Shinichi Nakagawa

Clinical outcomes of tracheoesophageal diversion and laryngotracheal separation in neurologically impaired children

OBJECTIVE Outcomes of tracheoesophageal diversion and laryngotracheal separation were evaluated in 15 neurologically impaired children treated for intractable aspiration. METHODS A retrospective analysis of the hospital records was carried out in 15 consecutive pediatric patients who underwent either tracheoesophageal diversion or laryngotracheal separation with trumpet-shaped tracheotomy from 1999 to 2006 in Kagawa Childrens Hospital. RESULTS The number of hospital admissions for aspiration pneumonia after surgery was significantly decreased in 6 patients who were cared for at home. The parent-reported number of secretion suctioning was decreased after surgery especially in patients with pre-operative tracheotomy or intubation. Four patients fed through naso-gastric tube progressed with oral diet post-operatively, whereas 3 patients who had pre-operative tracheotomy developed temporary post-operative tracheocutaneous fistula that was managed by local wound care. CONCLUSION It is suggested that tracheoesophageal diversion and laryngotracheal separation decrease the morbidity of pediatric patients and improve their quality of life and that of their parents. It is suggested that the risk of developing post-operative fistula is higher in pediatric patients with than without pre-operative tracheotomy.

Two Cases of Invasive Aspergillus Sinusitis and Mastoiditis Successfully Treated with Voriconazole

We report two cases of invasive aspergillosis of the head and neck regions. One patient was a 56-year-old male with invasive aspergillus sinusitis. The other patient was a 14-year-old boy with aspergillus mastoiditis after bone-marrow transplantation. Both cases were inoperable because of vascular invasion by aspergillus, and treatment with antifungal agents was discontinued due to severe side effects. A novel triazole voriconazole (VRCZ) was then used for salvage therapy and successfully treated invasive aspergillosis in both cases. VRCZ is an effective and well tolerated agent to treat invasive aspergillosis of the head and neck regions.

Biofeedback Rehabilitation in a Patient with Severe Bell's Palsy as Prophylactic Treatment for Synkinesis.

Synkinesis of the facial muscles are common sequelae of peripheral facial nerve palsy. However, treatment for synkinesis is limited. The case of an 18-year-old woman with right-sided Bells palsy is reported. An electroneurography (ENoG) test showed complete degeneration of the facial nerve on the right side. There was a good possibility that the patient would eventually be troubled by synkinesis. As prophylactic treatment for the prevention of synkinesis, biofeedback rehabilitation was undertaken using a mirror and electromyography. Subsequently, the patient showed no simultaneous activation of the orbicularis oculi during mouth movements, which is the most common clinical symptom of Synkinesis. It is proposed that biofeedback rehabilitation is an effective prophylactic treatment for synkinesis.