Taro Komachi

A Pathological Study of Bamboo Nodule of the Vocal Fold

We examined pathologically a bamboo nodule of the vocal fold by means of immunohistochemical studies and scanning electron microscopic examination. A 38-year-old female showed a high index of antinuclear antibodies without any systemic symptoms but had complained of progressive voice disorder for 9 months. She had used her voice excessively in her occupation and for singing. Hematoxylin and eosin staining showed submucosal edema with lymphocyte and neutrocyte infiltrations and hyaline degeneration. Periodic acid methenamine silver staining showed hypertrophy of the basal lamina of the blood vessels. Immunohistochemical study showed IgG-positive cells in the blood vessel walls. Scanning electron microscopic study demonstrated immune complexes deposited as fine granules of high electrodense materials in the hypertrophic walls of the micro-blood vessels. After surgical resection of the bamboo nodules and advising her to avoid using her voice excessively, her voice improved gradually and the levels of IgG, immune complexes, and antinuclear antibody decreased for 1 year. These findings suggest that the bamboo nodules were not induced by an organ-specific reaction to an autoimmune disease, but mechanical damage to the micro-blood vessels induced by phonation injury of the vocal fold might have caused the deposit of high-molecular weight immune complexes in the damaged micro-blood vessels at the midportion of the vocal folds, which induced secondary inflammatory change at the midportion of the vocal fold.

A Case of Creutzfeldt-Jacob Disease with Bilateral Vocal Fold Abductor Paralysis

Bilateral vocal fold abductor paralysis was seen in a patient with Creutzfeldt-Jacob disease. After tracheotomy, the patient showed disappearance of reduced oxygen saturation with high-pitched inspiratory stridor and pulling phenomenon of the supraclavicular region and larynx. Electromyographic examinations of the intrinsic laryngeal muscles, including the thyroarytenoid and posterior cricoarytenoid muscles, demonstrated that there was no apparent action potential in those muscles during spontaneous respiratory movements, and there was no abnormal potential for those muscles at rest. By pushing the infrasternal region of the patient on the expiration, normal motor unit action potential could be seen in the posterior cricoarytenoid muscle on the next inspiration. Based on those findings, we concluded that bilateral vocal fold abductor paralysis in this case of Creutzfeldt-Jacob disease was not induced by disorders of the degeneration of motor nucleus in the ambiguus as in multiple system atrophy, but by a disorder of the upper motor neuron.

Clinical Study of the Incidence of Arytenoid Cartilage Dislocation for the Patients after General Anesthesia with Tracheal Intubation

Incidence of arytenoid cartilage dislocation for patients treated or examined under general anesthesia with tracheal intubaion in one hospital had not been reported. And true incidence and mechanism of arytenoid cartilage dislocation after tracheal intubation are not investigated yet. Here, we examined retrospectively the incidence of arytenoid cartilage dislocation for patients after general anesthesia with tracheal intubaion in the Central Surgical Center of Nippon Medical School Main Hospital for two years from 2004 until 2005. The incidence of arytenoid cartilage dislocation for patients after general anesthesia with tracheal intubaion was 0.2%, and patients received cardiovasucular surgeries were the most common. The mean age of the patients with arytenoid cartilage dislocation was 70 years. It could be considered that additional medical instrumentation of the esophagus including transesophageal echocaridiography probe or upper gastrointestinal endoscopy, and prolonged tracheal intubation for more than two days should be the risk factors causing arytenoid cartilage dislocation. And calcification of the laryngeal cartilage and morphological changes of the cervical vertebrae along with aging might also contribute to dislocate the arytenoid cartilage.