Vocal fold scarring is one of the most important issues that have remained a therapeutic challenge. It occurs following injury or inflammation, and disrupts the layer structure of the vocal fold lamina propria, which in turn stiffens the vocal fold resulting in severe dysphonia that is difficult to treat. Scarring is histologically characterized by the replacement of normal tissue by fibrosis. Recent investigations have found disorganization of various extracellular matrix (ECM) components such as collagen, elastin, hyaluronic acid, and fibronectin. The key to restore a scarred vocal fold to a normal state is to reorganize ECM in the lamina propria to its normal order. Many therapeutic strategies have been attempted in the treatment of vocal fold scarring including voice therapy, steroid injection, injection laryngoplasty, and framework surgery. The outcomes, however, have turned out to be disappointing. Recently, a new approach has appeared using tissue engineering strategies such as growth factor therapy and cell therapy using stem cell with encouraging results in animal models. Future studies using this approach may shed some light on the treatment of vocal fold scarring.
Development of the laryngeal mucosa and its relationship to the appearance of glandular distribution was studied by examining the changes in the laryngeal structures at the level of subglottic larynx of 55 human infants. By making a transverse section at the level of cricoid cartilage, the area and diameter of each subglottic structure were examined using an image analysis system. The results were analyzed not only by their age at birth, but also based on the Total Development Score (TDS) that was estimated by adding the age at death and the gestational period. The areas of the whole structure, cricoid ring, maximum airway, subglottic mucosa and inner cavity (available airway) increased in close correlation with the TDS. In contrast to the increased diameter of the inner cavity, the thickness of the mucosa was almost the same size. The area occupied by the glands increased according to TDS. These results indicate the stability of the subglottic airway with advancing age and, also, the local defense system by glandular tissues develops constantly after birth.
We conducted a histopathological study of supraglottic carcinoma extension to the pre-or paraglottic space and it's correlation to cervical lymph node metastasis. This study was performed on T3 supraglottic carcinoma patients who had undergone total laryngectomies at Kurume University Hospital from1991 to 1997. The following results were obtained. 1) In patients whose cancer was limited within the pre-epiglottic space, the frequency of cervical lymph node metastasis was low. 2) In patients whose cancer extension was found to extend into the paraglottic space, cervical lymph node metastasis readily occured. 3) In supraglottic carcinomas with deep invasion, the frequency of cervical lymph node metastasis differed between the pre-or para-glottic space. 4) Metastases to cervical lymph nodes were found to be localized in only the upper or middle deeper cervical region.
We clinically investigated 19 cases of bilateral recurrent laryngeal nerve paralysis that were referred to our clinic over the 8-year period of 1993 to 2000. Eleven males and 8 females were studied. Laryngeal nerve paralysis was often seen in the 4th and 6th decades of life for males and in the 6th decade of life for females. Thyroid surgery was the most frequent cause, and the most common complaint was dyspnea. If the patient suffers dyspnea at rest, then a tracheostomy should be performed initially. For the next step, we need to strategize the best course of treatment for the bilateral recurrent laryngeal nerve paralysis according to the patient's needs in order to keep the quality of voice or to provide relief from dyspnea. There were two cases of paralysis following endotracheal intubation whose vocal cord movement recovered in 2 months. We performed laser cordectomies on 6 patients and as well as Woodman's operation on 4 patients to widen the airway. There were 2 cases that suffered dyspnea from stenosis of the airway after receiving laser cordectomey due to the granulation generated from the wound after vaporizaton of the posterior half of the glottis. It appears that Woodman's operation was more reliable than laser cordectomy in keeping the widened airway in good condition for a long time after surgery.
It is well known that the patients with cedar pollen nasal allergy frequently suffer from various pharyngo-laryngeal symptoms, such as itching, the sensation of a foreign body in the larynx, persistent coughing or soreness of the throat. In this study, we focused on the pharyngo-laryngeal symptoms of patients with the birch pollen nasal allergy and the non-allergic patients with abnormal pharyngo-laryngeal sensations. A clinical study was carried out on 119 patients with birch pollen nasal allergy and 29 non-allergic patients with abnormal pharngo-laryngeal sensations. Diagnoses of cases as allergic were confirmed by the clinical symptoms of seasonal rhinitis along with the presence of the specific anti-birch IgE antibody by CAP-RAST. Laryngeal allergy was diagnosed according to the criteria proposed by the society of study for laryngeal allergy in Japan (1995). It was found that more than 60% of the birch pollen nasal allergy patients, especially with laryngeal allergy, had abnormal sensations in the throat with seasonally and daily alteration. Patients with birch pollen nasal allergy complained more frequently of itching in the larynx, whereas the patients with abnormal pharyngo-laryngeal sensations tended to complain about foreign-body sensations in the larynx. The results of the present study could be considered important and useful to re-evaluate the criteria for laryngeal allergy.
There are many kinds of therapeutic methods for laryngeal papillomatosis. Surgical treatment is the first choice. Laser surgery in particular has been widely used. As a treatment, laser surgery via laryngo-microscope was conducted between 1982 and 1998 for 9 cases with monofocal papilloma and 15 cases (4 juveniles and 11 adults) with multifocal papilloma. 4 of the 11 adult cases with multifocal papilloma were treated in combination with flexible endoscopic laser surgery (FELS). FELS was performed under local anesthesia on an outpatient clinic basis. The KTP laser was delivered by flexible endoscope and the tumor was vaporized. 5 to 8 watts of laser power was sufficient for the surgery. The procedure was completed in 20 minutes, and no case had postoperative hemorrhage or edema of the larynx. The tumors were well controlled without recurrence.
We reported a case of sleep apnea syndrome caused by an epiglottal prolapse. This case was a 63-year-old man who was suffering from snoring and apnea, especially while sleeping in the supine position. There was neither a history of head and neck surgery, nor any head injury or coma. Flexible fiberscopic laryngoscopy suggested that the epiglottis was contacting the posterior pharyngeal wall during sleep, causing airway obstruction. Utilizing an apnea monitor, this case was diagnosed as obstructive sleep apnea syndrome with an apnea index of 15.3. There was no physical findings suggesting relapsing polychondritis. His symptoms disappeared following a partial epiglottectomy under an operating microscope. Considering the patient's age, a staged epiglottectomy was performed in order to avoid postoperative swallowing dysfunction. The diagnosis of the location and severity of sleep dyspnea should take into account a careful history of the symptoms and signs, local and general physical findings, including fiberscopy, X-ray films of the upper airway profile, as well as data collected from an apnea monitor.