Utility of Ultrahigh-Resolution Computed Tomography for Laryngeal Reconstructive Surgery2024 · Objective: Unilateral vocal fold paralysis (UVFP) presents as incomplete glottal closure and leads to breathy hoarseness.Various treatments, including laryngeal framework surgery (type 1 thyroplasty [TP1] and arytenoid adduction [AA]), have beendevised to correct this condition. Ultrahigh-resolution computed tomography (U-HRCT) allows detailed three-dimensionalimaging of the larynx, which aids our understanding of vocal fold motion disorders. This study assessed whether U-HRCT isbeneficial for correct diagnosis and surgical planning. Methods: The participants were 26 UVFP patients who underwent laryngeal framework surgery (TP1 and/or AA).U-HRCT was used to measure the vocal fold volume (VFV) and level difference (LD). The need to combine AA with TP1 toobtain satisfactory surgical outcomes was evaluated by U-HRCT and various voice function tests. Results: VFV was smaller in paralyzed folds than in unaffected folds. LD correlated strongly with voice parameters andshowed high intra-rater and inter-rater reliability. The surgical outcome of the laryngeal framework surgery performed wasjudged to be excellent for improving voice function. Comparison of LD between the TP1 group and TP1 + AA group indicatedthat LD is an excellent parameter to determine the need to combine AA with TP1. Conclusion: These findings underscore the value of preoperative U-HRCT, especially LD, in surgical decision-making andafford insights for optimal phonosurgery and individualized intervention. Patients with LD >1.0 mm may benefit fromthyroplasty with AA.
癒着性中耳炎に対する一期的人工内耳手術2021 · <p>Cochlear implant surgery has been introduced successfully and is now one of the commonly performed surgeries. However, the surgical strategy of cochlear implantation in patients with chronic middle ear diseases, such as chronic otitis media and cholesteatoma, has not yet been fully established. In the present report, we describe the surgical technique adopted and prognosis of two patients with severe adhesive otitis media who underwent cochlear implant surgeries. Both underwent one-stage cochlear implantation combined with external auditory canal closure (blind-sac closure). Mastoidectomy with removal of the whole canal wall was performed to remove the otitis lesion thoroughly, and external auditory canal wall closure was performed to prevent recurrence of the lesion. A pneumatized tympanic cavity was observed and canal wall closure was maintained in both cases. Both patients acquired fair hearing ability with the cochlear implants. No severe complications have occurred until now, four years since the cochlear implantation. Although external ear canal closure destroys the natural structure of the external ear, one-stage cochlear implant surgery combined with canal closure is useful for elderly patients with systemic complications who desire shortening of hearing-deprived period.</p>
