Functional electrical stimulation (FES) has been proposed as a potential treatment for restoring the motor functions of denervated motor systems. Furthermore, FES on denervarted muscle has the potential to prevent muscle atrophy and promote reinnervation. In this study, to assess these effects of FES, we evaluated what kind of changes occurred in neuromuscular junctions (NMJ) by FES to muscle after denervation. Tibialis anterior muscles of rats were used for this study. A sciatic nerve anastomosis was performed after having cut off the nerve. We applied electric stimulation (2Hz, 0.5ms, 4.0mA) three days a week to the rats. Electric stimulation was performed using surface electrode percutaneously for an hour. The rats were euthanized 2, 4 or 8 weeks after treatment. To evaluate the number of axon nerve terminals and acetylcholine receptors (AchRs), synaptic vesicles of the nerve endings were labeled using antisynaptophysin antibody and AchRs were labeled by α-Bungarotoxin. We analyzed the effects of FES by counting the number of AchRs and axon nerve terminals. The number of AchRs decreased slightly after denervation for the group that did not receive electrical stimulation; whereas, the group that did have electrical stimulation to the denervated muscles increased the number of AchRs. After denervation the number of nerve terminals decreased at once and gradually increased according to completion of reinnervation. Electrical stimulation promoted regenerating nerve terminals during the reinnervation process. From the results of this study, we confirmed that electrical stimulation promoted regenerating NMJ during reinnervation process.
Reinnervation of recurrent laryngeal nerve was performed on 8 cases with unilateral vocal fold paralysis. The period of paralysis was from 7 months to 8 years. Fixation of the vocal fold within an intermediate section and severe atrophy were observed in all 8 cases preoperatively. The preoperative maximum phonation time (MPT) was from 0 to 6.1 seconds (the median was 2.2 seconds). All cases underwent anastomosis from the ansa cervicalis to the recurrent laryngeal nerve. Disposition of the paralyzed vocal fold in the paramedian portion was observed in 5 cases, and improvement of vocal fold atrophy was observed in 7 cases. There was improvement of MPT in all 8 cases postoperatively, which then ranged from 6.6 to 24.1 seconds(the median was 13.5 seconds). We considered the indications of reinnervation to be the preservation of distal stamp for the recurrent laryngeal nerve and a good prognosis to be at least 6 months. Reinnervation of the recurrent laryngeal nerve is useful for treating unilateral vocal fold paralysis.
Type I thyroplasty is a useful method of treatment for patients suffering from breathy hoarseness due to unilateral vocal fold paralysis. With this treatment, however, it is difficult to correct the level difference between bilateral vocal fold. We performed type I thyroplasty in combination with arytenoid adduction to improve phonation in the patients with a wide vocal fold gap. We assessed cases in which type I thyroplasty was performed in our hospital. Ten patients underwent type 1 thyroplasty for unilateral vocal fold paralysis from 2006 to 2008 (7 males and 3 females; ages ranging from 50 to 82 years). Type I thyroplasty alone was performed in 4 cases, and type I thyroplasty combined with arytenoid adduction in 6 cases. Maximum phonation time (MPT), mean flow rate (MFR), and the GRBAS scale were used to evaluate voice before and after surgery. Preoperative mean MPT was 2.6 sec and postoperative mean MPT prolonged to 13.7 sec(p<0.01). Preoperative mean MFR was 793 ml⁄sec and postoperative mean MFR reduced to 190 ml/sec(p<0.01). It was also confirmed that hoarseness improved in all patients, according to the evaluation of GRBAS scale. Arytenoid adduction easily combined with type I thyroplasty during laryngeal framework surgery. Type I thyroplasty combined with arytenoid adduction is effective in treating unilateral laryngeal paralysis with a wide vocal fold gap.
Objects: The aim of this study was to evaluate the clinical features and salvage surgery after radiotherapy in patients with early glottic cancer. Patients and Methods: From 2001 to 2006, 88 patients with T1 and T2 glottic cancer were treated with radiation alone (82 patients)and chemoradiation(6 patients). In general, T1 cancers with bulky tumors and T2 cancers without deep invasion were treated with hyperfractionated radiotherapy (19 patients). T2 cancers with deep invasion were treated with platinum-based concurrent chemoradiation. Local failure after radiotherapy occurred in 14 patients (rest in 4 patients and recurrence in 10 patients). Median follow-up was 31 months. Results: Local control rates with radiotherapy were 90％, 75％ and 81％ in T1a, T1b, T2 glottic cancer, respectively. Local recurrence after radiotherapy occurred in 3 out of 6 patients (50％) with widely extended T1b glottic cancer. All patients with local failure underwent salvage surgery as follows, LASER cordectomy (6 patients), vertical partial laryngectomy (4 patients), and total laryngectomy (4 patients). 2 patients with recurrent local disease after salvage LASER cordectomy were both salvaged successfully via total laryngectomy. The laryngeal preservation rate was 57％ in patients with local failure of radiotherapy. Conclusions: Our findings indicate that the extent of the tumor is an important predictor of radiotherapy outcomes in T1b glottic cancer. Although the follow-up periods were not long enough, favorable local control and laryngeal preservation in patients with local failure of radiotherapy were obtained. Treatment strategies for advanced aged patients with T2 glottic cancer require resolution.
Early glottic cancer is usually treated with radiotherapy; however, throat discomfort due to radiation-induced xerostomia frequently affects the quality of life for patients. The occurrence of radiation-induced cancer especially in younger patients, as well as second primary head and neck cancer, particularly in elderly patients, are additional potential side effects of this treatment. Therefore surgery involving laser microsurgery can also be considered for untreated early laryngeal cancer. Only one in fifteen patients treated with laser microsurgery for untreated T1aN0M0 glottic cancer had a recurrence during the follow-up period. Evaluation of postoperative voice with the visual analog scale (VAS) demonstrated 70％ satisfaction compared with that of 76％ in eleven T1aN0M0 glottic cancer patients treated with radiotherapy during same period. These results suggest that laser microsurgery can be an optional treatment for T1a glottic cancer with a satisfactory control rate as well as postoperative voice.
Rheumatoid arthritis (RA) is a systemic autoimmune disease which primarily involves the synovial membrane in articular capusules, and leads to the destruction of articular cartilage and bone. Laryngeal involvement of RA is not uncommon and sometimes causes arthritis of the cricoarytenoid joint. The occurrence of upper airway obstruction due to immobilization of bilateral vocal folds in RA patients is rare. In this article, we reported on a 71-year-old male with RA who also exhibited hoarseness and dyspnea. The diagnosis was made by laryngeal fiberscopy, laryngeal electromyography and Computed Tomography (CT). The bilateral vocal folds were fixed at the median position while a normal electromyogram was recorded, and the cricoarytenoid joint was partially destructed on CT. The patient was treated with an intravenous injection of corticosteroid and surgery (Ejnell's method) after a tracheostomy.
We reported on the case of a 50-year-old male with localized amyloidosis of the larynx. He was referred to us because he had a two and a half year history of odynophagia and hoarseness. A dark brown elevated lesion was detected on his false vocal cord and laryngeal ventricle. We performed laryngomicrosurgery under general anesthesia and resected the mass to the maximum extent. Histopathological findings with hematoxylin and congo red stain revealed amyloidosis. Immunohistopathological analysis showed chemical classification as AL type, lamda chain. Extensive examinations excluded systemic amyloidosis. The patient showed a favorable outcome and there was no recurrence two and half years after surgery. We also reviewed the diagnostic approach, treatment and follow up of amyloidosis.
Adenoid cystic carcinoma (ACC) is a malignant tumor that frequently arises in the major salivary glands. ACC originating in the subglottic region is very rare. Only 13 cases of subglottic ACC have been reported in the Japanese literature. We report a case of ACC of the subglottic region. A 57-year-old female complained of hoarsness and dyspnea. Fiberscopic examination revealed a tumor in the subglottic region. The histological diagnosis was ACC. The patient underwent a total laryngectomy. There has been no recurrence and no distant metastasis.
An adenosquamous carcinoma (ASC) of the larynx is a very rare occurrence. Generally, the prognosis of this tumor is poorer than that of squamous cell carcinoma of the larynx. Surgical resection is recommended at first for treatment of this type of tumor due to its low radiosensitivity. The pathological diagnosis and choice of the treatment are important. We presented a case of a 61-year-old male who had complained of hoarseness for two months. An examination with a flexible laryngoscope revealed a 7mm irregular tumor on the left vocal cord. The histological diagnosis of a biopsied specimen was ASC. Neither metastasis in the lymph node nor distant metastases were indicated. The patient rejected the option of a vertical partial laryngectomy. Chemoradiotherapy was performed after debulking surgery of the tumor using a CO2 laser. The patient was free from recurrence for two months.
Of the various surgical options for bilateral vocal fold paralysis cases, Ejnell's operation, so called laterofixation, is a non-invasive and straightforward technique. Ejnell's operation requires two surgeons at the same time; while one is observing the larynx, the other is operating on it percutaneously from outside the neck. We chiefly perform this procedure to improve the airway in laryngeal paralysis cases because it doesn't necessitate the excision of tissue and keeps the vocal cord lateral for long time. We reported on a case, which four months after Ejnell's operation was performed, had formed a reactive granulation in the laryngeal ventricle after the nylon thread had been cut.
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