Ai Kawamoto

Central-part laryngectomy is a useful and less invasive surgical procedure for resolution of intractable aspiration

A novel narrow-field laryngectomy procedure known as central-part laryngectomy (CPL) for less invasive laryngeal diversion in patients with intractable aspiration is introduced. We conducted retrospective case reviews of 15 patients who underwent CPL. In this procedure, an area of the glottis including the mid-part of the thyroid cartilage and cricoid cartilage is removed to separate the digestive tract from the air way. The lateral part of the thyroid cartilage, the entire hypopharyngeal mucosa and epiglottis are preserved. The superior laryngeal vessels and nerve are not invaded. All fifteen patients were relieved of aspiration without major complications. In good accordance with cutting of the cricopharyngeal muscles and removal of the cricoid cartilage, postoperative videofluoroscopy demonstrated smooth passages of barium. Ten of 12 patients who had hoped to resume oral food intake became able to do so after CPL and two others also achieved partial oral deglutition. CPL is a useful procedure for treatment of intractable aspiration and offers considerable advantages over other laryngotracheal diversion procedures from the view point of oral food intake.

The cricothyroid joint in elderly Japanese individuals

Using 15 cricothyroid joint (CT joint) specimens obtained from donated cadavers of elderly individuals, we examined the morphologies of the ceratocricoid ligaments as well as the synovial tissue. The ligaments consistently contained abundant elastic fibers: the fibers tended to be straight on the anterior side in contrast to a mesh-like arrangement on the posterior side. Thick and/or long synovial folds were often evident in the CT joint. The synovial tissue usually contained CD68-positive macrophages, but the positive cells were often restricted to certain parts of the tissue. Factor VIII-positive capillaries were present but few in number, and CD3- or IgM-positive lymphocytes were absent in the synovial tissue. Degenerative changes in the joint cartilage, such as roughness or thinning, were often present, but no cartilage defects were evident. Therefore, in contrast to the small, non-weight-bearing joints of the musculoskeletal system, we considered the degeneration of the CT joint to be a specific, silent form of osteoarthritis. For high-pitched phonation and ossification of the laryngeal cartilage, the CT joint in elderly individuals seemed to maintain its anterior gliding and rotation with the aid of elastic fiber-rich tissues compensating for the loss of congruity between the joint cartilage surfaces.

Cricothyroid Articulation in Elderly Japanese With Special Reference to Morphology of the Synovial and Capsular Tissues.

OBJECTIVE The present study aimed to clarify individual variations in the cricothyroid joint (CT joint). METHODS Using 30 specimens of the CT joint obtained from elderly donated cadavers, we examined the composite fibers of the capsular ligament as well as the morphology of the synovial tissue. RESULTS The capsular ligament consistently contained abundant thick elastic fiber bundles on the anterior side of the joint (anterior band) and an elastic fiber-made mesh on the posterior side (posterior mesh). The synovial membrane, lined by synovial macrophages, was usually restricted to the recesses in the medial or inferior end of the joint cavity. Without the synovial lining, elastic fibers of the capsular ligament were subsequently detached, dispersed, and exposed to the joint cavity. We also observed a folded and thickened synovial membrane and a hypertrophic protrusion of the capsular ligament. In six specimens, the joint cavity was obliterated by debris of synovial folds and elastic fiber-rich tissues continuous with the usual capsular ligament. Notably, with the exception of two specimens, we did not find lymphocyte infiltration in the degenerative synovial tissue. DISCUSSION We considered the CT joint degeneration to be a specific, silent form of osteoarthritis from the absence of lymphocyte infiltration. For high-pitched phonation, the elderly CT joint seemed to maintain its anterior gliding and rotation with the aid of elastic fiber-rich tissues compensating for the loss of congruity between the joint cartilage surfaces. Conversely, however, high-pitched phonation may accelerate obliteration of the joint.

Morphological differences in innervation between mucous glands and serous glands: a quantitative histological study using the sublingual glands of elderly humans.

Abstract Conclusion: In the sublingual gland, the serous lobule usually carried a higher density of NSE-positive nerve elements than the mucous lobule, whereas the mucous acinus in the mucous lobule was larger than the serous acinus in the serous lobule. Objectives: To demonstrate quantitative differences in nerve elements between the mucous and serous lobules of sublingual glands. Methods: This study investigated using specimens from 14 donated cadavers (mean age = 78 years). Since immunohistochemistry for neuron-specific enolase (NSE) stains all nerves in addition to other mesenchymal cells possibly of nerve origin, the present quantitative evaluation was based on NSE-positive areas per visual field under a ×20 objective lens (0.6 × 0.45 mm when printed). Results: In mucous lobules, the areas occupied by NSE-positive nerve elements ranged from 5798–16,541 μm2 (mean ± SD = 9280 ± 2584 μm2). In contrast, the corresponding areas in serous lobules ranged from 7853–23,540 μm2 (mean ± SD = 13,520 ± 4351 μm2). The difference in NSE-positive areas was statistically significant (p = 0.0022). However, the mucous acinus in the mucous lobule was 2-times larger than the serous acinus in the serous lobule (2474 ± 1477 μm2 vs 1119 ± 632 μm2).

Osseous hamartoma arising from the Eustachian tube

A fairly quite rare case of osseous tumor arising from the Eustachian tube (ET) is described. A 56-year-old man presented with a smooth bulky mass in the nasopharynx and secretory otitis media in the right ear. Computed tomography and magnetic resonance imaging indicated a solid tumor-like region occupying the nasopharynx with apparent extension to the right ET. Transnasal endoscopic surgery demonstrated that the tumor had originated from the ET, and the tumor was partially removed in the area where it had expanded into the nasopharynx. The pathological diagnosis was an osseous hamartoma consisting of bony tissue, fat cells and fibroblasts. To our knowledge, this is the first reported case of osseous hamartoma arising from the ET in the world literature. The patient presented symptoms of nasal obstruction and unilateral aural fullness. Reduction surgery and tympanostomy tube insertion were useful for accurate diagnosis and resolution of the symptoms.

Outcomes of Arytenoid Adduction under Laryngeal Mask Mechanical Ventilation for Unilateral Vocal Fold Paralysis

Objectives: Arytenoid adduction surgery for the unilateral vocal fold paralysis is usually carried out under intravenous sedation because improvement of the voice evaluable during surgery. In patients preferred for surgery under general anesthesia due to their physical or mental condition, we selected general anesthesia using laryngeal mask mechanical ventilation, and we confirmed the location of the vocal fold during surgery using a flexible fiberscope. To evaluate this procedure of anesthesia, we compared outcomes of the adduction surgeries between intravenous sedation and general anesthesia. Methods: From September 2012 to August 2013, adduction surgeries were performed in 17 cases under intravenous sedation with spontaneous breathing, and in 5 cases under general anesthesia using laryngeal mask. Pre- and postoperative maximum phonation time (MPT), mean flow ratio (MFR), and voice handicap index-10 (VHI-10) were evaluated. Results: MPT, MFR, and VHI-10 were remarkably improved in all adduction surgery with intravenous sedation cases. In the general anesthesia group, improvement of the factors was also recognized in most cases, but not in all. Conclusions: Adduction surgery under general anesthesia with laryngeal mechanical mask ventilation is a useful tool for the unilateral vocal fold palsy patient. However, even though we checked the position of the vocal fold in surgery, the efficacy of the surgery is not guaranteed in a few cases because the actual voice cannot be evaluated in general anesthesia.