We described transoral surgery for laryngeal cancer in terms of surgical indication, treatment outcome and postoperative functional analysis. The indication of laser cordectomy for glottic carcinoma is Tis to T2 lesion. As the type of cordectomy by ELS classification advanced, the postoperative voice quality deteriorated. Voice quality after either type I or type II cordectomies is almost equivalent to that after radiation therapy for T1 glottic carcinoma (T1RT). When a partial or total thyroarytenoid muscle resection is required (type III-VI), surgeons should inform patients about the possibility of postoperative dysphonia. Since transoral surgery has its own merits such as shorter treatment duration, no risk for radiation induced cancer and keeping the choice of radiation therapy for the future, treatment modality should be determined after thorough discussion with patients.
With regard to supraglottic cancer, T1 and T2 cases indicate transoral videolaryngoscopic surgery (TOVS). By using a distending laryngoscope and a rigid video endoscope a wide working space and a wide view of the operative area could be obtained. The oncological outcome by this system is excellent and patients‘ larynges could be preserved (5 year laryngeal preservation rate 90%) with good swallowing function.

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We reviewed our experiences with concurrent chemoradiotherapy (CCRT) treatment for patients with resectable squamous cell carcinoma (SCC) of the larynx and considered the indication of CCRT for this malady. With early stage patients, the survival and the larynx preservation rates of stage I laryngeal SCC patients treated by radiotherapy alone were sufficient. CCRT for stage II laryngeal SCC patients was efficacious in improving the larynx preservation rate. With advanced stage patients, the treatment method including indication of CCRT may be determined by the contents of the chemotherapy and the TN staging of the laryngeal SCC. In our evaluation reports for the laryngeal functions in patients with laryngeal SCC treated with CCRT, it was concluded that laryngeal functions could be preserved in most cases after CCRT, though some hoarseness ensued after treatment and the tracheostoma could not be closed with some patients.

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Objectives: In resectable advanced laryngeal cancer, the locoregional control rate achieved with reduced intra-arterial cisplatin and concurrent radiotherapy (Kanazawa regimen) was comparable to that of the concurrent chemoradiotherapy arm of the Radiation Therapy Oncology Group study 91-11 with reduced toxicities. However, distant metastases were more frequent. This study retrospectively evaluated the efficacy and feasibility of adjuvant chemotherapy with TS-1®, an oral fluoropyrimidine, on distant metastases following the Kanazawa regimen.
Methods: Sixty-one patients treated with the Kanazawa regimen, who had achieved a complete response at the primary site, were analyzed. Following the Kanazawa regimen, twenty-four patients were administered TS-1® for 2 weeks, followed by 1-week rest, and the cycle was repeated for 6 months {TS-1(+) group}. Thirty-seven patients were not administered TS-1® {TS-1(-)group}.
Results: There were significant differences in distant metastases-free survival (p=0.015) and disease-free survival (p=0.046) in favor of the TS-1(+) group. Nineteen patients (79.2%) in the TS-1(+) group received TS-1® according to the planned schedule and dose. Grade 3 toxicities were observed in two patients (8.3%), but there was no grade 4 event.
Conclusions: In resectable advanced laryngeal cancer, TS-1® adjuvant chemotherapy is an effective and feasible treatment option to control distant metastases following the Kanazawa regimen.

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The larynx is the most frequently affected organ by recurrent respiratory papillomatosis, caused by low-risk human papillomaviruses. Many treatment modalities including CO₂ laser surgery have been applied to control the disease. Cidofovir is an anti-viral agent and has been anticipated to eradicate human papillomavirus. Here, we summarize five cases of recurrent laryngeal papillomatosis, including two previously reported cases, treated with intralesional injection of the agent. The patients received local injections three times in four weeks. Post-treatment results were two disease free patients and minimal residual disease in two other patients; however, the disease worsened after a tentative mild regression in the remaining patient.

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Wegener‘s granulomatosis (WG), more recently referred to as granulomatosis with polyangiitis (Wegener‘s) (GPA), is an incurable form of vasculitis that affects the nose, lungs, kidneys and other organs. Rhinitis is generally the first sign in most of the patients. Laryngeal involvement in GPA is often observed in subglottis. GPA of the larynx usually occurs concomitantly with the nasal presentation, and the PR3-ANCA (proteinase 3 antinuclear cytoplasmic antibodies) is typically positive. The positive rate of PR3-ANCA is however lower in patients with predominant granulomatosis manifestations limited to the upper respiratory tract. Unfortunately, many biopsies can be nonspecific and provide too little information for the diagnosis of GPA. If immunosuppressive treatment is not available, mortality within one year is over 80%. Administration of corticosteroids and cyclophosphamide dramatically improved prognosis of GPA. Survival rate of GPA in our hospital is in excess of 90%.

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Spasmodic dysphonia (SD) is a focal laryngeal dystonia. In its most common form, adductor spasmodic dysphonia (AdSD), abnormal contraction of the thyroarytenoid (TA) and lateral cricothyroid muscles results in excessive spasms and disproportionate glottal closure; consequently, the voice is characterized by stoppages and a strained⁄strangled quality. Diagnosis of AdSD is primarily based on patient complaint; i.e. difficulty of phonation and of auditory perception of the voice characteristics of the AdSD.
Type II thyroplasty is a laryngeal framework surgery based on the hypothesis that the voice symptoms in AdSD are a consequence of excessively tight glottal closure. Previously, we reported the outcome of type II thyroplasty for AdSD using a patient questionnaire and objective perceptual, aerodynamic, and acoustic analysis. Type II thyroplasty provides relief from voice strangulation in patients with AdSD, but none of these methods quantifies the effects of AdSD on a patient’s quality of life (QOL).
In this study we outlined a diagnostic approach for AdSD and reported on the effectiveness of type II thyroplasty for AdSD with perceptual analysis through use of the Voice Handicap Index-10 (VHI-10).

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The microflap technique for vocal fold lesions is an innovation that originally began in the mid 1980’s, and became established between the mid 1990’s and 2000. The concept is to preserve as much tissues as possible in vocal fold surgery under microscopy. Vocal function is the most important aspect, and post operative form of the vocal folds follows function. Microfalp technique consists of a superficial cordotomy, dissection of the lesion preserving healthy tissues in the lamina propria and the epithelium, removal of the lesion, and realignment of the remaining tissue. The microfalp technique is feasible and useful for a variety of vocal fold lesions including vocal polyp, nodule, cyst, Reinke’s edema, leukoplakia, carcinoma in situ, scar, sulcus, etc.

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We have performed endoscopic laryngomicrosurgery under general anesthesia during 12 years. In all cases, endoscopic laryngomicrosurgery was successfully performed. Especially with high vision monitoring system, resection of polyp and tumor were easily and safely performed. To prevent the tremor of surgeon’s fingers during microflap maneuver, multitask arm board was useful as a arm rest. Both the powered ENT instruments or instruments designed for properly for endolaryngeal surgery like hand-piece type CO₂ laser, but also Laparoscopic surgical instruments were useful to remove supraglottic cyst or tumor under endoscopic laryngomicrosurgery.

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Human papillomavirus (HPV) is classified into low-risk (HPV types 6 and11) and high-risk (HPV types 16, 18, and 33) according to their oncogenic potentials. We report on the incidence of HPV infection in 33 patients with laryngeal carcinoma and 3 with laryngeal papilloma. All of these patients (34 male and 2 female; ages ranging from 27 to 81) were treated between 2007 and July 2011. HPV DNA was examined by polymerase chain reaction (PCR) using freshly frozen samples. The viral load and physical status of HPV were subsequently investigated by real-time PCR of HPV type 16 positive samples.
HPV-DNA was detected in 15.2% of patients (5 out of 33) with laryngeal cancer (4 with type 16 and one with type 33) and in 100% of patients (3 of 3) with laryngeal papilloma; all with type 6. Although all HPV type 16 positive samples showed integration, their viral load varied among cases. No significant difference was found for age, smoking, tumor stage, response to treatment, and survival rate between HPV-positive and HPV-negative patients with laryngeal cancer.
Considering the high integration rates in type 16 positive samples and the presence of samples with high viral load, high-risk HPV may be important for the etiology of laryngeal cancer as well as oropharyngeal cancer.

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Arytenoid adduction is the most effective procedure for improving voice function in patients affected by unilateral vocal fold paralysis, but it is often associated with severe complications following airway obstruction. We report on the principle operative procedures for our novel and less invasive Endoscopic-assisted Arytenoid Adduction Surgery (EAAS). This paper aims to describe the safe performance of the EAAS procedure resulting in the lowest chance of severe complications.
Before performing clinical procedures, we recommend many practice trials with clinically extirpated larynges damaged by laryngeal cancer. The 3 axes of these extirpated larynges were measured with CT and X-ray images. We demonstrated insertion techniques upon the fixed larynges with penetration and loop needles.
EAAS was performed with a curved laryngopharyngoscope using a laryngeal videoendoscope under general anesthesia. Two needles were inserted from the cricothyroid ligament and nylon threads were passed around the muscular process with our novel technique. After the extraction of the laryngopharyngoscope, the two threads were tied between a spacer.
Sixteen patients underwent EAAS. Post-operatively, most patients achieved a maximum phonation time of more than 10 seconds and a mean airflow rate of less than 200ml⁄second.
Practice is necessary for successful EAAS and practice makes perfect.

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Background : The indication of Kano’s glottic closure procedure for infants remains unclear, and it is unknown whether it is a better procedure in terms of complications and postoperative length of stay compared with existing operations for the prevention of aspiration. We therefore conducted a retrospective study to assess Kano’s glottic closure procedure, and discussed the findings.
Methods : Five patients (aged between 1.5 and 25 years) with severe motor and intellectual disabilities underwent surgical closure of the larynx with removal of the thyroid and cricoid cartilage. We investigated the background factors, operative durations, complications of surgery, length of hospital stays after surgery, and outcomes in five patients.
Results : The median height and weight of patients was 123cm and 18.6kg. Primary diseases ranged from birth injury to congenital disorder of unknown etiology. In 3 patients, tracheostomies and glottic closure were performed simultaneously. Two patients initially had tracheotomies. The median operative duration was 233 minutes. There were no postoperative complications; nevertheless, the length of the hospital stays after surgery was extended by three times compared to the time period of postoperative management. After being discharged from the hospital, four patients received home care, and three patients were free of tracheal cannula.
Conclusion : The advantages of Kano's glottic closure procedure for infants were a short period of postoperative management due to no postoperative complications and being free from a tracheal cannula.

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We studied two cases which didn’t have improvement of voice after type ・ thyroplasty. Both cases underwent surgery in different hospitals. The positions of fenestration and implant insertion methods were found to be the causes for poor post-surgical voice. We performed follow-up surgery in these cases, and their voices showed improvement.
Patients with a large posterior glottal gap and improper vocal fold level in the vertical plane need to have an arytenoid adduction in addition to a type1 thyroplasty performed. Although vocal fold paralysis is located in the median or that neighborhood, it can’t keep that position at the time of the phonation. Such cases are adaptation of an arytenoid adduction. We introduced our type・ thyroplasty operative procedure.

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Acute chorditis (acute laryngitis) is a relatively common occurrence encountered in ambulatory practice. However, acute chorditis of a newborn baby is rare. We had a case of acute chorditis in a 10-day-old female.

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Laryngomalacia is one of the most common diseases of laryngeal stenosis in newborns and infants. In contrast, adult-onset laryngomalacia cases are rare and the majority of them are classified as an epiglottic type. We report on a case of 20-year old female with arytenoid type laryngomalacia who presented with an intermittent inspiratory stridor after catching a cold. Her pulmonary function was normal; however, endoscopic examination showed an inward prolapse of the bilateral flaccid arytenoid mucosa during strained inspiration resulting in supraglottic stenosis. She underwent a resection of the flaccid mucosa bilaterally with the use of CO₂ laser. Postoperatively, her inspiratory dyspnea had been successfully relieved for over a year. The rarity of adult-onset laryngomalacia may lead to overlooking the possibility of this disease. Physicians treating dyspneic patients should be aware of laryngomalacia even in adults and thorough endoscopic observation of the larynx should be mandatory.

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