For the purpose of studying the clinical characteristics of vocal fold bowing, the correlation between the quantitative analysis and vocal function tests was investigated in 287 patients with unilateral recurrent laryngeal nerve paralysis. Parameters for the quantitative analysis included patient's age, sex, period of unilateral recurrent laryngeal nerve paralysis, fixed position of the vocal fold, cause of paralysis, and degree of aspiration. For vocal function tests, phonatory parameters (MPT, MFRc, SPLrange, FOrange) and acoustic parameters (PPQ, APQ) were analyzed. The following results were obtained : 1) The vocal fold bowing ranged from 5% to 15% in most (236 of 286) cases with the average being 11.5%. 2) The degree of vocal fold bowing increased from the age group of forty or older. 3) The degree of vocal fold bowing showed a tendency to decrease from 270 days after the onset of recurrent laryngeal nerve paralysis. 4) In the vocal function tests, FOrange, PPQ, APQ showed a relationship to the degree of vocal fold bowing.
The purpose of this study was to review the operative method, the functional evaluation and the treatment outcome of cases treated for hypopharyngeal cancer whose could be sustained by preserving laryngeal function. [Method] In case it was determined that there was less tumor invasion of the larynx, the primary tumor was extracted while partially retaining the larynx. This procedure, a pharyngectomy with partial laryngectomy, was chosen with the intent of preserving phonation for hypopharyngeal cancer patients. Modified surgery was avoid as much as possible. The tracheal stoma was closed to the maximum potential extent. A phase operation was favorably considered in order to accomplish our aim of minimizing the resected area while aggressively resecting the tumor. This was achieved by neoadjuvant chemotherapy and postoperative concurrent chemo-radiation therapy. [Result] Between 1999 and 2004, 31 cases with hypopharyngeal cancer underwent treatment. Eight cases (26%) had function preservation surgery in 20 cases (65%) that primary lesion treated with the adaptive operation. As a result, 11 cases received only neck dissection; the laryngeal function preservation totaled 19 cases (61%). Phonation and oral intake were possible in all the cases that received functional preservation surgery of larynx. Distant metastasis was recognized in one case; however, the cumulative average survival time was 24.6±12.8 months. [Conclusion] We suggest the utilization of laryngeal function preservation surgery for hypopharyngeal cancer patients.
The causes of death of 303 cases who had received primary treatment in our department for their early stages laryngeal cancer (Stage I : 185 cases, Stage II : 118 cases) were analyzed. For the majority of Stage I patients, radiation was the primary treatment employed, while radiation and total laryngectomies were used for approximately one half of Stage II patients. The mortality rates of the Stage I and Stage II patients, thus treated, were 2.7% (5/185) and 10.0% (12/118), respectively. Except for the cases where treatment was rejected by patients, there were only three cases with local recurrence which led to the patients' deaths. Multiple primary tumors were noted in 11.3% of Stage I and 14.4% of Stage II patients with lung, esophageal, and head and neck cancers. In the head and neck region, hypopharyngeal and mesopharyngeal cancers occur conspicuously after 5 years. Analysis of our cases, either with recurrence or death as an outcome, indicates the importance of 1) thorough dissection of the paratracheal tissues to avoid stomal recurrence, 2) early detection and management of lung and esophageal cancers, and 3) early detection of multiple primary tumors in the head and neck, which had a tendency to occur after 5 years after the initial treatment of laryngeal cancer.
Ejnell's laterofixation of the vocal cord has been our first choice of surgical management for patients with laryngeal obstruction due to bilateral vocal cord paralysis. It is, however, difficult to insert the needle to the appropriate position of the vocal cord from outside of the larynx. Thus, we have introduced endo-extralaryngeal needle carrier (EENC) for Ejnell's operation to overcome this problem. When compared to the conventional procedure, EENC had advantages. 1) The surgical procedure was simpler and quicker. 2) Less skin incision on the neck was necessary. The EENC also had disadvantages. 1) The existing EENC is large for Japanese larynges and its use is problematic. 2) Due to its curved needle, the thread is guided in the direction lower than the insertion point inside the larynx, resulting in the vocal cord being pulled downward. 3) The thread directly penetrates thyroid cartilage, therefore fine adjustments of thread traction is not easy. 4) There is possible risk of intra-laryngeal bleeding. In conclusion, EENC is useful instrument for Ejnell's operation; however surgeons should be aware of its possible shortcomings.
Three cases with laryngeal spindle cell carcinoma, a relatively rare malignancy, were reported on in this study. Every case had hoarseness as a chief compliant and was treated by radiation and surgery. Case 1 (67-years-old male) and case 2 (63-years-old male) had polypoid mass appear in their larynx and underwent biopsy by laryngo-microscopic tumor resection. The histopathological diagnosis in both cases was spindle cell carcinoma. Postoperative radiotherapy was performed. Case 1 had complete response (CR) but case 2 had progressive disease (PD). The latter had a subsequent total laryngectomy; however, the postoperative histopathological findings revealed only fibrosis with no malignant cells. Case 3 (62-years-old male) was treated with radiotherapy for early stage squamous cell carcinoma of the larynx. The malady was diagnosed with a small specimen removed by fiberscopy. Case 3 had CR, but two years after radiation therapy, relapse of the tumor was found via laryngomicroscopic biopsy. The resulting histopathological diagnosis was spindle cell carcinoma and case 3 had a following partial laryngectomy. Histopathological findings for spindle cell carcinoma are quite varied, therefore a biopsy with a larger specimen is recommended in order to grasp the whole image and obtain a more definite diagnosis.
Surgical treatment is sometimes necessary for patients with degenerative neuron disease that experience repeated aspiration pneumonia. Mitochondrial encephalomyopathy with severe dysphagia has rarely been reported. We performed laryngotracheal separation for a patient with mitochondrial encephalomyopathy who had been suffering from severe dysphagia and repeated aspiration pneumonia. The patient (a 31-year-old woman) complained of repeated convulsive and stroke-like episodes since 11 years of age. Mitochondrial encephalomyopathy, lactic acidosis and stroke-like episodes (MELAS) was diagnosed by clinical findings and muscle biopsy revealed ragged red fibers as well as mitochondrial DNA mutation (A3243G). A tracheostomy and a gastrostomy had been performed. but aspiration pneumonia could not be prevented due to the patient's continuous aspiration of saliva. She had severe complications such as cardiac and renal dysfunction. We evaluated her swallowing function using videofluorography and videoendoscopy. No laryngeal paralysis was found, but there was severe pooling of saliva above the hypolarynx, which indicated a significant degree of aspiration. In August of 2003, a laryngotracheal separation was performed. She no longer suffered from further episodes of aspiration pneumonia and experienced an overall satisfactory improvement of her general condition and an increase in her quality of life. We reached the conclusion that laryngotracheal separation is a highly beneficial procedure for patients with dysphagia due to progressive degenerative neuron diseases such as mitochondrial encephalomyopathy.
Cicatricial pemphigoid is an intractable autoimmune disease characterized by blisters and erosions, leaving scars in the mucous membranes of the mouth, conjunctiva, pubic region, etc. The mucous membranes of the larynx and trachea are also affected in rare cases. Recently, we experienced a case of cicatricial pemphigoid that induced lesions in the mucous membranes of the larynx and trachea in addition to other mucosal membranes. The patient was a 45-year-old female whose main complaints were dry cough, hoarseness, lacrimation, and vulval ulceration. Since the disease appeared to be resistant to steroid therapy, double filtration plasmapheresis was performed. This treatment stabilized the symptoms, allowing reduction of steroid dosage. A new form of treatment for this disease is needed.
A rare case of metastatic cancer of the larynx was reported. A 72-year-old male was previously treated for rectal cancer with lung metastasis. He complained of hoarseness and dyspnea which had persisted for 2 weeks. Upon laryngeal fiberscopic examination, papillary tumors were found between the glottic and subglottic space and the left vocal cord was fixed. Due to aggravation from dyspnea, a tracheostomy was required and a biopsy was also performed. Histological examination indicated poorly differentiated adenocarcinoma, which was the same type as the previous instance of rectal cancer. A total laryngectomy was perfomed because there were no recurrences of rectal nor lung metastases. Seven months after the operations were perfomed, the patient died of tumor recurrence.
A case of Werner's syndrome with a vocal cord polyp is presented. Werner's syndrome was confirmed as being an inherited autosomal recessive trait in a study of forty-two affected Japanese families. This syndrome has distinctive characteristic features, habitus and many resultant diseases due to premature senescence. Of these various diseases, this report focuses on cancer in particular. Since hoarseness is one of the diagnostic criteria of Werner's syndrome, it is essential that otolaryngists be cognizant of this syndrome. When doing diagnostic analyses we must pay attention to the possibility of malignancy.
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