Tatsuzo Taira

Recent Modifications in Thyroplasty Type I

Among thyroplasties, type I is the most frequently used for medialization of the vocal cord. Follow-up study on patients indicated that reversion of voice can occur after operation. Revision was done in five cases with improvement of voice. On the basis of this experience, modifications were made in the technique of thyroplasty type I. They include 1) cutting the calcified cartilage with minimal intervention in the soft tissue, 2) fixation of the window with a silicone plug to enhance medialization, and 3) overmedialization of the vocal cord and definition of criteria for it that can be used during surgery.

Surgical treatment of laryngeal web with mucosa graft

Surgical treatment of laryngeal webbing varies with the extent and site of the web. An extensive one seems to be best treated by laryngofissure and skin or mucosa transplantation. Recent experiences with four cases of thick glottal webbing indicated that a mucosa graft was better for the voice result than a skin graft. For success in the airway and voice results, the salient points in surgery include 1) precise midline thyrotomy, 2) shaping of the vocal cord under fiberoptic control, and 3) mucosa grafting with the combined use of a pliable stent or fibrin glue for fixation.

Facial injuries from falling: age-dependent characteristics.

A retrospective analysis was undertaken of 108 patients with facial injuries from falling who presented at the Plastic Surgery Unit of the Toyo-oka Public Hospital from 1988 to 1990. Facial injuries from falling were common in little children, in those >6 years of age comprising 45.4% of injuries. Age-dependent characteristic injury sites were found (i.e., in those ≷2 years old, the forehead; in small children, the chin; in students, the lip; and in older persons, the cheek); this disparity can be explained by the mechanism of injury. The injury pattern also depended on age, varying activities, and tissue strength. In children of ≷6 years of age, small lacerations on the forehead or chin were most common, but even conservative treatment could achieve good results. On the other hand, inadequate suturing by emergency room physicians brought on poor results. In adults, abrasions and traumatic tattoos occurring with late-night inebriation tended to develop some sequelae.Shinya K, Taira T, Sawada M, Isshiki N. Facial injuries from falling: age-dependent characteristics. Ann Plast Surg 1993;30:417–423

Effects of Lateral Manual Compression upon Glottic Incompetence: Objective Evaluations

Forceful manual compression of the thyroid and cricoid cartilages modifies the position, shape, and tension of the vocal folds. This is the basis of the four laryngeal manual compression tests, adjunctive examinations used as a means of preoperative assessment of patients for medialization laryngoplasty, ie, Isshiki thyroplasty types I and IV and arytenoid adduction. The laryngeal manual compression tests are simple to perform and noninvasive. Each of the four examinations yields valuable information on the effects on the voice of changes in vocal cord characteristics produced by manual compression. In this report, one of the four tests, lateral manual compression, is evaluated objectively with well-attested methods of videostroboscopic, aerodynamic, and acoustic analysis. The technique of performing lateral manual compression is described, and advantages and disadvantages are noted and compared in 10 patients. Preliminary findings in 4 patients in this group indicate that medialization laryngoplasty should be considered when test results are conclusive of effective glottic closure. Data derived in this preliminary study will be augmented as patients are added to the series.

Surgical techniques for a deep concha, a pseudomeatus, and high projection in congenital microtia.

Some modified surgical techniques are described for constructing a deep conchal cavity and pseudomeatus and obtaining high auricular projection in congenital microtia. At the primary operation, a rather small portion of the microtic vestige is utilized for the lobule by switching, sparing the skin for the concha, with no free skin graft used. For higher projection of the auricle, three-dimensional transposition of a retroinfraauricular flap together with cartilage pieces underneath is applied to the cephaloauricular sulcus. A deep conchal cavity is constructed by further removal of the soft tissue there, transplantation of a cartilage for building a high posterior wall of the concha. The external meatus is successfully imitated by transplantation of a cone-shaped composite graft taken from the cymba of the opposite ear. The retroinfraauricular flap, the reconstruction of a deep concha, and the composite graft technique were successfully used in 55, 16, and 1 1 ears, respectively.

The use of microsurgical planing to treat traumatic tattoos.

A traumatic tattoo results from an abrasion in which dirt, carbon, tar, asphalt, or other particles have become embedded beneath the superficial layer of the dermis. These embedded particles are difficult to remove completely. Under a microscope, rectangular epidermal and upper dermal grids including these pigments are made, and each section of the grid is removed. The microsurgical planing technique has the following advantages: it saves the maximum possible amount of normal skin, and the particles are completely removed. Twenty patients have been treated with this technique and have obtained excellent results.

Use of a microcrystalline collagen hemostatic agent in palatoplasty for cleft palate.

The push back operation was performed as the first palatoplasty in 51 patients with cleft palate. During surgery a microcrystalline collagen hemostatic agent (MCH) was used in 23 (MCH group). The other 28 served as controls.Good hemostasis was obtained with MCH. It was very useful in 4 patients, useful in 15, and indefinite in 4. There were no differences in the duration of infusion or fever between the MCH group and the control group.In the MCH group there was no postoperative fever and no side effects.In some cases MCH was applied to the open wound, and wound healing was accelerated.

A wound speculum (Isshiki) for a narrow deep surgical field

SummaryA wound speculum, or an operator-controlled wound retractor, was devised to facilitate surgery in a narrow and deep field. It is specifically designed to make hemostasis and suturing easy as well as accurate. The blades of the speculum are teflon-coated for electrical insulation on electrocoagulation, and made in the shape of a frame with a narrow opening at the side for the convenience of suturing.

Morphological and histochemical observation of human levator muscles.

The morphological and histochemical characteristics of the levator muscles were investigated in patients with velopharyngeal insufficiency. Muscle samples were obtained from 2 patients with cleft palate (CP), 2 with submucosal cleft palate (SMCP) and 2 with congenital velopharyngeal incompetence (CVPI). The muscles removed from the cleftside of CP, SMCP and CVPI revealed disturbed growth. Abnormal patterns of muscle fibers were noted in SMCP and CVPI. The proportions of muscle fiber types (red, white and intermediate) were similar in the non-cleftside of CP and CVPI, while on the cleftside of CP and SMCP there were reduced numbers of red fibers. The diameter of the red fibers in CVPI was significantly smaller than that in the other 3 types of disease. These findings may be closely related to the development of velopharyngeal insufficiency.

Use of temporal muscle flap in complicated defects after intra-arterial infusion.

Temporal muscle flaps are usually used for defects of the upper two thirds of the face and anterior skull base after trauma and cancer surgery. A 75-year-old female had complicated defects after intra-arterial infusion for maxillary cancer. Defects of the external auditory meatus and pre-auricular soft tissues were caused by extravasation of anti-neoplasmic agent. A temporal fascio-musculo-periosteal flap with a free skin graft was used successfully to reconstruct the defects.