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[in Japanese]
1993 Volume 39 Issue 2Supplement1 Pages
251
Published: March 25, 1993
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Shinobu IWAMURA
1993 Volume 39 Issue 2Supplement1 Pages
252-255
Published: March 25, 1993
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In 1981 further modification of a Weerda distending type of a direct laryngoscope was initiated and now completed 10 years later. The greatest length of the upper spatula of the new opening and closing type of a direct laryngoscope is 155mm while the lower spatula is 113mm long. The proximal orifice of the laryngoscope is 31mm wide horizontally and 16mm long vertically on closure of both spatulas. The vertical dimension created by the upper and the lower sputulas when being opened up to the maximum point is 36mm long so as to permit a phonosurgeon or an endoscopist to appreciate direct access to greatly wider surgical fields of the larynx, including the subglottis, the true vocal folds, the ventricles, the false vocal folds, the arytenoid bodies, the aryepiglottic folds and the interarytenoid space. A laser beam, when indicated, is utilized through this widely opened laryngoscope with safety. Every smoke is automatically suctioned away through a piece of metal canal which is attached inside the laryngoscope. A new supporting system of the opening and closing type of a direct laryngoscope is also developed.
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[in Japanese], [in Japanese], [in Japanese]
1993 Volume 39 Issue 2Supplement1 Pages
256-258
Published: March 25, 1993
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[in Japanese], [in Japanese], [in Japanese], [in Japanese]
1993 Volume 39 Issue 2Supplement1 Pages
259-263
Published: March 25, 1993
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1993 Volume 39 Issue 2Supplement1 Pages
264
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Hisayoshi KOJIMA, Koichi OMORI, Kazuhiko SHOJI
1993 Volume 39 Issue 2Supplement1 Pages
265-266
Published: March 25, 1993
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Free mucasal transplantation was performed for a case of glottic and subglottic stenosis. After the larynx was exposed using a laryngofissure technique, the scar was removed and mucosa from lip was sutured onto the raw surface with the use of human fiblin glue. The larynx was successfully reconstructed without a stent placed. The adhesive properties of human fiblin glue were helpful for precise suturing procedure as well as for stabilization of the free mucosal flap.
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1993 Volume 39 Issue 2Supplement1 Pages
267-268
Published: March 25, 1993
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Ikuro MORIKAWA, Hiroshi WATANABE, Junichi FUKAURA, Kuniyoshi TSUDA, Mi ...
1993 Volume 39 Issue 2Supplement1 Pages
269-272
Published: March 25, 1993
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A grade, extent or complexity of laryngeal traumas is variable. Therefore, how to cure by phonosurger-y seems to one of key factors about complete functional curability. However, all injured cases would be analyzed in two type of injury. One of injury involving the laryngeal framework and other of injury involving the intralaryngeal cavity. These findings lead us to a destination of treatment of individual and variable independent applied way of phonosurgery. In this study, beforementioned typical two subjects with laryngeal injury were cured via individual most profitable approach of both an extraframework reposition and an intralaryngeal repair. These results were successful from phoniatric aspects.
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[in Japanese]
1993 Volume 39 Issue 2Supplement1 Pages
273
Published: March 25, 1993
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
1993 Volume 39 Issue 2Supplement1 Pages
274-276
Published: March 25, 1993
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[in Japanese]
1993 Volume 39 Issue 2Supplement1 Pages
277-278
Published: March 25, 1993
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1993 Volume 39 Issue 2Supplement1 Pages
279
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Gentaro MIZOJIRI, Yuko SHIBA, Toshitsugu NOZAKI, Tetsuo HOSHINO, Kozo ...
1993 Volume 39 Issue 2Supplement1 Pages
280-285
Published: March 25, 1993
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We observed 66 cases of polypoid vocal cord and some cases of vocal cord edema correlated with laryngeal cancer. Conclusions are as follows.
1. Almost all patients of polypoid vocal cord were over 40 years of age, smoker, and vocal abuser.
2. Histopathological findings of polypoid vocal cord were characteristic with epithelial hyperplasia and dysplasia, and subepithelial edema. inflammatory cell infiltration, telangiectasia and increasing of connective tissue.
3. Vocal cord edema on irradiated larynx had a tendency to disappear spontaneously.
4. Polypoid vocal cord didn't disappear spontaneously.
5. Circulatory disturbance of the vocal cord makes a vicious circle and causes polypoid vocal cord.
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Tetsuji YOSHIDA, Minoru HIRANO
1993 Volume 39 Issue 2Supplement1 Pages
286-290
Published: March 25, 1993
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Phonatory function following no smoking period for longer than two months was evaluated in 6 patients who had been diagnosed the polypoid vocal fold with Yonekawa classification type I. The results are summarized as follows: 1) Habirual FO (Pitch) tended to be high and FO range tended to be wide in aerodynamic tests. 2) Grade and rough factor of hoarseness were improved in psychoacoustic evaluation. 3) Amplitude of bilateral vocal folds became normal in stroboscopic examination. 4) The edematous lesions of bilateral vocal folds were markedly improved in fiberscopic finding of the larynx. Therefor, in a case with slight edematous lesions of the polypoid vocal fold, follow up with only no smoking is available at least for two months.
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A comparison between rapid voice recovering group and gradual voice recovering group after surgery
Ikuro MORIKAWA, Junichi FUKAURA, Hiroshi WATANABE, Takemoto SHIN
1993 Volume 39 Issue 2Supplement1 Pages
291-296
Published: March 25, 1993
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Almost all patients of polypoid vocal cord are treated surgically at our hospital, and half of these patients were reduced their voice to clear within a few weeks after surgery (rapid voice recovering group), but a few months are necessary for the rest patients (gradual voice recovering group). We compare these two groups, by some clinical parameters and report. Over 60 years patients belong to the gradual group except one patients and all of 40s patients belong to the rapid group. More than half of patients of unilateral lesions or Yonekawa' type I, II belong to the rapid group. Although, regarding to pre-surgical voice examinations, these are no difference between two groups.
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Toko TATEHARA, Kenzo INOUE, Gentaro MIZUOJIRI, Yuko SHIBA, Hiroyuki FU ...
1993 Volume 39 Issue 2Supplement1 Pages
297-302
Published: March 25, 1993
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We recently conducted a clinical, statistical study of the etiology of Reinke's edema. This study endorsed the previous finding that the onset of this disease closely correlates with smoking. Analysis of pathological changes of the vocal fold tissue after burn allowed us to propose a hypothesis that Reinke's edema occurs when chronic stimulation after burn disturbs lymph circulation in the burninjured vocal fold tissue.
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[in Japanese], [in Japanese], [in Japanese]
1993 Volume 39 Issue 2Supplement1 Pages
303-304
Published: March 25, 1993
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1993 Volume 39 Issue 2Supplement1 Pages
305-307
Published: March 25, 1993
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1993 Volume 39 Issue 2Supplement1 Pages
309-310
Published: March 25, 1993
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Hiroyuki YAMASHITA, Hiroshi MIYAZAKI, Sohtarou KOMIYAMA
1993 Volume 39 Issue 2Supplement1 Pages
311-313
Published: March 25, 1993
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Six in-patients with dysphagia of neurogenic origin were studied. All patients underwent cricopharyn. geal myotomy. Manometry using four micro-tip transducers was performed bofore and after surgery. Comuputed analysis of swallowing pressure displayed propagation of pharyngeal peristaltic waves to PE junction and cervical esophagus. All pharyngeal peristaltic waves were propagated to PE junction. Disappearance of peristaltic waves were observed in cervical esophagus of three patients. Manner of propagation of peristaltic waves were indifferent to severity of dysphagia and the results of cricopharyngeal myotomy.
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1993 Volume 39 Issue 2Supplement1 Pages
314-315
Published: March 25, 1993
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[in Japanese]
1993 Volume 39 Issue 2Supplement1 Pages
316-317
Published: March 25, 1993
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Hiroshi WATANABE, Takemoto SHIN, Koichi MATSUO, Tadatsugu MAEYAMA, Iku ...
1993 Volume 39 Issue 2Supplement1 Pages
319-325
Published: March 25, 1993
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The pectoralis major myocutaneous flap (M-C flap) was applied for the immediate repair of defects from excisions of tongue and oral floor cancers. Applicable number of patients with M-C flap was 8 out of 21 (38%) for tongue cancer and 3 out of 7 (43%) for oral cancer. Histopathological and three dimensional analysis using computed tomography clarified the efficacy of the adipose tissue degeneration from the muscle layer of the M-C flap. Furthermore, thickness of degenerated M-C flap resulted in fatty changes doesn't always decrease after postoperatve one year or more. Elasticity of degenerated adipose tissue from a part of the muscle layers has mobility of the tongue improved.
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Kiminori SATO, Yasunao KUROIWA, Hidetaka MATSUOKA, Tetsuji YOSHIDA, Mi ...
1993 Volume 39 Issue 2Supplement1 Pages
326-328
Published: March 25, 1993
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Postsurgical dysphagia were investigated in 43 patients who had underwent an extensive oral cancer surgery. Patients who had had hemiglossectomy without reconstruction ate normal food. Among patients who had had hemiglossectomy with tongue base resection, two-third ate gruel and one-third ate normal food. Patients who had underwent two-to three-quater glossectomy or that with tongue base resection ate gruel. Patients who had had near-total or total glossectomy ate gruel or liquid. The degree of dysphagia became worse in patients who had underwent near-total or total glossectomy with tongue base resection.
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1993 Volume 39 Issue 2Supplement1 Pages
329
Published: March 25, 1993
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[in Japanese], [in Japanese], [in Japanese], [in Japanese], [in Japane ...
1993 Volume 39 Issue 2Supplement1 Pages
330-334
Published: March 25, 1993
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Koji FUKUI, Toshihiro MORI, Hiroshi OKAMURA, Shoko INAKI
1993 Volume 39 Issue 2Supplement1 Pages
335-340
Published: March 25, 1993
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Swallowing functions of two cases of partial laryngectomies were investigated by pharyngo-esophagofluorography and manometry. In a case of supraglottic laryngectomy, laryngeal elevation and cricopharyngeal myotomy were undergone to prevent aspiration. In the early stage of postoperative course, the posterior movement of the tongue base was diminished and lingual-laryngeal contact was not tight, so aspiration was observed in the ascending stage of the larynx. However, as the posterior movement of the tongue base was spontaneously improved, lingual-laryngeal contact became tight and aspiration was prevented. In a case of frontolateral laryngectomy, who had cricopharyngeal myotomy, laryngeal elevation tended to be delayed, and therefore aspiration was observed in the ascending stage of the larynx. In both cases, no aspiration was observed in the descending stage of the larynx. The cricopharyngeal myotomy was indispensable for prevention of aspiration in the descending stage of the larynx.
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1993 Volume 39 Issue 2Supplement1 Pages
341
Published: March 25, 1993
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The change of swallowing pressure with the recovery of dysphagia
Yukio OHMAE, Tetuzo INOUE, Satosi KITAHARA, Masami OGURA
1993 Volume 39 Issue 2Supplement1 Pages
342-347
Published: March 25, 1993
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The purpose of this paper is to investigate improvement of swallowing function manometrically following conservative therapy. The swallowing pressure were recorded simultaneously with four microsensores, spaced at 2.5cm intervals, at oropharynx, middle and low part of hypopharynx, and pharyngoesophageal levels. This method is useful for evaluating the swallowing function through pressure change in respect to time. The nearly normal patterns of swallowing pressure were observed in the cases that recovered the swallowing function.
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[in Japanese], [in Japanese], [in Japanese], [in Japanese]
1993 Volume 39 Issue 2Supplement1 Pages
348
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[in Japanese]
1993 Volume 39 Issue 2Supplement1 Pages
349-350
Published: March 25, 1993
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Toshihiro MORI, Kohji FUKUI, Hiroshi OKAMURA, Shoko INAKI
1993 Volume 39 Issue 2Supplement1 Pages
351-356
Published: March 25, 1993
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Three patients with polymyositis and a patient with dermatomyositis are presented. Every case of the former polymyositis group had the following characteristics; 1) an emaciated old woman, 2) complaining only of a severe dysphagia of slow onset, 3) the failure of passive dilatation of the esophageal inlet in spite of the normal relaxation of the cricopharyngeal muscle, and 4) a marked improvement of dysphagia by cricopharyngeal myotomy. The latter man with dermatomyositis complained of dysphagia of sudden onset during administration of steroid for skin eruption and muscle pain. The most notable finding of this case as to pharyngeal dysphagia was a laryngeal penetration due to the failures of laryngeal elevation and closure which were caused by the weakness of the thyrohyoid muscle.
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[in Japanese], [in Japanese], [in Japanese]
1993 Volume 39 Issue 2Supplement1 Pages
357-359
Published: March 25, 1993
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1993 Volume 39 Issue 2Supplement1 Pages
360
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Hironobu SATO, Isao MURAYAMA, Kiyomi SUDA, Keio SOU, Joji OOTUKI, Naoh ...
1993 Volume 39 Issue 2Supplement1 Pages
361-363
Published: March 25, 1993
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Evaluation of esophagitis with Gastro-esophageal reflex was made by endoscopic ultrasonography. In patient with reflux esophagitis, there is variable findings on the third and forth layers of the esophageal wall by the endoscopic ultrasonography. These findings revealed the fibrosis of submucosal and muscle layers by hisological study in resected cases. The reflux esophagitis was classified in three types by the endoscopic ultrasonography.
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Tsuyako FUKUYAMA, Toshirou UMEZAKI, Toshiaki MATSUSE, Shinji OOTANI, T ...
1993 Volume 39 Issue 2Supplement1 Pages
364-367
Published: March 25, 1993
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An evaluation procedure for the functional laryngeal sensory system has not been established, as yet. In this paper, we have recorded a sensory evoked potential elicited by electrical stimulation of the SLN reflection of activities in the brain stem and cortex in anesthetized cats. This evoked potential was named LSEP (Laryngeal Sensory Evoked Potential). LSEP was mainly composed of four components, N1, N2, N4 and N12. The peak latencies of these components were as follows; N1: 1.09±0.18 msec, N2: 1.93±0.19 msec, N4: 3.97±0.19 msec and N12: 12.07±0.75 msec. And the origin of these components were identified as follows; N1: nodosa ganglion, N2: pre synaptic potentials of the NTS, N4: NTS complex including post synaptic potentials and N12: activity of the front-orbital gyrus. LSEPs were also recorded at the scalp, not only by the stimulation of the SLN but also of the laryngeal mucosa. These results suggest that monitoring of LSEPs can serve as a clinically applicable method for evaluating the function of the laryngeal sensory pathway.
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Hiroshi WATANABE, Takemoto SHIN, Tadatsugu MAEYAMA, Toshiro UMEZAKI, T ...
1993 Volume 39 Issue 2Supplement1 Pages
368-380
Published: March 25, 1993
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Maximum rapid dry swallows constitute an easy and non-invasive procedure for subjects with swallowing disorders. Rapid dry swallowing tests using a phonato-functionary apparatus were performed. When defining the borderline of normal limits, twenty three healthy volunteer subjects, 14 males and 9 females, ranging in age from 7 to 82 years (mean=41.8, SD=23.2), were recruited, The results were as follows. The mean swallow to swallow interval was 3.0±0.8 sec. An extension of this time interval beyond 4.0 sec was considered to be an abnormal value. Lowering the peak pressure below 10cmH
2O, as measured in the oral cavity, was also considered to be an abnormal value. When evaluating subjects with deglutitive problems, both interval time between swallows and peak pressure were determined to be important factors. Dysphasias occurring in postoperative patients following resection of the tongue, oral floor, mesopharynx and/or hard palate and neurological disorders relevant to the 3, 7, 9, 10th and 12th cranial nerves were tested by this method, which proved to be useful means for evaluating such cases.
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Improvement of the Function with Administration of Tensilon
Toshihiro MORI, Hiroshi OKAMURA, Shoko INAKI, Koji FUKUI
1993 Volume 39 Issue 2Supplement1 Pages
381-386
Published: March 25, 1993
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In three patients with Myasthenia Gravis, who complained of mild dysphagia only, the improvement of swallowing function with administration of tensilon was evaluated by means of pharyngoesophageal fluorography and manometry. In case 1, aspiration during laryngeal elevation was eliminated by an accelerated laryngeal elevation. In case 2, aspiration at the end of the pharyngeal phase was eliminated by an extended range of anterosuperior motion of the larynx. And in case 3, a time of pharyngeal phase was shortened from 1.20 second to 0.93 second by improved movements of all the components participating in oropharyngeal swallowing. The intraluminal swallowing pressure in the velopharynx was also raised up in all three patients. A pair of these clinical measurements was usefull to decide wheather the tensilon test was positive or not.
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Shoko INAKI, Hiroshi OKAMURA, Toshihiro MORI
1993 Volume 39 Issue 2Supplement1 Pages
387-391
Published: March 25, 1993
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A infant with cricopharyngeal dysphagia was reported. The patient developed swallowing difficulty with dyspnea, cough and vomiting after birth. Radiologic examination for swallowing showed cricopharyngeal impression, nasal regurgitation and aspiration. The patient was fed for 10 months through a nasogastric tube. Swallowing function improved gradually with the development of age. The methods of diagnosis and treatment of cricopharyngeal dysphagia were discussed with special reference to radiologic assessment for infant with dysphagia. The authors emphasized the necessity of careful radiologic assessments for infants.
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[in Japanese], [in Japanese], [in Japanese], [in Japanese]
1993 Volume 39 Issue 2Supplement1 Pages
392-394
Published: March 25, 1993
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Niro TAYAMA, Masashi SUGASAWA, Masahiro MIZUNO, Seiji NIIMI, Hajime HI ...
1993 Volume 39 Issue 2Supplement1 Pages
395-398
Published: March 25, 1993
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This report presents a new method of laryngeal closure under laryngomicrosurgery to control misdeglutition. Silicone gel (Fycone 6600, Fx82®) was injected into the bilateral vocal cords to close the glottis, combining the application of fibrinogen (Beriplast P®) after removing the glottic mucosa. This technic was applied for six poor risk patients with severe aspiration and good outcome was obtained. Altough various surgical methods were reported for the treatment of misdeglutition, most of these are performed by the external approach under general anesthesia and are not suitable to undergo forthe poor risk patients with severe underlyning diseases. The authors emphasize that this method is a simple and safe technic especially for poor risk patients with aspiration.
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[in Japanese], [in Japanese], [in Japanese], [in Japanese]
1993 Volume 39 Issue 2Supplement1 Pages
399-402
Published: March 25, 1993
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