We used video-bronchoscopy for the purpose of laryngopharyngeal observation. The Narrow Band Imaging (NBI) system on the video-bronchoscope was useful for the differential diagnosis of benign and malignant micro-lesions and for estimating the range of intraepithelial cancer lesions. It was easy to manipulate the bronchoscope for otorhinolaryngologists since it could be inserted transnasally. After the observation, a biopsy was performed immediately through the channel. Proper diagnoses were obtained in most of cases.
Early glottic cancer is usu-ally treated with radiotherapy. In addition, surgery involving laser microsurgery is reported to be almost equally effective in treating the disease. Laser microsurgery can also be applicable for selected recurrent glottic cancer after radiotherapy or initial laser surgery. Only one in sixteen patients treated with laser microsurgery for untreated T1aN0M0 glottic cancer had a recurrence during the follow-up period, whereas three out of eight patients with rT1N0M0 glottic cancer had a further recurrence. Evaluation of postoperative voice with the visual analog scale (VAS), the voice-related quality of life questionnaire (V-RQOL), and the voice handicap index-10 questionnaire (VHI-10) demonstrated comparable satisfaction between untreated cases and rT1 cases. These results suggest that laser microsurgery can be considerable for selected recurrent T1 glottic cancer.
The objective of our study was to determine the risk factors of late-onset radiation induced morphologic change and function disorder in larynx. Six cases of late-onset laryngeal necrosis and fibrosis after radiotherapy for head and neck cancers between 1994 and 2008 were evaluated. All of the patients were male with ages ranging from 57 to 74 years. The cases included three with supraglottic laryngeal cancer (T2), two with glottic laryngeal cancer (T1a), and one with an unknown origin metastatic neck tumor. Radiation injury was found from as early as 4 months up to 77 months after radiotherapy. Laryngeal late-onset radiation-induced Morphologic change and functional disorder were observed in patients having had supraglottic laryngeal cancer (T2), concurrent chemoradiotherapy, LASER surgery, or an over exposure dose. Consequently these patients were thought to be at risk for delayed radiation-induced sequelae. While almost all laryngeal necrosis was found within 6 months, supra-laryngeal fibrous stenosis was observed even beyond 24 months. It was difficult to discriminate between i Laryngeal necrosis and recurrent cancer, as well as to determine an early diagnosis of supra-laryngeal fibrous stenosis. It is, Therefore, essential that patients with risk factor of late-onset radiation-induced sequelae be followed up over the long-term.
Laryngeal papilloma is the most common benign tumor of the larynx and is caused by the human papilloma virus. It is often difficult to treat papilloma because it recurs or disseminates frequently. Micro laryngeal surgery is usually employed under general anesthesia, however some patients need to have the surgery repeatedly. That can be physically and mentally demanding and can lead to complications associated with general anesthesia or direct laryngoscopy. In addition, some patients have difficulty undergoing general anesthesia. We reported on 4 adult cases with laryngeal papilloma treated by surgery with a Nd-YAG laser under local anesthesia. One case had multiple and expanded papillomatosis. General anesthesia was difficult in this case because of a cervical problem due to a previous traffic accident. He underwent surgery using the Nd-YAG laser twice. The lesion has not recurred for more than 1 year. Other cases also underwent surgery with the Nd-YAG laser several times, and their lesions had not recurred for over a year. The Nd-YAG laser can be effective on exophytic laryngeal papillomas which recur because of their high tissue permeability. Operation under local anesthesia is less invasive procedure. We believe that endoscopic surgery with the Nd-YAG laser under local anesthesia plays a supplementary role in the treatment of laryngeal papilloma. It is most prudent to observe the lesions in detail and at a minimum to perform a biopsy under a microscope during the first operation.
[Introduction] It has been reported that satisfactory surgical treatment is difficult to accomplish on cases with post-operative vocal fold scarring where flexibility has decreased. In the present study, the primary goal was to attain voice improvement for a professional singer, who had undergone laryngeal micro-surgery repeatedly. We removed scar tissue and performed autologous fat augmentation thereby successfully improving the wave motion of mucosa during phonation. The result of our study on the changes of acoustical analyses are reported. [The Case and the Course] The patient was a 60-year-old female folk singer. She had a history of smoking and had undergone laryngeal micro-surgery for polypoid degeneration of the vocal folds several times in the past. Mucosal depression was noted on left vocal fold. Using a stroboscope, mucosal wave motion was determined to be partially lacking on the left, and a deficiency of glottal closure was seen. In order to repair the vocal fold defect, autologous fat augmentation was performed. After the operation, her daily conversation voice had improved; however, no improvement of her singing voice was noted and mucosal defect remained. The patient was a professional singer and had a strong desire for her voice to be improved further. Subsequently, using laryngeal microscope, we tried to remove the intra-mucosal scar tissue and to inject fat tissue. Post-operatively, mucosal defect had diminished almost completely and wave motion during phonation had improved.[Summary] The results of the study suggest that the removal of scar tissue and fat augmentation seem to be effective surgical treatments for vocal fold scarring.
In general, the primary therapy for mutational voice disorder has been voice therapy. However, we sometimes see cases in which voice therapy does not decrease the high pitch of mutational voice disorder. We performed an Isshiki type III thyroplasty on a patient with mutational voice disorder who had been treated by voice therapy for two years without remarkable improvement of his voice. His voice pitch became much lower after the Isshiki type III thyroplasty surgical procedure. The patient's fundamental frequency (F0) decreased from 276 Hz before surgery to 126 Hz after surgery. Isshiki type III thyroplasty was found to be useful as surgical treatment for higher pitch and resulted in a voice that was satisfactory to the patient with mutational voice disorder.
Laryngomalacia is one of the most common forms of laryngeal stenosis in newborns and infants. We reported two cases of laryngomalacia that were treated with surgical intervention for intractable dyspnea and dysphagia. A 4-year-old girl with complication due to cerebral palsy presented with progressive inspiratory stridor and saliva aspiration. Combined type laryngomalacia was diagnosed and she underwent a tracheotomy. A 2-year-old boy suffered from brain injury incurred from domestic violence at 4-months of age. He presented with inspiratory dyspnea followed by repeated aspiration bronchitis. Endoscopic examination revealed strongly flaccid arytenoid mucosa. The mucosal lesion was resected with a CO2 laser. A retrospective review of the charts of 13 cases of laryngomalacia in our hospital revealed that 9 cases (69%) were arytenoid type and 3 (23%) were combined type. Ten cases (77%) were complicated with central nervous system (CNS) disorders such as cerebral palsy. Besides dyspnea, swallowing disturbance was a major symptom in the cases. Generally symptoms will decrease with a physical growth; however, those cases with CNS disorders, gastroesophageal reflux, or additional laryngeal anomalies tended to have persistent symptoms. In such cases, surgical intervention might be indicated.
MALT lymphoma is a malignant lymphoma arising from mucosa-associated lymphoid tissue (MALT). Two cases of supraglottic MALT lymphoma of the larynx are presented. Case 1 was a 33-year-old female. During the initial consultation, the patient complained of pharyngodynia and hoarseness that had persisted for a month. Endoscopic examination revealed a supraglottic mass with a smooth surface. The histopathological diagnosis was MALT lymphoma. No other lesions were detected in a systemic evaluation. The patient was diagnosed as having clinical stage IE and was treated with 3 courses of R-CHOP followed by 30.6 Gy of radiotherapy. Case 2 was a 35-year-old female complaining of hoarseness. Multiple smooth lesions were exhibited in the supraglottic region. The diagnosis was MALT lymphoma in clinical stage IE. The patient was treated with the same protocol as Case 1. Both patients are alive with no evidence of recurrence at present.
Cicatricial pemphigoid is a rare autoimmune disease with chronic blister and decomposition formation in the membrane leaving scarring. Blistering and decomposition may also be expected in the pharynx, larynx or esophagus. This study began when the subject started showing symptoms from 3 years of age and continued for 10 years as the cicatricial pemphigoid progressed. Breathing difficulty appeared nightly when she was 3 years and 10 months old. It was urgent, requiring endotracheal intubation and a tracheotomy. Rubor of a left main bronchus and strangulation effects were observed from 4 and a half years of age. A keloplasty of the epiglottis was performed and the glottis was closed by cicatricial adhesion. In Japan, the number of cicatricial pemphigoid cases requiring tracheotomies, including this case, was 15. The number of cases whose tracheal gill holes were closed relatively quickly was 3. Medical treatment of the larynx cannot be carried out while the condition is not under control. The girl in this study is now a junior high school student and has the ability for satisfactory everyday conversation as well as functional deglutition. Since steroids are prescribed for ongoing treatment, we think it's important to see and carefully monitor progress. Depending on future progress, it may be that larynx reconstruction among other physical treatments could be indicated.
Klippel-Trenaunay syndrome (KTS) is defined as a clinical triad of capillary malformations (port wine stain), soft tissue and bone hypertrophy, and varicose veins. The case in this report is a 39-year-old male who had suffered from severe obstructive sleep apnea due to extensive hemangiomas in the nasopharyngeal lesion. Hemangiomas also presented in other lesions of the neck, lateral abdomen and the limbs. A tracheostomy under local anesthesia was performed for maintain the upper air way. When an incision on the anterior wall of the trachea was done, unexpected bleeding from the intra-tracheal space occurred. This bleeding originated from the capillary malformations in the tracheal wall. Hypo-oxygenation due to hypoventilation continued for a few minutes until an intubation was performed. After the treatment, patient was moved to the ICU for general recovery. During his stay in the ICU, there were recurrent incidents of active, frequent bleeding from the paratracheal space with further complications due to disseminated intravascular coagulation (DIC). Strict management for recurrent bleeding was required for a month. About two months after surgery, he was discharged from the hospital with cessation of bleeding. In the event that bleeding occurs with KTS, treatment for local hemangioma may be difficult. It should be considered that unexpected and recurrent bleeding may occur in the management of KTS.