Surgical outcomes in cases of postoperative recurrence of primary oral cancer that required reconstruction

[Purpose] In order to clarify prognostic factors of recurrent oral cancer,[Patients and Methods] In 17 oral cancer patients with their age ranging from 28 to 86 years old, who underwent extensiveresection accompanied by reconstruction for recurrence of a primary oral cancer, correlations between survival rate after salvage surgery and subsite, T classification and N classification of their initial and recurrent tumors, and time of recurrence were analyzed by using Kaplan-Meier method and kai-square analysis. [Results] Tongue cancer (10 patients) was found to have the poorest prognosis among all the subsites, and especially those whohad recurrence within 3 months after previous surgery had extremely poor prognoses; 30% (3/10) of them died without being discharged from the hospital after salvage surgery, and in 40% of them QOL was remarkably impaired losing their voice andchance of peroral food intake, etc. While T classification and N classification of initial and recurrent tumors were found to have no correlations with the prognosis. [Conclusion] More appropriate and realistic information should be provided to those patients to assist them to make a fully informed decision prior to surgery

Effects of a tongue-holding maneuver during swallowing evaluated by high-resolution manometry.

OBJECTIVE: This study aimed to investigate the effects of a tongue-holding maneuver (THM) during swallowing using a novel high-resolution manometry (HRM) system. STUDY DESIGN: Case series with planned data collection. MATERIALS AND METHODS: Thirty-three asymptomatic Japanese adults were studied. A solid-state HRM assembly with 36 circumferential sensors spaced 1-cm apart was positioned to record pressures from the velopharynx to the upper esophagus at rest and during swallowing. The maximum values of the dry swallowing pressures at the velopharynx, mesohypopharynx, upper esophageal sphincter (UES), and distance from the nostril to each point of maximum values with and without the THM were measured. RESULTS: The distance from the nostril to the UES was statistically shorter when swallowing with the THM than without the THM (paired t test, P=0.009). The maximum pressure at UES was greater when swallowing with the THM than without the THM, although there was no statistically significant difference (paired t test, P=0.051). There was no difference in the pressures and the distance between swallowing with or without the THM at any other site. CONCLUSIONS: These findings suggest that the THM may not have a potential to facilitate compensatory swallowing power when swallowing

Non-recurrent inferior laryngeal nerve (NRILN); Report of a case

Recurrent nerve (inferior laryngeal nerve) injury in thyroid surgery is a very severe and serious complication that impairs patient’s quality of life and it is one of the major complications in thyroid surgery. If the recurrent nerve can be detected during the surgery, injury can be prevented. We report a case of a woman with right non-recurrent inferior laryngeal nerve (NRILN) branching from the vagus nerve directly at the level of the right thyroid upper lobe in thyroid surgery. NRILN is a very rare anatomic variation and is associated with aberrant right subclavian artery (ARSA). In such cases, preoperative contrast-enhanced computed tomography should be monitored closely to avoid injuring this nerve

Non-recurrent inferior laryngeal nerve (NRILN); Report of a case

Recurrent nerve (inferior laryngeal nerve) injury in thyroid surgery is a very severe and serious complication that impairs patient’s quality of life and it is one of the major complications in thyroid surgery. If the recurrent nerve can be detected during the surgery, injury can be prevented. We report a case of a woman with right non-recurrent inferior laryngeal nerve (NRILN) branching from the vagus nerve directly at the level of the right thyroid upper lobe in thyroid surgery. NRILN is a very rare anatomic variation and is associated with aberrant right subclavian artery (ARSA). In such cases, preoperative contrast-enhanced computed tomography should be monitored closely to avoid injuring this nerve

Exploring the relationship between plasma substance P and glottal incompetence in the elderly

We speculated that increased blood-plasma levels of Substance P may serve as an indicator of glottal incompetence, which is usually indicated by reduced maximum phonation time. We performed an initial study to test the plausibility of this hypothesis. Patients with dysphonia caused by glottal incompetence were asked to perform vocal exercises for six months to reduce glottal incompetence and we compared the plasma concentration of Substance P before and after the vocal exercise to detect correlation between maximum phonation time and plasma concentration of Substance P. Based on the results, we further hypothesized that patients exhibiting dysphonia with maximum phonation time less than 14 s, in particular less than 10 sec, caused by glottal incompetence may have increased plasma concentration of Substance P with the results of elevated thresholds of cough reflex associated with subclinical aspiration in airways. Further study is needed on patients with decreased Substance P levels, with low scores on Activities of Daily Living and who are hospitalized with aspiration pneumonia

Investigation of pharyngeal swallowing function using high-resolution manometry.

OBJECTIVES/HYPOTHESIS: This study aimed to demonstrate the feasibility of a novel high-resolution manometry system, and to establish normal values of swallowing pressures along the velopharynx and upper esophagus. STUDY DESIGN: Prospective study. METHODS: Thirty-three asymptomatic adult Japanese controls were studied. A solid-state high-resolution manometry assembly with 36 circumferential sensors spaced 1 cm apart was positioned to record pressures during swallowing from the velopharynx to the upper esophagus. The maximum values of the swallowing (dry and 5 mL of water) pressures at velopharynx, meso-hypopharynx, and at the upper esophageal sphincter (UES) were measured. The resting UES pressure, the length of the part in the cervical esophagus showing the resting UES pressure, and the distances from the nostril to the above-mentioned points of pressure measurement were also measured. RESULTS: The maximum value of dry and water swallowing pressures at the velopharynx, meso-hypopharynx and UES, and the distances from the nasal vestibulum to each point in men were 141.1 +/- 73.5 (mm Hg, mean +/- standard deviation) and 162.7 +/- 94.9, 175.3 +/- 59.7 and 182.9 +/- 83.6, 172.7 +/- 73.8 and 236.1 +/- 78.9, and 10.0 +/- 1.3 (cm) and 10.1 +/- 1.4, 14.1 +/- 1.5 and 14.4 +/- 1.3, 17.9 +/- 1.7 and 18.0 +/- 1.4, respectively. Those in women were 118.9 +/- 38.0 (mm Hg) and 124.7 +/- 43.4, 165.9 +/- 41.5 and 167.3 +/- 65.0, 149.2 +/- 68.7 and 243.7 +/- 87.4, and 9.5 +/- 1.2 (cm) and 9.4 +/- 1.2, 13.0 +/- 1.5 and 12.8 +/- 1.4, 15.8 +/- 1.5 and 16.0 +/- 1.3, respectively. The maximum value of resting UES pressure, the length of the part in the cervical esophagus showing the resting UES pressure and the distance from the nostril to the mid-point of the width of the resting UES pressure in men and in women were 70.2 +/- 30.0 mm Hg, 4.0 +/- 0.7 cm, 19.1 +/- 1.3 cm, and 61.8 +/- 26.7 mm Hg, 3.6 +/- 0.6 cm, 17.0 +/- 1.2 cm, respectively. CONCLUSION: The present study provides anatomical and physiological information about normal swallowing along the velopharynx and upper esophagus, which will be an aid to the future clinical and investigative studies

Amplitude and area ratios of summating potential/action potential (SP/AP) in Meniere\u27s disease.

CONCLUSIONS: Our results suggest that summating potential/action potential (SP/AP) area ratio may not necessarily have higher sensitivity in the diagnosis of endolymphatic hydrops of Meniere\u27s disease (MD) than SP/AP amplitude ratio in transtympanic electrocochleography (ECochG). OBJECTIVE: Recent studies suggested that SP/AP area curve ratio was more sensitive to endolymphatic hydrops in comparison with SP/AP amplitude ratio in extratympanic ECochG. The purpose of the present study was to evaluate the utility of the SP/AP area curve ratio in transtympanic ECochG for the diagnosis of MD. PATIENTS AND METHODS: A retrospective chart review of 198 patients (209 ears) was conducted in cases of MD. RESULTS: With regard to SP/AP amplitude ratio, 57.1% in definite cases of MD (group 1), 39.6% in probable cases of MD (group 2), and 50.0% in the cases who had transformed from probable MD to definite MD (group 3) showed abnormally high values, respectively. Abnormally high values were observed in 43.9%, 27.7%, and 30.0% in SP/AP area ratio in groups 1, 2, and 3, respectively, indicating that abnormal values were observed more frequently in the amplitude ratio than in the area ratio in all three groups