Etsuyo Tamura

Feasibility of Sentinel Lymph Node Radiolocalization in Neck Node-Negative Oral Squamous Cell Carcinoma Patients

We examined the reliability of the use of lymphoscintigraphy (LS) and a hand-held gamma probe (GP) to identify the sentinel lymph node (SLN), and sequentially determined the feasibility of SLN radiolocalization in clinical neck node-negative oral squamous cell carcinoma (SCC) patients. A radiolabel with the unfiltered 99mTc tin colloid was injected submucosally around the primary site followed by LS at 2-hour intervals. Preoperative localization was performed with GP. After en bloc removal of the regional lymphatics, histopathologic results for the nodes were compared with the SLN radiolocalization. The LS and GP counts were well correlated, and there was concordance between SLN and neck node status in 7 of 8 cases (87.5%). We thus considered that our concept in this study was valid in determining the necessity for neck dissection for those node-negative oral SCC patients.

Adipose tissue formation in response to basic fibroblast growth factor

Conclusion. Formation of new fat cells may occur in injected adipose tissue in response to basic fibroblast growth factor (bFGF). Objective. In an effort to prevent loss of fat volume and generation of additional adipose tissue after intracordal injection of autologous fat, the effects of injecting fat together with basic fibroblast growth factor bFGF were evaluated. Materials and methods. Models of bilateral recurrent laryngeal nerve paralysis were prepared using 12 beagle dogs. Autologous fat was injected into one vocal cord, and a mixture of autologous fat with bFGF, gelatin microspheres, and collagen sponge was injected into the other. Histologic reactions were examined over time. Results. In vocal cords where autologous fat was injected together with bFGF, fusiform immature adipocytes were found in the injected fat at 8 weeks after injection. The volume of the injected fat was maintained almost completely even at 24 weeks after injection. Vocal cords where only autologous fat was injected showed a marked decrease in volume of injected fat over time.

Use of the buccal fad pad for vocal cord augmentation

Conclusion. We performed therapeutically successful intracordal injection of autologous fat harvested from the buccal fat pad. Objective. Autologous fat has been used increasingly for intracordal injection as vocal rehabilitation in patients with deficient glottal closure. Adipose tissues used have been harvested mostly from the lower abdomen. However, patients differ considerably in the amount of fat available from the lower abdomen, and it is often difficult to obtain sufficient fat in patients with a low body mass index (BMI). Moreover, the scar visible after harvesting can be cosmetically undesirable. As an alternative, we evaluated harvesting of the buccal fat pad, as in plastic surgery. Patients and methods. From January to December 2005, intracordal buccal fat injection was performed for 10 patients, who were subsequently followed up for over 6 months. Buccal mucosa was incised under general anesthesia to expose and harvest the buccal fat pad. This fat was cut into small pieces and injected into the vocal cord. Maximum phonation time and glottal aerodynamics were evaluated pre- and postoperatively. Glottal closure and mucosal vibration were examined stroboscopically. Results. Except in one patient, no postoperative complications such as swelling or infection followed either harvesting or injection. After injection, phonation showed notable improvement that was maintained throughout follow-up.

Comparison of fat tissues used in intracordal autologous fat injection

CONCLUSIONS The buccal fat pad appears to be more useful as a source of fat tissues in intracordal fat injection than the abdominal fat tissues used previously. However, further studies are required to confirm this point. OBJECTIVES Fat tissues used in vocal fold augmentation surgery have primarily been harvested from the subcutaneous region of the lower abdomen. It is often difficult to obtain sufficient fat tissue for injection due to the physical features of the individual patient. We have thus adopted a method using fat tissue from the buccal fat pad, which is already used in other plastic surgeries. METHODS This was a retrospective study. We evaluated and compared the histological characteristics of fat cells and the condition of vocal folds after injection of fat tissue extracted from the subcutaneous region of the lower abdomen and from the buccal fat pad. RESULTS Buccal fat cells were relatively smaller than abdominal fat cells and were not influenced by body mass index (BMI), showing less individual differences according to the physical features of the patient. Numbers of vascular endothelial cells tended to be higher in buccal fat tissues. The percentage of cases showing continuous effects for more than 6 months was slightly higher in cases using buccal fat.

Buccal fat augmentation for insufficient neoglottal closure after supracricoid laryngectomy with cricohyoidoepiglottopexy

OBJECTIVE Supracricoid laryngectomy with Cricohyoidoepiglottopexy (SCL-CHEP) is a functional organ preservation surgery for laryngeal cancers. Post-operative laryngeal function is generally promising. Some patients, however, cannot attain satisfactory functional results because of an excessively wide neoglottis resulting in an insufficient neoglottal closure. Autologous buccal fat augmentation was conducted to correct the insufficiency. PATIENTS AND METHODS Two patients underwent intervention. Under general anesthesia, autologous fat was harvested from the buccal fat pad. Fat tissue was injected into the widest plane of the neoglottis under direct laryngoscopy; a navigation system was incorporated to identify the responsible site. Acoustic, aerodynamic, and perceptual analyses along with videofluoroscopic swallowing study and screening questionnaires were used for functional evaluation. RESULTS A total of 0.8ml (Case 1) and 0.7ml (Case 2) of fat tissues were injected into the submucosal space of the responsible sites. Both patients experienced functional improvement subjectively after augmentation; psychological parameters for voice and swallowing also improved. CONCLUSIONS Buccal fat augmentation to correct insufficient neoglottal closure after SCL-CHEP was technically feasible. A navigation system was helpful for confirmation. Fat absorption occurred and one third of the volume remained at 3 and 6 months. Although, vocal measurements remained unchanged, psychological parameters for voice and swallowing improved.

Autologous fat augmentation of the vocal fold with basic fibroblast growth factor: Computed tomographic assessment of fat tissue survival after augmentation

Abstract Conclusion: The volume of fat tissue loss after vocal fold augmentation can be decreased when augmentation is performed with addition of basic fibroblast growth factor (b-FGF). Objectives: The effectiveness of augmentation is easily decreased due to absorption. Canine experiments have confirmed that the decreased effectiveness caused by absorption after augmentation can be reduced by administering low-concentration b-FGF. Clinical application was trialed after acquiring approval from the institutional clinical review committee. Method: Autologous fat tissue with b-FGF was injected into the vocal folds in cases of unilateral vocal cord paralysis. This study compared fat tissue survival after injection by assessing images from computed tomography (CT). Results: Assessments using CT revealed that the decrease in volume of injected fat tissue was smaller in cases treated using b-FGF than in cases using the conventional method. No severe complications were encountered using this method.

Fat Injection for Voice Improvement in Atrophic Vocal Folds

With the incidence of geriatric dysphonia expected to rise in conjunction with the aging population in Japan, we propose a vocal fold injection augmentation technique with autologous fat for vocal improvement. Vocal fold injection augmentation is a safe, simple procedure that can improve quality of life (QOL) by enabling vocal improvement within a shorter period than voice training, without the need for open surgery. Between April 2012 and March 2016, we performed vocal fold injection augmentation with autologous fat under general anesthesia for 18 men and 3 women (mean age, 66 years; range, 60–79 years). Buccal fat tissue was used for the injection; therefore, no skin incisions were required. Evaluation following fat injection was based on maximum phonation time, auditory impression (GRBAS; G: grade of hoarseness, R: rough, B: breathy, A: asthenic, S: strained), and Voice Handicap Index-10 (VHI10) score. Auditory impression improved significantly and VHI10 score also tended to improve after injection. Vocal fold injection augmentation technique with autologous fat is minimally invasive, does not require the use of biologically foreign material, and appears effective for improving voice and QOL by enhancing the vocal folds of elderly individuals.

A Case of Bilateral Laryngeal Nerve Paralysis after Endotracheal Intubation

Tetsuya Tanabe, Tetsuya Murakawa, Shiho Katoh, Etsuyo Tamura, Naoyuki Kohno and Satoshi Kitahara A 58-year-old woman with diffuse goiter underwent an expansive laminectomy of the spinal canal under general anesthesia in the prone and head down position. Her trachea was intubated uneventfully with a spiral tube (7.0-mm I.D.), and the cuff was filled with air (3 ml). It took 2 hours and 40 minutes to finish the surgical procedure. After extubation, stridor was noticed. Flexible laryngoscopic examination revealed stenosis of the glottis caused by bilateral laryngeal nerve paralysis, and a tracheotomy was performed. The paralysis disappeared within two weeks and the tracheal stoma was closed. The cause of the laryngeal nerve paralysis after endotracheal intubation is usually considered to be a local circulatory disorder produced by the endotracheal tube and cuff. In this case, however, the patient with diffuse goiter condition and the head down position may have been causes of the paralysis, because the other possible factors were negligible.

Six Cases of Malignant Melanoma in the Head and Neck Region.

Six cases of malignant melanoma occurring in the head and neck region, and treated at National Defense Medical College from 1989 to 1997, are presented. Patient age ranged from 42 to 79 years and all cases were male.The location of the tumor was the nasal mucosa in 3 patients, oral mucosa in 1 patient and laryngeal mucosa in 2 patients. The 2 cases of laryngeal tumor were considered to be metastatic. Histologically, three cases were diagnosed as amelanotic melanoma, 2 cases as melanotic melanoma and 1 case as amelanotic and melanotic melanoma. Two patients were treated with chemotherapy. One patient was treated with chemotherapy and immunotherapy. One patient was treated with surgery and immunotherapy. One patient was treated with surgery and chemotherapy. One patient was treated with surgery, radiation and immunotherapy. Five cases died of metastasis. Only one patient remains alive on having tumor as of June, 1997.