Nihon Kikan Shokudoka Gakkai Kaiho
Online ISSN : 1880-6848
Print ISSN : 0029-0645
ISSN-L : 0029-0645
Volume 67, Issue 4
Displaying 1-11 of 11 articles from this issue
Original
  • Masatsugi Mitsuhashi, Keisuke Okubo, Yuichi Ikari, Mayumi Tsunoda
    2016 Volume 67 Issue 4 Pages 249-255
    Published: 2016
    Released on J-STAGE: August 25, 2016
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    In our hospital, we have been treating insufficient glottic closure due to ipsilateral vocal cord paralysis or vocal cord atrophy by injecting BIOPEX-R calcium phosphate paste into the vocal cords to achieve a medial shift. We investigated the occurrence of aspiration before and after this procedure in terms of both subjective symptoms and a variety of objective findings. We used vocal cord BIOPEX injection to treat 112 cases of ipsilateral vocal cord paralysis or vocal cord atrophy in 97 patients during the 11-year 3-month period from May 2004 to July 2015. After the exclusion of 22 cases in which a condition other than insufficient glottic closure that could clearly cause aspiration was also present, the study sample comprised 90 cases in 79 patients. Subjective symptoms of aspiration were assessed on “a five-point choking frequency scale” that we devised to rate the frequency of choking when drinking water. Objective findings were assessed by rating video recordings from videofluoroscopy (VF) on an eight-point scale. Preoperatively, 57 of 90 subjects reported subjective symptoms of choking when drinking water. Postoperatively, 49 of these 57 (86%) reported that the frequency of choking had improved on the choking frequency scale. Of 12 patients who underwent preoperative and postoperative VF, aspiration was evident on preoperative VF in 10, but postoperatively no aspiration was evident in any patient. Medial shift of the vocal cords is thus an effective surgical treatment for insufficient glottic closure due to recurrent nerve paralysis.

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  • Masayuki Tomifuji, Koji Araki, Hiroshi Suzuki, Yoshihiro Miyagawa, Shi ...
    2016 Volume 67 Issue 4 Pages 256-263
    Published: 2016
    Released on J-STAGE: August 25, 2016
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    Laryngeal necrosis is known to be a serious complication after radiotherapy or chemoradiotherapy for laryngopharyngeal cancer. Cases of laryngeal necrosis from 2006 to 2015 were reviewed and 8 cases were identified. All cases had a history of (chemo) radiation together with transoral surgery. Patients treated solely by (chemo) radiation or transoral surgery did not develop laryngeal necrosis. The larynx was preserved in 7 cases by treatment with antibiotics, steroid, hyperbaric oxygen therapy or surgical debridement. A total laryngectomy was performed in 1 case for concomitant recurrence and in 2 cases for delayed recurrence. Transoral surgery is gaining acceptance as a minimally invasive surgery; however, in cases with previous or postoperative irradiation, the surgeon should note the possibility of laryngeal necrosis and make careful observation. Even in laryngeal necrosis, larynx preservation might be possible by combination therapy including antibiotics, steroid, surgical debridement and hyperbaric oxygen therapy.

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  • Yo Kishimoto, Morimasa Kitamura, Ichiro Tateya, Seiji Ishikawa, Mami M ...
    2016 Volume 67 Issue 4 Pages 264-271
    Published: 2016
    Released on J-STAGE: August 25, 2016
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    After the approval of cetuximab for the treatment of head and neck cancer (HNC) in Japan in 2012, the number of patients who have received bioradiotherapy (BRT) using cetuximab has been increasing. Because BRT is expected to have less adverse effects compared to platinum-based chemoradiotherapy (CRT), salvage surgeries after BRT are thought to be safer and easier. However, salvage surgeries after BRT for HNC have rarely been reported and have not been well discussed.

    We have performed salvage surgeries after BRT on 3 HNC patients. One had a local recurrence of hypopharyngeal cancer and underwent a total pharyngo-laryngo-esophagectomy and right neck dissection. Another had lymph node relapses and underwent left neck dissection, and the third had a local recurrence of laryngeal cancer and underwent a total laryngectomy and right neck dissection. This third case showed severe fibrosis and impaired blood flow, ultimately resulting in an infection and delayed healing of the wound. Although it is difficult to draw any conclusion from only 3 cases, our cases suggested that salvage surgery after BRT should be performed in a manner as prudent as that after CRT.

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  • Ryohei Fujiwara, Shinya Uchino, Shiro Noguchi, Kousuke Hayamizu, Mutuk ...
    2016 Volume 67 Issue 4 Pages 272-277
    Published: 2016
    Released on J-STAGE: August 25, 2016
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    In cases of autonomous functioning thyroid nodule (AFTN), a nodular lesion in the thyroid gland autonomously secretes hormones, causing thyrotoxicosis. We investigated 63 cases diagnosed with AFTN and surgically treated at Noguchi Thyroid Clinic and Hospital Foundation between 2004 and 2013. Thyrotoxicosis was treated by surgery in all cases, and no cases of permanent or transient recurrent nerve paralysis were observed. However, there were three and four cases (5% and 6%) of permanent and transient hypoparathyroidism, respectively. An investigation of the tissue type indicated that 31 (58%) of the 53 cases of single functioning nodule were follicular adenoma, and five (50%) of the 10 cases of multiple functioning nodules were adenomatous goiter. The functioning nodule was cancerous in three cases (5%). In 15 cases (24%), the functioning nodule was benign but cancer was present. Currently, the main types of treatment for AFTN are surgery and radioiodine therapy. Taking our findings into consideration, the type of treatment suitable for each AFTN case should be carefully selected.

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Case Report
  • Etsuyo Tamura, Seiji Niimi, Yoshihiro Wada, Masahiro Iida
    2016 Volume 67 Issue 4 Pages 278-282
    Published: 2016
    Released on J-STAGE: August 25, 2016
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    Vocal changes that occur with pregnancy are referred to as pregnancy-related laryngeal disorders, and postpartum remission is considered characteristic. We report two patients in whom fundamental frequency (F0) became markedly lower with pregnancy, and failed to recover after birth. Patient 1 : A 33-year-old woman presented with markedly lower voice from about the third month of pregnancy. On examination, her F0 was 127 Hz, her vocal range was 118-511 Hz, and no organic lesions were apparent. In a test of male hormones, testosterone was within the normal range, but androsterone was about twice the normal level. When menstruation resumed 1 year later, her F0 had changed to 152 Hz and her vocal range to 141-555 Hz. Her androsterone level had also decreased to near normal. She later became pregnant and gave birth again, but experienced no change in F0. Patient 2 : A 35-year-old woman was examined for lowering of the F0 from about the sixth month of pregnancy. On presentation, F0 was 133 Hz and vocal range was 82-606 Hz. Neither patient desired aggressive treatment, so they were kept under observation. In both patients, the vocal range was about 30 semitones. This was within the normal range, but F0 decreased and shifted toward the lower limit of the vocal range. Symptoms were thought to be similar to voice masculinization from hormone-related vocal disorders, such as instability near the vocal register change during phonation.

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  • Aiko Oka, Terushige Mori, Seiichiro Makihara
    2016 Volume 67 Issue 4 Pages 283-288
    Published: 2016
    Released on J-STAGE: August 25, 2016
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    Although applications of radiation to head and neck cancers have increased, laryngeal necrosis remains a serious complication. We describe two patients who developed laryngeal necrosis after neck radiotherapy. A 67-year-old male with vocal cord cancer (clinical T3N0M0) received radiotherapy (70 Gy) with cetuximab. Five months after radiotherapy, he underwent a tracheostomy because of airway obstruction. Prior imaging was unable to differentiate between radionecrosis of the larynx and tumor recurrence, so a laryngectomy was performed. Pathological examination revealed no malignant lesions. Another patient was a 79-year-old male with cecum cancer accompanied by neck lymph node metastasis. He received neck chemoradiotherapy (66 Gy), but by 44 months later the lymph node had regrown. One month after additional radiotherapy (54 Gy) was performed, he developed dysphagia and odor from his larynx. He received hyperbaric oxygen therapy, not surgery, for radionecrosis of the larynx, because common carotid artery invasion of the lymph node tumor was suspected. The symptoms of radionecrosis disappeared temporarily, but he finally died of cancer one month later. Since differentiating between radionecrosis of the larynx and tumor recurrence is difficult, laryngectomy tends to be selected as a method of diagnosis and treatment. Conservative treatments such as antibiotics, steroids or hyperbaric oxygen therapy can be performed if the patient's physical state is not good enough to permit surgery or the patient has a strong desire to preserve his or her larynx.

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  • Hiroto Ohto, Shigeru Kasugai, Masatoshi Akutsu, Yoshimitsu Saito, Yosh ...
    2016 Volume 67 Issue 4 Pages 289-294
    Published: 2016
    Released on J-STAGE: August 25, 2016
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    The nasogastric tube (N-G tube) has become frequently used in routine medical care. Although complications caused by N-G tube insertion are rare, nasogastric tube syndrome (NGTS) causes severe complications such as bilateral vocal cord paralysis and supraglottic edema. We reported 2 cases of patients with abrupt onset of serious airway obstruction presumed to be due to NGTS, together with bibliographic considerations. Case 1 was an 83-year-old male who presented with dyspnea and stridor during medical treatment for ileus at his previous doctor. He showed adduction paralysis of the bilateral vocal cords, and we performed an emergency tracheotomy. Case 2 was a 51-year-old woman suffering from progressive stomach cancer. She presented with pyloric stenosis, and an N-G tube was inserted. After 3 days, she showed dyspnea and stridor as well as adduction paralysis of the bilateral vocal cords. We performed a tracheotomy. NGTS is a syndrome that causes sore throat, bilateral vocal cord paralysis and supraglottic edema. Infection in the posterior cricoid region caused by ulcerative lesions at the upper end of the esophagus has been implicated as a pathophysiological mechanism of this syndrome. The albumin level was very low in both of our cases, implying a severely malnourished or immunocompromised state, which may represent a high risk factor for this syndrome. After N-G tube insertion, observation of the larynx using fiberscopy is recommended especially for patients suffering from malnutrition. Whenever this life-threatening syndrome is suspected, direct vocal cord examination and removal of the tube are recommended.

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  • Kenji Kudo, Hiroyuki Sato, Tatsushi Iwagaki, Toshihiko Tochihara, Masa ...
    2016 Volume 67 Issue 4 Pages 295-302
    Published: 2016
    Released on J-STAGE: August 25, 2016
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    We herein report a case of dabigatran-induced severe esophagitis caused by compression of the esophagus by the tortuous descending aorta (dysphagia aortica). An 81-year-old woman underwent endoscopy for dysphagia. The endoscopy showed severe esophagitis with esophageal stenosis. Over the next two years, endoscopic findings indicated that esophagitis was intermittent with periods of exacerbation and periods of relative improvement. She stopped taking dabigatran without permission for several months, after which periodic endoscopy showed that esophagitis was significantly improved. Drug administration guidance, especially to elderly patients, is important. We should also pay attention to deformity of the esophageal lumen due to compression by other organs around the esophagus.

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  • Masako Shimizu, Fumiaki Matsumi, Mika Tsuruoka
    2016 Volume 67 Issue 4 Pages 303-308
    Published: 2016
    Released on J-STAGE: August 25, 2016
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    Thyroglossal duct cyst is often discovered as a midline neck mass. We experienced a case of endolaryngeal extension of a laterally located thyroglossal duct cyst requiring extraction after tracheotomy. A 37-year-old male presented neck swelling that gradually increased for ten days without dyspnea. Endolaryngeal extension of the mass was found under fiberscope. Radiologic examination showed a clear and uniform mass which was located proximal to the hyoid bone. Extractive operation was performed. Tracheostomy was recommended to avoid technical difficulties of intubation before extraction. The cyst was not connected to the hyoid bone or pharyngeal wall. Pathological examination led to a diagnosis of thyroglossal duct cyst. Moderate postoperative laryngeal swelling occurred, but improved three days postoperative. A thyroglossal duct cyst should be considered in diagnosis of laterally located cervical cysts and in cases with airway obstruction.

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  • Takeshi Watanabe, Fujinobu Tanaka, Kenichi Kaneko, Haruo Takahashi
    2016 Volume 67 Issue 4 Pages 309-313
    Published: 2016
    Released on J-STAGE: August 25, 2016
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    Cervical hematoma after blunt thyroid trauma is rare, but may induce severe respiratory distress. We report a 69-year-old woman with cerebral infarction being treated with acetylsalicylic acid, who was transferred to our hospital by helicopter ambulance (HEMS : Helicopter Emergency Medical Service) with dyspnea and cervical swelling after a fall. Endoscopic examination revealed laryngeal edema, and X-ray revealed severe stenosis of the trachea. Because of the severe laryngeal edema, she could not be intubated. Suddenly, her oxygen saturation decreased, and because standard ventilation was not possible, we elected to perform a tracheostomy. On incision of the skin, we found a massive outflow of retained blood from her neck, whereupon her oxygen saturation was instantly improved. Ultimately, nasal intubation was performed using a flexible endoscope, without resorting to a tracheostomy. Computed tomography of the neck revealed a crushed thyroid gland. She gradually recovered without complications. Cervical hematoma sometimes results in severe respiratory distress, and the decision of whether to intubate or perform a tracheostomy should be taken cautiously.

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