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1.
Artigo em Coreano | WPRIM (Pacífico Ocidental) | ID: wpr-652155

RESUMO

The current trend in managing head and neck cancer is to perform organ preservation therapy which improves quality of life and decreases treatment related morbidity. Transoral robotic surgery (TORS) can overcome the limit of "line of sight" often met in classic transoral procedure. We utilized robotic surgical system for the treatment of oropharyngeal, hypopharyngeal and laryngeal cancer. TORS was performed using the da Vinci surgical robot (Intuitive Surgical, Inc., Sunnyvale, CA). It is consisted of a surgeon's console and a manipulator cart equipped with 3 robotic arms. The surgeon is provided with 3-dimensional magnified images from the endoscopic arm and can control 2 instrument arms for delicate operations from the console. TORS can provide magnified three dimensional views and overcome the limitation resulting from the "line of sight" which hinders classic transoral procedure. Safe resection of the head and neck cancer lesion was possible with the 3-dimensional magnified images and two robotic arms which have 360 degree joint motion. The application of TORS for lateral oropharyngectomy, partial hypopharyngectomy and partial laryngectomy is technically feasible and safe


Assuntos
Braço , Cabeça , Neoplasias de Cabeça e Pescoço , Articulações , Neoplasias Laríngeas , Laringectomia , Pescoço , Preservação de Órgãos , Qualidade de Vida , Robótica
3.
Artigo em Coreano | WPRIM (Pacífico Ocidental) | ID: wpr-121724

RESUMO

An ankylosis of temporomandibular joint (TMJ) can cause severe trismus, thus it may bring on many difficulties in airway management such as orotracheal intubation or laryngeal mask airway insertion. Such difficulties may cause serious complications related to airway management because the trismus due to ankylosis of TMJ can not be improved by administration of muscle relaxants or deep anesthesia in most cases. We report a case of nasotracheal intubation guided by a fiberoptic bronchoscope in a male patient with severe trismus due to TMJ ankylosis, who was scheduled for undergoing ophthalmic surgery.


Assuntos
Humanos , Masculino , Manuseio das Vias Aéreas , Anestesia , Anestesia Geral , Anquilose , Broncoscópios , Intubação , Articulações , Máscaras Laríngeas , Articulação Temporomandibular , Trismo
4.
Auris Nasus Larynx ; 32(4): 387-91, 2005 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-16076539

RESUMO

OBJECTIVE: In this prospective study, we attempted to use objective techniques to measure shoulder disability and evaluate patients who underwent functional neck dissection (FND) procedure. Patients were compared on the basis of preoperative and postoperative range of motion (ROM) measurements, pain and stiffness domains. At the final visit, a Neck Dissection Impairment Index (NDII) questionnaire was applied to all patients. METHOD: Twenty-five patients treated with head and neck cancer who underwent bilateral FND simultaneously with the resection of primary tumor enrolled in this study from April 2001 to July 2004. Flexion, extension, abduction, internal and external rotations of the shoulder have been measured with electronic incliometer preoperatively, and at the 1st, 3rd, 6th, and 18th months postoperatively. A questionnaire modified from neck dissection impairment index was applied to all patients to measure neck and shoulder disability at final visit. Pain and stiffness domains were also assessed preoperatively and at postoperative 18th month. RESULTS: Measurements of abduction at the first and third months were found to be decreased in comparison with preoperative measurements. These differences were statistically significant (p<0.05). The pain and stiffness scores of all patients at the final visit were significantly worse than the preoperative scores (p<0.005). At the final visit NDII of patients who underwent total laryngectomy were significantly worse than of the patients who underwent partial laryngectomy and glossectomy (p=0.002 and 0.043, respectively). All these results did not correlate with age, radiation therapy (RT), operation side, T stage. CONCLUSION: FND is oncologicaly safe procedure and gives rise to less shoulder morbidity. Although, ROM improved after 18 months from surgery, pain and stiffness were found to be worse than preoperative values. The patients with total laryngectomy had lower NDII scores regarding to other patients. Therefore, shoulder disability can be attributed not only to neck dissection but also to primary surgery.


Assuntos
Artropatias/etiologia , Artropatias/fisiopatologia , Esvaziamento Cervical , Complicações Pós-Operatórias , Articulação do Ombro/fisiopatologia , Idoso , Avaliação da Deficiência , Feminino , Humanos , Artropatias/diagnóstico , Neoplasias Laríngeas/cirurgia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Estudos Prospectivos , Amplitude de Movimento Articular/fisiologia , Índice de Gravidade de Doença , Inquéritos e Questionários , Neoplasias da Língua/cirurgia
5.
Artigo em Coreano | WPRIM (Pacífico Ocidental) | ID: wpr-213995

RESUMO

The authors report on a severe case of pseudoankylosis of the temporo-mandibular(TM) joint following a pterional craniotomy and the intubation difficulty encountered in the second surgery. Preventive and therapeutic aspects in addition to the clinical pitfalls of the case are discussed.


Assuntos
Humanos , Craniotomia , Intubação , Articulações , Máscaras Laríngeas
6.
Artigo em Coreano | WPRIM (Pacífico Ocidental) | ID: wpr-27558

RESUMO

We describe here a case of difficult intubation due to pseudoankylosis of the temporo-mandibular joint after a pterional craniotomy. A 50-year-old female was admitted to our hospital presenting with severe headache. According to her angiogram, a ruptured aneurysm in left posterior communicating artery (PCoA) and an unruptured right PCoA aneurysm were detected. We the operation in two-steps; the first operation for the left PCoA proceeded without any problem, and the tracheal intubation also was not difficult. Four weeks later, while inducing the general anesthesia for her second operation, severe trismus was detected after the infusion of propofol 120 mg. While ventilating the patient with a well-fitted mask, we performed several attempts of conventional tracheal intubation, and the patient was finally managed using a ProSealTM laryngeal mask airway with controlled ventilation. According to patient's history, trismus has also occurred after her first operation. We think that the reason for her trismus was a result of contracture of the temporalis muscle after her first pterional craniotomy.


Assuntos
Feminino , Humanos , Pessoa de Meia-Idade , Anestesia Geral , Aneurisma , Aneurisma Roto , Artérias , Contratura , Craniotomia , Cefaleia , Intubação , Articulações , Máscaras Laríngeas , Máscaras , Propofol , Trismo , Ventilação
7.
Artigo em Coreano | WPRIM (Pacífico Ocidental) | ID: wpr-126375

RESUMO

PURPOSE: In order to develop the national guide-lines for the standardization of radiotherapy we are planning to establish a web-based, on-line data-base system for laryngeal cancer. As a first step this study was performed to accumulate the basic clinical information of laryngeal cancer and to determine the items needed for the data-base system. MATERIALS AND METHODS: We analyzed the clinical data of patients who were treated under the diagnosis of laryngeal cancer from January 1998 through December 1999 in the South-west area of Korea. Eligibility criteria of the patients are as follows: 18 years or older, currently diagnosed with primary epithelial carcinoma of larynx, and no history of previous treatments for another cancers and the other laryngeal diseases. The items were developed and filled out by radiation oncologist who are members of Korean Southwest Radiation Oncology Group. SPSS v10.0 software was used for statistical analysis. RESULTS: Data of forty-five patients were collected. Age distribution of patients ranged from 28 to 88 years (median, 61). Laryngeal cancer occurred predominantly in males (10:1 sex ratio). Twenty-eight patients (62%) had primary cancers in the glottis and 17 (38%) in the supraglottis. Most of them were diagnosed pathologically as squamous cell carcinoma (44/45, 98%). Twenty-four of 28 glottic cancer patients (86%) had AJCC (American Joint Committee on Cancer) stage I/II, but 50% (8/16) had in supraglottic cancer patients (p=0.02). Most patients (89%) had the symptom of hoarseness. Indirect laryngoscopy was done in all patients and direct laryngoscopy was performed in 43 (98%) patients. Twenty-one of 28 (75%) glottic cancer cases and 6 of 17 (35%) supraglottic cancer cases were treated with radiation alone, respectively. The combined treatment of surgery and radiation was used in 5 (18%) glottic and 8 (47%) supraglottic patients. Chemotherapy and radiation was used in 2 (7%) glottic and 3 (18%) supraglottic patients. There was no statistically significant difference in the use of combined modality treatments between glottic and supraglottic cancers (p=0.20). In all patients, 6 MV X-ray was used with conventional fractionation. The fraction size was 2 Gy in 80% of glottic cancer patients compared with 1.8 Gy in 59% of the patients with supraglottic cancers. The mean total dose delivered to primary lesions were 65.98 Gy and 70.15 Gy in glottic and supraglottic patients treated, respectively, with radiation alone. Based on the collected data, 12 modules with 90 items were developed for the study of the patterns of care in laryngeal cancer. CONCLUSION: The study items for laryngeal cancer were developed. In the near future, a web system will be established based on the items investigated, and then a nation-wide analysis on laryngeal cancer will be processed for the standardization and optimization of radiotherapy.


Assuntos
Humanos , Masculino , Distribuição por Idade , Carcinoma de Células Escamosas , Diagnóstico , Tratamento Farmacológico , Glote , Rouquidão , Articulações , Coreia (Geográfico) , Doenças da Laringe , Neoplasias Laríngeas , Laringoscopia , Laringe , Radioterapia (Especialidade) , Radioterapia
8.
Artigo em Coreano | WPRIM (Pacífico Ocidental) | ID: wpr-118297

RESUMO

PURPOSE: To analyze the causes of vocal cord fixation in laryngeal cancer and to demonstrate its spiral CT findings. MATERIALS AND METHODS: We retrospectively applied the five pathologic mechanisms of vocal cord fixationto spiral CT findings and evaluated mechanisms of fixed vocal cord in 16 patients with laryngeal cancer of T3 or more on staging. CT findings of another six patients (T2) showing one or more suspicious mechanisms of vocal cord fixation in conventional CT were compared with those of the 16 patients (T3 or more). RESULTS: In 16 patients with laryngeal cancer of T3 or more, the most common finding of vocal cord fixation was the complete replacement of the true vocal cord (including the thyroarytenoid and vocalis muscle) by the tumor and tumor invasion of the paralaryngeal space (n = 16). Other findings were tumor invasion and fixation of the cricoarytenoid joint (n = 9), interference with cord mobility by the bulky mass (n = 6), tumor invasion of the thyroid cartilage, with vocalcord fixation (n = 4) and subglottic tumor spread (n = 3). In another six patients (T2) with suspicious vocal cordfixation, conventional CT showed partial vocal cord invasion and intact or minimal invasion of the paralaryngeal space (n = 3), a bulky mass without vocal cord invasion (n = 1) and subglottic extension but movable vocal cord (n= 2). CONCLUSION: Although the cause of vocal cord fixation from laryngeal cancer may be due to one of five patterns of cancer spread, or to a combination of these, the most common spiral CT finding is complete replacement of true vocal cord by the cancer and tumor invasion of the paralaryngeal space. Accurate evaluation of vocal cord fixation and the extent of the tumor could be evaluated with spiral CT using the breathing technique.


Assuntos
Humanos , Articulações , Neoplasias Laríngeas , Respiração , Estudos Retrospectivos , Cartilagem Tireóidea , Tomografia Computadorizada Espiral , Prega Vocal
9.
Gac. méd. Caracas ; 102(2): 151-62, abr.-jun. 1994. ilus, tab
Artigo em Espanhol | LILACS | ID: lil-148131

RESUMO

Se presenta la experiencia de 22 años de un nuevo procedimiento de laringectomía funcional que se comenzó en el Instituto Oncológico "Luis Razetti" de Caracas en agosto de 1971. Se exirpa toda la glotis para eliminar los carcinomas TI glóticos dividiendo el cartílago tiroides transversalmente dos veces en planos paralelos: un plano superior a nivel de los ventrículos de Morgagni y otro inferior a nivel de la sub-glotis. Se preservan cuidadosamente los cartílagos aritenoides, sus apófisis vocales y las articulaciones cricoaritenoideas al desinsertar los músculos tiro-aritenoideos de las estructuras aritenoideas. Se realiza luego el avance de las inserciones pósterolaterales externas de las falsas cuerdas a las apófisis vocales de los cartílagos aritenoides que han sido preservados. Se operaron 51 pacientes entre 31 y 82 años, 46 varones y 5 hembras desde 1971-1993. El 29,4 por ciento de los pacientes recibieron radioterapia adyuvante a pesar de que todos los márgenes en tejido sano pre-operatorio fueron negativos para tumor. La mayor incidencia por edad fue entre 50 y 70 años. En todos los pacientes se obtuvo una voz satisfactoria y una función respiratoria y deglutoria normal excepto en uno en quien se extirpó además un aritenoide y presentó una reacción exagerada a la radioterapia adyuvante de 5400 cGy. La sobrevida actuarial de 5 años es del 97,8 por ciento


Assuntos
Humanos , Glote/patologia , Glote/cirurgia , Neoplasias Laríngeas/radioterapia , Neoplasias Laríngeas/terapia , Laringectomia/tendências , Laringectomia/estatística & dados numéricos
10.
Artigo em Coreano | WPRIM (Pacífico Ocidental) | ID: wpr-158809

RESUMO

PURPOSE: CT or MRT is performed in preoperative staging of laryngeal cancer. These methods are used in assessment of the deep tissues and cartilage of the larynx, but cannot compete with laryngoscopy in the evaluation of the laryngeal surface. The purpose of this study is to evaluate feasibilty and clinical value of the 3-D reconstruction of the mucosal surface in laryngeal cancer. METHODS AND MATERIALS: Twenty two patients with laryngeal cancer proved by means of surgical.exploration (pathologic) or clinical examinations including laryngoscope, imaging studies and biopsy underwent preoperative staging with computed tomography(G-P);and three dimensional(3D) CT reconstruction. The TNM classification of the American Joint Committee on Cancer was used to compare the imaging findings with pathologic or clinical staging. RESULTS: When the extension of primary tumor(T staging) was evaluated, the findings at only transaxial CT and those at pathologic or clinical examination were concordant in 8 of 14 cases(57.1%) of supraglottic tumor, and 3 of 6 cases(50%) of glottic tumor. The overall accuracy of CT with additional 3D-reconstruction was 85.7% for assessment of supraglottic tumor, and 66.6% for glottic tumor. CONCLUSION: 3D CT reconstruction after transaxial CT may improve outcome in preoperative staging of laryngeal cancer and has a potential value in guiding management decisions.


Assuntos
Humanos , Biópsia , Cartilagem , Classificação , Articulações , Neoplasias Laríngeas , Laringoscópios , Laringoscopia , Laringe
11.
J Otolaryngol ; 17(2): 65-7, 1988 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-3385869

RESUMO

Eight normal larynges from autopsy cases were CT scanned and 1.5 mm contiguous slices in the cricoarytenoid joint region were taken. The larynges were then sectioned and stained for histological correlation. Different degrees of calcification, ossification and bone marrow cavitation of the cricoid and arytenoid cartilages were observed. This explained the variety of presentations of these structures on CT films. For example, the cricoarytenoid articular interspace was not always visible due to the saddle-shaped configuration of the joint superimposing cartilages on axial views. Features of normal CA joints on CT scan are discussed.


Assuntos
Cartilagem Aritenoide/anatomia & histologia , Cartilagem Cricoide/anatomia & histologia , Articulações/anatomia & histologia , Cartilagens Laríngeas/anatomia & histologia , Tomografia Computadorizada por Raios X , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
12.
Radiology ; 158(2): 463-6, 1986 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-3941873

RESUMO

The cricoarytenoid (CA) joint is a true diarthrodial joint that can be affected by rheumatoid disease. Its strategic location in the airway anatomy makes its evaluation of clinical importance. Direct fiberoptic laryngoscopy (DFL) and high-resolution computerized tomography (HRCT) were used to assess the larynx in 32 rheumatoid patients. Abnormalities were seen in 75% of patients at endoscopic examination. HRCT studies showed abnormalities in 72%. Erosion-luxation of the CA joint and surrounding soft-tissue swelling can be demonstrated on HRCT scans. A radiologic grading of the rheumatoid larynx is proposed, stressing that accurate evaluation of the larynx should be part of the diagnostic evaluation of every rheumatoid arthritic patient, given the high frequency of occurrence of rheumatoid laryngitis.


Assuntos
Artrite Reumatoide/diagnóstico por imagem , Cartilagem Aritenoide/diagnóstico por imagem , Cartilagem Cricoide/diagnóstico por imagem , Cartilagens Laríngeas/diagnóstico por imagem , Laringite/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Adulto , Idoso , Artrite Reumatoide/complicações , Artrite Reumatoide/patologia , Artrografia/métodos , Feminino , Tecnologia de Fibra Óptica , Glote/diagnóstico por imagem , Humanos , Articulações/patologia , Laringite/etiologia , Laringite/patologia , Laringoscopia/métodos , Masculino , Pessoa de Meia-Idade , Fator Reumatoide/análise
14.
Laryngoscope ; 88(4): 667-74, 1978 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-642663

RESUMO

The cricoarytenoid joints of 45 larynges were dissected and examined with respect to ligaments, articulating surfaces and movements. In this study the capsule of the joint was uniformly thin, and was strengthened by a superficial, medially placed, flattened band of fibers of one or two strata, known as the posterior cricoarytenoid ligament. Three movements of the arytenoid cartilage at this joint were found, the axes and ranges of which were directly related to the shape and position of the cricoid facet. Notwithstanding these differences, the positions of all the vocal folds in extreme adduction or abduction were similar. These findings contradict the traditional concepts of uniformity of the anatomy and movements of the cricoarytenoid joint and also the position and therefore name, of the "posterior" cricoarytenoid ligament.


Assuntos
Articulações/anatomia & histologia , Laringe/anatomia & histologia , Antropometria , Feminino , Humanos , Articulações/fisiologia , Cartilagens Laríngeas/anatomia & histologia , Cartilagens Laríngeas/fisiologia , Laringe/fisiologia , Ligamentos Articulares/anatomia & histologia , Ligamentos Articulares/fisiologia , Masculino , Movimento
16.
Biochim Biophys Acta ; 483(2): 386-97, 1977 Aug 11.
Artigo em Inglês | MEDLINE | ID: mdl-889838

RESUMO

The action of the serine proteinase (EC 3.4.21--)of human neutrophil leucocytes, elastase and cathepsin G, on cartilage and tendon was investigated. With cartilage, both enzymes first degraded the proteoglycan, then solubilized collagen by an attack on the terminal peptides, destroying the inter- and intramolecular cross-links. There was little degradation of the helical region of the type II collagen. Elastase also solubilized type I collagen from tendon, though this was less susceptible than cartilage collagen, and attacked the terminal peptides and perhaps the helical region of type I skin collagen in solution. Cathepsin G had little or no effect on type I collagen of skin or tendon. Since massive infiltration of joint tissues by neutrophil leucocytes is a prominent feature of inflammatory joint disease, it may well be that elastase and cathepsin G make a significant contribution to the tissue damage that occurs.


Assuntos
Catepsinas/sangue , Colágeno/metabolismo , Neutrófilos/enzimologia , Elastase Pancreática/sangue , Tendão do Calcâneo/metabolismo , Animais , Cartilagem Articular/metabolismo , Humanos , Articulações , Cartilagens Laríngeas/metabolismo , Modelos Biológicos , Proteoglicanas/metabolismo , Coelhos , Pele , Suínos , Tripsina
17.
J Otolaryngol ; 6(4): 277-83, 1977 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-99524

RESUMO

Twin male premature infants suffering from hyaline membrane disease were intubated with Cole endotracheal tubes. One died at 25 weeks of age of cor pulmonale, still intubated. The other died at 32 weeks, six weeks after tracheotomy. Both larynges were serially sectioned and compared to normal. The crico-arytenoid joints were destroyed by inflammatory granulation tissue, and later obliterated by fibrous tissue. The probable pathogenesis and implications are discussed.


Assuntos
Cartilagem Cricoide/lesões , Doenças em Gêmeos , Doenças do Prematuro/etiologia , Intubação Intratraqueal/efeitos adversos , Articulações/lesões , Cartilagens Laríngeas/lesões , Humanos , Doença da Membrana Hialina/patologia , Doença da Membrana Hialina/terapia , Recém-Nascido , Laringe/patologia , Assistência de Longa Duração , Masculino
18.
Laryngol Rhinol Otol (Stuttg) ; 55(5): 389-92, 1976 May.
Artigo em Alemão | MEDLINE | ID: mdl-135162

RESUMO

A case of aphonia following a long-time endotracheal intubation is presented. The paramedian position of the left and the incomplete adduction of the right vocal cord were caused by a complete, respectively partial ankylosis of the cricoarytenoid joints. The ankylosis was the result of an arthritis during the intubation period. A nearly normal mobility of the vocal cords and a normal voice was achieved by translaryngeal injections of Fludrocortisone and Hyaluronidase into the cricoarytenoid joints and by their passive mobilisation.


Assuntos
Artrite/etiologia , Intubação Intratraqueal/efeitos adversos , Articulações , Cartilagens Laríngeas , Acidentes de Trânsito , Adolescente , Anquilose/etiologia , Afonia/etiologia , Artrite/complicações , Feminino , Fludrocortisona/uso terapêutico , Humanos , Hialuronoglucosaminidase/uso terapêutico , Fatores de Tempo
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