Objective : The aim of the present study is to clarify central phonation control during high pitch vocalization. Subjects and methods : The participants were 16 right-handed, healthy adults. Functional magnetic resonance imaging (fMRI) was employed to detect brain activity in response to vowel phonation (⁄i:⁄) with high pitch. The sparse sampling method for MRI scanning was used to reduce body movement artifacts due to phonation and acoustic artifacts due to scanner noise. The brain activity in response to phonation with comfortable pitch as well as high pitch was measured using the statistic parametric mapping 5 software. Result : Brain activation specific to high pitch phonation was observed in the anterior cingulate cortex and cerebellum. There was however no specific motor cortex activity during high pitch phonation. Conclusion : In the central phonation control system proposed by Symonyan et al, subsystem II (periaqueductal gray matter, anterior cingulate cortex, and limbic input structures) is involved in regulating vowel phonation with high pitch.
We investigated the medical records of 77 sulcus vocalis cases from January 2006 to Jun 2010 at the voice outpatient clinics of National Center for Global Health and Medicine. A retrospective review of the medical records of these patients was conducted. We evaluated age, sex, GRBAS scale, maximal phonation time (MPT), and mean airflow rate (MFR) during comfortable phonation to assess the physiological characteristics of sulcus vocalis. 61 of the 77 (78%) patients had the following treatments performed once or several times: collagen injection (51 cases), fat injection (12 cases), fascia transplantation (2 cases), and voice training (7 cases). These procedures were often repeated or combined. In the collagen and fat injection groups, MPT and MFR data improved significantly after treatment; whereas, R (Roughness) improved only in the fat injection group. The treatment method was decided on according to the symptom levels and depth of “Sulcus”. Mild cases underwent collagen injection, voice training or observation but severe cases often needed fat injection or fascia transplantation. At present, we can only reduce symptoms but cannot remove “Sulcus” nor return it to a normal membrane. It is necessary to continue the examination of the treatment methods going forward.
The vocal fold is of utmost importance among the functional components of vocalization. It is, therefore, important in the care of early glottic cancer patients not only to improve treatment results but also to preserve vocal function. Endoscopic laser surgery and Radiotherapy (including chemo radiotherapy) are all accepted treatments for early (stage I and II) glottic cancer. Until 2006 in Kyushu University Hospital, department of otolaryngology, the first choice of treatment for early glottic cancer had been radiotherapy (TAR therapy, TS-1 and vitamin A with radiotherapy), but selected cases of early glottic cancer have undergone endoscopic CO2 laser narrow margin phonomicrosurgery since 2007. This report investigated the results of CO2 laser surgery alone and CO2 laser surgery combined with radiotherapy or chemoradiorherapy (TAR, TS-1 and vitamin A with radiotherapy) while considering voice qualities. A retrospective study was conducted of 136 cases of Stage I (T1a, n=60, T1b, n=31) and stage II (T2N0, n=45) glottic carcinoma (UICC TNM 2002). The follow-up period was from 24 months to 138 months, average 61 months. Of the T1aN0 cases, 24 cases received endoscopic laser surgery alone (Subepithelial cordectomy, type I cordectomy), 19 underwent endoscopic laser surgery followed by radiotherapy, and 17 cases received radiotherapy (60-70 Gy, including TAR therapy). Of the T1bN0 cases, two cases received endoscopic laser surgery alone (type I cordectomy), 12 had endoscopic laser surgery followed by radiotherapy, and 16 received radiotherapy (60-70 Gy, including TAR therapy). Of the T2N0 cases, 3 underwent endoscopic laser surgery alone (Type I or type II, Subligamental cordectomy), 15 cases received endoscopic laser surgery followed by radiotherapy, and 27 had radiotherapy (60-70 Gy, including TAR therapy). Among the 60 T1aN0 cases, 5-year survival rate and voice preservation rate were 100% and 95%, respectively. Local recurrence occurred in nine of these patients (15%), all of whom were successfully re-treated by salvage surgery. In T1b cases, the 5-year survival rate and voice preservation rate were 97% and 93%, respectively. Local recurrence occurred in two of these patients (7%), and one of them was successfully re-treated by salvage surgery. Among the 45 T2N0 patients, the 5-year survival rate and voice preservation rate were 100% and 93%, respectively. All of whom were successfully re-treated by salvage surgery. The post treatment voice qualities (pitch perturbation quotient (PPQ), amplitude perturbation quotient (APQ), and noise to harmonic ration (NHR)), were judged to be improved over pretreatment observations. There were no differences between laser surgery and radiotherapy for voice qualities in T1a cases.
Arytenoid cartilage dislocation is a relatively rare condition, and as such, its diagnosis and treatment are not standardized. A retrospective review was conducted on the charts of 7 cases (5 male and 2 female) with arytenoid cartilage dislocation in our hospital. It was found that dislocation occurred during the process of endotracheal intubation in 6 cases, but the cause for 1 case was unknown. Self-correction occurred in 4 cases, 2 patients underwent corrective surgery, and 1 case did not appear again. There are several possible methods of repositioning the dislocated arytenoid cartilage, but convalescence is difficult in many cases. Improvement may become evident as late as 2 to 3 weeks after treatment. In some cases, arytenoid cartilage inflammation and elongation of the joint capsule delay recovery. Although the outcome of corrective surgery for this condition is not guaranteed, we have developed a technique to assist and expedite patient recovery. Protecting the palate with cotton balls improves the course of convalescence and surgical outcome of arytenoid dislocation. This technique was used with one patient suffering from arytenoid cartilage dislocation. The hoarseness characteristic of this condition was reduced immediately after the operation, and had improved markedly over the following 6 days. This technique is useful in surgical correction of arytenoid cartilage dislocation.
Fourteen patients who underwent vertical partial laryngectomies after failure of irradiation between 1982 and 2010 were evaluated. Median follow up was 70 months (range 8-215 months). One local recurrence occurred within 69 months, which required a total laryngectomy and was successfully treated. One patient developed lung metastases and died of their disease 52 months after surgery. The resultant cause-specific five year survival and laryngeal preservation rate were 88.9% and 80.2% respectively. Two patients developed complications such as necrosis of local skin flap; however these complications were minor in nature. All of the patients were decannulated and achieved oral intake. No patients suffered from aspiration pneumonia. We came to the conclusion that the partial vertical laryngectomy procedure is an excellent alternative to total laryngectomy for salvage following failure of irradiation.
We report a patient with tracheal stenosis from advanced esophagus cancer with the preparation for percutaneous cardiopulmonary support if required. The patient was a 60-year-old female. She complained of dyspnea and checked-in to our emergency room. Computed tomography (CT) confirmed advanced esophagus cancer had invaded the trachea. The tracheal stenosis was so severe that tracheal intubation tube may not pass over the stenosis site; therefore we prepared percutaneous cardiopulmonary support (PCPS) during airway management. Tracheal intubation and tracheostomy was performed safely without the use of PCPS. When we have to perform tracheostomy on patients with severe tracheal stenosis, PCPS should be prepared for sudden airway obstruction during the operation.
Laryngeal chondrosarcoma (LCS) is seen in up to 1% of all laryngeal tumors and shows indolently slow growth. Distant metastases and lymph node involvement are rare. Although a number of foreign series of LCS have been presented in the English literature, this has not been the case with Japanese series. To allow comparison with other series, we report on a Japanese series with the addition of our own case. A 64-year-old man presented with a 1-year history of hoarseness and gradually increasing dyspnea. We suspected LCS based on findings from CT and MRI scans. For post-tracheostomy histological confirmation, direct laryngoscopy and a biopsy were performed under general anesthesia. Chondrosarcoma was confirmed histologically. A total laryngectomy was performed to allow preservation of the laryngeal framework. As of 2 years postoperatively, no evidence of recurrences or metastases has been seen. Since 1973, the Japanese literature has described 45 cases (28 males, 15 females, 2 unknown) including several laryngeal chondromas, which were excluded from this review. Several cases contained incomplete information, but we analyzed their information to achieve a more complete grasp of LCS in Japan. The mean age was 62 years (range, 27-82 years). The site of origin was on the cricoid cartilage in 36 patients, on the thyroid cartilage in 6 patients, on the epiglottis cartilage in 1 patient and unknown in 2 patients. Total laryngectomies were performed in 27 patients as initial treatment. Organ preservation surgery was performed in 17 patients, of whom 4 underwent total laryngectomy. No patients in the Japanese literature showed distant or regional metastases.
The frequency of a supraglottic carcinoma as an occult primary of cervical lymph node metastasis is high therefore such cervical lymph node involvement is an early symptom. Our study will reference a difficult case of supraglottic carcinoma that ocular inspection assisted in differentiation on the tongue side of the epiglottis base which is a rare site of origin. With this case,a 59-year-old man,the chief complaint was a mass on the lower left-side of his chin. He noticed a sudden increase in size of this mass and consulted with another hospital's otolaryngology department. Aspiration biopsy cytology was performed on the mass and a squamous cell carcinoma (SCC) was diagnosed. He was introduced to this hospital with occult primary cervical metastatic cancer of the lymph node without having had the primary tumor identified yet by medical examination. PET-CT imaging revealed abnormal accumulation in the cervical lymph node to the left of the vallecula. We performed ａ biopsy from the lesion which seemed to be an epiglottic cyst. Because SCC was diagnosed,we took the epiglottic cyst to be the primary tumor of the cervical lymph node metastasis. We performed a horizontal partial laryngectomy and left neck dissection,followed postoperatively by radiation 60Gy treatment. There Has been to recurrence of the primary tumor nor metastasis as of two year and four months since surgical treatment.