Noriya Kakitsuba

Peculiar snoring in patients with multiple system atrophy : Its sound source, acoustic characteristics, and diagnostic significance

It is known that abductor paralysis (AP) of the vocal folds sometimes occurs in patients with multiple system atrophy (MSA), and some of them have sleep apnea and loud snoring during sleep. However, the site of obstruction and the sound source of the snoring are still unknown. We performed fiberscopic examinations under diazepam sedation in 8 MSA patients with AP and analyzed the snoring sound. We found that the peculiar snoring occurred with inspiratory vibration of the vocal folds, and there was no obstruction in this portion. Acoustic analysis showed that the fundamental frequency of vocal fold snoring was 260 to 330 Hz, which is different from that of ordinary soft palate snoring. Recognition of vocal fold snoring is important in the early diagnosis of MSA and sleep-related breathing disorders.

Sleep Apnea and Sleep-related Breathing Disorders in Patients with Craniofacial Synostosis

Seventeen patients with craniofacial synostosis (CFS) have been treated at the Department of Plastic and Reconstructive Surgery at Osaka Medical College during the past 10 years. Six patients were thoroughly evaluated at the Department of Otolaryngology by polysomnography (PSG), cephalometric X-ray and nasopharyngoscopy during sleep. In 4 of the patients PSG showed obstructive sleep apnea syndromes (OSAS). Heavy snoring without apnea and paradoxical respiration were noted in the other 2 patients. Thus, all of the patients had sleep-related breathing disorders (SRBD). It is assumed that the incidence of SRBD in CFS is high. Cephalometric analysis and profilogram showed maxillomandibular hypoplasia in each patient, and it was assumed that the main cause of SRBD in CFS was stenosis of the upper airway tract caused by maxillo-mandibular hypoplasia. Nasopharyngoscopy was performed during sleep in 2 patients with OSAS secondary to CFS. One patient with adenotonsillar hypertrophy had nasopharyngeal obstruction and another patient whose posterior airway space (PAS) on cephalometric radiograph was 3 mm (normal value: 11 mm) had obstruction at the tongue base.

Articulation after uvulopalatopharyngoplasty.

We performed perceptual and acoustic studies to demonstrate articulation after uvulopalatopharyngoplasty (UPPP) in Japanese patients at 28.6 days (mean) after surgery (range 21–50 days). The results of listening tests showed that there were no significant changes between pre- and postoperative articulation scores for any of 25 monosyllables tested, and there were no significant changes in the timbres of 5 Japanese vowels after UPPP. In the acoustic study of the first and second formant frequencies of the vowels, some formant frequencies had significant changes after UPPP. However, these changes in formants fell within the range of intraindividual variation. In the acoustic study of /ka/ with a palatal plosive /k/, there was no significant change in the voice onset time or F2 transition after UPPP.

Limitation of vocal fold abduction only during sleep in a patient with Shy-Drager syndrome

(Editorial Comment: This patient had a vocal for normal vocal fold motion while awake, however, severe narrowing during sleep was attributed to multiple systemic atrophy. This report should alert physicians to another possible ediology for snoring and sleep disorder breathing.) Vocal fold palsy in patients with multiple system atrophy (MSA) was first reported by Bannister et all in 1967. Since then, there have been several more reports of vocal fold palsy in MSA.2-12 Vocal fold palsy in MSA patients without tracheostomies has attracted special attention recently because of the risk of sudden nocturnal death. However, the mechanism of vocal fold palsy has not been elucidated. Bannister et al1 and other investigators2J0 reported that alertness to the presence of sleep respiratory disorders may be life-saving, because this occasionally fatal respiratory complication may occur with vocal fold palsy. We had one patient with Shy-Drager syndrome who had severe laryngeal dysfunction while she was asleep, but no vocal fold palsy while she was awake. We report this rare case and our experience with the evaluation of laryngeal dysfunction while the patient was awake and asleep.

Clinical Analysis of Factors Related to the Viability of Pectoralis Major Myocutaneous Island Flap.

In the present study, we analysed patient characteristics and other factors related to flap viability in 19 patients who underwent reconstructive surgery using a pectoralis major myocutaneous island flap in our department over 6+ the past eight years. In these 19 patients (15 males and 4 females), the flap was used on the luminal side of the oral cavity and oropharynx after radical surgery for the treatment of carcinoma of the tongue (10 cases), carcinomas of the oral floor and gingiva (5 cases), and oropharyngeal carcinoma (1 case). Wound complications in the island flap or cervical skin incision site occurred in 11 out of 19 patients, and included partial necrosis of the island flaps (8 cases), dehiscence of the cervical skin incision site (7 cases), dehiscence of the island flap margin (3 cases) and so on. All four of the patients with diabetes mellitus had some wound complications. A comparison of blood data a month before surgery patients with and without wound complications, revealed the mean value of total protein to be significantly lower in the group with wound complications than that in the group without wound complications. A comparison of blood data one month after surgery revealed a significantly higher leukocyte count in the group with wound complications than in the group without wound complications. When a comparison of the incidence of wound complications was made between the group with radiation therapy and that without radiation therapy, the former group showed a higher incidence of complications in the cervical skin incision site than the latter group did, in cases of cervical irradiation.