Yoshihito Yasuoka

Congenital Arhinia: A Case Report and Functional Evaluation

Objectives: Congenital arhinia is rare clinical entity. An unusual case of congenital arhinia with no surgical treatment is presented.

A New and Less Invasive Procedure for Arytenoid Adduction Surgery: Endoscopic-Assisted Arytenoid Adduction Surgery

Arytenoid adduction (AA) is the most effective procedure for improving voice function in patients affected by unilateral vocal fold paralysis (UVFP), but it is often associated with severe complications following airway obstruction. The aim of this study is to describe a new and less invasive AA surgical procedure termed endoscopic‐assisted AA surgery (EAAS) and to evaluate its voice outcomes.

Simple and new surgical procedure for laryngotracheal separation in pediatrics.

Objectives: In children with severe physical and mental disabilities who repeatedly develop aspiration pneumonia due to intractable aspiration, laryngotracheal separation/tracheoesophageal anastomosis or laryngotracheal separation has been performed in many institutions for the prevention of aspiration, and good results have been reported. However, families sometimes show a marked reluctance to give consent to these surgical techniques because of tracheal transection. A purpose of this study is to evaluate a new surgical procedure for laryngotracheal separation without tracheal transection.

Congenital laryngeal anomalies presenting as chronic stridor: a retrospective study of 55 patients.

OBJECTIVES Congenital laryngeal anomalies are less frequent, but their causes are surprisingly variable. In addition, a variety of synchronous airway lesions as well as comorbidities are accompanied. The objective of this study was to review of patients with congenital laryngeal anomalies presenting as chronic stridor in our experiences. METHODS Fifty-five patients, 30 male (54.5%) and 25 female (45.4%), were enrolled in this study, and their hospital records were retrospectively reviewed. RESULTS The most frequent diagnosis was laryngomalacia (36.4%), followed by subglottic stenosis (30.9%) and vocal cord paralysis (29.1%). Twenty-six (47.3%) of the 55 patients had synchronous airway lesions, whereas thirty-one (56.4%) had various comorbidities. Further analysis was performed in patients diagnosed with laryngomalacia, subglottic stenosis, or vocal cord paralysis, which are major causes of congenital laryngeal stridor. The frequency of synchronous airway lesions was not different significantly in these three groups. On the other hand, the frequency of establishment of airway in patients with laryngomalacia was significantly lower compared to those with subglottic stenosis or vocal cord paralysis. Moreover, median duration of the symptoms and the proportion of patients with poor outcome and decease in laryngomalacia were shorter and lower than that in subglottic stenosis or vocal cord paralysis. CONCLUSIONS While a variety of congenital airway anomalies were causes of chronic stridor, laryngomalacia was the most frequent diagnosis. Severe condition and progression of symptoms should increase suspicion of the synchronous airway lesions and/or comorbidities, which may be important factors for outcome as well as indication of surgical intervention.

Improvement of tracheal flap method for laryngotracheal separation.

Recurrent pneumonia due to intractable aspiration is a life‐threatening disease. A tracheal flap method for children without previous tracheostomy has been previously reported. This study reports that improvements of this method and its three subtypes are widely applicable to patients with various conditions.

Angiotensin II receptor blocker–induced angioedema in the oral floor and epiglottis

We report the rare case of angioedema (also known as Quincke edema), which was induced by valsartan, an angiotensin II receptor blocker (ARB). ARBs are a new class of antihypertensive agent that is developed to exclude the adverse effects of angiotensin-converting enzyme inhibitors. In theory, ARBs do not contribute to the occurrence of angioedema because they do not increase the serum level of bradykinin, the responsible substance for angioedema. However, some reports of ARB-induced angioedema have recently been published. In this study, we present the forth case and the first Asian case of angioedema due to valsartan, which is one of the ARBs. Otolaryngologist should be wary of the prescribing ARB and discontinue ARBs treatment soon, if angioedema is recognized.

Subglottic Schwannoma: A report of a rare case that was treated with medial thyrotomy

We present a rare case of primary subglottic schwannoma in a 51-year-old man. He presented with subacute dyspnea and progressively worsening stridor. Videoendoscopy revealed the presence of a submucosal mass in the subglottic area, which measured 2 cm in diameter and had occluded approximately 80% of the lumen. Computed tomography (CT) and magnetic resonance imaging (MRI) showed a tumor arising from the left posterior wall of the subglottis and extending from the level of the cricoid cartilage to the first tracheal ring. After tracheostomy for airway management, subglottic schwannoma was diagnosed via fiberscopy-assisted punch biopsy. We removed the tumor via a medial thyrotomy (laryngofissure), and the post-excisional raw surface of the cricoid and tracheal cartilage was covered with a free buccal mucosal flap, which was attached using absorbable sutures and fibrin glue. No complications including recurrent nerve palsy developed after the procedure, and early postoperative ambulation was successfully performed. The patient is currently well, and the subglottic wound is clear. Although long-term follow-up is required, medial thyrotomy and coverage of the exposed cartilage with a free buccal mucosal flap is more effective for large subglottic schwannomas than laryngeal or tracheal resection with permanent tracheal tunnel formation from the viewpoint of phonation disability and the risk of complications.

A Case of Pyriform Sinus Fistula Infection with Double Tracts

Pyriform sinus fistula is a rare clinical entity and the precise origin remains controversial. The fistula is discovered among patients with acute suppurative thyroiditis or deep neck infection of the left side of the neck and is usually located in the left pyriform sinus. To the best of our knowledge, only a single tract has been reported to be responsible for pyriform sinus fistula infection. We present a case of a 13-year-old female patient with a pyriform sinus fistula that caused a deep infection of the left side of the neck and showed double-tract involvement discovered during surgical resection of the entire fistula. Both tracts arose around the pyriform sinus and terminated at the upper portion of the left lobe of the thyroid.

Congenital microtia complicated by congenital facial palsy; A report of four cases.

Clinical findings were evaluated in 4 cases of congenital microtia complicated by congenital facial palsy. Cases 1 and 2 were representative of atypical microtia with a fistula originating from the first branchial fissure and stenosis of the external auditory canals. Cases 3 and 4 presented with a nearly normal morphology in ears of mildly decreased size. No fistulae were present. The external auditory canal was occluded near the junction of the osseous and cartilagenous sections.Facial palsy was incomplete in all patients. It was most dramatic at the forehead and lower lip.Tear secretion was normal in 3 cases.Taste sensation was decreased in 3 cases in areas innervated by the chorda tympani. The areas innervated by the glossopharyngeal and major pyramidal nerves exhibited normal taste sensation in all the cascs.The following 4 factors were suggested as the causes of paralysis.Developmental abnormalities of the external and middle ear.Developmental abnormalities of the facial nerve within the temporal bone.Developmental abnormalities in the facial bones and the associated muscles of facial expression.Decreased distribution of collaterals from peripheral branches of the facial nerve.