Surgical treatment of dysphagia and aspiration is usually considered when swallowing rehabilitation is not effective, especially in cases of progression of neuromuscular disease or sequelae of surgery for brain tumor or traumatic disease. In this study, we retrospectively analyzed the outcomes of surgical treatment for dysphagia and aspiration performed at Nagoya University Hospital from April 2003 to March 2018. For our analysis of surgery for aspiration, we collected data on the time needed for surgery, amount of bleeding, surgical complications, nutritional status, and inflammatory data from clinical records. For our analysis of surgery for dysphagia, we collected data on the AsR score （Aspiration and Residue Score） and NRRS （Normalized Residue Ratio Scale）. Regarding the results of our analysis of surgery for aspiration, Kano’s laryngeal closure was commonly performed in our institute. This procedure had a relatively low complication rate and little variation in the time needed for the surgery among cases. Kano’s laryngeal closure was able to be performed even for patients with a poor nutritional status. Regarding the results of our analysis of surgery for dysphagia, the AsR score and NRRS were improved after surgery. Surgery for aspiration was able to be performed even if the patient’s nutritional status was poor, and surgery for dysphagia was thus shown to be a useful and effective treatment procedure.
People with severe intellectual and motor disabilities often develop aspiration pneumonia due to swallowing dysfunction. The risk of aspiration pneumonia remains high even after gastrostomy because of concomitant gastroesophageal reflux disease in these individuals. They as well as their families are also annoyed with the need for frequent suctioning of sputum. When conservative and medical therapies are ineffective for controlling aspiration pneumonia, laryngotracheal separation is an option. After this procedure, the need for sputum suctioning may decrease. In Japan, a quarter of people in facilities for severe intellectual and motor disabilities have undergone gastrostomy. When gastrostomy is planned, laryngotracheal separation should also be considered, if possible. However, the rate of food-swallowing acquisition after laryngotracheal separation is reportedly lower in people with severe intellectual and motor disabilities than in those with cerebrovascular disorders or pharyngeal cancer. This difference may depend on a number of disease characteristics as well as the patient’s strength of will. Laryngotracheal separation should be performed with a thorough understanding of the cause, condition and course of a given patient’s intellectual and motor disabilities. In this review, the indications and complications of laryngotracheal separation are presented, along with illustrations of various operation methods.
Introduction: Tracheo-esophageal voice prostheses are widely used following total laryngectomy. A number of authors have explored safe and effective surgical methods. However, changes in the tracheo-esophageal voice have received little attention. We studied the tracheoesophageal voice trends over time. Materials and Methods: The patients were 7 men and 1 women an average of 64.6±7.2 years old who had undergone total laryngectomy reconstruction. The survey items were CSL 4500（KayPENTAX）and PS-77E（Nagashima Medical Instruments）for the analysis, using the maximum phonation time （MPT）, fundamental frequency, maximum sound pressure, mean air flow rate（MFR）, and range of voice. We statistically analyzed the time course of each item at 1/, 3/, 6/, and 12 months postoperatively（analysis of variance, p<0.05）. In addition, the vowels at each point were analyzed by a sound spectrum, and changes in the formant information were confirmed. Result: the MPT significantly lengthened over time postoperatively（p<0.01）. Regarding the range of voice, although there was no significant difference over time, the frequency band tended to increase. In addition, the sound spectrum gram tended to become clearer as the formant structure progressed. The fundamental frequency, maximum sound pressure, and MFR did not differ markedly over time. Conclusion: In the rehabilitation of the tracheo-esophageal voice, it is important to acquire a stable expiratory volume, teach efficient speech methods, and give consulting to help at each periods.
Objective: To evaluate the post-operative speech and swallowing functions of tongue cancer patients who underwent subtotal glossectomy and free-flap reconstruction.
Method: We reviewed the data of 14 patients: 6 in whom the lingual defects were reconstructed with anterior lateral thigh （ALT） flaps, and 8 with rectus abdominis myocutaneous （RAM） flaps. The postoperative speech and swallowing functions of ALT and RAM flaps were compared.
Results: The speech outcomes were poorer in two ALT flap patients and one RAM flap patient than in other 11 patients. The ALT flaps performed worse in the production of linguopalatal-linguovelar consonants /k/, /c/ and /ʃ/ than for other sounds because of the lack of flap volume. In contrast, the RAM flap performed worse in the apex of the tongue consonant /r/ than for other sounds. Nevertheless, these 3 patients were able to pronounce 80% of words and had little trouble in their daily life. Swallowing outcomes were satisfactory in both ALT and RAM flaps. All patients ultimately achieved oral feeding without need for a stomach or gastrostoma tube.
Conclusion: Speech and swallowing outcomes following subtotal glossectomy and free-flap reconstruction with both ALT and RAM flaps were satisfactory. Postoperative dysfunction can be reduced if suitable flaps are selected.
It is not uncommon for otolaryngologists to encounter laryngeal edema due to infection in routine practice. However, we rarely encounter laryngeal edema caused by allergic reactions to orally ingested food.
We herein report two cases of oral allergy syndrome after consumption of manuka honey candy. Both cases developed laryngeal edema and subsequent steroid administration led to the prompt improvement of symptoms. A basophil activation test for manuka honey candy was negative in both cases.
Laryngomicrosurgery with a suspension laryngoscope under general anesthesia requires cervical extension. Patients with cervical spondylosis cannot undergo cervical extension because of the risk of exacerbating their cervical issues. Videoendoscope-assisted laryngeal surgery with office-based equipment is often performed in such patients; however, there are some cases in which laryngeal surgery under general anesthesia is necessary. We herein report two patients with cervical spondylosis who underwent laryngeal surgery under general anesthesia with the aid of a rigid curved laryngo-pharyngoscope, which was accomplished with minimal cervical extension.
A 50-year-old woman with a laryngeal cyst and a history of cervical spondylosis and panic disorder presented to our hospital. A physical examination revealed a strong gag reflex. Laryngeal surgery under general anesthesia was undertaken with minimal cervical extension by means of a rigid curved laryngo-pharyngoscope. Her cyst was removed without aggravating her cervical spondylosis. The second patient was a 71-year-old man with vocal cord leukoplakia. He also had a history of cervical spondylosis. A physical examination revealed wide-spread leukoplakia. Laryngeal surgery under general anesthesia was also performed without aggravating his cervical spondylosis. Laryngeal surgery using a rigid curved laryngo-pharyngoscope is a new strategy for treating laryngeal disorders in patients with cervical issues.
We herein report a patient with late-onset laryngeal stenosis after burn and inhalation injury. The patient, an 18-year-old male, suffered a burn and smoke inhalation injury. Because of laryngeal edema, the patient was intubated for two days followed by tracheotomy. Fourteen days later, endoscopic laryngoscopy revealed normal laryngeal finding. However, 14 months after the injury, he started to complain of hoarseness and respiratory distress. Given findings of a severe reduction in oxygen saturation, the patient underwent tracheotomy. A laryngeal examination revealed posterior glottic adhesion that was released by laryngeal microsurgery with steroid injection. Over one year of follow-up, no recurrence of his laryngeal stenosis was observed. Although late-onset laryngeal stenosis after burn and inhalation injury is rare, clinicians should consider the risk of this potentially fatal condition in susceptible patients.
We herein report a case of anterior glottic web with a review of the relevant literature. A 35-year-old woman with a chief complaint of hoarseness visited our hospital. Her symptom occurred after frequent vomiting due to vomiting diarrhea. Laryngoscopy revealed anterior glottic web. Endoscopic resection was performed and a silicon plate was placed at the anterior part of the glottis to prevent anterior glottic adhesion postoperatively. We removed the silicon plate 35 days after the first operation. Although granulation and erosion were detected on the anterior commissure and the anterior part of the left vocal fold, there was no glottic adhesion and her VHI-10 and acoustic analysis results mostly improved. This is the first report of anterior glottic web caused by vomiting. In the management of anterior glottic web, the prevention of reformation is important. Placing a silicon plate at the glottis can not only prevent reformation of the web but also adhesion at the posterior part of the membranous portion of the vocal fold. However the hardness of the silicon plate means that placement at the glottis can lead to the development of granulation and erosion on the vocal fold. For similar cases, we are going to create a silicon plate attached to a soft silicon tube, which will be advantageous for preventing anterior glottic web.