The Shiga University of Medical Science installed the first intraoperative MR unit in Japan, the GE SIGNA SP/i 0.5 T, and began clinical studies starting January 2000. This system, called a double-doughnut type open MR system, was designed especially for minimally invasive MR-guided surgery and interventional therapy. The MR imaging of the GE SIGNA SP/i 0.5 T is characterized by superior soft tissue discrimination and flexible MR planes. We report here on the use of this intraoperative MR system to assess vocal fold medialization by thyroplasty and arytenoid adduction. Intraoperative MRI can repeatedly assess by axial and coronal planes, and provided additional information about bilateral vocal fold symmetry, medial-to-lateral displacement, heights of both vocal folds, and the orientation of implants. An Intraoperative MRI unit is useful in assessing several aspects of vocal fold medialization procedures.
We devised a method to scan the whole larynx within five seconds period with the aid of multislice helical computed tomography (MSHCT). This method allows us to quantitatively evaluate the three-dimensional movement of the arytenoid cartilage muscular process of the in vivo human larynx during inspiration and phonation. The distances involved in the arytenoid cartilage muscular process and several other points were measured in patients with unilateral vocal fold paralysis (UVFP). The purposes of the present study were to determine accuracy of the measurements and to compare the measurements taken during phonation with those observed during inspiration. Utilizing an excised human larynx, two examiners independently measured the two distances between the muscular process and the most lateral superior point of the cricoid, and between the muscular process and the posterior inferior point at the midline of the posterior cricoid lamina. They measured these two distances 10 times with the aid of MSHCT and then directly measured with fine-scale. The subjects included 17 men and 16 women with UVFP. Points were set to simulate the points where each intrinsic laryngeal muscle starts. The reliability and the accuracy of the measurements of the two examiners were confirmed. Distances simulating the thyroarytenoid and lateral cricoarytenoid muscles became shorter during phonation than those during inspiration on the healthy side while those on the paralyzed side became longer during phonation. These changes were statistically significant. In conclusion, MSHCT was quite useful in assessing the functional movements of laryngeal structures in patients with UVFP.
Our study involves the retrospective investigation of two groups of patients that were treated at our hospital between 1987 and 1996. The first group consists of thirty-six cases of T3 and T4 laryngeal cancer. The second group consists of thirty cases of T3 and T4 hypopharyngeal cancer. Total laryngectomy and total pharyngo-laryngo-esophagectomy were performed on 24 of the first group and on 15 of the second group. The five-year survival rate were 61% and 44% respectively. Complete remission cases with chemotherapy and radiation therapy were five cases and four cases respectively. Local recurrence occurred in 2 cases of laryngeal cancer and cervical lymph node metastasis occurred in a case of hypopharyngeal cancer. The remaining cases of laryngeal preservation showed tumors were highly responsive to chemotherapy and radiation therapy and that vocal cord paralysis disappeared after 40 Gy irradiation.
In this study, we analyzed the treatment outcomes of 200 cases with laryngeal squamous cell carcinoma at Saga Medical School Hospital from 1985 to 1997. In all were 142 cases of glottic type, 54 cases of supraglottic type and 4 cases of subglottic type carcinomas. The breakdown of treatment procedures for the 122 stage I and II cases of the glottic type was as follows : initially treated by CO2 laser surgery alone (55 cases), CO2 laser surgery followed by irradiation therapy (39 cases), partial laryngectomy (3 cases), total laryngectomy (24 cases) and total laryngectomy with elective neck dissection (1 case). The treatment courses for 23 early stage cases of the supraglottic type were : initially treated by laser surgery followed by irradiation therapy (3 cases), partial laryngectomy (5 cases), total laryngectomy (11 cases) and total laryngectomy with elective neck dissection (4 cases). The 20 advanced stage cases of the glottic type were treated by total laryngectomy (12 cases), total laryngectomy with radical neck dissection (7 cases) and total laryngectomy with elective neck dissection (1 case). The treatments for the 31 advanced cases of the supraglottic type included : treated by total laryngectomy (4 cases), total laryngectomy with radical neck dissection (16 cases), total laryngectomy with elective neck dissection (6 cases), partial laryngectomy, radical neck dissection and concomitant chemoradiotherapy (1 case), irradiation (1 case), chemotherapy (2 cases) and CO2 laser surgery followed by irradiation therapy (1 case). The cause specific 5-year survival rates of the glottic type cases for stage I through IV were 98.5%, 95.2%, 90.9% and 50.0% respectively. Those of the supraglottic type were 100%, 86.2%, 90.9% and 54.3% respectively. The 5-year larynx preservation rate of the glottic type cases for stage I through IV were 90.4%, 46.9%, 0%, and 0% respectively. Those of the supraglottic type cases were 71.4%, 18.8%, 14.3% and 17.6% respectively. We concluded that, in most patients with early stage disease (stage I or II) especially of glottic cancer, the preservation of larynx was achieved by laser surgery alone. In contrast, advanced stage carcinoma of the larynx required chemo-radiation therapy combined with surgery.
Polymyositis and dermatomyositis are characterized by non-specific inflammation of the systemic skeletal muscles. Involvement of the pharyngolaryngeal muscles causes swallowing and articulatory disorders. In this report, the clinical aspects of 8 patients with polymyositis or dermatomyositis who complained of dysphagia were analyzed. The patients mean age was 66.6 years and the duration of their dysphagia ranged from 10 days to 7 years. Videofluorography showed impaired pharyngeal clearance and laryngeal elevation. In the majority of patients, cricopharyngeal obstruction was identified which resulted in aspiration. Manometric examination revealed weakened pharyngeal contraction and normal relaxation of the cricopharyngeal muscle. These findings suggested that the obstruction of the esophageal inlet was due to an impaired passive dilatation of the cricopharyngeal muscle. The clinical course of dysphagia did not correlate with the laboratory data or systemic muscle symptoms. In two patients, cricopharyngeal myotomy successfully treated sustained and severe dysphagia.
Recently, it has been recognized that gastroesophageal reflux disease (GERD) could contribute laryngospasm, called acid-induced laryngospasm. And in infant, central apnea could be caused by GERD with acid-induced laryngospasm, reaching to sudden infant death syndrome (SIDS). We report two cases of acid-induced laryngospasm. Subject 1 was 1-year-old boy showing severe laryngospasm with apnea. From two weeks ago, he had been complaining of much belching and hiccups. Subject 2 was 87-year-old woman whose laryngospasm was lighter than that of subject 1, without apnea. Positioning to the left side on her bed induced her laryngospasm. In both cases, the finding of posterior laryngitis was observed under indirect laryngoscopy. However, we could not monitor their ph in their esophagus and observe the condition of the esophageal mucosa with the esophageal fiberscopy, because of their urgent respiratory manifestations and their excessive physical stress. After therapeutic trials with proton pump inhibitor (lansoprazole 10mg for subject 1, and 30mg for subject 2), both of them recovered almost completely without any side effect.
A 65-year-old patient with a hemorrhaging airway, that was being obstructed by a hemangioma, was examined. Hemangioma is classified according to its own malformation as well as vascular malformation. Hemangioma is characterized by cell proliferation and common regression in growth. On the other hand, vascular malformation is characterized by a normal cell cycle and continual growth. Vascular malformation is classified as either low-flow type or high-flow type according to blood flow speed. Major treatments for hemangioma are as follows : sclerotherapy, arterial embolization, surgical resection, corticosteroid therapy, and INF-alfa2A therapy. The treatment is selected according to the classified type. Radiotherapy was once a popular treatment before 1970, but is no longer performed today because of radiation-induced malignancy and growth delay. This case of hemangioma was diagnosed as a high-flow type vascular malformation using both MRI and MRA. Embolization was not indicated because the following were not found : a major feeding artery to the lesion, side effects of thrombosis to the brain or lung, dysfunctions like dysphagia and dysphonia. Surgical resection was not performed for the same reasons. Corticosteroid therapy and INF-alpha2A therapy were not indicated for vascular malformation. We selected radiotherapy considering that at the patient age, she would have less possibility of malignancies occurring. The bleeding stopped after only 6Gy irradiation. 30Gy was performed in total.
Two cases of localized laryngeal amyloidosis were reported. The two patients were 39-years-old male (case 1) and 49-years-old male (case 2). Case 1 had complained of hoarseness for about 2 years. A polypectomy was performed by laryngomicrosurgery. Two years later, laryngeal fiberscopy showed tumorous swelling at the bilateral false cords. Case 2 had complained of a resent dyspnea after having hoarseness for about 15 years with no treatments. At the left false cord, the posterior commissure and the subglottic area, tumorous masses were observed under laryngeal fiberscopy. In both case, laser vaporization was performed by laryngomicrosurgery and the histological diagnosis was amyloidosis. Their hoarseness was improved, and there have been no remarkable recurrent signs since the last operations. Laser surgery is an effective treatment for laryngeal amyloidosis.
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