RUI IMAMURA
Projetos de Pesquisa
Unidades Organizacionais
Instituto Central, Hospital das Clínicas, Faculdade de Medicina
LIM/32 - Laboratório de Otorrinolaringologia, Hospital das Clínicas, Faculdade de Medicina
LIM/32 - Laboratório de Otorrinolaringologia, Hospital das Clínicas, Faculdade de Medicina
7 resultados
Resultados de Busca
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- Bipedicled Vocal Fold Mucosal Flap Use in Phonomicrosurgery: Case Series(2021) TSUJI, Domingos Hiroshi; KINCHOKU, Vanessa Mika; IMAMURA, Rui; HACHIYA, Adriana; YAMASAKI, Rosiane; MARINHO, Guilherme Rodrigues; SENNES, Luiz UbirajaraObjectives. The objective of this study was to present a novel surgical technique involving the use of a ""bipedicled vocal fold mucosal flap"" to repair a mucosal defect and to evaluate the outcomes of patients in whom it was used. Material and methods. This was a retrospective study of 6 clinical cases. All patients underwent surgery between November 2000 and July 2018, and all procedures were performed by the same surgeon. For the auditory-perceptual assessment, the Grade-Roughness-Breathiness-Asthenia-Strain hoarseness scale was used. We based the stroboscopic evaluation on the European Laryngological Society protocol, analyzing the parameters glottal closure, mucosal wave, and phase symmetry. Results. Ages at the time of surgery ranged from 10 to 52 years, and all of the patients were male. Preexisting vocal fold lesions included polyps, cysts, a sulcus, and mucosal bridges. Among the stroboscopic parameters, only the mucosal wave differed significantly between the preoperative and postoperative periods (P = 0.046). There were also significant postoperative improvements in the overall grade of dysphonia (P = 0.025) and in the degree of breathiness (P = 0.025). Conclusions. The use of a bipedicled vocal fold mucosal flap appears to promote significant improvements in the mucosal wave and in voice quality. In the patients evaluated here, the technique was used without preoperative planning. However, it proved to be a safe and appropriate means of repairing mucosal defects in the vocal folds, with the potential to preserve rheological properties and promote healing with less chance of fibrosis.
- Endoscopic Laser Thyroarytenoid Myoneurectomy in Patients with Adductor Spasmodic Dysphonia: A Pilot Study on Long-Term Outcome on Voice Quality(2012) TSUJI, Domingos Hiroshi; TAKAHASHI, Marystella Tomoe; IMAMURA, Rui; HACHIYA, Adriana; SENNES, Luiz UbirajaraObjectives. Adductor spasmodic dysphonia (ADSD) is a focal laryngeal dystonia, which compromises greatly the quality of life of the patients involved. It is a severe vocal disorder characterized by spasms of laryngeal muscles during speech, producing phonatory breaks, forced, strained and strangled voice. Its symptoms result from involuntary and intermittent contractions of thyroarytenoid muscle during speech, which causes vocal fold to strain, pressing each vocal fold against the other and increasing glottic resistance. Botulinum toxin injection remains the gold-standard treatment. However, as injections should be repeated periodically leading to voice quality instability, a more definitive procedure would be desirable. In this pilot study we report the long-term vocal quality results of endoscopic laser thyroarytenoid myoneurectomy. Study Design. Prospective study. Methods. Surgery was performed in 15 patients (11 females and four males), aged between 29 and 73 years, diagnosed with ADSD. Voice Handicap Index (VHI) was obtained before and after surgery (median 31 months postoperatively). Results. A significant improvement in VHI was observed after surgery, as compared with baseline values (P = 0.001). The median and interquartile range for preoperative VHI was 99 and 13, respectively and 24 and 42, for postoperative VHI. Subjective improvement of voice as assessed by the patients showed median improvement of 80%. Conclusions. Because long-term follow-up showed significant improvement of voice quality, this innovative surgical technique seems a satisfactory alternative treatment of ADSD patients who seek a definite improvement of their condition.
- Diffusion of aniline blue injected into the thyroarytenoid muscle as a proxy for botulinum toxin injection: an experimental study in cadaver larynges(2013) ALONSO, Valéria Maria de Oliveira; CHAGURY, Azis Arruda; HACHIYA, Adriana; IMAMURA, Rui; TSUJI, Domingos Hiroshi; SENNES, Luiz UbirajaraINTRODUCTION: Endolaryngeal injection of botulinum toxin into the thyroarytenoid (TA) muscle is one of the methods for treatment of focal laryngeal dystonia. However, after treatment, there is variation in laryngeal configuration as well as the side effects reported by patients. As a consequence of the functional variability of results, it was hypothesized that botulinum toxin diffuses beyond the limits of the muscle into which it is injected. OBJECTIVES: After injection of botulinum toxin into the TA muscle for the treatment of focal laryngeal dystonia, patients differ in terms of laryngeal configuration and side effects. We hypothesized that this toxin diffuses from the target muscle to adjacent muscles. METHOD: The TA muscles of 18 cadaver larynges were injected with aniline blue (0.2 mL). After fixation in formaldehyde and nitric acid decalcification, the larynges were sectioned in the coronal plane and the intrinsic muscles were analyzed. RESULTS: We found diffusion of aniline blue to the lateral cricoarytenoid muscle, cricothyroid muscle, and posterior cricoarytenoid muscle in 94.3%, 42.9%, and 8.6% of the cases, respectively. In terms of the degree of diffusion to adjacent muscles, we found no differences related to the size (height and width) of the TA muscle or to gender. CONCLUSIONS: Our findings suggest that diffusion of botulinum toxin from its injection site in the TA muscle to the lateral cricoarytenoid muscle is likely in most cases. On the other hand, diffusion to the cricothyroid muscle occurs in approximately half of cases and diffusion to the posterior cricoarytenoid muscle occurs in very few cases.
bookPart Doenças da Laringe(2016) TSUJI, Domingos Hiroshi; IMAMURA, Rui; HACHIYA, AdrianabookPart Paralisias laríngeas(2022) RAMOS, Marystella Tomoe Takahashi; HACHIYA, Adriana; IMAMURA, Rui- Bipedicled Vocal Fold Mucosal Flap: An Experimental Study(2022) KINCHOKU, Vanessa Mika; IMAMURA, Rui; HACHIYA, Adriana; YAMASAKI, Rosiane; SENNES, Luiz Ubirajara; TSUJI, Domingos HiroshiObjective. To determine the dimensions of mucosal defects that can be covered by a bipedicled vocal fold mucosal flap.Methods. We used 20 adults human larynges (10 of each gender) excised from cadavers, divided into 2 groups of 10 larynges (5 of each gender) each. In one group (the normal flap group), we created the largest possible bipedicled vocal fold mucosal flap and then quantified the dimensions of the largest defect that could be covered by displacing the flap medially. In the other group (the augmented flap group), the flap was augmented laterally with mucosa from the laryngeal ventricle and we determined whether the larger flap would effectively cover larger defects.Results. The mean width of mucosal defect capable of being covered was 1.51 mm when the normal bipedicled flap was employed and was 1.67 mm when the augmented flap was applied. However, the difference was not sta-tistically significant. We found that defect size correlated with vocal fold length, width and flap size in the normal flap group, whereas it correlated only with vocal fold length in the augmented flap group. The bipedicled flap is capable of covering larger defects in males.Conclusion. Enlargement of a bipedicled vocal fold mucosal flap with laryngeal ventricular mucosa does not necessarily translate to an increase in the size of defect that can be covered. On average, the flap should be 30% larger than the width of the defect. The statistical model for predicting the defect size based on the vocal fold length, vocal fold width, and flap size has excellent predictive quality when a normal flap is employed.
- Congenital laryngeal saccular cyst(2012) SENNES, Luiz Ubirajara; IMAMURA, Rui; FRIZZARINI, Ronaldo; HACHIYA, Adriana; CHAGURY, Azis Arruda