Vocal function following CO₂ laser surgery was evaluated in 6 patients from whom various amounts of vocal fold tissue had been removed. Phonatory function was examined by means of ultra high speed photography, aerodynamic tests, psychoacoustic evaluation and sound spectorography. The results are summarized as follows: 1) When a part of the unilateral or bilateral vocal ligaments was removed, phonatory function was almost normal. 2) When the entire unilateral vocal fold was removed or when both vocal ligaments on the one side and a part of the vocalis muscle on the other side were removed, phonatory function was somewhat disturbed. However, there was no serious problem in normal conversation. 3) In a case where the vocalis muscle on the bilateral vocal folds was removed, an incomplete glottal closure was observed and phonatory function was severely disturbed.

抄録全体を表示

Fifty specimens of carcinoma of the hypopharynx obtained by laryngopharyngectomy were histopathologically studied by whole organ sections. Of the 50, 41 were pyriform sinus (PS), 5 were postcricoid (PC) and 4 were posteior wall (PW) carcinomas. The results were as follows: 1. Involvement of the laryngeal cartilages was observed most frequently in the thyroid cartilage, which was first invaded around the posterior upper 2/3 edge. 2. Intralaryngeal invasions usually arose via the paraglottic space. 3. Carcinomas on the medial wall of the pyriform sinus spread into the laryngeal structures along the muscular process of the arytenoid cartilage. 4. Paraglottic space involvement at the false fold level with massive invasion of the upper aspect of the arytenoid cartilage could cause fixation of the hemilarynx in PS carcinomas. 5. Invasions into the posterior cricoarytenoid muscle and/or recurrent laryngeal nerve caused vocal fold fixation in PC carcinomas. 6. Conservation surgery could have been indicated in 18 of the 50 cases.

抄録全体を表示

In order to decide the feasibility of conservation surgery in hypopharyngeal carcinoma, an accurate preoperative determination of involvement into various laryngeal structures is necessary. Twenty-two cases of hypopharyngeal carcinoma were investigated to evaluate the preoperative diagnostic accuracy of determination of the extent of laryngeal involvement by comparing preoperative CT and inspection with corresponding histopathological findings of whole organ serial section study after total laryngopharyngectomy. The results were summerized as follows: 1) Estimation of the involvement into laryngeal cartilages by CT was difficult. Most incorrect readings were false positives due to overestimation. 2) Invasions into thyroarytenoid, cricothyroid, lateral cricoarytenoid and interarytenoid muscles were detected relatively easily, but those of the posterior cricoarytenoid muscle were difficult to determin by CT. For the estimation of the involvement into the interarytenoid and posterior cricoarytenoid muscles, inspection proved more useful than CT. 3) Invasion into the paraglottic space was easily detectable by CT, but at the glottic level, it was difficult to detect by inspection. In the preepiglottic space, some false positive cases were observed with CT, but it was almost possible to determine the invasion by inspection. 4) In the aryepiglottic fold, there were some false positive diagnoses with CT. Inspection was more accurate than CT. 5) It was possible to predict the invasion into the recurrent laryngeal nerve by CT.

抄録全体を表示

Fourty laryngectomy specimens were histopathologically studied by serial sections. The following results were obtained: 1. The incidence of carcinomatous invasion of the thyroid cartilage was 55%, and that of the cricoid cartilage was 35% in glottic carcinomas. The incidence of frame-work invasion was closely related to the extension to the subglottic region. 2. Invasions of laryngeal frame-wark were observed at the anterior commissure and lower portions of the thyroid cartilage and the upper portion of the cricoid cartilage. 3. In half of the cases of anterior commissure involvement, thyroid cartilage invasion at the anterior commissure was observed. 4. Fixation of the vocal fold in glottic carcinoma was accounted for by carcinomatous invasion into three fourths or more of the thyroarytenoid muscle. Impairment of the vocal fold movement was accounted for by carcinomatous invasion into three fourths or less of the thyroarytenoid muscle. 5. In cases concerning involvement of both vocal folds, conservation surgery should be indicated only in those in which the carcinoma lesion of the contralateral side is superficial.

抄録全体を表示

Macroscopic and histopathological studies were done of 30 cases of supraglottic carcinoma obtained by total laryngectomy. Similarities and differences between macroscopic and histopathological studies were investigated to identify more precisely the indications for conservative surgery. The results were as follows: 1) There was a standard similarity and considerable relationship between macroscopic and histopathological studies. 2) After macroscopic study, 26 of the 30 cases could be considered as candidates for conservative surgery, but after the histopathological study, only 20 of the 30 could be so treated. The problems between macroscopic and histopathological studies were as follows: a) To infer the invasion on thyroid cartilage, when cancer extended to the anterior commissure. b) To infer the invasion on the thyroarytenoid muscle or arytenoid region, when the vocal fold movement was inhibdited or fixed and to judge the conservation of vocal folds.

抄録全体を表示

53 cases of carcinoma of the tongue were clinicopathologically studied by whole organ sections. The following results were obtained: 1. There was a direct relation between the size and depth of the primary lesion of tongue cancer. 2. In cases of primary recurrence, the depth of invasion was larger than in new cases. Perineural invasion was observed in all cases. 3. Perineural invasion is an important factor in primary recurrence. 4. Incidence of cervical metastasis is closely related to the size and depth of the primary lesion. The incidence of cervical metastasis is high, particularly in cases of perineural invasion.

抄録全体を表示

The diagnostic value of CT images for finding the extent of hypopharyngeal cancer was evaluated by comparing preoperative CT images with their corresponding slices of extirpated specimens in 11 cases. For this purpose, the following 4 factors were examined; (1) demonstration of submucosal extension of the tumor on CT images,(2) invasion into laryngeal cartilages,(3) invasion into laryngeal muscles and paraglottic space as possible cause of vocal cord fixation, and (4)extraluminal spread. The results were as follows; 1. It was relatively easy to identify the extent of the tumor into the submucosal fibrofatty tissue except when the tumor extended near to the laryngeal ventricle, which contains many mucous glands and is usually depicted as a somewhat dense shadow. 2. When the margin of the ossified cortex of the thyroid cartilage was irregular and surrounded by tumor shadow, or when the margin of the cricoid cartilage which was in contact with tumor shadow was irregular and accompanied by increased medullary concentration, the invasion of the tumor into these cartilages was histopathologically demonstrated. However, tumor extension next to these ossified cartilages did not indicate histopathological invasion of the tumor whenever their margins were smooth and regular. On the other hand, it was extremely difficult to estimate the invasion of tumor into these cartilages unless they were sufficiently ossified. 3. Each intrinsic laryngeal muscle and the inferior pharyngeal constrictor muscle were identified on CT images, and tumor extent into these muscles was well correlated to histopathologically demonstrated tumor invasion. CT images in cases with vocal cord fixation showed tumor extension either into (1) paralaryngeal space,(2) both paralaryngeal space and thyroarytenoid muscle or (3) both paralaryngeal space and posterior cricoarytenoid muscle. 4. Extraluminal spread through the thyrohyoid membrane was demonstrated on CT images as distinctive shadows in the visceral space that surrounds the hypopharyngeal cavity. The evaluation of CT images of tumor invasion either into the submucosal layer, into muscles or into laryngeal cartilages, was often overestimated mainly because it was not possible to exactly discriminate between the tumor shadow and the surrounding fibrosis. However, the author considers that this overestimation may help to decide safer excision levels for this unexpectedly malignant tumor.

抄録全体を表示