Tetsuji Yoshida

Dysphagia following Various Degrees of Surgical Resection for Oral Cancer

Postoperative swallowing problems were investigated in 20 patients who had undergone various degrees of surgical resection for oral cancer. The swallowing problems were evaluated on the basis of type of food, degree of aspiration, and duration of postoperative nasogastric tube feeding. Two patients with tongue cancer who had had hemiglossectomy without reconstruction ate normal food without aspiration within a week after operation. Eight patients who had undergone two- to three-quarter glossectomy for tongue cancer ate gruel with no or occasional liquid aspiration. Among 4 patients who had had near-total or total glossectomy for tongue cancer, 3 ate thin gruel or liquid with occasional aspiration. The other could not eat orally because of consistent severe aspiration. One patient with mouth floor cancer underwent resection of the mouth floor in combination with hemiglossectomy and she ate gruel without aspiration. Among 5 patients with mouth floor cancer who had had surgical removal accompanied by near-total or total glossectomy, 3 ate gruel with no or occasional liquid aspiration, 1 ate thin gruel with no aspiration, and the other could not eat orally. A diagnosis of T4 lesions, extensive removal of the tongue base, removal of the geniohyoid and mylohyoid muscles, and removal of the lateral pharyngeal wall were significantly related to poor swallowing function.

Sulcus Vocalis: Functional Aspects

The vocal function of 126 patients with sulcus vocalis was evaluated with the use of a test battery of multidimensional evaluation items. Of the 126 patients, 31 had a unilateral sulcus and 95, bilateral lesions. The results were as follows. 1) The majority of the patients had a mild degree of hoarseness with a breathy quality. 2) An incomplete glottic closure, a small vibratory amplitude, and a small mucosal wave were frequently observed in the stroboscopic examination. 3) The maximum phonation time, fundamental frequency range, and sound pressure level range of phonation were decreased, whereas the airflow during phonation was increased. 4) The pitch perturbation quotient, amplitude perturbation quotient, and normalized noise energy were increased. 5) Abnormal test results were more frequent and more marked for bilateral lesions than for unilateral lesions.

Acoustic Analysis of Pathological Voice: Some Results of Clinical Application

Tape-recorded voices of 30 patients were acoustically analysed: 10 had glottic Tla carcinoma, 10 unilateral vocal fold polyp and 10 unilateral recurrent laryngeal nerve paralysis. The carcinoma cases were treated with laser surgery with/without radiotherapy, the polyp cases with endolaryngeal microsurgery and the paralysis cases with intrafold silicone injection. The acoustic analysis was conducted before and after the treatment for each patient. Three acoustic parameters, viz. pitch perturbation quotient (PPQ), amplitude perturbation quotient (APQ) and normalized noise energy (NNE), were employed. The results were as follows: (1) PPQ and APQ were greater in paralysis cases than in carcinoma and polyp cases; (2) none of the parameters was useful in differentiating the three disease groups investigated; (3) all three parameters proved to be useful in monitoring the effects of treatments; (4) all three parameters were positively correlated to the grade of hoarseness, rough and breathy quality of hoarseness, mean airflow rate and regularity of vocal fold vibration viewed under stroboscopy; (5) PPQ, APQ and NNE were positively related to each other.

Strobofiberscopic video recording of vocal fold vibration

We describe our current system for strobofiberscopic video recording of vocal fold vibration and our early clinical experiences. The advantages of the strobofiberscopic video system over the strobotelescopic video systems are 1) the range of subjects is wide, and 2) the patient can phonate while maintaining normal head position during examination.

Hydroxylapatite for laryngotracheal framework reconstruction

Hydroxylapatite plates and rings were employed for reconstruction of the laryngotracheal framework in 12 patients. The cause of the framework defect was surgery for stenosis in nine cases and removal of malignancy in the other three. The trough method associated with a two-stage procedure was tolerated in all 12 cases. Hydroxylapatite plates or rings were used to reconstruct the framework during the second stage. The implant was well taken in all cases, without any infection or rejection. Nine of the 12 cases resulted in excellent airways.

Improved Surgical Technique for Epidermoid Cysts of the Vocal Fold

An improved surgical technique for epidermoid cysts of the vocal fold is presented. This technique employs a specially designed double-bladed elevator. Following betamethasone injection around the cyst, an incision is made posterior to the cyst at its mediolateral midpoint. The incision is extended anteriorly over the cyst with the use of a double-bladed elevator. The cyst then is elevated carefully from the surrounding tissue and removed. A single incision line on the upper aspect of the vocal fold should be the result. Eight patients were operated on with the present technique. The voice was improved postoperatively in all patients. The voice improvement was reflected objectively in stroboscopic findings, maximum phonation time, airflow rate, fundamental frequency and intensity of phonation, and results of acoustic analyses of voice.

Partial Laryngopharyngectomy for Piriform Sinus Carcinoma. Technique and Preliminary Results

This paper presents a technique for partial laryngopharyngectomy followed by a one-stage reconstruction and its preliminary results. This surgery is indicated for carefully selected cases in which the lesion is confined to the ipsilateral piriform sinus, aryepiglottic fold, arytenoid eminence and paraglottic space at the level of the false fold. The hyoid bone, thyroid ala, arytenoid cartilage, epiglottis, aryepiglottic fold, arytenoid eminence and false fold are removed on the affected side. Reconstruction is performed with the use of a pectoralis major myocutaneous (PMMC) flap. The surgery was performed on four cases: two were successful; one suffered from persistent postsurgical aspiration because the reconstructed hypopharynx was too wide; and one developed necrosis of PMMC flap and a secondary reconstruction procedure was performed.

Distortions of videofiberoscopy imaging: Reconsideration and correction**

Summary An analysis was made of the optical distortion of a lens system of a fiberscope and the distortion related to lens-object angles and lens-object distances used in laryngeal flexible endoscopic examinations. The optical distortion was systematic and, therefore, could be corrected through computer processing once the calibration was made. Similarly, the distortion related to the lens-object angle and distance varied systematically depending on distance and angle and, therefore, could be predicted if those parameters were measured simultaneously. The correction of those distortions of videofiberoscopic image is demonstrated, and a procedure for recording and measuring laryngeal images that minimizes measurement error due to those distortions is suggested.

Strobofibrescopic colour video recording of vocal fold vibration

We have designed a system for strobofibrescopic video recordings of vocal fold vibration. The system consists of a flexible laryngofibrescope, an improved model of laryngo-stroboscope, a colour video-camera, a video printer, a video-recorder and a TV monitor set. This system is applicable to most patients, even to children and those patients whose larynx is difficult to visualize.

Benign Neoplasms of the Larynx. A 10-Year Review of 38 Patients

We reviewed the clinical records of 38 patients with benign neoplasms or tumors of the larynx that were examined in the Department of Otolaryngology, Kurume University Hospital during the 10-year period from 1971 to 1980. There were 24 patients with papilloma, 4 amyloid tumor, 2 hemangioma, 2 chondroma, 1 neurofibroma, 1 pleomorphic adenoma, 1 eosinophilic granuloma, 2 non-specific swelling of the ventricular fold, and 1 so-called prolapse of the ventricle. Some of these conditions, such as chondroma, neurofibroma, pleomorphic adenoma and eosinophilic granuloma, are vary rare.