Syunichi Chitose

Unilateral associated laryngeal paralysis due to varicella-zoster virus: virus antibody testing and videofluoroscopic findings

The relationship between varicella-zoster virus and idiopathic associated laryngeal paralysis was examined in five patients, using complement fixation or enzyme immunoassay testing. In all cases, significant changes in serum levels of varicella-zoster virus antibody were observed. Videofluoroscopy was useful in assessing the severity of the dysphagia and in making an accurate diagnosis; both laryngeal elevation and weakness of pharyngeal wall contraction were also observed. In two cases in which antiviral therapy was delayed, the outcome was poor, with increased levels of varicella-zoster virus immunoglobulin M found on enzyme immunoassay. The outcome of the condition may thus depend both on the speed of antiviral therapy commencement following onset of symptoms, and on the levels of varicella-zoster virus immunoglobulin M antibody (measured by enzyme immunoassay). Our study suggests that varicella-zoster virus should be considered in the differential diagnosis of patients with idiopathic associated laryngeal paralysis, and rapid antiviral therapy should be initiated when necessary.

Microenvironment of macula flava in the human vocal fold as a stem cell niche.

BACKGROUND There is growing evidence that the cells in the maculae flavae are tissue stem cells of the human vocal fold mucosa, and that the maculae flavae are a candidate for a stem cell niche. The role of microenvironment in the maculae flavae of the human vocal fold mucosa was investigated. METHOD Anterior maculae flavae from six surgical specimens were cultured in a mesenchymal stem cell growth medium or a Dulbeccos modified Eagles medium. RESULTS Using mesenchymal stem cell growth medium, the subcultured cells formed a colony-forming unit, and cell division reflected asymmetric self-renewal. This indicates that these cells are mesenchymal stem cells or stromal stem cells in the bone marrow. Using Dulbeccos modified Eagles medium, the subcultured cells showed symmetric cell division without a colony-forming unit. CONCLUSION A proper microenvironment in the maculae flavae of the human vocal fold mucosa is necessary to be effective as a stem cell niche that maintains the stemness of the contained tissue stem cells.

Comparative study of framework surgery and fat injection laryngoplasty

OBJECTIVE To evaluate differences between the functional results of framework surgery and autologous fat injection laryngoplasty, for patients with unilateral vocal fold paralysis. STUDY DESIGN Sixty-two patients underwent framework surgery, while 64 received autologous fat injection laryngoplasty. Voice function before and after both procedures was assessed using aerodynamic and acoustic analysis, with differences evaluated using paired t-test in both groups. RESULTS In both groups, all parameters improved significantly after surgery, compared with before surgery. Post-operative improvement in all parameters was significantly greater after fat injection laryngoplasty, compared with framework surgery. CONCLUSION Autologous fat injection laryngoplasty was thus found to be a more effective and reliable therapy for improving voice function in patients with vocal fold paralysis, compared with framework surgery.

Cell origin in the macula flava of the human newborn vocal fold.

BACKGROUND There is growing evidence to suggest that cells in the maculae flavae are tissue stem cells of the human vocal fold and maculae flavae are a stem cell niche. METHODS Three newborn vocal folds were investigated. Immunoreactivity to antibodies directed to cytokeratin, desmin, glial fibrillary acidic protein, vimentin, cluster of differentiation 34, cluster of differentiation 45, collagen type I, telomerase reverse transcriptase, SOX17 and stage-specific embryonic antigen 3 was investigated. RESULTS The cells in the newborn maculae flavae expressed haematopoietic markers (cluster of differentiation 34, cluster of differentiation 45) and collagen type I, which are the major makers of bone marrow derived circulating fibrocytes. The cells expressed epithelium, muscle, neural and mesenchymal cell associated proteins, and endodermal marker, indicating that they are undifferentiated and express proteins of all three germ layers. The cells also expressed stage-specific embryonic antigen 3 and telomerase reverse transcriptase. CONCLUSION The cells in the newborn maculae flavae are undifferentiated cells arising from the differentiation of bone marrow cells. The results of this study are consistent with the hypothesis that the cells in maculae flavae are tissue stem cells.

Tetra-probe, 24-hour pH monitoring for laryngopharyngeal reflux: a technique for simultaneous study of hypopharynx, oesophagus and stomach.

OBJECTIVE This study aimed to introduce the technique of tetra-probe, 24-hour pH monitoring for laryngopharyngeal reflux disease. METHODS Tetra-probe, 24-hour pH monitoring was performed for 30 suspected cases of laryngopharyngeal reflux. The proximal probe was placed in the hypopharynx, just above the upper oesophageal sphincter, the second probe was placed in the middle oesophagus, the third probe was placed a few centimetres above the lower oesophageal sphincter, and the distal probe was placed in the stomach. RESULTS As the pH at the four sensor sites could be monitored simultaneously, gastric acid levels and gastroesophageal and laryngopharyngeal reflux could be examined. This pH monitoring technique enabled the pH relationship between the four sensor locations to be well documented, enabling gastric acid levels and patterns of reflux to be assessed. This procedure was also able to be used as a functional examination to evaluate anti-reflux medication efficacy. CONCLUSIONS Tetra-probe, 24-hour pH monitoring is a reliable functional examination for laryngopharyngeal reflux.

Efficacy of autologous fat injection laryngoplasty with an adenoviral vector expressing hepatocyte growth factor in a canine model

OBJECTIVE The effectiveness of autologous fat injection laryngoplasty may be reduced by resorption of injected fat tissue. The aim of the present study was to clarify the efficacy of fat injection laryngoplasty using autologous fat plus a replication-defective adenoviral vector expressing hepatocyte growth factor, regarding reduction of injected fat tissue resorption. MATERIAL AND METHODS Four female beagle dogs were used in this study. After sedation, a direct laryngoscope was introduced to enable visualisation of the larynx. In each dog, harvested autologous fat plus an adenoviral vector expressing hepatocyte growth factor was injected into the right true vocal fold, and harvested fat plus an adenoviral vector expressing no gene was injected into the left true vocal fold. A total laryngectomy was performed one year after the intracordal fat injection. Coronal sections of the resected whole larynges were made and the following parameters assessed using light and electron microscopy: size of fat area; number of vasculoendothelial cells surrounding adipocytes; and shape of injected adipocytes in the vocal fold. RESULTS The fat area was significantly larger and the number of vasculoendothelial cells surrounding adipocytes significantly greater in the intracordal fat injection containing adenoviral vector expressing hepatocyte growth factor, compared with the control intracordal fat injection containing adenoviral vector expressing no gene. When viewed under electron microscopy, the injected adipocytes were observed to have grafted better in the intracordal fat injection with hepatocyte growth factor adenoviral vector, compared with the control intracordal fat injection with adenoviral vector expressing no gene. CONCLUSIONS Injection into the vocal fold of autologous fat containing an adenoviral vector expressing hepatocyte growth factor can reduce subsequent resorption of injected fat.

New silicone tube placement therapy for patients with an anterior glottic web.

An anterior glottic web in adults comprises a bridge of scar tissue commonly formed as a result of iatrogenic laryngeal injury. Traditionally, procedures such as transcervical midline thyrotomy and keel placement have been used to repair this condition. However, we recently repaired an anterior glottic web using a new surgical procedure involving a silicone tube instead of a keel. We herein report this case, in which we placed a silicone tube at the anterior commissure after resection of an anterior glottic web, under endolaryngeal microsurgery, without performing a tracheostomy.

Endoscopic surgical treatment of posterior glottic stenosis

A six-year-old girl developed posterior glottic stenosis following surgery for lateral curvature. She was post-operatively intubated for 17 days and had inspiratory stridor after extubation. Laryngoscopy revealed an adhesion at the posterior commissure which severely limited abduction of the bilateral vocal folds and arytenoids. Initially, tracheal fenestration was performed and the scar tissue of the posterior commissure was vaporised using a CO2 laser under endolaryngeal microsurgery. However, despite this procedure the stenosis reformed and an interarytenoid adhesion developed.Endolaryngeal microsurgery was performed again three months later. Using endoscopic microscissors, the posterior commissure and interarytenoid scar tissue were submucosally separated and the bilateral corniculate cartilages of the superior arytenoids were debulked using CO2 laser. A posteriorly based mucosal flap obtained from the postcricoid region was extended to approximate to the mucosa of the posterior commissure. The mucosal flap was sutured to the inferior subglottic mucosa by two 4-0 polyglactin absorbable sutures. Three months later, the patients respiratory and phonatory function was satisfactory.Based on the successful results of the present case, the authors highly recommend the use of a posterior mucosal flap for the treatment of posterior glottic stenosis. This procedure does not require the use of either a laryngofissure or a laryngeal stent.

Local immune status and tumour marker expression in the human larynx.

This study examined the local immune status and tumour marker expression in secretions and related tissue specimens from the laryngeal ventricle, comparing individuals with and without head and neck cancer. Laryngeal secretion and mucosal tissue specimens were collected during laryngeal microsurgery or surgical laryngectomy. The laryngeal secretions were found to contain immunological factors such as immunoglobulins G and A and secretory immunoglobulin A. A high level of the tumour marker Cyfra 21-1 was also detected in laryngeal secretions and mucosal tissue. Lows levels of secretory immunoglobulin A and Cyfra 21-1 were seen in the laryngeal mucosal tissue of controls and patients who had previously undergone radiation therapy. The level of secretory immunoglobulin A in laryngeal secretions closely correlated to the level of this immunoglobulin in mucosal tissue. These results indicate that local immunity is present in the human larynx; furthermore, it is strongly affected both by the presence of malignancy and by laryngeal cancer treatments such as irradiation.

Cricopharyngeal dysfunction with significant piriform sinus expansion: case report

This report describes the case of a patient with cricopharyngeal dysfunction with significant piriform sinus expansion. An 80-year-old man presented with a three-year history of dysphagia. Palsy of the cricopharyngeal chalasis was identified by electromyography under both videofluorography and manofluorography. Although a widening procedure was performed in the cricopharyngeal region using a bougie, the patient gained only minor relief from his dysphagia. After the patient had had adequate time to recover spontaneously (six months), a cricopharyngeal myotomy was performed. As a result, his dysphagia resolved and the post-operative course was uneventful. The clinical and histopathological findings in this case suggested that significant piriform sinus expansion had resulted from the cricopharyngeal dysfunction, due to cricopharyngeal myopathy.