Hidetaka Matsuoka

Dysphagia following Various Degrees of Surgical Resection for Oral Cancer

Postoperative swallowing problems were investigated in 20 patients who had undergone various degrees of surgical resection for oral cancer. The swallowing problems were evaluated on the basis of type of food, degree of aspiration, and duration of postoperative nasogastric tube feeding. Two patients with tongue cancer who had had hemiglossectomy without reconstruction ate normal food without aspiration within a week after operation. Eight patients who had undergone two- to three-quarter glossectomy for tongue cancer ate gruel with no or occasional liquid aspiration. Among 4 patients who had had near-total or total glossectomy for tongue cancer, 3 ate thin gruel or liquid with occasional aspiration. The other could not eat orally because of consistent severe aspiration. One patient with mouth floor cancer underwent resection of the mouth floor in combination with hemiglossectomy and she ate gruel without aspiration. Among 5 patients with mouth floor cancer who had had surgical removal accompanied by near-total or total glossectomy, 3 ate gruel with no or occasional liquid aspiration, 1 ate thin gruel with no aspiration, and the other could not eat orally. A diagnosis of T4 lesions, extensive removal of the tongue base, removal of the geniohyoid and mylohyoid muscles, and removal of the lateral pharyngeal wall were significantly related to poor swallowing function.

Deglutition following Supraglottic Horizontal Laryngectomy

In order to determine factors that may contribute to deglutition problems following supraglottic horizontal laryngectomy or its modified techniques, clinical records of 38 patients were studied. Contribution of the following factors was investigated: Age; sex; tumor classification; radical neck dissection; extent of and symmetry in removal of the aryepiglottic folds, arytenoid cartilages, and false folds; removal of the base of the tongue, hyoid bone, and a part of the vocal folds; extent of removal of the epiglottis and thyroid cartilage; cricopharyngeal myotomy; and some complications and concomitant diseases. The results suggest that removal of the arytenoid cartilage and asymmetrical removal of the false folds contribute to deglutition problems. We conclude that the standard supraglottic horizontal laryngectomy associated with surgical approximation of the larynx to the base of the tongue and cricopharyngeal myotomy does not usually cause serious deglutition problems. When the arytenoid cartilage is removed, reconstruction of the structure is required for the prevention of severe aspiration.

Vocal function following hemilaryngectomy

Vocal function following hemilaryngectomy was investigated in 54 cases in which a superiorly based sternohyoid muscle flap was used for glottic reconstruction. Four types of material were employed for covering the muscle flap: Hypopharyngeal mucosa, lip mucosa, thyroid perichondrium, and island cervical skin flap. The vocal function varied greatly from individual to individual; however, the following tendencies were observed in many cases: 1) the glottis did not close completely; 2) supraglottic structures (false fold, arytenoid region, and epiglottis) were hyperfunctional and vibrated instead of or together with the unaffected vocal fold; 3) vibrations of the laryngeal structures were irregular; 4) maximum phonation time was short; 5) mean airflow rate was high; 6) fundamental frequency and intensity ranges of phonation were limited; 7) the voice was rough, breathy, and/or strained; and 8) cases with poor vocal function were most frequent in the skin flap group and least frequent in the lip mucosa group.

Vocal Fold Fixation in Laryngeal Carcinomas

The mechanisms of vocal fold fixation were determined by means of a whole-organ serial section study. A total of 80 laryngectomy specimens, 36 supraglottic and 44 glottic carcinomas, was investigated. In the supraglottic carcinomas, the most frequent cause of fixation of the ipsilateral vocal fold was a deep massive tumor invasion in the arytenoid eminence and the second most frequent cause was an extensive involvement of the thyroarytenoid (TA) muscle. Fixation of the contralateral vocal fold resulted from a deep tumor invasion in the contralateral arytenoid eminence. In the glottic carcinomas, fixation of the ipsilateral vocal fold resulted from an extensive invasion into the TA muscle. Fixation of the contralateral vocal fold was caused chiefly by an invasion into the contralateral TA muscle through the anterior commissure region. It resulted occasionally from an invasion into the interarytenoid muscle and contralateral arytenoid cartilage and cricoarytenoid joint via the posterior part of the larynx.

A Histopathological Study of Carcinoma of the Larynx

Fifty-one laryngectomy specimens were histopathologically studied in serial sections. The incidence of thyroid cartilage invasion was 10% in supraglottic, 48% in glottic, and 67% in subglottic carcinomas. The incidence of cricoid cartilage invasion was 0% in supraglottic, 22% in glottic, and 33% in subglottic carcinomas. The sites of cartilage invasion were the anterior commissure portion and an ossified lower portion of the thyroid cartilage, and an ossified upper portion of the cricoid cartilage. Fixation of the vocal fold in glottic carcinoma was accounted for by carcinomatous invasion into three-fourths or more of the thyroarytenoid muscle. Impairment of the vocal fold movement was accounted for by carcinomatous invasion into three-fourths or less of the thyroarytenoid muscle. Fixation of the vocal fold in supraglottic carcinomas was accounted for by a massive carcinomatous invasion around the upper aspect of the arytenoid cartilage.