Nihon Kikan Shokudoka Gakkai Kaiho
Online ISSN : 1880-6848
Print ISSN : 0029-0645
ISSN-L : 0029-0645
Volume 64, Issue 3
Displaying 1-11 of 11 articles from this issue
Original
  • Keiko Hasegawa, Shimpei Ichihara, Shuji Nishikawa, Masaaki Higashino, ...
    2013 Volume 64 Issue 3 Pages 175-181
    Published: June 10, 2013
    Released on J-STAGE: June 25, 2013
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    Acute epiglottitis sometimes causes sudden upper airway obstruction, so it is very important to manage the airway. We retrospectively reviewed the clinical findings of 91 patients with acute epiglottitis who were hospitalized and received treatment between 2001 and 2011. There were 55 men and 36 women and their ages ranged from 16 to 82 years old (median 47). Among the 91 cases we performed airway management (tracheostomy/intubation) to preserve the airway in 9 cases. We divided the 91 cases into two groups, tracheostomy/intubation and conservative therapy, in order to investigate the characteristics of each group. In the tracheostomy/intubation groups, most patients complained of dysphagia and dyspnea at the first examination. WBC count and CRP showed no significant differences between the groups. Mean duration from symptom onset to first examination was 1.6 days in the tracheostomy/intubation group and 2.4 days in the conservative therapy group. We divided the patients into three groups by laryngeal findings according to the classification of Katori et al. All patients who required airway management (tracheostomy/intubation) belonged to Stage IIIB, which shows serious edema and swelling not only of the epiglottis but also of the arytenoid region. Tracheostomy was performed in 8 cases, including 6 under local anesthesia. Inevitably, laryngeal findings are the most important factor for determining the indication of tracheostomy. However, symptoms and patient history are also helpful for determining airway management.
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  • Asanori Kiyuna, Hiroyuki Maeda, Noritomo Kise, Asano Higa, Hidetoshi K ...
    2013 Volume 64 Issue 3 Pages 182-188
    Published: June 10, 2013
    Released on J-STAGE: June 25, 2013
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    Laryngeal granuloma is a space-occupying lesion due to nonspecific inflammation in the larynx. It usually appears at the posterior portion of the vocal cord, especially at the vocal process of arytenoid cartilage. Although tracheal intubation, cough, acid reflux, or vocal abuse might be causes for developing laryngeal granuloma, the precise cause in individual cases is not always clear. A number of treatments have been tried for laryngeal granuloma, but we have often experienced cases that show no clear response to conventional treatment. In the present study, the treatment courses in 30 cases were analyzed retrospectively to evaluate treatment efficacy.
    Various treatments were selected depending on the lesion condition. The overall cure rate of laryngeal granuloma was 69.6%, a figure consistent with previous reports. There were several cases that resisted conventional treatment but that were subsequently successfully treated by voice therapy. The findings in the present study suggest that control of acid reflux in combination with voice therapy including voice hygiene, is effective for laryngeal granuloma accompanied by vocal abuse or hypertonic phonation.
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  • Takashi Taniyama, Tomonori Sugiyama, Mamika Araki, Kouhei Fukukita, Hi ...
    2013 Volume 64 Issue 3 Pages 189-193
    Published: June 10, 2013
    Released on J-STAGE: June 25, 2013
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    We reviewed 58 cases of emergent tracheotomy. Twenty-two cases demonstrated inflammatory disease, 16 cases demonstrated tumor disease and 13 cases demonstrated bilateral recurrent laryngeal nerve paralysis (RLNP).Operations were performed in the operating room on 53 patients, whereas with five patients we had no margin to take them to the operating room, so their operations were performed in their ward or the emergency room. These operations took 18.6 minutes to perform on average. Postoperative complications occurred in 3 cases. These were 2 cases of aerodermectasia and 1 case of mediastinal emphysema and pneumothorax caused by inappropriate operation involving intratracheal intubation. Emergent tracheotomy is more difficult than elective tracheotomy, so head and neck surgeons should have thorough knowledge about local anatomy and sufficient surgical technique.
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  • Shigeyuki Murono, Tomokazu Yoshizaki
    2013 Volume 64 Issue 3 Pages 194-198
    Published: June 10, 2013
    Released on J-STAGE: June 25, 2013
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    Unilateral recurrent laryngeal palsy frequently affects quality of life in thyroid cancer patients. Medialization thyroplasty (MT) including type I thyroplasty and arytenoid adduction is often attempted to improve hoarseness. We evaluated perceptual voice assessment before and after MT using two questionnaires, the voice-related QOL questionnaire (V-RQOL) and the voice handicap index-10 (VHI-10), in 14 patients. With regard to the V-RQOL, in which the best and the worst scores are 100 and 0, respectively, the average score significantly improved from 30.6 preoperatively to 68.4 postoperatively (p<0.01). With regard to the VHI-10, in which the best and the worst scores are 0 and 40, respectively, the average score significantly improved from 23.4 preoperatively to 13.2 postoperatively (p<0.01). Furthermore, average maximum phonation time also significantly improved from 3.3 seconds to 10.6 seconds (p<0.01). These results indicate that MT achieves acceptable voice satisfaction in patients with unilateral recurrent laryngeal palsy due to thyroid cancer.
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  • Akiteru Maeda, Shunichi Chitose, Hirohito Umeno, Buichiro Shin, Takeha ...
    2013 Volume 64 Issue 3 Pages 199-205
    Published: June 10, 2013
    Released on J-STAGE: June 25, 2013
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    In this report, we reviewed the clinical records of 5 cases (4 males and 1 female) of head and neck tumor (3 hypopharyngeal cancer and 1 papillary thyroid cancer, 1 malignant peripheral nerve sheath tumor) who underwent reconstruction of the carotid artery at Kurume University Hospital between 2000 and 2012. The ages of the patients ranged from 38 to 75 years. The 5-year survival rate of the 5 cases averaged to 50%. Aspiration and recurrent laryngeal nerve palsy occurred postoperatively in 4 cases and Horner sign occurred postoperatively in 3 cases. Cerebral infarction occurred postoperatively in 1 case. As prognoses, 4 cases were alive and 1 case died by neck recurrence. Although the prognosis of head and neck tumor patients with carotid artery reconstruction is generally poor, we intend to address such cases proactively in a quest to provide better local control.
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Case Report
  • Takao Goto, Shingo Takano, Niro Tayama
    2013 Volume 64 Issue 3 Pages 206-211
    Published: June 10, 2013
    Released on J-STAGE: June 25, 2013
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    We experienced a case of interarytenoid adhesion after tracheal intubation. A 39-year-old woman was intubated due to anaphylactic shock. Eight days later, laryngoscopy showed granulomas of the vocal processes and bilateral vocal cord paralysis, and as a result tracheostomy was performed 15 days after the intubation. Approximately 1.5 months later, interarytenoid adhesion was found. When the vocal cords were abducted, the adhesion was pulled;therefore we assumed that the vocal cords would not adhere again only by excising the adhesion. Under general anesthesia, the adhesion was excised. Vocal cord mobility improved and 1 month after the operation the tracheostoma was closed.
    We assume that the cause of vocal cord palsy was recurrent nerve paralysis or inflammation of the cricoarytenoid joint because the palsy recovered naturally. We suppose that the vocal cords adhered around the granulations, since glottic stenosis owing to disorder of vocal cord movement and granulation of vocal cords existed simultaneously.
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  • Kenichi Watanabe, Yuuri Okumura, Koji Hozawa
    2013 Volume 64 Issue 3 Pages 212-218
    Published: June 10, 2013
    Released on J-STAGE: June 25, 2013
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    The majority of vascular anomalies which arise in the head and neck regions in adults are venous malformations (VMs). In this study, we performed a 5-year retrospective review in our department to evaluate the efficacy of potassium titanyl phosphate (KTP) laser surgery for hypopharyngolaryngeal VMs. Eight patients who had undergone laryngoscopic KTP laser surgery under general anesthesia were enrolled. There were 7 males and 1 female, the mean age at first treatment was 63.8 years, 4 cases were in the larynx and 4 in the hypopharynx, and the mean longest diameter of the pathological region on an image was 16.3 mm. Patients were treated by resection (3 cases) or photocoagulation (5 cases) ; subsequently, only one of the photocoagulated cases has recurred, two years later, and it was re-treated by resection. The resection therapy, due to its features regarding dissection and hemostasis, tended to be carried out when the pathological regions were smaller or could be reached by rigid laryngoscope. On the other hand, photocoagulation therapy was useful given its feature of preferential absorption by hemoglobin, which resulted in a lower risk of operative hemorrhage;hence, it can be used for palliative treatment for extremely large VMs that are impossible to remove. Because neither postoperative hemorrhage nor severe edema in the surgical field occurred, no patient required emergency airway treatment such as endotracheal intubation or tracheostomy. KTP laser surgery is a feasible and relatively safe treatment for hypopharyngolaryngeal VMs in adults.
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  • Keisuke Mizuta, Yusuke Naito, Keiichi Izuhara, Takesumi Nishihori, Bun ...
    2013 Volume 64 Issue 3 Pages 219-223
    Published: June 10, 2013
    Released on J-STAGE: June 25, 2013
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    We experienced a case of tracheoesophageal fistula associated with tracheal stenosis after tracheostomy. The case was a 15-year-old male. Tracheostomy was performed for disturbance of consciousness after a traffic accident. The tracheostomy cannula was removed, but because of repeated pneumonia, swallowing training had been carried out for suspected aspiration. Tracheal stenosis was noted by CT, but tracheoesophageal fistula and aspiration were absent by esophagram. We performed tracheal stenosis removal and T-tube retention, and during this surgery a tracheoesophageal fistula was observed in the narrow segment of the trachea. The left wall and posterior wall of the trachea were exfoliated from the surrounding tissues, and the local flap was translocated to between the trachea and esophagus so as to cover the site of the tracheoesophageal fistula. Suture of the fistula was carried out again after the surgery. The T-tube was removed after 1 year. Tracheal stenosis and pneumonia did not recur.
    Tracheoesophageal fistula after tracheostomy is relatively rare. If aspiration is suspected in the history, we should plan surgery for tracheal stenosis assuming the presence of a tracheoesophageal fistula even if there are no positive findings.
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  • Masanori Teshima, Shigemichi Iwae, Yuji Hirayama, Hirotaka Shinomiya, ...
    2013 Volume 64 Issue 3 Pages 224-230
    Published: June 10, 2013
    Released on J-STAGE: June 25, 2013
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    Brown tumors are rare focal giant-cell lesions that arise as a direct result of the action of the parathyroid hormone (PTH) on bone tissue in patients with hyperparathyroidism. A 43-year-old woman was referred to the Department of Orthopedic Surgery at Hyogo Cancer Center with a complaint of swelling and pain in her right patella. Multiple cystic lesions were found in this area, and she underwent curettage of the bone lesions. Pathological findings showed a giant cell-like tumor. Postoperative examinations revealed that the patient had a very high serum calcium level, a high PTH level, and a tumor in the left lower portion of the thyroid gland. The neck tumor was examined at the Department of Head and Neck Surgery. The findings suggested that the patient had primary hyperparathyroidism with a brown tumor. We performed total thyroidectomy and parathyroidectomy. Pathological findings indicated papillary carcinoma and parathyroid adenoma. In this case, brown tumor was diagnosed on the basis of the clinical features, blood biochemical determinations, and pathological findings. A diagnosis of brown tumor should be considered when a patient presents with hypercalcemia and multiple bone tumors due to primary hyperparathyroidism.
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