglottic fold, and then extirpated the tumor completely. The postoperative course was uneventful and the patient was discharged 14 days after the operation. This surgical technique can be considered a useful procedure in reducing postoperative complications such as pharyngeal fistulae or problems in swallowing.
Vascular leiomyoma is known as a subcutaneous tumor that commonly occurs with pathognomonic pain in the lower limbs of middle-aged women. Laryngeal vascular leiomyoma is extremely rare, with this being the 28th case of its kind in the literature worldwide. Of these 28 patients, 25 were male and 3 were female. Their ages ranged from 39 to 78, with a mean of 59. The most common symptoms are hoarseness, an uncomfortable feeling in the pharynx, and dyspnea due to the mass effect of the tumor. Only 5 patients complained of pain. According to clinical data such as sex, age distribution and symptoms, laryngeal vascular leiomyomas are distinctly different from typical ones.View full abstractDownload PDF (1377K) -
Tomonori Sugiyama, Mamika Araki, Kouhei Fukukita, Hiroyuki Yamada2013 Volume 64 Issue 1 Pages 36-40
Published: February 10, 2013
Released on J-STAGE: February 25, 2013
JOURNAL RESTRICTED ACCESSHypopharyngeal benign tumors are an uncommon disease, and these tumors do not always have symptoms.
We report a 79-year-old female patient with a history of recurrent cough. She was diagnosed as having a hypopharyngeal hemangioma which covered the glottis. After performing a tracheotomy, we tried to exenterate the hemangioma through the mouth. However, as it was difficult to remove only the large tumor, alternatively we conducted a lateral pharyngotomy to exenterate it. The hemangioma was successfully excised with a small amount of bleeding.
A tracheotomy is necessary to improve surgical safety in cases of large hemangioma because the possibilities of bleeding from the hemangioma, technical difficulties of intubation, and laryngeal edema after operation are relatively high.
The through-the-mouth method affords only a limited field of operation. Therefore, to create a clear surgical field, we think lateral pharyngotomy is strongly recommended for removing a large hypopharyngeal hemangioma.View full abstractDownload PDF (2518K) -
Yoshiko Masuda2013 Volume 64 Issue 1 Pages 41-46
Published: February 10, 2013
Released on J-STAGE: February 25, 2013
JOURNAL RESTRICTED ACCESSWe experienced five patients in whom middle lobe atelectasis was caused by kinking of the middle lobar bronchus after right upper lobectomy. Four patients recovered with conservative treatment, while the remaining patient did not recover. To date, prevention and treatment of such kinking after right upper lobectomy have not been established. The effects of NPPV (non-invasive positive pressure ventilation) and insufflation during bronchoscopy were temporary. Although recovery time varied across patients, middle lobe atelectasis was alleviated within 4 months. This time frame may be consistent with the time required for bronchial mucosal edema improvement, and therefore the administration of steroids could have been effective in reducing recovery time. No significant difference was seen in smoking history or lung function between the recovered and non-recovered patients, but the non-recovered patient had received preoperative radiation therapy.View full abstractDownload PDF (1793K)
Glossary
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[in Japanese]2013 Volume 64 Issue 1 Pages 47-49
Published: February 10, 2013
Released on J-STAGE: February 25, 2013
JOURNAL RESTRICTED ACCESSDownload PDF (1622K)
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