• Asian Pacific Journal of Cancer Prevention
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• v.16 no.17
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• pp.7457-7461
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• 2015

Some thyroid cancer patients undergone insufficient tumor removal in the primary surgery in China. our aim is to evaluate the impact of dissection of the recurrent laryngeal nerve during a salvage thyroid cancer operation in these patients to prevent nerve injury. Clinical data of 49 enrolled patients who received a salvage thyroid operation were retrospectively reviewed. Primary pathology was thyroid papillary cancer. The initial procedure performed included nodulectomy (20 patients), partial thyroidectomy (19 patients) and subtotal thyroidectomy (10 patients). The effect of dissection and protection of the recurrent laryngeal nerve and the mechanism of nerve injury were studied. The cervical courses of the recurrent laryngeal nerves were successfully dissected in all cases. Nerves were adherent to or involved by scars in 22 cases. Three were ligated near the place where the nerve entered the larynx, while another three were cut near the intersection of inferior thyroid artery with the recurrent laryngeal nerve. Light hoarseness occurred to four patients without a preoperative voice change. In conclusion, accurate primary diagnosis allows for a sufficient primary operation to be performed, avoiding insufficient tumor removal that requires a secondary surgery. The most important cause of nerve damage resulted from not identifying the recurrent laryngeal nerve during first surgery, and meticulous dissection during salvage surgery was the most efficient method to avoid nerve damage.

• Archives of Plastic Surgery
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• v.39 no.1
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• pp.71-75
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• 2012

Recurrent laryngeal nerve paralysis is the most common and serious complication after thyroid cancer surgery. The objective of this study was to report the advantages of the vein wrapping technique for nerve reconstruction in patients with thyroid cancer invading the recurrent laryngeal nerve and its effects on postoperative phonatory function. The subjects were three patients who underwent resection of the recurrent laryngeal nerve during surgical extirpation of papillary thyroid cancer. Free ansa cervicalis nerve graft or direct neurorrhaphy with a vein wrapping technique was used to facilitate nerve regeneration, protect the anastomosed nerve site mechanically, and prevent neuroma formation. One-year postoperative laryngoscopic examination revealed good vocal cord mobility. Maximum phonation time ($19.5{\pm}0.3$ sec) was longer than a previously-reported value in conventional reconstruction patients ($18.8{\pm}6.6$ sec). The present phonation efficiency index ($7.88{\pm}0.78$) was higher than that previously calculated in conventional reconstruction ($7.59{\pm}2.82$). The mean value of the Voice Handicap Index-10 was 6, which was within the normal range. This study demonstrates improvement in phonation indices measured 1 year after recurrent laryngeal nerve reconstruction. Our results confirm that the vein wrapping technique has theoretical advantages and could be favored over conventional reconstruction techniques for invenerate nerve injuries.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.26 no.2
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• pp.137-140
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• 2015

Neurofibroma is characterized as a benign, slow growing neoplasm, originating from Schwann cells or fibroblast in peripheral nerve sheaths. It may appear as a solitary tumor or have multiple localizations in von Recklinghausen disease. They are commonly found in the gastrointestinal tract and laryngeal neurofibromas are extremely rare, accounting for only 0.03 to 0.1% of benign tumors of the larynx. The aryepiglottic fold and arytenoid are the common site of occurrence for laryngeal neurofibroma, because the branch of the superior laryngeal nerve is involved. We present a case of solitary plexiform neurofibroma arising from the laryngeal surface of epiglottis in a 55-year old female who found the lesion incidentally. We removed the tumor completely by transoral laser surgery and no recurrence was found after 7 months. The case of solitary neurofibroma arising from laryngeal surface of epiglottis has not been reported in Korea. We report this case regarding the diagnosis and treatment with review of literatures.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.25 no.2
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• pp.99-103
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• 2014

A laryngeal web is connective tissue covered with epithelium stretching between both sides of the true vocal cords. Laryngeal webs were first reported by Fleischmann in 1882, and they cause upper airway obstruction and abnormalities of phonation. Congenital webs result from an arrest of reabsorption of the epithelium of the larynx at the tenth week of the fetus. The most common site of webbing is the anterior commissural glottic area, followed by other glottic areas and rarely subglottic or supraglottic areas. We have experienced two cases of congenital laryngeal webs. The webs were operated in two different methods. The first was excised under magnified vision through a laryngoscope, with a silastic keel secured between the raw surfaces of the separated mucosa. In the second case, the deepithelialized surfaces were exposed for a certain time length to mitomycin C to prevent postoperative webbing. We, hereby, report our experience of the diagnosis and management of two cases of a rare entity known as the congenital laryngeal web, and discuss the results with relevant studies.

• Proceedings of the KOR-BRONCHOESO Conference
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• 1993.05a
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• pp.90-90
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• 1993

When illustrating the therapeutical plan of laryngeal cancer, there are difficulties in obtaining the three dimensional volume of tumor, submucosal extension of tumor, and particularly whether or not invasion on laryngeal cartilage has occurred. In particular clinical significance is the invasion to the laryngeal framework, which correlates with poor prognosis due to high frequency of local recurrence and cervical metastasis. Therefore the purposes of histopathological evaluation according to serial section study after laryngectomy are firstly, apprehension of the spread of laryngeal cancer and the pattern of invasion to laryngeal cartilage and secondly, obtaining an aid to establish direction of management to make higher the validity of preoperative clinical diagnosis. The following results were obtained : 1. The pattern of tumor invasion in cartilage 1) The tumor invades ossified cartilage chiefly and invades nonossified cartilage in extensive lesion only. 2) The tumor spread through intramarrow space at invaded ossified cartilage with intact perichondrium. 3) The perichondrium is strong barrier. 2. The incidence of cartilage invasion in order of frequency is as follow thyroid, arytenoid, cricoid, epiglottic cartilage. 3. The transglottic cancer has higher incidence(811.8%)of cartilage invasion. 4. The sensitivity, specificity, and accuracy rate of preoperative CT scan was 100%, 62.5%, 82.3% respectively.

• Annals of Rehabilitation Medicine
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• v.41 no.6
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• pp.1019-1027
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• 2017

Objective To analyze the clinical characteristics between neurogenic and non-neurogenic cause of vocal cord immobility (VCI). Methods The researchers retrospectively reviewed clinical data of patients who underwent laryngeal electromyography (LEMG). LEMG was performed in the bilateral cricothyroid and thyroarytenoid muscles. A total of 137 patients were enrolled from 2011 to 2016, and they were assigned to either the neurogenic or non-neurogenic VCI group, according to the LEMG results. The clinical characteristics were compared between the two groups and a subgroup analysis was done in the neurogenic group. Results Among the 137 subjects, 94 patients had nerve injury. There were no differences between the neurogenic and non-neurogenic group in terms of demographic data, underlying disease except cancer, and premorbid events. In general characteristics, cancer was significantly higher in the neurogenic group than non-neurogenic group (p=0.001). In the clinical findings, the impaired high pitched 'e' sound and aspiration symptoms were significantly higher in neurogenic group (p=0.039 for impaired high pitched 'e' sound; p=0.021 for aspiration symptoms), and sore throat was more common in the non-neurogenic group (p=0.014). In the subgroup analysis of neurogenic group, hoarseness was more common in recurrent laryngeal neuropathy group than superior laryngeal neuropathy group (p=0.018). Conclusion In patients with suspected vocal cord palsy, impaired high pitched 'e' sound and aspiration symptoms were more common in group with neurogenic cause of VCI. Hoarseness was more frequent in subjects with recurrent laryngeal neuropathy. Thorough clinical evaluation and LEMG are important to differentiate underlying cause of VCI.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.17 no.1
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• pp.38-42
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• 2006

Background and Objectives: There has been a gradual decline in the incidence of laryngeal tuberculosis due to effective an-tituberculous chemotherapy and improvement in the standard of living. During the last decade, however, the disease has changed its clinical pattern. We aimed to study a clinical and telescopic evaluation of laryngeal tuberculosis. Materials and Method: A retrospective clinical analysis was done for 16 patients who diagnosed laryngeal tuberculosis from January 2000 through December 2004. All patients had a complete clinical and laboratory work-up including telescopy, chest X-rays, sputum cultures, Tbc PCR(polymerase chain reaction). Laryngeal biopsies were performed in some cases. All the patients received proper antituberculous chemotherapy. Results: The patients age ranged from 21 to 59 with a mean age 43. The male to female ratio was 10:6. The prominent presenting symptom was hoarseness. The various telescopic findings were categorized: 7 patients showed ulcerative, 4 patients granulomatous, 3 patients ulcerofungative, 2 patients had nonspecific inflammatory lesions. Involving sites were true vocal cord most commonly in 12 patients. Three of 16 patients had normal chest X-ray fmding. Among 16 patients, 4 patients showed positive response for AFB stain, 13 patients showed positive for Tbc PCR. Biopsy was done for 3 patients who were not confirmed in initial tuberculous test. All patients responded satisfactorily to antituberculous medication. Conclusion: The telescopic findings and clinical manifestations of laryngeal tuberculosis have changed and seemed to be different from those of classic reports. Thus, the clinicians who deal with the various symptoms and diseases should be aware of the existence of laryngeal tuberculosis and the changing patterns of the disease.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.21 no.1
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• pp.37-41
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• 2010

Background and Objectives : Transient minor voice changes after thyroidectomy are not infrequent complaints even in cases without any evidence of recurrent laryngeal nerve damage. However, clinical course, diagnosis and management of such voice changes are not fully understood. This study aimed to evaluate the clinical characteristics of minor voice changes after thyroidectomy. We also tried to assess the significance and feasibility of superior laryngeal nerve monitoring and to find out the optimal evaluation tools for such voice changes after thyroidectomy. Materials and Method : Nine adult patients who received total thyroidectomy without evidence of recurrent laryngeal nerve injury were enrolled for this prospective study. Voice evaluations were performed preoperatively and 3 months postoperatively ; acoustic analyses including voice range profile, aerodynamic study, stroboscopic evaluation and subjective voice assessment with questionnaires. The external branch of superior laryngeal nerve was monitored by nerve stimulator after ligation of superior thyroidal vessels. Results: Four of nine patients complained their voice change at 3 months after the surgery. Three of them reported complete recovery of their voice at 6 months after the surgery. Acoustic analysis revealed significant decrease in their phonatory range especially with high tone loss. Questionnaires related to singing was more sensitive than previously well-known "voice handicap index". Stimulation of the superior laryngeal nerve was feasible in most of the cases (94.4%), but it failed to show any correlation with minor voice changes after thyroidectomy. Conclusion : Minor voice changes were not rare events during the first 6 month after thyroidectomy. Decrease in phonatory range with high tone loss and therefore, discomfort in singing was the most common finding. Superior laryngeal monitoring was feasible but it was not a sensitive tool for the prediction of minor voice change after thyroidectomy.

• Proceedings of the KOR-BRONCHOESO Conference
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• 1977.06a
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• pp.7.1-7
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• 1977

According to Bryce and Cranston, prolapse of the laryngeal ventricle is a protrusion of the ventricular mucosa into the laryngeal cavity from inflammatory hyperplasia or edema. This 53 year old female patient was admitted to our hospital March 11, 1977 with the chief complaints of dyspnea and hoarseness. On admission, evaluation of the larynx revealed smooth surfaced round pink-reddish mass protruding bilaterally beneath the false cord. The airway was almost completely obstructed by the tumor mass, but neither ulceration nor infiltration was seen, also no lymphnode was palpable in the neck. Tracheotomy was performed for the relief of dyspnea and biopsy was done endoscopically. Histologic study showed chronic inflammation. On April 2, 1977 laryngofissure was performed under general anesthesia. Laryngeal examination revealed smooth surfaced, plate like, pinkreddish mass protruding bilaterally from both laryngeal ventricles into the laryngeal cavity and extending the whole length of the ventricle antero-posteriorly and touching each other. Biopsy was taken of the mass and the result was non-specific inflammatory hyperplasia of the larynx. Postoperatively, the air way is completely clear of obstruction but mild hoarseness still remains. No recurrent mass is visible in the larynx. In view of the symptoms, operative findings and histological findings, this case is diagnosed as "Prolapse of the laryngeal ventricle". The prolapse of the laryngeal ventricle is a very rare lesion and is reported with review of the literature.

• Journal of the Korean Society of Laryngology, Phoniatrics and Logopedics
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• v.12 no.1
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• pp.46-54
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• 2001

Background and Objectives : Nitric oxide(NO) is a short-lived molecule with messenger and cytotoxic functions in nervous, cardiovascular, and immune systems. Among the three distinct NOS isoforms, the neuronal isoform is expressed in small, discrete neuronal populations of CNS and PNS. Axonal injury in adult animals results in a dramatic NOS up-regulation in many types of central and peripheral neurons which normally lack the enzyme or express it only at very low levels. In previous study, we confirmed the efficacy of PEMS on the early functional recovery in rats with surgically transected and reanastomosed recurrent laryngeal nerve. Therefore, after we obtained functionally recovered rats using PEMS in this study, we studied to evaluate the expression of nNOS through the analysis of the difference between functional recovery group and non-recovery group in the recurrent laryngeal nerve. Materials and Method : Using 84 healthy male Sprague-Dawley rats, transections and primary anastomosis were performed on their left recurrent laryngeal nerves. Rats were then randomly assigned to 2 groups. The rats in group A(n=42) received PEMS by placing them in custom cages equipped with Helm-holz coils(3 hr/day, 5 days/wk, for 12 wk). The rats in group B(n=42) were handled the same way as the group A, except that they did not receive PEMS. Laryngovideoendoscopy was performed before and after surgery and followed up weekly. Laryngeal EMG was obtained in both PCA and TA muscles. Immunohistochemisty staining using monoclonal anti-neuronal nitric oxide synthase(nNOS) antibody was performed to detect nNOS in recurrent laryngeal nerve and nodose ganglion. Results : 20 rats(63%) in group A and 5 rats(17%) in the group B showed recovery of vocal fo1d motion. The number of NOS-positive cells was increased in functionally-recovered rats. NOS-staining intensity was reduced 12 weeks after nerve injury. The difference between PEMS group and non-stimulated group was not found. Conclusion : This study shows that nNOS may exert a beneficial effect on nerve regeneration and functional repair.