Ki Hwan Hong

Phonatory Characteristics of Patients Undergoing Thyroidectomy without Laryngeal Nerve Injury

Complications that arise after thyroid surgery may be associated with infection, hemorrhage, hormonal problems, and laryngeal nerve injury. Voice alteration after thyroidectomy is usually caused by recurrent or superior laryngeal nerve injury. This voice dysfunction may also be associated with laryngotracheal fixation with impairment of vertical movement or by temporary malfunction of the strap muscles after surgery. In this study, we evaluated the voice function phonetically before and after thyroidectomy in 54 patients, although function of the recurrent and superior laryngeal nerves was normal. During surgery, the superior and recurrent laryngeal nerves were identified and protected, and after surgery electromyographic testing of the cricothyroid muscle was performed. Typical voice symptoms after surgery were easy fatigue during phonation and difficulty with high pitch and singing voice. Acoustic analysis revealed that the phonation time and fundamental frequency were not changed after surgery, but the speaking fundamental frequency, range of speaking fundamental frequency, and vocal range were significantly diminished after surgery. These data allowed us to suggest that the cause of voice dysfunction is not seen in neural lesions, but in a disturbance of the extralaryngeal skeleton. These voice changes emphasize the importance of the extralaryngeal mechanism for pitch control.

The role of strap muscles in phonation—In vivo caninelaryngeal model

In spite of the presumed importance of the strap muscles on laryngeal valving and speech production, there is little research concerning the physiological role and the functional differences among the strap muscles. Generally, the strap muscles have been shown to cause a decrease in the fundamental frequency (F0) of phonation during contraction. In this study, an in vivo canine laryngeal model was used to show the effects of strap muscles on the laryngeal function by measuring the F0, subglottic pressure, vocal intensity, vocal fold length, cricothyroid distance, and vertical laryngeal movement. Results demonstrated that the contraction of sternohyoid and sternothyroid muscles corresponded to a rise in subglottic pressure, shortened cricothyroid distance, lengthened vocal fold, and raised F0 and vocal intensity. The thyrohyoid muscle corresponded to lowered subglottic pressure, widened cricothyroid distance, shortened vocal fold, and lowered F0 and vocal intensity. We postulate that the mechanism of altering F0 and other variables after stimulation of the strap muscles is due to the effects of laryngotracheal pulling, upward or downward, and laryngotracheal forward bending, by the external forces during strap muscle contraction.

Intraoral Removal of the Submandibular Gland: A New Surgical Approach

The transcervical procedure used for treating sialolithiasis in the submandibular gland has been generally accepted by head and neck surgeons. However, several clinical problems after surgery through the transcervical approach have been described. We introduce a new surgical approach for excision of the submandibular gland indicated in the chronically inflamed salivary gland with or without calculus and benign mixed tumor of the submandibular gland. Thirty-one cases of submandibular gland excision through the intraoral approach were reviewed, analyzing surgical technique and morbidity. Early postoperative discomforts developed, such as a temporary lack of function of lingual nerve and a temporary limitation of tongue movement, but recovery was within a short period of time in all patients involved. No symptomatic late complications appeared, such as residual inflammation of Whartons duct and neurologic sequelae. We suggest that this approach can be extended to the excision of the submandibular gland as an alternative to the transcervical approach. The major advantages of this approach are the avoidance of an external scar and injury to the marginal mandibular nerve or the hypoglossal nerve.

Surgical results of the intraoral removal of the submandibular gland

Objectives Most patients with benign submandibular disorders have been treated surgically without difficulty via the transcervical approach. An alternative to the standard transcervical approach has been reported such as an intraoral approach. Subjects and Methods Retrospective chart review of the 77 patients with benign submandibular disorders. All patients underwent an excision of the submandibular gland via intraoral approach. Results Early postoperative complications developed in 74.0% of the temporary lingual sensory paresis followed by 70.1% of temporary limitation of tongue movement. However, these complications soon resolved in all patients spontaneously. Two cases of postoperative bleeding and 1 case of abscess formation were developed. Whereas late complications developed in 4 cases of residual salivary gland and abnormal sense of mouth floor and 1 case of gustatory sweating (Freys) syndrome. Conclusion The major advantages of this approach are no external scar, no injury to the marginal mandibular nerve. The disadvantage is a more difficult dissection to transcervical approach before proper expert, especially in the severe adhesion of salivary gland to surrounding tissue.

The Assessment of Nasality with a Nasometer and Sound Spectrography in Patients with Nasal Polyposis

With the development of computerized acoustic analysis systems, an objective measure of nasal speech has become readily available by means of a simple, noninvasive technique. In this study, we assessed the nasality in patients with multiple nasal polyposis before and after endoscopic sinus surgery. With the nasometer, we measured nasalance, which reflects the ratio of acoustic energy output of nasal sounds from the nasal and oral cavities, and the slope score of the nasogram curve. The nasalance scores of nasal sentences and the slope scores of the nasogram curves for all nasal consonants were significantly lower in patients with nasal polyposis than in healthy subjects. After surgery, however, the nasalance and slope scores increased significantly to the normal range. On the sound spectrographic analysis, the frequencies of the first nasal formant decreased slightly and the sound intensity increased slightly for all nasal consonants after surgery. However, no significant change was noticed in the frequencies of the second nasal formant. In conclusion, nasometric and sound spectrographic analyses are considered to be useful tools for objectively assessing the extent of nasality in patients with nasal airway obstruction.

Sialolithiasis in the sublingual gland

Sialolithiasis is a major cause of salivary gland dysfunction. The submandibular gland is the most common site followed by the parotid gland. The sublingual gland and minor glands are very rare sites for stone formation. This paper describes a case of multiple sialoliths arising in the sublingual gland. They presented on the right floor of the mouth. The sublingual gland and sialoliths were completely removed with careful preservation of the lingual nerve and Whartons duct. This was an uncommon sialolithiasis of the sublingual gland in a 14-year-old female.

Arytenoid Appearance and Vertical Level Difference Between the Paralyzed and Innervated Vocal Cords

Objectives/Hypothesis In unilateral vocal fold paralysis, it has been generally accepted that the paralyzed vocal fold presents at a higher level than a normally innervated vocal fold. In this study, we correlate the appearances of the paralyzed arytenoid and the differences in level between the paralyzed and innervated vocal folds.

Functional differences between the two bellies of the cricothyroid muscle

The contraction of the cricothyroid (CT) muscle, which results in a decrease in the distance between the thyroid and cricoid cartilages, is considered to be the main factor in lengthening the vocal folds. This is achieved by rotation of the CT joint. The CT muscle is composed of two distinct bellies, the pars recta and the pars obliqua. The function of each subunit is not clearly understood, although it is believed that they act differently because their fibers run in different directions. To clarify the function of the two bellies in phonation, the fundamental frequency (F0), vocal intensity, subglottic pressure, vocal fold length, and CT distance were measured using an in vivo canine laryngeal model. On the basis of these measurements, we demonstrated that the two bellies are varied in their effect on raising the pitch, rotation, and forward translation of the CT joint. The stimulation of the pars recta nerve resulted in a greater increase in the F0 value compared with that of pars obliqua. The combined activity of the pars recta and pars obliqua is important in adjustment of the vocal fold length. The CT approximations directed parallel to the pars recta and pars obliqua simultaneously were more effective in elevation of the pitch than the approximation placed parallel to the pars recta only. This finding may be clinically significant with regard to CT approximation thyroplasty in human trails. (Otolaryngol Head Neck Surg 1998;118:714–22.)

Extraskeletal Ewing's sarcoma of the larynx.

Primitive neuroectodermal tumour/extraskeletal Ewings sarcoma (PNET/EES) is a rare disease of the head and neck region. We report a case of a 74-year-old man with a laryngeal Ewings sarcoma. This is the first reported case of extraskeletal Ewings sarcoma of the larynx in an elderly male patient. The patient was successfully treated with surgical resection and post-operative radiotherapy.

BENIGN FIBROUS HISTIOCYTOMA OF THE FLOOR OF THE MOUTH

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