New technology for diagnostic laryngo-endoscopic systems has been developed in the field of laryngology. A computer integrated laryngo-videostroboscope system has been manufactured to precisely visualize vocal fold vibration. Although this system provided distinct slow-motion dynamic images of quasi-periodic vocal fold vibration, aperiodic vibration could not be visualize with laryngo-videostroboscopy. High-speed digital imaging system appears to be useful for this condition. Electronic videoendoscopy with a single-plate RGB sequencing method has also been applied to precisely observe laryngeal lesions; however, the laryngostroboscope cannot connect with this system. Advantages and disadvantages of these systems are discussed here.
This study investigated 54 cases of supraglottic carcinoma treated between 1982 to 1997 at our institute. The aims of present study were to review recurrent cases with supraglottic carcinoma and to study the problem of regional failure. We also compared the treatment outcomes of surgery with and without elective neck dissection in NO cases. The minimum follow-up period was 24 months and the maximum was 177 months (mean 64 months). The five-year cause specific survival rate was 79.8%. The recurrence rate was 27.8%. Recurrence was lower in early stage patients than in those who were at an advance stage. The mean disease free period was 13 months in the recurrent cases. Patients who present neck metastasis have a shorter disease free period than those who are staged as NO. Nine of 15 recurrence cases were successfully treated by salvage surgery. Five of 6 (83.3%) recurrent patients in the NO neck treated by watchful waiting (without elective neck dissection) were successfully salvaged. Distant metastasis was a major cause of failure associated with death from cancer. The success of salvage surgery depends on the strict diagnosis of NO, early detection of the recurrence, and intensive follow-up. In early stage NO cases treated by watchful waiting, surgical salvage was highly successful with our intensive follow-up method.
Non-specific laryngeal granuloma is a rare inflammatory mass. Its etiology is still unclear. We herein report the retrospective review of 46 patients with non-specific laryngeal granuloma who visited our clinic from 1982 to 1999. Thirty-two out of 46 cases were contact granuloma, and 14 were intubation granuloma. Thirty-six cases were male and 10 were female. In male cases, 83% (30/36) were contact granuloma, while in female, 80% (8/10) were intubation granuloma. Endolaryngeal microsurgery using CO2 laser was performed for 43 patients as an initial treatment. In the surgical cases, there was recurrence in 65% and 25% of patients with contact granuloma and intubation granuloma, respectively. Beclomethasone dipropionate inhaler (BDI) was used in 7 cases (two with contact granulomas and five with recurrent granulomas). No recurrence was observed in the cases treated by BDI. Proton pump inhibitor (PPI) and Fluticasone propionate dry powder inhaler (FPI) were used for a contact granuloma patients. The granuloma decreased remarkably in size. Conservative therapies such as steroid inhalation and or PPI administration should be adopted as the initial treatment for non-specific granuloma. Untreated surgical excision should be avoided because of its high recurrence rate.
A curved hand-piece CO2 laser was developed to facilitate CO2 laser surgery under topical anesthesia with fiberoptic monitoring. Laser irradiation experiments with the hand-piece demonstrated minimal damage to soft tissues. In a clinical trial, the CO2 laser vaporized a vocal polyp and a vocal nodule. The wound assessment turned out well within a couple of weeks, and the mucosal vibration of vocal cords was preserved. Although the study is preliminary, the newly developed hand-piece proved to be useful in performing CO2 laser surgery under topical anesthesia.
Bilateral vocal fold paralysis is a relatively rare laryngeal disease in infants. This condition causes dyspnea, therefore, long-term airway management including tracheal intubation and tracheostomy is necessary. Several surgical techniques have been proposed to restore laryngeal obstruction, however, a generally accepted therapeutic strategy for children has not been established. In this article, a girl who had bilateral congenital vocal fold paralysis was successfully treated by Ejnell's operation. She underwent intubation for severe respiratory distress immediately after the birth. Bilateral vocal fold fixation at midline position was diagnosed by endoscopic observation of the larynx. A tracheostomy was performed when she was 6 months old. Thereafter, laterofixation of the right vocal fold described by Ejnell was carried out at the age of 7-years resulting in a successful closure of tracheostoma. This operation is simple, safe and less traumatic, and it should be considered as a choice for surgical intervention for children with bilateral vocal fold fixation.
Three cases of laryngeal foreign bodies in infants were treated in our hospital over the past 10 years. Among them, a case of a 1-year-old boy was reported. His chief complaint was coughing after having eaten fish. Videolaryngoscopy revealed pieces of fish bones in his subglottic space. First we removed a part of the fish bones with forceps via a flexible fiberscope following placement of a laryngeal mask under general anesthesia. Because of edema in the larynx, we removed the bones piece by piece with forceps by way of a rigid ventilation bronchoscope. With infants it is difficult to diagnose a laryngeal foreign body especially in the subglottic space. Videolaryngoscopy is useful in such cases. Before removal of a laryngeal foreign body, careful observation is mandatory to avoid unnecessary damage to the trachea and the larynx. To inspect the larynx and the trachea, the flexible fiberscope is a choice instrument following placement of a laryngeal mask under general anesthesia.
Extracardiac rhabdomyoma is rare benign tumor found in soft tissue. The majority of instances of extracardiac rhabdomyoma arise in the head and neck regions. Rhabdomyomas are classified into adult and fetal variants. A case of adult rhabdomyoma occurring in the larynx, which appeared in a 29-year-old lady, was reported. The tumor was removed surgically by the laryngofissure approach. The patient remains free of disease at the present time. The clinicopathological features of the tumor are presented with a review the pertinent literature.
We observed a case of postoperative granuloma that had developed 1 month after the transplantation of fascia into the vocal fold. The patient was a 55 year-old man who complained of hoarseness following an operation on an aortic anourisma 1 year prior to his first visit to our clinic. The left vocal fold was fixed at the paramedian position. We performed a tansplantation of fascia into the left vocal fold in order to for improve glottic closure. Immediately after the operation, the patient's voice had improved. However, 1 month later, we found a tumor on the left vocal fold just above the transplantation scar. The tumor was then removed via direct laryngoscopy. The tumor was diagnosed as a granulomotous polyp, which had apparently developed at the transplantation wound.
We examined a case of a 46-year old Japanese female who had a lateral type of saccular cyst. The patient noticed a painless swelling in the left lateral part of her neck and an abnormal feeling in her throat. A fiberoptic examination revealed swelling along the left aryepiglottic fold to the left false cord. An MRI scan exposed a retention cyst in the larynx extending from the foramen of the superior laryngeal bundle in the thyroid membrane to the upper portion of the anterior cervical triangle. Using an external approach to the neck, the cyst was totally removed. A histopathologic study revealed that the cyst was lined mainly by cuboidal epithelium and partially by squamous epithelium. Based on clinical findings by image analysis as well as histopathology of the larynx, we concluded that it was a saccular cyst of the larynx. The patient's postoperative course was uneventful without any recurrence for one and half of the years.