Masami Ogura

Effects of Head Rotation on Pharyngeal Function during Normal Swallow

This study quantified the effects of head rotation on pharyngeal swallowing in healthy subjects. Videofluoroscopic and oropharyngeal manometric examinations of pharyngeal swallowing were performed on seven volunteers with the head in neutral and rotated positions. Videofluoroscopic study revealed that head rotation swallow causes the bolus to lateralize away from the direction of head rotation. Pharyngeal manometric study indicated that the pharyngeal peak pressures toward the side of head rotation were significantly increased, whereas the pharyngeal pressures opposite the side of head rotation were not affected. Head rotation swallow produced a significant fall in upper esophageal sphincter (UES) resting pressure and a delay in UES closing. We concluded that the head rotation swallow in normal subjects not only alters the bolus pathway, but also has a useful effect on both pharyngeal clearance and UES dynamics.

Voice Quality After Laser Surgery or Radiotherapy for T1a Glottic Carcinoma

Objective To compare the effect on phonation of radiotherapy and endoscopic laser surgery for stage T1a glottic squamous cell carcinoma.

Laser surgery for allergic and hypertrophic rhinitis.

Laser surgery, which is one type of surgical treatment for allergic and hypertrophic rhinitis, was investigated basically and clinically. The basic investigation showed morphological changes in the nasal mucosa before and after laser surgery. Before laser surgery, hyperplasia of the mucous epithelium, thickening of the basement membrane, edema of the lamina propria mucosa, eosinophilic infiltration, and enlargement of the nasal glands were noted. After laser surgery, the nasal mucosa was covered with 1) epithelium that was squamatized or cuboidal and/or 2) columnar epithelium that was stratified. Granulation-like tissue or cicatricial tissue was found in the lamina propria mucosa. Clinically, we performed laser surgery in 204 cases. Regarding the short-term results, laser surgery was effective in 87%. In the long term, the short-term results persisted in 81% of cases treated for sneezing, 78% for nasal discharge, and 76% for nasal obstruction. From these results, we concluded that laser surgery was a useful surgical treatment for allergic and hypertrophic rhinitis.

The operation of upper esophageal web in Plummer-Vinson syndrome: a case report.

Most cases of dysphagia associated with Plummer-Vinson syndrome are expected to improve with the oral administration of ferrous agents. When a web is the cause of the symptoms, surgical management is rarely necessary. However the surgical indication and technique for the web have been controversial. The patient was a 56-year-old woman who complained of restricted dietary habit because of an upper esophageal circumferential web associated with Plummer-Vinson syndrome. The circumferential and membranous web was resected with a surgical knife and scissors through the inner lumen of esophagus and the raw surface was sutured at five places with 4-0 proline thread under microlaryngosurgery. This surgical treatment resulted in diminished dysphagia and no recurrence of the web after the surgery.

Use of freeze-dried autologous fascia to augment the vocal fold: an experimental study in dogs.

This study assessed the practicality of using autologous freeze-dried fascia to augment the vocal fold. Freeze-dried autologous fascia was injected into the vocal fold and skin of dogs in order to monitor sequential histological changes. Fascia lata was harvested from six adult dogs. After freeze-drying, minced fascia suspended in hyaluronic acid was injected subcutaneously into the abdominal wall and directly into the vocal fold. The specimens were extracted 3 weeks after injection and studied histologically. Freeze-drying destroyed all cellular components but did not affect the collagen fibers, which are the major components of fascia. There was no evidence of degeneration, necrosis or infection. Fibroblastic infiltration was seen in the fascia injected into the vocal fold, but the fascia remained as an unencapsulated mass at the site of injection. This study demonstrates that freeze-drying does not compromise the collagen in fascia and that the injection of freeze-dried collagen is well tolerated. Freeze-dried fascia is a promising new augmentation material.

Endonasal laser dacryocystorhinostomy in outpatient clinic

Abstract The endonasal laser dacryocystorhinostomy (DCR) was performed in five patients with obstruction after conventional external DCR. The surgery was performed in an outpatient setting with local anesthesia. After intranasal superficial anesthesia with gauze impregnated with 4% lidocaine hydrochloride diluted with 5000-fold epinephrine, 0.5% lidocaine hydrochloride was injected. A 20-gauge light probe, originally developed for vitrectomy, was inserted from the upper punctum. The obstructed region was illuminated using the light probe and was observed intranasally with the endoscope. The KTP laser was delivered through a 0.4-mm quartz fiber that was passed through the hand-piece for nasal surgery. The mucosa surrounding proposed rhinostomy was vaporized by the laser (continuous wave, 5 to 8 W, near-contact mode). The obstructed region was then opened and the desired rhinostomy size was achieved. Bicanalicular silicone tube intubation of the surgical ostium was performed. No complications occurred during and after surgery. The ostium continued to be patent, and the patients were free of symptoms. We concluded that the endonasal laser DCR is useful for reconstruction after conventional DCR.

Carcinoma of the larynx: role of laser surgery

68 cases of glottic carcinomas (T1 53 and T2 15 cases) treated with CO2 laser or KTP/532 laser April 1982 through March 1992 were reviewed. The patients were followed up from 13 to 130 months (mean 60 months). The 3-year determinate survival rate was 100% and 5-year determinate survival rate was 100% for T1 and 80% for T2. The voice conservation rate was 97% for T1a, 83% for T1b, and 80% for T2 and vocal function was satisfactorily preserved for daily life. The results led to the following conclusions: (1) Glottic T1 carcinomas can be treated by laser surgery alone. (2) Lesions involving the anterior commissure can be treated by laser excision and vaporization. (3) Laser surgery followed by external radiation therapy for glottic T2 carcinomas improves the voice conservation rate.

Direction of lateral traction in Ejnell's technique: An experimental study and case report of bilateral vocal cord paralysis

In order to develop the method of laterofixation of the vocal cord (Ejnells method) in cases of bilateral vocal cord paralysis, six autopsy specimens of normal larynx were obtained. We inserted traction sutures under conditions of direct visualization and studied the relationship between the direction of the traction exerted by the suture and subsequent enlargement of the glottis. When the vocal cord was pulled perpendicular to the thyroid cartilage wing, the mean glottal area was 106.2% of its area before traction. When the vocal cord was pulled perpendicular to the median line of the glottis, the mean glottal area was 112.7% of its area before traction. The latter angle of traction therefore produced more efficient enlargement of the glottis ( p < 0.05; paired t -test). Based on an anatomic study of cadaveric laryngeal regions, a formula was developed to predict at which point the needle should be placed in order to produce optimal results using Ejnells technique. Further clinical studies will be carried out in patients to test the validity of this formula.

Laser application for hypertrophic rhinitis

The CO2 and KTP/532 lasers have been used in the treatment of an allergic and hypertrophic rhinitis for the past several years. As we know, the laser enables a surgeon to perform the operation with minimum hemorrhage and minimized pain, during and after the procedure. Additionally many of these operations can be performed under local anesthesia instead of general anesthesia, on an outpatient basis. The laser is used to irradiate the mucous membranes of the inferior turbinates. Vaporization and cutting is easily done. Post operative management of the local operated area is easy. The advantages of laser surgery over regular surgical techniques are supreme for intranasal operations when performed under local anesthesia.

Endoscopic laser surgery for subglottic and tracheal stenosis

Seventeen patients with subglottic or tracheal stenosis were treated with laser surgery. Six patients had airway compromise caused by malignant tumors. Sixteen patients required emergency endolaryngeal laser surgery, and satisfactory results were achieved in 12 obtaining an adequate lumen for ventilation. Five patients with airway tumors underwent laser surgery to increase the airway lumen, however, only one patient showed excellent results, with a sufficient airway lumen not being obtained in the other. Airway obstructions due to tumors can be treated satisfactorily by laser surgery, although long term postoperative follow up confirmed recurrence of tumor in most cases.