Koji Araki

Laryngeal function after supracricoid laryngectomy.

Objective: The purpose of this study was to assess laryngeal function after supracricoid laryngectomy. Study Design: Case series. Subjects and Methods: Supracricoid laryngectomy (SCL) has been performed in our institution for 24 selected patients with laryngeal cancer since December 2000. Reconstruction was performed through cricohyoidoepiglottopexy for 23 patients and cricohyoidopexy for 1 patient. Seven patients had ipsilateral arytenoid removal, and 15 patients underwent SCL as salvage surgery. A retrospective chart review was performed to assess postoperative speech and swallowing function. Stroboscopy and/or fiberscopy of the neoglottis were used to assess postoperative speech kinetics. Acoustic parameters were measured to evaluate vocal function, and several questionnaires were used to evaluate postoperative quality of life (QOL). Results: In the absence of postoperative complications, stoma closure and normal diet intake were achieved 1 month after surgery. The neoglottis comprises the arytenoid(s), epiglottis, and pyriform sinus mucosa. Several different combinations of vibrating regions were observed among patients during phonation. Although vocalization sounded rough and breathy, vocal communication was possible with little inconvenience. Conclusion: Acceptable functional recovery and tolerable QOL can be achieved after SCL.

Sentinel Node Concept in Clinically N0 Laryngeal and Hypopharyngeal Cancer

BackgroundSentinel nodes (SNs) are the lymph nodes that directly receive lymphatic flow from a primary cancer lesion. The SN concept implies that lymphatic metastasis initially occurs at SNs. SN navigation surgery can be introduced for cancers in which the SN concept is established. In SN navigation surgery, lymph node dissection beyond SNs can be omitted if SNs are metastasis free. Although the SN concept has been investigated frequently for oral and oropharyngeal cancer, it has so far been investigated less for laryngeal and hypopharyngeal cancer. In this study, we investigated whether the SN concept is applicable for laryngeal and hypopharyngeal cancer.MethodsTwenty patients with T2–T4 and clinically N0 laryngeal and hypopharyngeal cancer were recruited. 99mTc-phytate was injected into several sites surrounding the tumor on the day before surgery. Lymphoscintigrams were acquired from at least two different viewpoints. SNs were surveyed intraoperatively, and neck dissections including at least levels II, III, and IV were performed.ResultsSNs had occult metastases in five cases. In the remaining 15 cases, neither SNs nor other lymph nodes contained metastases, consistent with the SN concept. There was one false-negative case showing delayed nodal metastasis 2xa0years after initial surgery. The overall accuracy of the SN concept was 95%.ConclusionOur study shows that SN biopsy is a reliable strategy to determine correct lymph node status in N0 laryngeal and hypopharyngeal cancer. SN detection was valuable in evaluating the need for neck dissection, whether ipsilaterally or bilaterally.

Injection laryngoplasty with calcium phosphate cement

Objective: To assess the feasibility of injection laryngoplasty with calcium phosphate cement (CPC), which is an injectable paste, self-hardening, and which recrystallizes to calcium hydroxylapatite after injection. Study Design: A case series with planned data collection. Methods: Fifty-six patients with unilateral vocal fold paralysis, who received injection laryngoplasty with CPC between August 2003 and August 2007 with a minimum follow-up period of six months, were enrolled in this study. Volumetric and migration analysis for injected CPC were performed using CT after surgery. Vocal function was also assessed by GRBAS subjective voice assessment scale and maximum phonation time (MPT), acoustic analysis including period perturbation quotient (PPQ), amplitude perturbation period (APQ), and noise-to-harmonics ratio (NHR). Results: No remarkable migration or absorption of injected CPC was observed on CT up to two years after surgery. The average remaining volume of CPC was 87.8% ± 5.3% two years after injection compared to immediately after injection. Significant improvements in GRBAS scales, MPT, PPQ, APQ, and NHR were observed postoperatively. No adverse effects were observed. Conclusions: Our clinical experience revealed that CPC was safe, nonabsorbable, and effective. Injection laryngoplasty with CPC may be a useful option in the treatment of glottic insufficiency.

A novel drug therapy for recurrent laryngeal nerve injury using T-588.

Objectives/Hypothesis: We have previously shown that gene therapy using Insulin‐like growth factor (IGF)‐I, glial cell line‐derived neurotrophic factor (GDNF), and brain‐derived neurotrophic factor (BDNF), or a combination of these trophic factors, is a treatment option for recurrent laryngeal nerve (RLN) palsy. However, there remain some difficulties preventing this option from becoming a common clinical therapy for RLN injury. Thus, we need to develop novel treatment option that overcomes the problems of gene therapy.

Gene therapy for laryngeal paralysis.

Objectives: The surgical options for laryngeal paralysis only achieve static changes of vocal fold position. Laryngeal reinnervation procedures have had little impact on the return of dynamic laryngeal function. The development of a new treatment for laryngeal paralysis, aimed at the return of dynamic function and neurologic restoration and regeneration, is necessary. Methods: To assess the possibility of gene therapy for laryngeal paralysis aiming for the return of dynamic laryngeal function, we investigated the therapeutic effects of gene therapy using rat laryngeal paralysis models. Results: In a rat vagal nerve avulsion model, we transferred glial cell line-derived neurotrophic factor (GDNF) gene into the nucleus ambiguus using an adenovirus vector. Two and 4 weeks after the GDNF gene transfer, a significantly larger number of surviving motoneurons was observed. These neuroprotective effects of GDNF gene transfer were enhanced by simultaneous brain-derived neurotrophic factor gene transfer. In a rat recurrent laryngeal nerve crush model, we transferred GDNF gene into recurrent laryngeal nerve fibers after crush injury. Two and 4 weeks after GDNF gene transfer, we observed significantly faster nerve conduction velocity and better vocal fold motion recovery. Conclusions: These results indicate that gene therapy could be a future treatment strategy for laryngeal paralysis. Further studies will be necessary to demonstrate the safety of the vector before clinical application.

Contents Vol. 76, 2014

R.L. Alford, Houston, Tex. M. Anniko, Uppsala Y.A. Bayazit, Ankara H.H. Birdsall, Houston, Tex. P.J. Bradley, Nottingham J. Califano, Baltimore, Md. P.F. Castellanos, Bimingham, Ala. C. Cernea, São Paulo F.-L. Chi, Shanghai A. Chiu, Tucson, Ariz. N. Cohen, Philadelphia, Pa. M.D. Eisen, Hartford, Conn. L.M. Elden, Philadelphia, Pa. E. Ferekidis, Athens A. Ferlito, Udine R.L. Ferris, Pittsburgh, Pa. L.L. Gleich, Cincinnati, Ohio D.-M. Han, Beijing J.P. Harris, San Diego, Calif. R. Häusler, Bern I. Hochmair, Innsbruck K. Hörmann, Mannheim W. Hosemann, Greifswald K.-B. Hüttenbrink, Köln S. Iurato, Bari A. Kakigi, Tokyo B.N. Landis, Geneva T. Linder, Luzern S. Malekzadeh, Washington, D.C. W.J. Mann, Mainz G. Marioni, Padova J.N. Palmer, Philadelphia, Pa. R. Probst, Zürich A. Rinaldo, Udine R.J. Ruben, Bronx, N.Y. I. Salahuddin, Karachi A. Schrott-Fischer, Innsbruck A. Shiotani, Saitama T.N. Teknos, Columbus, Ohio K. Tomoda, Osaka R.P. Tufano, Baltimore, Md. R.T. Younis, Miami, Fla. P. Zbären, Bern Journal for Oto-Rhino-Laryngology, Head and Neck Sugery

Resection of an orbital tumor with coronal incision and frontal sinus fenestration

A case of orbital tumor is reported. A 52-year-old man consulted our hospital with left exopthalmus and impaired vision. On opthalmologic exmination, left exopthalmos in Hertel statometer, left impaired visual acuity and degeneration of retina in superolateral region of the optic disk of his left eye were noted. Magnetic resonance imaging (MRI) demonstrated a tumor with clear margin in the retro bulbar space. He was referred to our oto-rhino-laryngological section for surgery. At surgery, coronal incision was made and the extended lateral orbitotomy was made with fenestration of the frontal sinus. The tumor was easily removed without any complication on visual acuity and eye-ocular movement. We conclude that the approach with coronal incision and frontal sinus fenestration is useful for resection of orbital tumor.