Various lasers have been used for transoral laser microsurgery. We herein proposed the application of the Holmium: YAG（Ho:YAG）laser in transoral laser microsurgery for three cases of laryngeal benign lesions. According to the distance between the laser fiber tip and the target, we designed three irradiation methods: non-contact irradiation, contact irradiation, and shooting irradiation. Each of the three methods shows a different maximum depth of evaporation. Benign lesions in the larynx, such as leukoplakia, papilloma, and vascular malformation can be treated with non-contact irradiation and contact irradiation. The Ho:YAG laser can therefore be an alternative laser for performing transoral laser microsurgery.
Chemoradiotherapy has become the most popular in modality of laryngeal preservation treatment for patients with locally advanced laryngeal cancer. However, larynx-preservation surgery is only an option in select patients with T3-4a laryngeal cancer, and it may be able to achieve organ-preservation without chemoradiotherapy. In this study, we reviewed the medical records of 13 patients with locally advanced laryngeal squamous cell carcinoma who were primarily treated with organ-preservation surgery. We defined organ-preservation as （1）local relapse-free, （2） survival,（3） eating a regular diet, （4） no requirement for a feeding tube and （5） decannulation in this report. The 3-year overall survival rates were 100% for cT3, 75% for cT4a and 92% for all. None of the patients experienced any local recurrences, and the 3-year locoregional control rates were 78% for T3, 100% for T4 and 84% for all. The 3-year organ-preservation rates were 89% for T3, 50% for T4 and 76% for all. The 3 -year radiotherapy-avoidance rates were 56% for T 3 , 0% for T 4 and 38% for all. Larynxpreservation surgery can produce a substantial local control and organ-preservation rate in locally advanced laryngeal cancers. Additionally, in select T3 laryngeal cancers, it can achieve both organ-preservation and radiotherapy-avoidance.
We retrospectively analyzed 178 patients with laryngeal carcinoma treated at our department from 2007 to 2014. The cases included 125 glottic and 53 supraglottic cancers. The 3-year disease specific survival rates were 95.4% in the glottic cancer group and 83.7% in the supraglottic cancer group. In T3 patients treated with radiotherapy or chemoradiotherapy, the 3-year laryngeal preservation rates were 70% in the glottis cancer group and 100% in the supraglottic cancer group. .
In T3 glottic cancer, the radiation failure rate was 50% for the cases of vocal cord fixation, and 14% for the cases of paraglottic space invasion. Laryngeal preservation therapy is indicated for patients with T3 carcinoma with paraglottic space invasion.
In 2007, we reported a newly-developed surgical airway-opening technique（cricoid fenestration）using a partial resection of the cricoid cartilage to form a stoma. From 2006 to 2014, a total of 57 cricoid fenestration procedures were performed at our hospital. The reasons for surgery included cervical disturbances such as low-set larynx, obesity, short neck, thyroid tumor, cervical abscess, and tortuous brachiocephalic and common carotid artery. Surgeries were also performed in high-risk patients who required long-term airway management, hemostasis, and urgent airway establishment. In this study, only one patient developed subcutaneous emphysema as an intra- or postoperative complication.
Cricoid fenestration enables us to easily create a stoma at a higher level of the cricoid cartilage without transecting the thyroid gland. In addition, this technique can quickly establish a controlled airway with a low risk of intraoperative bleeding. Finally, long-term airway management can be performed easily using this technique without tube-related complications including scarring or stenosis, despite the resection of the cricoid cartilage. Cricoid fenestration is therefore considered to be a safe and effective surgical airway-opening technique.
A laryngeal papilloma is a benign tumor that occurs due to human papilloma virus infection. Although basically benign, the lesions often recur and grow in size. Furthermore, they sometimes show malignant transformation and often suffer from treatment. We performed a retrospective clinical analysis of 15 patients with laryngeal papilloma who were treated at our department over the past ten years. As with previous reports, most cases involved adult males and occupied the glottis. Canceration only occurred in one patient. Human papilloma virus infections were detected in 14 patients. All of the cases involved with type 6 or type 11（benign types）infections. Canceration occurred in one patient who did not show infection. The treatments performed at our center included, surgical resection and/or transpiration by a CO2 laser. Recurrence was observed in some cases. This was treated with multiple surgeries. Remission was achieved by the combination of treatment under local anesthesia and adjuvant therapy. It is difficult to cure laryngeal papilloma radically because it is a viral disease. Thus, we treat the disease as follows; we first confirm the lesion with a laryngeal endoscope under general anesthesia and perform a biopsy; and then conduct resection and/or transpiration using CO2 laser. When recurrence is observed, we immediately attempt extraction or laser transpiration under local anesthesia while the lesion is small. As the number of cases increases, it will be necessary to examine surgical method and postoperative adjuvant therapies.
We herein report 109 cases of infantile stridor treated in our department. The primary diseases diagnosed were low birth weight, cerebral palsy, and multiple malformations, however non-disorder cases were most common. Stridor was diagnosed because of swallowing disorder, laryngomalacia, and tracheomalacia, however in most cases the cause was unknown. The majority of unknown cases（28cases）were comprised infants less than 1 year of age, and only one case need tracheostomy. It is very important to detect precisely both the larynx and trachea using endoscopy.If swallowing disorder is suspected, then the swallowing function should be evaluated. If the cause of stridor is unknown, it is possible to use the wait-and-see approach without surgical intervention .
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