[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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[in Japanese]

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In the treatment of laryngeal carcinoma, in particular, vocal fold carcinoma, the question today is how to preserve the voice well. Recently, in consideration of the required period of over 6 weeks and the risk of radiation induced carcinoma, as well as improved therapeutic results, there has been a tendency to avoid radiotherapy for the vocal fold carcinoma staged T2 or under. The incidence of induced carcinoma at an ordinary therapeutic dose (60 to 70 Gy) is not very high, and considering the excellent phonatory function after radiotherapy, careful selection of indications for conservative operation (including laser surgery) as the initial treatment is need. Therefore, we must compare phonatory function after radiotherapy and after conservative surgery. For this purpose, the phonatory function in patients without recurrence after radiotherapy was compared with that of patients treated by laser surgery for recurrence after radiotherapy for a Tla lesion.

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Reconstructed vocal folds following vertical partial laryngectomy become atrophic gradually after surgery. The purpose of this paper is to clarify the cause of the above atrophy by follow-up studies. As a result, removal of the ala of the thyroid cartilage might result in atrophy of reconstructed vocal folds, together with atrophy of the filled muscle flap, since cicatricial contraction in the cervial region draw vocal folds outward. To prevent the occurrence of atrophy of the vocal folds, therefore, the authors recommended to preserve the ala of the thyroid cartilage or to reconstruct it using a cartilagenous homograft or artificial bone (ex. hydroxyl apatite).

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[in Japanese]

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Fifty-four T-E shunt voice, which is consisted of Komorn's modification and the muco-dermal method, were analyzed, Mean max. phonation time (MPT) of the former method was 18sec, while that of the latter was 17 sec. On the other hand, mean max. SPL of the former was 77 dB, while the latter was 81 dB. Three out four patients, who underwent T-G shut operation, were also analyzed. Mean MPT was 11 sec and Mean max. SPL was 70 dB. Air intake of the T-G shunt voice was weaker than the T-E shunt voice, but aspiration was not encountered in the T-G shunt. T-G shunt voice was useful for daily conversation.

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In 1986, Strome reported a new surgical procedure, Strome's T-E shunt, for speech rehabilitation following total laryngectomy, It is characterized by a mucosa-lined tracheoesophageal fistula and a ‘Sling’ for the prevention of aspiration. 4 patients were operated on with his procedure in our department. Only lout of 4 acquired speech and 2 suffered from serious aspiration to need reoperation with Voice Prosthesis. It is concluded that this procedure is difficult to reappear and not a good way for voice restoration.

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[in Japanese]

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[in Japanese]

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[in Japanese]

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Ten cases with postintubation granuloma of the larynx were reported. There were eight females and two males. They ranged in age from twenty-one to eighty years old, with a mean of forty-six. All lesions were located at the mucous menbrane of the process vocalis of the arytenoid cartilage. Seven of the patients were affected on the right side, one on the left and two on both sides, Three out of four cases with sessile granuloma complained of a sensation of foreign bodies in the throat. Three of the six cases with pedicle granuloma complained of dyspnea. In two of these cases, the sessile granulomas disappeared spontaneously, and in the others, the lesions were resected under endolaryngeal microsurgery. No recurrence of the symptoms occurred in any patient following surgery or spontaneous recovery.

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[in Japanese]

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A case of glottic stenosis after vertical hemilaryngectomy was treated by the following surgical technique: after the removal of the adhesive scar of anterior part of glottis and subglottis under laryngofissure, the defect was covered with an island cervical skin flap on the right side and grafted on by a free lower-lip mucosal flap on the left side. Fibrin glue was used for the fixation of the mucosal flap. Surgical reconstruction of anterior commissure without a stent was performed successfully by this technique. The stoma was closed two weeks after the surgery and the glottic space has remained large enough for respiration for six months since the surgery.

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[in Japanese]

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[in Japanese]

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Tracheolaryngeal stenosis induced after neck blunt injury and prolonged endotracheal intubation were cured by using laryngeal stents and tracheal T-tubes. Case 1 had laryngotracheal stenosis after neck trauma and the patient had worn a laryngeal stent for 2 months and T-tube for 4 months after correction of thyroid and cricoid fracture under the laryngofissure operation. In case 2, a granuloma was found at subglottic area in 1 month after endotracheal intubation. The patient had worn a T-tube for 3 months after resection of subglottic granuloma under the larayngofissure operation. Case 3 had both vocal cord paralysis and severe subglottal stenosis after prolonged endotracheal intubation. After widening the glottal space by reverse Woodman's operation, a rod type stent was inserted in subglottic area and then this stent was replaced step by step with a larger T-tube during 2 years. All cases were relieved from dyspnea due to laryngotracheal stenosis by using the laryngeal stent and T-tube.

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