Masami Nakajima

Glottal configuration, acoustic, and aerodynamic changes induced by variation in suture direction in arytenoid adduction procedures.

Arytenoid adduction is a phonosurgical procedure in which the arytenoid cartilages are approximated to reduce posterior glottal gap size and improve voice. Voice outcomes following arytenoid adduction are not always optimal. The goal of this study was to systematically vary suture direction and force of pull on the arytenoid cartilages in a human excised laryngeal model to determine the optimal combination of factors for reducing glottal gap and improving voice. Several factors demonstrated significant effects. Changes in suture direction and force of pull affected glottal configuration in both the horizontal and vertical planes. Increased force of pull on the muscular process resulted in increased adduction of the vocal process for all suture directions. Changes in suture direction and force of pull also affected acoustic and aerodynamic measures of induced voice. Therefore, voice outcomes can be optimized with arytenoid adduction if the vocal fold plane is accurately adjusted.

A Case of Extramedullary Plasmacytoma of the Larynx

An 84-year-old male with a complaint of hoarseness was examined. A mass lesion was recognized in the false vocal fold. The tumor was excised and found to consist of atypical plasmacytes. Immunopathological examination revealed that leukocyte common antigen (CD45), UCHL1 (CD45RO), CD3 and L26 (CD20) were negative and that CD79 and Vs38C were positive. Neither uric Bence-Jones protein nor serum M-protein were observed. No other bony abnormalities were recognized on X-ray examinations including both bone and Ga scintigraphy. No atypical plasmacyte infiltration was observed in bone marrow. Our final diagnosis was extramedullary plasmacytoma of the larynx. Radiotherapy was performed following surgery. The tumor did not progress to multiple myeloma and no recurrence has been observed after 2 years.

S300 – Comparison of Endoscopy Diagrams for Obstructive Sleep Apnea

Objectives Most methods of waking and sedated sleep endoscopy evaluating the upper airway in obstructive sleep apnea inconsistently predict surgical results. Goals of exam have been to identify levels of obstruction or levels of tissue vibration. Examinations provide little information on airway structure. A novel method of describing airway collapse using airway structures has been developed. The objectives of this study are to compare sleep and wake examination: 1) during inspiration, and 2) expiration. Methods A retrospective review evaluated waking and sedated clinical endoscopic endoscopy. Clinical endoscopic examination was performed supine at end expiration. Sedated endoscopy used propofol anesthesia evaluated the airway during both inspiration, expiration, and with elimination of airway mechanoreceptors. Defined structural butressess included salpingo/palatopharyngeus, levator, and uvular muscle groups for the epi-pharynx and the epiglottis, lateral hypopharynx, vallecular and proximal tongue base for the hypopharynx. Structures were scored on 3 and 4 point scales with agreement indicating exact matching. Results Severity of obstruction scored higher on sedated exam than clinical exam. Structural agreement in epipharynx was 52%, 29%, and 24%, and in hypopharynx, 48%,24%, and 38%. False negative and positive assessment occurred in epipharynx (levator 30% and uvula 40%) but not in hypopharynx. Conclusions Consistent with a greater loss of muscle tone during sleep, exact agreement between wake and sleep exams was low, however, supine end expiratory exam predicted patterns of airway collapse in hypopharynx. Pattern of collapse in epipharynx is confounded by ventilation during wake.

Radiation-induced mucositis: An animal model

Problem: Radiotherapy usually plays an important role in the treatment of head and neck cancers. However, radiation-induced mucositis often occurs and interrupts the radiotherapy. Current studies cannot explain sufficiently the efficacy of medication for the radiation-induced mucositis. Because human studies of the effect of medication for mucositis are difficult, an animal model for radiation-induced mucositis must be used. Rat oral mucosa was locally irradiated for creating mucositis experimentally and a histological examination was performed. A pilot study for producing an animal model of radiation-induced mucositis is discussed. Methods: Eight rats were divided into 4 groups. These 4 groups were classified by the direction of irradiation and the degree of 1-day irradiation. Rats in each group were anesthetized by ketamine hydrochloride and irradiated using LINAC (6MeV X-ray irradiated machine). Macroscopic observations of the rat oral mucosa were performed and recorded day by day. Once oral mucositis was created, all rats were euthanized. Obtained oral specimen of mucositis was used for histological examination. Results: One of 8 rats created oral aphtha and ulcer at the total dose of 100 Gy (4 Gy/day) over a period of 25 days. Microscopic examination showed that numerous inflammatory small round cells were infiltrated around ulcers under hematoxylin-eosin stain. Conclusion: This pilot study presented a rat model of radiation-induced mucositis. In human beings, oral mucositis is usually created at the total amount of 40 Gy under 2 Gy/day irradiation. However, comparing between human being and rat, rats need about 2 to 3 the dosages of irradiation than do human beingss for creating oral mucositis. The explication of irradiation tolerance at the rat oral mucosa might play an important role for producing a new technique that treats radiation-induced mucositis in human oral mucosa. Significance: A rat model might be useful for producing a new technique for treating radiation-induced mucositis in human oral mucosa. Support: None reported.

The role of t cells in oral and pharyngeal intractable recurrent ulcers

Abstract Problem: The etiology and clinical definition of intractable recurrence ulcer (IRU) of the oral cavity and pharynx were unknown. The intractable recurrent ulcer of the oral cavity and pharynx was then defined as irregular ulcerative lesions occurring mainly in the oral cavity and pharynx, showing no specific findings in clinicohematological examinations, which recurred easily and were resistant to various treatments for at least 1 month. Histological examinations of these lesions have been performed for several years at our institute. Our previous study presented that apoptosis was observed in the epithelium around ulcers using the TUNEL method. Moreover the expressions of Fas were observed in epithelium around ulcers. The Fas and Fas-ligand reaction might play an important role in developing the intractable recurrent ulcer of the oral cavity and pharynx. However, the existence and localization of Fas-L have still not been understood. In this study, existences of the target memory T cells around ulcers were analyzed. Methods: Twenty patients (15 males and 5 females) with intractable recurrent ulcers of the oral cavity and pharynx were examined immunohistologically by using antihuman anti-T cell (CD45RO, UCHL1), anti-B cell (CD20/cy, L26), and anti-HLA-DR (Alpha-Chain, TAL 1B5) for detecting subclass of lymphocytes. Anti CD4, CD8, CD25, and CCR6 were used for detecting target memory T cells. Results: Eighteen of 20 IRU patients presented larger amounts of anti-T expressed cells comparing with anti-B expressed cells. Anti-HLA-DR expressed T cells were observed in both the epithelium and submucosa around ulcers. Moreover Langerhans’s cells were observed in submucosa. Conclusion: Our results suggested that the immunoactivity induced by T cells might play an important role in developing the intractable recurrent ulcer of the oral cavity and pharynx. Target memory T cell was classified as the expression of CD8, CD25, and CCR6. The Fas ligand-expressed target memory T cell might be a key cell for developing epithelial apoptosis induced by Fas and Fas ligand reaction. Significance: Immunoactivity, such as the reaction between the Fas in epithelium and the Fas-L on target memory T cell, might be one of the important roles in developing intractable recurrent ulcer of the oral cavity and pharynx. Support: None reported.