Cervical lymphorrhea is a complication that can be encountered following head and neck surgery, but it sometimes becomes refractory and may be hard to resolve. In our facility, we managed eight cases in which lymph leak was treated by intubation of a fat-free digestive fluid diet (Peptino®). In five of these eight cases, this treatment approach was combined with wound treatment and medication therapy. Lymph leak was stopped in all cases by the administration of Peptino® for 5 to 12 days. Because of its inexpensiveness and ease of administration, we believe that administration of a fat-free digestive fluid diet (Peptino®) should actively be attempted in cases of clinically suspected cervical lymphorrhea.
We herein report two cases that were able to be treated immediately based on a diagnosis of Sjogren syndrome (SS) made by confirming atrophy or the absence of submandibular glands on computed tomography (CT). The first case was a 79-year old man with a deep cervical abscess. He did not show typical inflammatory responses, such as an elevated C-reactive protein level or white blood cell count, but we still suspected SS based on his atrophy and absence of submandibular glands on neck CT. We were able to determine his specific course because certain cytokines suppress the usual inflammatory responses in some collagen diseases. Subclinical SS (SCSS) was diagnosed following a thorough inspection. The second case was an 83-year-old woman with chronic heart failure. She was admitted to the internal medicine department because her heart failure had worsened despite diuretic administration. Aspiration pneumonia was suspected based on CT, and she was introduced to the otolaryngology department to undergo an inspection of her swallowing function and the rumbling noise in her larynx that was produced when she ate. Of exacerbation of that disease. At the same time she complained of dysphagia and was suffering from aspiration pneumonia. We suspected SS based on her dry mouth and throat and severe atrophy of the submandibular glands on CT. Her dysphagia was attributed to her severe dry mouth and throat, as her swallowing function was found to be relatively good. Her symptoms first appeared after a diuretic had been administered to treat her worsening heart failure, and they improved on stopping the diuretic; we therefore concluded that her dysphagia and aspiration pneumonia had been caused by underlying dry mouth and throat that were worsened due to drug loading. There is necessary much opportunity to interpret CT of the neck at the department of otorhinolaryngology and head and neck surgery. Atrophy of the submandibular glands may help clarify the state of the disease and suggest potential diagnoses and treatments. We emphasize the need to interpret CT findings carefully, regardless of the presence of dry mouth. We also report here that 70% of the patients with SS in our clinic showed more than severe atrophy of the submandibular glands on CT.
Langerhans cell histiocytosis (LCH) has been referred to as Histiocytosis X in the past and divided into Letterer-Siwe disease, Hand-Schüller-Christian disease, or an acidophile-related granuloma, depending on the condition; however, all of these entities are now considered LCH. This disease has characteristics of both a neoplastic disease and inflammatory disease. As LCH causes organization injury to various organs, the symptom lasts for fever, exanthem, intractable otitis media, hearing loss, many divergences including the bone ache. In the nose and throat area in particular, lesions on the cranial facial bone except for the canopy part is the central nerve risk lesion, which can result in complications affecting the central nervous systeme. We herein report a case of eyelid swelling in which a blow to the face was initially suspected, but a diagnosis of Langerhans histiocytosis was ultimately made by a biopsy of the front part of the ethmoid sinus; remission was achieved with chemotherapy.
Surgery and biopsy for laryngeal/hypopharyngeal lesions under local anesthesia by inserting a flexible endoscope nasally and forceps orally are minimally-invasive and can be performed on an outpatient basis. In our department, these are performed either by 2 medical professionals, a surgeon and an assistant, or a surgeon alone. We evaluated the efficacy and safety of this transoral laryngeal endoscopic surgery. The study included 78 patients who underwent this technique under local anesthesia at the Department of Otolaryngology, Nagasaki University Hospital between January 2015 and November 2019. The primary disease in 79 patients was laryngeal/hypopharyngeal disease (33 with tumors, 16 unilateral vocal cord paralysis, 8 vocal cord polyps, 7 laryngeal granulomas, 5 vocal cord nodules, and 10 with other). Results showed a total of 143 procedures (3 duplicates) performed, including 79 vocal cord infusions, 35 biopsies, 24 tumor resections, 4 cystotomies, and 1 laser vaporization, with 83 procedures performed by 2 medical professionals including an assistant and 57 performed by a surgeon alone, and high completion rates of 98.8% and 94.7%, respective. Complications included laryngeal edema and vasovagal reflex in one patient each ; however, both were mild. This surgical method was thus considered to be effective and safe.
We treated a 25-year-old man with multiple fractures of the cricoid cartilage due to laryngeal injury. Examinations with a flexible endoscope and computed tomography revealed subglottic stenosis and multiple fractures of the cricoid cartilage. Reconstruction surgery for the cricoid cartilage was performed as promptly as possible. We used an Alexis® wound retractor to ensure the surgical field. The larynx was opened with a vertical anterior midline cut. We identified the parts of the multiple fractures of the cricoid cartilage and then reduced the fracture of the cricoid lamina, fixing them by suturing with special needles with sutures. The needle was easy to handle, even in the narrow laryngeal cavity and did not cause the cartilage to split during suturing as the needle has no cutting edges and no thread overlap. This special needle with sutures was useful for suturing the cricoid lamina.
We report a case of adult-onset recurrent laryngeal papillomatosis that spontaneously regressed after lifestyle improvement. A 47-year-old man visited our hospital with a two-year history of hoarseness. We diagnosed him with laryngeal papillomatosis and removed the papillomatous mass of the vocal folds through a phonomicrosurgical procedure. At the same time, he started taking a traditional Japanese medicine (yokuinin [coix seed]). The tumor recurred in the bilateral vocal folds and was removed surgically each time. After the sixth operation, the tumor recurred once more, but then spontaneously shrunk and ultimately disappeared. According to the patient, soon after the sixth operation, he began diet improvement and an exercise habit for the purpose of health care. He subsequently reached an appropriate body weight and regular bowel movements and felt that his physical condition improved substantially. Spontaneous regression has sometimes occurred in patients with human papilloma virus (HPV)-associated lesions, including laryngeal papillomatosis. Host immune responses are thought to play a crucial role in the progression or regression of HPV-associated lesions. A causative role for lifestyle improvement in the tumor regression was not proven in this case, but it shows that spontaneous regression can occur in cases of adult-onset intractable recurrent laryngeal papillomatosis.
We experienced a case in which a patient showed voice improvement with voice therapy after receiving thyroplasty due to mutational dysphonia. A 41-year-old man visited our institution for mutational falsetto as a chief complaint. We also found that his voice pitch was higher than that of junior high school students. After elderly people at work had pointed out that they had difficulty hearing him, he underwent type Ⅲ thyroplasty at a different institution. However, because his voice pitch had not stabilized by three months after surgery, we performed voice therapy. He focused on humming during voice rehabilitation. Since he markedly produced mutational falsetto in the low-pitched sound training, we stabilized his voice as a slightly higher-pitched sound and then gradually helped him produce a low-pitched sound. After the voice therapy, his mutational falsetto had disappeared, and his voice pitch had stabilized at a normal speaking fundamental frequency.