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González-Herranz R, Navarro-Mediano A, Hernández-García E, Plaza G. Autologous Adipose Tissue Injection of Vocal Cords in Presbyphonia. Otolaryngol Head Neck Surg 2021; 167:118-124. [PMID: 34546813 DOI: 10.1177/01945998211045292] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE This series evaluates the long-term results of autologous adipose injection (AAI) in patients older than 65 years with presbyphonia. STUDY DESIGN Retrospective cohort study. SETTING Academic secondary medical center. METHODS This was a retrospective study with a minimum follow-up of 12 months. All patients underwent AAI for atrophy of both vocal folds due to presbyphonia. We measured subjective parameters as Voice Handicap Index-10 (VHI-10) or GRBAS scale (grade, roughness, breathiness, asthenia, strain) and objective measures such as maximum phonation time (MPT) or square pixel closure defect. We reviewed the medical records of patients undergoing AAI during the 2011-2018 period. An analysis of the demographic variables of the group was performed, as well as the values of VHI-10, GRBAS, and MPT, and the minimum closure defect measured in square pixels and the number of closed frames in the glottal cycle before and after the intervention. RESULTS At 12 months, 17 of 18 patients reported subjective and VHI-10 improvement. The mean preoperative VHI-10 (26.7) was significantly higher than the postoperative value (14.4), and the GRBAS scale had a preoperative mean of 8.7 and a postoperative mean of 4.3, both with statistical significance. MPT increased from 7.7 to 12.4 seconds (P < .0001). The minimum closure defect measurements obtained in square pixels changed from 305 to 124, achieving complete closure in 3 patients. The closed phase of the glottal cycle change from 14.3% to 38.2% after the AAI. CONCLUSIONS AAI improves long-term vocal fold closure, demonstrating utility in patients with presbyphonia.
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Affiliation(s)
- Ramón González-Herranz
- Department of Otolaryngology, Hospital Universitario de Fuenlabrada, Madrid, Spain.,Department of Otolaryngology, Hospital Universitario La Zarzuela, Madrid, Spain
| | | | - Estefanía Hernández-García
- Department of Otolaryngology, Hospital Universitario de Fuenlabrada, Madrid, Spain.,Department of Otolaryngology, Hospital Universitario La Zarzuela, Madrid, Spain
| | - Guillermo Plaza
- Department of Otolaryngology, Hospital Universitario de Fuenlabrada, Madrid, Spain.,Department of Otolaryngology, Hospital Universitario La Zarzuela, Madrid, Spain
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Yumoto E, Sanuki T, Kumai Y, Kodama N. Modified Isshiki's arytenoid adduction without separating cricothyroid and cricoarytenoid joints. ACTA ACUST UNITED AC 2020; 40:99-105. [PMID: 32469003 PMCID: PMC7256903 DOI: 10.14639/0392-100x-n0183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 09/08/2019] [Indexed: 11/23/2022]
Affiliation(s)
- Eiji Yumoto
- Department of Otolaryngology, Asahino General Hospital 12-10, Murozono-cho, Kita-ku, Kumamoto, Japan.,Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Kumamoto University 1-1-1, Honjo, Chuo-ku, Kumamoto, Japan
| | - Tetsuji Sanuki
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine Nagoya City University 1, Kawasumi, Mizuho-cho, Mizuho-ku, Nagoya, Japan
| | - Yoshihiko Kumai
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Kumamoto University 1-1-1, Honjo, Chuo-ku, Kumamoto, Japan
| | - Narihiro Kodama
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Kumamoto University 1-1-1, Honjo, Chuo-ku, Kumamoto, Japan.,Department of Rehabilitation, Kumamoto Health Science University 325, Izumi-cho, Kita-ku, Kumamoto, Japan
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Lim S, Kim DC, Cho K, Kim MH, Moon S, Cho H, Ki S. Vocal cord paralysis following general anesthesia with endotracheal intubation: a clinical review on 43 cases. Anesth Pain Med (Seoul) 2020; 15:226-232. [PMID: 33329818 PMCID: PMC7713820 DOI: 10.17085/apm.2020.15.2.226] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2019] [Revised: 10/28/2019] [Accepted: 10/28/2019] [Indexed: 11/17/2022] Open
Abstract
Background Vocal cord paralysis (VCP) is one of the most stressful experiences for patients undergoing general anesthesia. Moreover, it is a risk factor for aspiration pneumonia and may increase morbidity and mortality. We examined several clinical features of the condition by reviewing the medical records of patients who experienced VCP following general anesthesia. Methods We reviewed the medical records of 321 patients who consulted an otolaryngologist owing to hoarseness, sore throat, throat discomfort, or dysphagia after general anesthesia. Among these, we included in the present study 43 patients who were diagnosed with VCP by laryngoscopy, who did not have symptoms of suspected VCP before surgery, who had no past history of VCP, and for whom endotracheal intubation was not continued after surgery. Results The mean age of patients with VCP was 51.3 years. With respect to surgical site, the most common was upper limb surgery, performed in 12 cases (9 cases were performed in sitting posture. With respect to surgical duration, only 11 cases lasted less than 3 h, whereas 32 cases required a surgical duration longer than 3 h. The most common symptom of VCP was hoarseness. Nine of the patients with VCP recovered spontaneously, but VCP persisted in 13 cases until the final follow-up examination. Conclusions We hope that this study might call attention to the occurrence of VCP following general anesthesia. Moreover, it is necessary to further evaluate the reasons for the higher incidence of VCP in upper limb surgery performed in sitting posture.
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Affiliation(s)
- Sehun Lim
- Department of Anesthesiology and Pain Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Dong-Chun Kim
- Department of Anesthesiology and Pain Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Kwangrae Cho
- Department of Anesthesiology and Pain Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Myoung-Hun Kim
- Department of Anesthesiology and Pain Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Sungho Moon
- Department of Anesthesiology and Pain Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Hakmoo Cho
- Department of Anesthesiology and Pain Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
| | - Seunghee Ki
- Department of Anesthesiology and Pain Medicine, Busan Paik Hospital, Inje University College of Medicine, Busan, Korea
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Zimmermann TM, Orbelo DM, Pittelko RL, Youssef SJ, Lohse CM, Ekbom DC. Voice outcomes following medialization laryngoplasty with and without arytenoid adduction. Laryngoscope 2018; 129:1876-1881. [PMID: 30582612 DOI: 10.1002/lary.27684] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2018] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Voice outcomes following medialization laryngoplasty (ML) for unilateral vocal fold paralysis (UVFP) were compared to those who underwent ML plus arytenoid adduction (AA) (ML+AA). METHODS Single institution retrospective review of patients with UVFP undergoing ML and ML+AA (2009-2017). Demographic information and history of laryngeal procedures were collected. Preoperative and postoperative Voice Handicap Index-10 (VHI-10) and Consensus Perceptual Auditory Evaluation of Voice (CAPE-V) were assessed. RESULTS Of 236 patients, 119 met study criteria. Of those, 70 (59%) underwent ML and 49 (41%) underwent ML+AA. Significant differences between groups at baseline were found for age at time of thyroplasty (P = 0.046), VHI-10 scores (P < 0.001), and CAPE-V scores (P = 0.007). Baseline VHI-10 scores for ML+AA (28 ± 7) were greater than those for ML alone (24 ± 7). At 12 months, overall VHI-10 scores improved compared to baseline for both groups (ML+AA = 9 ± 7, ML = 16 ± 9); however, there was greater improvement for the ML+AA group compared to ML group (P = 0.001). CAPE-V scores at 3 or 12 months improved, but differences between the groups were not statistically significant once controlled for covariates. CONCLUSION Based on current findings, patients who undergo ML+AA likely have greater voice handicap at baseline compared to those undergoing ML alone. Patients selected for ML+AA improve as much or more than those who underwent ML alone. This highlights the importance of appropriate selection of candidates for AA. LEVEL OF EVIDENCE 4 Laryngoscope, 129:1876-1881, 2019.
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Affiliation(s)
| | - Diana M Orbelo
- Department of Otorhinolaryngology, Rochester, Minnesota, U.S.A
| | | | | | - Christine M Lohse
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota, U.S.A
| | - Dale C Ekbom
- Department of Otorhinolaryngology, Rochester, Minnesota, U.S.A
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Vij S, Gupta AK, Vir D. Voice Quality Following Unilateral Vocal Fold Paralysis: A Randomized Comparison of Therapeutic Modalities. J Voice 2017; 31:774.e9-774.e21. [DOI: 10.1016/j.jvoice.2017.02.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 02/22/2017] [Indexed: 10/19/2022]
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Overton L, Adams K, Shah RN, Buckmire RA. Longitudinal Voice Outcomes After Type I Gore-tex Thyroplasty for Nonparalytic Glottic Incompetence. Ann Otol Rhinol Laryngol 2016; 126:14-19. [DOI: 10.1177/0003489416672475] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective: Type I Gore-tex thyroplasty (GTP) for nonparalytic glottic incompetence (GI) results in significantly improved subjective and perceptual voice outcomes. We endeavored to investigate the longitudinal course of voice outcomes measuring the same patients across time points stratified by diagnostic subgroup. Methods: Seventy-five patients with nonparalytic GI treated with GTP in the past 9 years were retrospectively reviewed and grouped according to their primary diagnoses (atrophy, scar, hypomobility, and paresis). Voice outcome measures, Voice-Related Quality of Life (VRQOL), Glottal Function Index (GFI), and GRBAS (grade, roughness, breathiness, asthenia, and strain) for each individual patient and diagnostic subgroup were grouped by time interval following surgery: 0 to 90 days, 3 to 9 months, 9 to 18 months, 18 to 36 months, 3 to 5 years, and 5 to 10 years. Results: Across all diagnoses, statistically significant improvement in VRQOL was maintained at 3 to 5 years ( P = .03) and GFI at 5 to 10 years ( P = .02). The GRBAS showed statistically significant improvements out to 18 to 36 months ( P = .02). In the subgroup analysis, hypomobility/paresis patients maintained significant improvement voice measures longer than patients with other diagnoses. As a group, scar patients did not show statistically significant postoperative improvement in VRQOL or GFI at any of the tested time points. Conclusions: Gore-tex thyroplasty provides durable improvement in subjective and perceptual voice outcomes for patients with nonparalytic GI. Patients treated for hypomobility/paresis have the most durable vocal outcomes followed by atrophy and lastly, scar.
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Affiliation(s)
- Lewis Overton
- Department of Otolaryngology-Head & Neck Surgery, University of North Carolina Hospitals, Chapel Hill, North Carolina, USA
| | - Katherine Adams
- University of North Carolina at Chapel Hill School of Medicine, University of North Carolina Hospitals, Chapel Hill, North Carolina, USA
| | - Rupali N. Shah
- Department of Otolaryngology-Head & Neck Surgery, University of North Carolina Hospitals, Chapel Hill, North Carolina, USA
| | - Robert A. Buckmire
- Department of Otolaryngology-Head & Neck Surgery, University of North Carolina Hospitals, Chapel Hill, North Carolina, USA
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Postdeglutitive residue in vagus nerve paralysis and its association with feeding style. Eur Arch Otorhinolaryngol 2016; 273:4369-4375. [DOI: 10.1007/s00405-016-4182-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2016] [Accepted: 06/25/2016] [Indexed: 10/21/2022]
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8
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Sonoda S, Kataoka H, Inoue T. Traction of Lateral Cricoarytenoid Muscle for Unilateral Vocal Fold Paralysis: Comparison with Isshiki's Original Technique of Arytenoid Adduction. Ann Otol Rhinol Laryngol 2016; 114:132-8. [PMID: 15757193 DOI: 10.1177/000348940511400209] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Between 1995 and 1997, we performed Isshiki's original method of arytenoid adduction alone or as an adjunct to type I thyroplasty for the treatment of unilateral vocal fold paralysis. From 1997 onward, we performed arytenoid adduction by traction of the lateral cricoarytenoid muscle (Iwamura's method), because it reduces discomfort to the patient and avoids rotation of the thyroid cartilage. Preliminary experiments and surgical procedures involving traction of the lateral cricoarytenoid muscle are described. Of 21 patients with a maximum phonation time of less than 9 seconds, 14 underwent type I thyroplasty as an adjunct to our method of arytenoid adduction and 7 underwent arytenoid adduction alone. Sixteen patients (76%) were able after surgery to extend their maximum phonation time beyond 10 seconds; this result compares favorably with the results of Isshiki's original adduction technique. We describe useful anatomic landmarks for approaching the lateral cricoarytenoid muscle in the hope that more voice surgeons will adopt this approach in the treatment of unilateral vocal fold paralysis.
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Affiliation(s)
- Satoshi Sonoda
- Department of Otolaryngology, Shiga University of Medical Science, Seta, Otsu 520-2192, Japan
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Hartl DM, Crevier-Buchman L, Vaissière J, Brasnu DF. Phonetic Effects of Paralytic Dysphonia. Ann Otol Rhinol Laryngol 2016; 114:792-8. [PMID: 16285270 DOI: 10.1177/000348940511401009] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives: This study was performed to determine whether and how unilateral vocal fold paralysis (UVFP) affects the production and perception of voiced stop consonants as compared with unvoiced stops, and to analyze the phonetic effects of UVFP on the voicing feature. Methods: Phonetic constructs pronounced by 7 male patients with UVFP and 5 normal male subjects were recorded. The 432 speech tokens consisted of intervocalic, prevocalic, and postvocalic stop consonants (/p/, /t/, /k/, /b/, /d/, /g/) in the vowel contexts / a/ and /i/. Perceptual consonant identification testing was performed with 5 voice and speech professionals as listeners. The type and frequency of errors made in consonant identification were analyzed. Spectrographic analysis was used to analyze acoustic cues. Results: The rate of correct consonant identification was significantly lower for tokens pronounced by patients with UVFP (77.3% versus 97.6%, p =.0001) because of incorrect identification of the voiced consonants, frequently perceived as their unvoiced homologues. Confusion between dental and alveolar place of articulation for unvoiced stops was also noted. Conclusions: Unilateral vocal fold paralysis alters the voiced-unvoiced stop consonant distinction and the dental-palatal stop consonant distinction in an experimental nonspeech context. This finding implies the existence of a phonetic handicap for patients with UVFP. Further studies should determine the effects of UVFP on global speech intelligibility.
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Affiliation(s)
- Dana M Hartl
- Voice, Biomaterials, and Head and Neck Oncology Research Laboratory, University Paris V, European Hospital Georges Pompidou, Paris, France
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Abstract
OBJECTIVE: To evaluate the indications, results, and safety of revision Gore-Tex medialization laryngoplasty (GML). METHODS: A retrospective chart review of 156 patients that underwent GML procedures between the years 1998–2002. Study population consisted of those patients who required revision surgery for any reason. RESULTS: Sixteen patients required 22 revision procedures. Indications for revision were divided into 2 groups, complications and glottal closure problems. Complications included extruded or displaced implants (n = 4). The most common glottal closure problem was undercorrection (n = 9). Others included anterior overcorrection (n = 1) and persistent posterior glottal gap (n = 2). Revision procedures included GML (n = 9), injection augmentation (n = 9), endoscopic implant removal (n = 2), and arytenoid adduction (n = 2). In patients with glottal closure problems, the GCI improved in all 10 and the voice rating scale improved in 9. CONCLUSION: Reasons for revision of GML are variable, the most common being undercorrection. A variety of safe, effective revision techniques are available with a high success rate.
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Affiliation(s)
- Jacob T Cohen
- Department of Otolaryngology, Center for Voice and Swallowing Disorders of Wake Forest University, Winston-Salem, North Carolina, USA
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11
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Duruisseau O, Wagner I, Fugain C, Chabolle F. Endoscopic Rehabilitation of Vocal Cord Paralysis with a Silicone Elastomer Suspension Implant. Otolaryngol Head Neck Surg 2016; 131:241-7. [PMID: 15365543 DOI: 10.1016/j.otohns.2003.11.021] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
OBJECTIVES: Because of the side effects of Teflon, the risk of infection from the use of collagen, autologous fat resorption, and the lack of alternative substances, injection laryngoplasty tends to be replaced by laryngeal framework surgery as the method of choice for the treatment of unilateral vocal cord recurrent paralysis (LP). The aim of this study was to evaluate the results, for morbidity and voice quality, of treating this paralysis by injection of a silicone suspension elastomer implant (SSEI). STUDY DESIGN: The study was retrospective, and 19 patients were included. Average follow-up was 25 months (range: 8.3-43). METHODS: Each patient underwent clinical and videostroboscopic assessment, and had an electroglottographic recording. Subjective assessment was obtained by self-evaluation. Results were classified as good, fair, or poor, and were based on 2 objective and 3 subjective criteria. A search was made for biologic signs of autoimmune disorders. RESULTS: Good, fair, and poor results were respectively 79%, 16%, and 5%. Each set of subjective data showed voice improvement ( P < 0.05). The fundamental frequency range, percentage of irregularity, and aspiration decreased significantly ( P < 0.05). There was only one case of postoperative dyspnea, which resolved after steroid injection. No biologic signs of autoimmune disorders were found. CONCLUSIONS: The use of SSEI is safe. Injection laryngoplasty is easy to perform and avoids cervical scarring. Its results are comparable to those obtained with other techniques, including laryngeal framework surgery, even if there is no standard criterion for the evaluation of voice quality. SSEI injection can reasonably be proposed as a surgical treatment for permanent unilateral vocal cord LP.
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Affiliation(s)
- Olivier Duruisseau
- Department of ENT and Cervicofacial Surgery, Foch Hospital, Suresnes, France
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Benninger MS, Hanick AL, Nowacki AS. Augmentation Autologous Adipose Injections in the Larynx. Ann Otol Rhinol Laryngol 2015. [PMID: 26195576 DOI: 10.1177/0003489415595427] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Autologous adipose injection (AAI) is a recognized method for vocal fold augmentation. The study's purpose is to explore short- and long-term outcomes of AAI. METHODS Retrospective chart review of 43 patients undergoing AAI was performed; patient perception of outcome, Voice Handicap Index (VHI), maximum phonatory time (MPT), and disposition were evaluated. RESULTS Over 5 years, 43 AAI patients had documented postoperative follow-up (25 paralysis, 8 paresis, 9 bowing/presbylarynges, and 5 scar/sulci). Mean follow-up was 32 weeks. There was gradual patient loss to follow-up. Thirty-nine of 40 (98%) had patient-reported improvement at 6 weeks, 28 of 34 (82%) had improvement at 2 to 6 months, with 10 of 12 (83%) sustaining their improvement for >1 year. Significant improvement in mean VHI was observed at 4 to 6 weeks (mean reduction, 26; P < .0001) and 2 to 6 months (mean reduction, 23; P < .0001). Improvement in mean MPT was observed at 4 to 6 weeks (mean increase, 8 s; P < .0001), 2 to 6 months (6 s; P = .007), and >1 year (4 s; P = .03). Eight patients went on to medialization laryngoplasty. CONCLUSION AAI successfully augments vocal folds in short-term outcomes with some gradual decrease in effectiveness. Although patient attrition limited conclusions, objective long-term benefit may occur in >50% of patients.
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Affiliation(s)
- Michael S Benninger
- Cleveland Clinic Department of Otolaryngology, Head and Neck Surgery, Cleveland, Ohio, USA
| | - Andrea L Hanick
- Cleveland Clinic Lerner College of Medicine of Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Amy S Nowacki
- Quantitative Health Sciences, Cleveland Clinic Foundation, Cleveland, Ohio, USA
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Parker NP, Barbu AM, Hillman RE, Zeitels SM, Burns JA. Revision Transcervical Medialization Laryngoplasty for Unilateral Vocal Fold Paralysis. Otolaryngol Head Neck Surg 2015; 153:593-8. [DOI: 10.1177/0194599815585091] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 04/13/2015] [Indexed: 11/17/2022]
Abstract
Objective To identify patterns of failure following transcervical medialization laryngoplasty for unilateral vocal fold paralysis and describe indications and revision techniques for optimal vocal outcomes. Study Design Case series with chart review. Setting Tertiary care center. Subjects and Methods Thirty-nine consecutive patients between January 2005 and April 2014 undergoing transcervical revision of failed primary medialization laryngoplasty were identified. Demographics, etiology, stroboscopic assessment, and surgical techniques were recorded. Patient self-assessment using the Voice-Related Quality-of-Life (VRQOL) questionnaire and objective acoustic and aerodynamic assessments performed pre- and postoperatively were analyzed using t tests for paired comparisons. Results Thirty-nine patients underwent 48 transcervical revision surgeries. Median follow-up was 14.6 months from time of final revision surgery. Indications included anterior glottic incompetence (38/48, 79%), posterior glottic incompetence (20/48, 42%), glottic overclosure (8/48, 17%), and/or decreased phonatory pliability (12/48, 25%). A combination of findings was present in 21 (44%) surgeries. Revision techniques included either anterior augmentation, arytenopexy, and cricothyroid subluxation (alone or in combination) in 46 of 48 (96%) patients or partial implant removal alone in 2 patients. Seven patients (18%) required multiple revisions. A complete set of voice parameters was available for 22 patients, and statistically significant improvements included VRQOL scores, fundamental frequency in females, jitter, noise-to-harmonic ratio, and mean airflow rate. Conclusion Patterns of failure in patients with suboptimal phonatory function after transcervical medialization laryngoplasty included persistent glottic incompetence, glottic overclosure, and decreased vocal fold pliability. Revision transcervical medialization surgery, guided by individualized consideration of vocal fold position and surface pliability, can improve phonatory outcomes.
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Affiliation(s)
- Noah P. Parker
- Department of Surgery, Harvard Medical School, and Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Anca M. Barbu
- Department of Surgery, Harvard Medical School, and Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Robert E. Hillman
- Department of Surgery, Harvard Medical School, and Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Steven M. Zeitels
- Department of Surgery, Harvard Medical School, and Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - James A. Burns
- Department of Surgery, Harvard Medical School, and Center for Laryngeal Surgery and Voice Rehabilitation, Massachusetts General Hospital, Boston, Massachusetts, USA
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Sims JR, Lalich IJ, Ekbom DC. Displacement of Residual Gore-Tex Thyroplasty Implant Presenting as a True Vocal Fold Mass. Otolaryngol Head Neck Surg 2014; 150:1090-1. [PMID: 24486783 DOI: 10.1177/0194599814521571] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Accepted: 01/08/2014] [Indexed: 11/17/2022]
Affiliation(s)
- John R Sims
- Department of Otorhinolaryngology-Head & Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Ian J Lalich
- Department of Otorhinolaryngology-Head & Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Dale C Ekbom
- Department of Otorhinolaryngology-Head & Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
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Narajos N, Samejima Y, Kumai Y, Yumoto E. Postdeglutitive residue in idiopathic unilateral vocal fold paralysis. Laryngoscope 2013; 123:2776-9. [DOI: 10.1002/lary.24132] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2012] [Revised: 03/08/2013] [Accepted: 03/08/2013] [Indexed: 11/07/2022]
Affiliation(s)
- Nena Narajos
- Department of Otolaryngology-Head and Neck Surgery; Kumamoto University Graduate School of Medicine; Kumamoto Japan
| | - Yasuhiro Samejima
- Department of Otolaryngology-Head and Neck Surgery; Kumamoto University Graduate School of Medicine; Kumamoto Japan
| | - Yoshihiko Kumai
- Department of Otolaryngology-Head and Neck Surgery; Kumamoto University Graduate School of Medicine; Kumamoto Japan
| | - Eiji Yumoto
- Department of Otolaryngology-Head and Neck Surgery; Kumamoto University Graduate School of Medicine; Kumamoto Japan
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Abstract
Glottal gaps can be either physiological or pathological. The latter are multifactorial, predominantly organic in origin and occasionally functional. Organic causes include vocal fold paralysis or scarring, as well as a deficiency or excess of tissue. In addition to loss of the mucosal wave, the degree of hoarseness is primarily determined by the circumferential area of the glottal gap. It is thus important to quantify the extent of glottal insufficiency. Although a patient's symptoms form the basis for treatment decisions, these may be subjective and inadequately reflected by the results of auditory-perceptual evaluation, voice analysis and voice performance tests. The therapeutic approach should always combine phonosurgery with conventional voice therapy methods. Voice therapy utilises all the resources made available by the sphincter model of the aerodigestive tract and knowledge on the mechanism of voice production. The aim of phonosurgery is medialization, reconstruction or reinnervation by injection laryngoplasty or larynx framework surgery. These different methods can be combined and often applied directly after vocal fold surgery (primary reconstruction). In conclusion, the techniques described here can be effectively employed to compensate for glottal gaps.
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Modified arytenoid adduction for cancer-related unilateral vocal fold paralysis. The Journal of Laryngology & Otology 2010; 125:173-80. [PMID: 21106137 DOI: 10.1017/s0022215110002434] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES (1) To evaluate the efficacy of modified arytenoid adduction in the management of patients with symptomatic cancer-related unilateral vocal fold paralysis, and (2) to assess the impact of this treatment on patients' quality of life. METHODS Forty-two patients with cancer-related unilateral vocal fold paralysis underwent modified arytenoid adduction between February 2001 and December 2008. Of these, 37 patients were enrolled in this retrospective study (one patient died of primary disease and four were lost to follow up). Laryngostroboscopy was performed to evaluate vocal fold orientation and mobility. Pre- and post-operative assessment of subjective and objective voice, aerodynamic parameters, and quality of life were also undertaken, and aspiration was subjectively rated. RESULTS Laryngostroboscopic findings indicated a significant post-operative improvement in vocal fold posterior glottal closure and vertical gap. Significant improvements in voice quality, aerodynamic parameters and quality of life were noted three months post-operatively in all patients (p < 0.01). The overall success rate for swallowing rehabilitation was 94.6 per cent (35/37). Subjective aspiration ratings decreased significantly post-operatively, compared with pre-operative values (p < 0.01). No major complication occurred in any patient, except for dyspnoea in one patient. CONCLUSION Modified arytenoid adduction is an effective and reliable medialisation technique which can restore satisfactory voice quality, prevent aspiration and lead to a better quality of life for patients with cancer-related unilateral vocal fold paralysis.
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Hartl DM, Hans S, Crevier-Buchman L, Vaissière J, Brasnu DF. Long-Term Acoustic Comparison of Thyroplasty versus Autologous Fat Injection. Ann Otol Rhinol Laryngol 2009; 118:827-32. [DOI: 10.1177/000348940911801201] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives: Medialization by thyroplasty or intracordal autologous fat injection provides voice improvement in patients with unilateral vocal fold paralysis. Thyroplasty is considered a “permanent” medialization, whereas fat injection is considered “temporary” because of reabsorption. The objective of this study was to compare the evolution of acoustic parameters for these procedures over 1 year and to evaluate the results of fat injection at 2 years. Methods: From 1994 to 1998, 46 consecutive patients (17 women and 29 men) were treated exclusively by intracordal injection of autologous fat, and then from 1999 to 2002, 48 consecutive patients (19 women and 29 men) were treated with the Montgomery Thyroplasty Implant System or Gore-Tex thyroplasty. Each patient's voice was prospectively recorded before operation and at 1, 3, 12, and 24 months after operation. Six patients (13%) in the injection group underwent a second injection, and 1 patient (2%) in the thyroplasty group underwent revision surgery. Jitter, shimmer, and noise-to-harmonics ratio (NHR) were calculated for a 1,000-ms midvowel segment of the vowel / a/. Results: One month after operation, jitter, shimmer, and NHR were significantly improved in both groups (Wilcoxon's test, p < 0.05 in all cases). Jitter and shimmer did not change significantly between 1 and 3 months or between 1 and 12 months (p > 0.05). The NHR had improved at 12 months in both groups (injection, p = 0.0004; thyroplasty, p = 0.0178) and at 24 months in the injection group (p = 0.0076). No significant difference was noted between the two techniques before operation or at 1, 3, or 12 months after operation (Mann-Whitney test, p > 0.05). Jitter and shimmer had not changed significantly after 24 months in either group. At 24 months, there was no difference in acoustic parameters between the two treatment groups. Conclusions: The two techniques provided comparable objective acoustic voice improvement. At 2 years, autologous fat injection provides long-term acoustic voice improvement comparable to that of thyroplasty, but it has a higher rate of revision surgery.
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Aerodynamic and Acoustic Characteristics of Voice Before and After Adduction Arytenopexy and Medialization Laryngoplasty with GORE-TEX in Patients with Unilateral Vocal Fold Immobility. J Voice 2009; 23:261-7. [DOI: 10.1016/j.jvoice.2007.09.009] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2007] [Accepted: 09/26/2007] [Indexed: 11/17/2022]
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Morton R, Ahmad Z, Farquar G, Gillibrand J. Medialisation laryngoplasty: how we do it. Clin Otolaryngol 2008; 33:485-8. [PMID: 18983387 DOI: 10.1111/j.1749-4486.2008.01742.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- R Morton
- Department of Otorhinolaryngology-Head and Neck Surgery, Counties Manukau District Health Board, Manukau, New Zealand.
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Hoffman HT, Bock JM, Karnell LH, Ahlrichs-Hanson J. Microendoscopy of Reinke's Space. Ann Otol Rhinol Laryngol 2008; 117:510-4; discussion 515-6. [DOI: 10.1177/000348940811700707] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Objectives: Contemporary surgical treatment of the superficial layer of the lamina propria or Reinke's space is most commonly performed through an incision in the overlying vocal fold epithelium. This approach may disrupt normal tissue, induce scarring, and allow extrusion of implanted materials. Previously reported external approaches to Reinke's space required either a laryngofissure or a “minithyrotomy” for access. These surgical approaches were performed without direct imaging of Reinke's space. Instruments placed below the vocal fold epithelium via this external approach were visualized through the translucent vocal fold epithelium. We designed this study to identify the feasibility of limited-access surgery of the lamina propria using microendoscopes placed into Reinke's space through an external approach. Methods: A cadaveric human larynx was dissected, and microendoscopes were directly advanced into Reinke's space through a subepithelial puncture of the cricothyroid membrane, as well as lateral fenestration through the thyroid cartilage. Results: Photodocumentation of the undersurface of vocal fold epithelium, the opposing surface of the vocal ligament, and the intervening Reinke's space was successfully accomplished. Conclusions: Advances in both microendoscopes and accompanying instrumentation permit access to the superficial layer of the lamina propria without disrupting the overlying epithelium. This approach to microendoscopy of Reinke's space may allow for more effective surgical treatment of cysts, chronic edema, vascular abnormalities, atrophy, scarring, and sulcus vocalis.
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Andrews BT, Van Daele DJ, Karnell MP, McCulloch TM, Graham SM, Hoffman HT. Evaluation of open approach and injection laryngoplasty inrevision thyroplasty procedures. Otolaryngol Head Neck Surg 2008; 138:226-32. [DOI: 10.1016/j.otohns.2007.10.016] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2007] [Revised: 08/17/2007] [Accepted: 10/23/2007] [Indexed: 11/29/2022]
Abstract
INTRODUCTION: Vocal outcomes after medialization laryngoplasty are variable and may change over time. A revision procedure via open approach or an injection laryngoplasty may be necessary to improve vocal outcomes. METHODS: A retrospective chart review was performed. RESULTS: Twenty-nine subjects were identified and stratified into group 1A (n = 9) if the allograft was repositioned/replaced, group 1B (n = 4) if the allograft was removed, and group 2 (n = 16) if an injection laryngoplasty was performed. Statistically significant differences were found between all data prerevision to postrevision ( P ≤ 0.05) for group 1A and group 2 when multiple paired-sample t tests were calculated for patient-reported voice severity ratings and voice impact ratings as well as clinician-reported voice ratings of grade, roughness, and breathiness. Results of group 2 were often temporary, with 10 of 16 (62.5%) subjects receiving multiple injections. CONCLUSION: Both open revision laryngoplasty and injection laryngoplasty are successful at providing improved vocal outcomes. Results are often temporary after injection laryngoplasty and often require multiple procedures.
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Affiliation(s)
- Brian T. Andrews
- Departments of Otolaryngology–Head and Neck Surgery and Speech Pathology and Audiology, University of Iowa Hospitals and Clinics, Iowa City, IA; Department of Otolaryngology–Head and Neck Surgery, Harborview Medical Center, Seattle, WA
| | - Douglas J. Van Daele
- Departments of Otolaryngology–Head and Neck Surgery and Speech Pathology and Audiology, University of Iowa Hospitals and Clinics, Iowa City, IA; Department of Otolaryngology–Head and Neck Surgery, Harborview Medical Center, Seattle, WA
| | - Michael P. Karnell
- Departments of Otolaryngology–Head and Neck Surgery and Speech Pathology and Audiology, University of Iowa Hospitals and Clinics, Iowa City, IA; Department of Otolaryngology–Head and Neck Surgery, Harborview Medical Center, Seattle, WA
| | - Timothy M. McCulloch
- Departments of Otolaryngology–Head and Neck Surgery and Speech Pathology and Audiology, University of Iowa Hospitals and Clinics, Iowa City, IA; Department of Otolaryngology–Head and Neck Surgery, Harborview Medical Center, Seattle, WA
| | - Scott M. Graham
- Departments of Otolaryngology–Head and Neck Surgery and Speech Pathology and Audiology, University of Iowa Hospitals and Clinics, Iowa City, IA; Department of Otolaryngology–Head and Neck Surgery, Harborview Medical Center, Seattle, WA
| | - Henry T. Hoffman
- Departments of Otolaryngology–Head and Neck Surgery and Speech Pathology and Audiology, University of Iowa Hospitals and Clinics, Iowa City, IA; Department of Otolaryngology–Head and Neck Surgery, Harborview Medical Center, Seattle, WA
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[Annex I: surgical management of differentiated thyroid cancers]. ANNALES D'ENDOCRINOLOGIE 2007; 68 Suppl 2:S73-S76. [PMID: 18342282 DOI: 10.1016/s0003-4266(07)78637-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
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Durucu C, Kanlikama M, Mumbuc S, Bayazit Y, Bakir K, Karatas E. Medialization Laryngoplasty With Gore-Tex: An Animal Study. J Voice 2007; 21:632-9. [PMID: 16822647 DOI: 10.1016/j.jvoice.2006.05.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2006] [Accepted: 05/09/2006] [Indexed: 11/19/2022]
Abstract
Vocal cord paralysis is a disease that can cause voice disability and aspiration problems. Expanded polytetrafluoroethylene (ePTFE; Gore-Tex) has been widely used in cardiovascular and plastic surgery; however, its biocompatibility and safety have not been established precisely in the larynx. In this study, the biocompatibility and safety of ePTFE used in vocal cord medialization in the rabbit larynx were assessed. Type 1 thyroplasty with Gore-Tex was performed on one side of the larynx in eight rabbits. A sham procedure was applied on the contralateral side of their larynx. The rabbits were sacrificed after 6 months, and macroscopic and microscopic evaluations and comparisons were performed. No significant inflammatory response to Gore-Tex or displacement of the implant was seen. There was only a tiny fibrotic capsule surrounding the material in each specimen. Intense eosinophilic cell infiltration was seen surrounding one rabbit specimen. Gore-Tex seems to be a biocompatible, stable, and reversible material that can be safely used in laryngeal framework surgery.
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Affiliation(s)
- Cengiz Durucu
- Gaziantep University Otorhinolaryngology Department, Gaziantep, Turkey.
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Ohta N, Kuratani T, Hagihira S, Kazumi KI, Kaneko M, Mori T. Vocal cord paralysis after aortic arch surgery: Predictors and clinical outcome. J Vasc Surg 2006; 43:721-8. [PMID: 16616227 DOI: 10.1016/j.jvs.2005.11.054] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2005] [Accepted: 11/29/2005] [Indexed: 11/26/2022]
Abstract
OBJECTIVE This study is retrospective cohort study of data on vocal cord paralysis after aortic arch surgery collected during 14 years at a general hospital. We investigated factors in the development of vocal cord paralysis after aortic arch surgery and the effect of vocal cord paralysis on clinical course and outcome. METHODS We reviewed data for 182 patients who underwent aortic arch surgery for aortic arch aneurysm and aortic dissection between 1989 and 2003, of whom 58 patients had proximal aortic repair, 62 had distal arch repair, and 62 had total arch repair. We assessed factors associated with the development of vocal cord paralysis and examined in detail the clinical outcome of patients with vocal cord paralysis. RESULTS Postoperative vocal cord paralysis occurred in 40 patients. Multiple logistic regression analysis revealed the following risk factors with odds ratios (OR) for vocal cord paralysis: extension of procedures into distal arch (OR, 17.0), chronic dilatation of the aorta at the left subclavian artery (OR, 9.14), and total arch repair (OR, 4.24). Adoption of open-style stent-grafts reduced the incidence of vocal cord paralysis (OR, 0.031). The postoperative occurrence of vocal cord paralysis itself emerges as an independent predictor of pulmonary complications (OR, 4.12) and leads to a longer duration of hospital stay. CONCLUSIONS The risk of vocal cord paralysis after aortic arch surgery depends on surgical factors, such as aneurysmal involvement of the distal arch, or the application of newer, less invasive surgical procedures. Vocal cord paralysis after aortic arch surgery itself, under aggressive postoperative respiratory management, did not increase aspiration pneumonia but was associated with postoperative complications leading to higher hospital mortality and prolonged hospitalization.
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Affiliation(s)
- Noriyuki Ohta
- Department of Anesthesiology, Osaka General Medical Center, Japan.
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Abstract
Pulmonary complications are the major source of morbidity and mortality after esophageal resection, and numerous studies have identified various associated with these complications. This article discusses preoperative, intraoperative, and postoperative factors affecting pulmonary complications and strategies to reduce these complications after esophagectomy.
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Su CY, Tsai SS, Chuang HC, Chiu JF. Functional Significance of Arytenoid Adduction with the Suture Attaching to Cricoid Cartilage versus to Thyroid Cartilage for Unilateral Paralytic Dysphonia. Laryngoscope 2005; 115:1752-9. [PMID: 16222189 DOI: 10.1097/01.mlg.0000172203.28583.63] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE In the treatment of unilateral paralytic dysphonia, traditional arytenoid adduction is designed to place suture through the muscular process of the arytenoid attaching anteriorly to the thyroid ala. In contrast with the suture direction of this technique, a new paramedian approach to arytenoid adduction anchors anteroinferiorly to the cricoid cartilage, mimicking the force action of the lateral cricoarytenoid muscle (the major adductor of the larynx). This study investigated the influence of these changes in suture direction on the vocal fold level as well as the vocal outcomes in these two techniques of arytenoid adduction. STUDY DESIGN A prospective clinical series. METHODS Thirty patients with unilateral paralytic dysphonia underwent medialization laryngoplasty with arytenoid adduction and strap muscle transposition. Under local anesthesia, the thyroid lamina on the involved side was paramedially separated. The inner perichondrium was carefully elevated away from the overlying thyroid cartilage, carrying the dissection posteriorly to the level of the superior and inferior cornua. The lamina was retracted laterally, the inner perichondrium was opened near the midpoint, and the lateral cricoarytenoid muscle identified. Tracing the muscle fibers posterosuperiorly, the muscular process of the arytenoid was identified. A 2-0 Prolene suture was placed through the muscular process and temporarily tied to the anterolateral aspect of the thyroid ala (AA-thyroid suture). Intraoperative acoustic and perceptual assessments were performed. After releasing the tie, the suture was anchored to the cricoid cartilage at the origin of the lateral cricoarytenoid muscle (AA-cricoid suture). Voice assessments were repeated, and the outcomes of the two tests were compared. The choice of the type of arytenoid adduction suture was made intraoperatively according to which condition provided better vocal performance. After securing the suture, a bipedicled strap muscle flap was transposed into the space between the lamina and inner perichondrium and the thyroid cartilages sutured back into place. RESULTS The intraoperative acoustic and perceptual assessments revealed the vocal performance was significantly better with AA-cricoid suture than the AA-thyroid suture in this series. No major complications occurred in the study. CONCLUSION This study suggests that arytenoid adduction with suture attachment along the longitudinal axis of the lateral cricoarytenoid muscle to the cricoid cartilage is more physiologic and effective than that attaching the suture to the thyroid ala. A paramedian approach to arytenoid adduction with or without strap muscle transposition is a safe and effective method for treatment of unilateral paralytic dysphonia.
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Affiliation(s)
- Chih-Ying Su
- Department of Otolaryngology and voice center, Chang Gung University, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Taiwan.
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Tokashiki R, Hiramatsu H, Tsukahara K, Yamaguchi H, Motohashi R, Suzuki M. Direct pull of lateral cricoarytenoid muscle for unilateral vocal cord paralysis. Acta Otolaryngol 2005; 125:753-8. [PMID: 16012038 DOI: 10.1080/00016480510028555] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
CONCLUSION Lateral cricoarytenoid muscle-pull surgery (LCA pull) is a safe and effective method for the treatment of unilateral vocal cord paralysis. OBJECTIVE To evaluate the results of an improved method of LCA pull for unilateral vocal cord paralysis. MATERIAL AND METHODS Thirteen patients with unilateral vocal cord paralysis underwent LCA pull between April 2003 and January 2004. A small window was made in the posterior lower part of the thyroid cartilage and 2-3 mm in a cranial direction to the lower edge of the thyroid cartilage. The inner perichondrium was carefully removed to expose the LCA muscle. A 4-0 nylon suture placed through the LCA muscle was pulled to adduct the arytenoid and was tied to the anterior lower part of the thyroid cartilage. All cases were treated by LCA pull alone. In all cases, the maximum phonation time was measured and an auditory evaluation was performed using the grade, roughness, breathiness, asthenia and strain scale. The airflow rate was measured in five cases. RESULTS Vocal improvement was obtained in 11/13 cases (85%). One of the unimproved cases had cricoarytenoid joint ankylosis. No complications were observed.
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Affiliation(s)
- Ryoji Tokashiki
- Department of Otorhinolaryngology, Tokyo Medical University, Tokyo, Japan.
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Atkins BZ, Shah AS, Hutcheson KA, Mangum JH, Pappas TN, Harpole DH, D'Amico TA. Reducing hospital morbidity and mortality following esophagectomy. Ann Thorac Surg 2005; 78:1170-6; discussion 1170-6. [PMID: 15464465 DOI: 10.1016/j.athoracsur.2004.02.034] [Citation(s) in RCA: 303] [Impact Index Per Article: 15.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/10/2004] [Indexed: 01/11/2023]
Abstract
BACKGROUND Esophagogastrectomy (EG) is a formidable operation with significant morbidity and mortality rates. Risk factor analyses have been performed, but few studies have produced strategies that have improved operative results. This study was performed in order to identify prognostic variables that might be used to develop a strategy for optimizing outcomes after EG. METHODS The records of all patients (n = 379) who underwent EG patients at a tertiary medical center between 1996 and 2002 were retrospectively reviewed. Thirty-day morbidity and mortality were determined, and multivariable logistical regression analysis assessed the effect of preoperative and postoperative variables on early mortality. RESULTS Operations included Ivor Lewis (n = 179), transhiatal (n = 130), and other approaches (n = 70). Operative mortality was 5.8%; 64% experienced complications, including respiratory complications (28.5%), anastamotic strictures (25%), and leak (14%). Increasing age, anastomotic leak, Charlson comorbidity index 3, worse swallowing scores, and pneumonia were associated with increased risk of mortality by univariate analysis. However, only age (p = 0.002) and pneumonia (p = 0.0008) were independently associated with mortality by multivariable analysis. Pneumonia was associated with a 20% incidence of death. Patients with pneumonia had significantly worse deglutition and anastomotic integrity on barium esophagogram compared with patients without pneumonia (p < 0.001, Mann-Whitney rank sum test). CONCLUSIONS Morbidity and mortality of EG are significant, but most complications, including anastomotic leak, are not independent predictors of mortality. The most important complication after EG is pneumonia. Strategies to decrease postoperative mortality should include careful assessment of swallowing abnormalities and predisposition to aspiration by cineradiography or fiberoptic endoscopy. After EG, acceptable pharyngeal function and airway protection should be verified before resuming oral intake.
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Affiliation(s)
- B Zane Atkins
- Department of Surgery, Wilford Hall Medical Center, San Antonio, Texas, USA
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Périé S, Roubeau B, Lacau St Guily J. Laryngeal paralysis: distinguishing Xth nerve from recurrent nerve paralysis through videoendoscopic swallowing study (VESS). Dysphagia 2003; 18:276-83. [PMID: 14571333 DOI: 10.1007/s00455-003-0025-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Distinction between unilateral recurrent laryngeal nerve paralysis and Xth nerve paralysis is a rarely addressed issue in the literature. However, it may be crucial to examine the cause of the paralysis and to perform the appropriate investigation. The videoendoscopic swallowing study has been demonstrated to be a useful tool in assessing pharyngeal function. Since in unilateral Xth nerve paralysis the pharynx is impaired on the same side as the vocal fold immobility, it may be easily detected by videoendoscopic swallowing study. The rotation of the posterolateral pharyngeal wall toward the opposite side during swallowing is a sign of impaired motor pharyngeal branches. To demonstrate the usefulness of the videoendoscopic swallowing study in distinguishing unilateral Xth nerve from isolated recurrent nerve paralysis, a series of six patients were studied prospectively. Diagnosis of Xth nerve paralysis focused the investigation toward the high neck or the skull base area. Paralysis of the Xth nerve was suspected in all cases and diagnosis was achieved in five cases by the workup performed. Videoendoscopic swallowing study is a cost-effective and easily available tool which should be performed in all cases of vocal fold paralysis.
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Affiliation(s)
- Sophie Périé
- Service d'Oto-Rhino-Laryngologie et Chirurgie Cervico-faciale, Faculté de Médecine Saint Antoine, Université Paris VI, Hôpital Tenon, Paris, France.
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Unilateral and bilateral vocal fold paralysis: techniques and controversies in management. Curr Opin Otolaryngol Head Neck Surg 2002. [DOI: 10.1097/00020840-200212000-00011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Périé S, Roubeau B, Liesenfelt I, Chaigneau-Debono G, Bruel M, St Guily JL. Role of medialization in the improvement of breath control in unilateral vocal fold paralysis. Ann Otol Rhinol Laryngol 2002; 111:1026-33. [PMID: 12450179 DOI: 10.1177/000348940211101114] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A prospective study was performed on 18 adults to analyze disturbances of voice and respiratory function in unilateral vocal fold paralysis and the role of medialization in the improvement of breath control. In addition to physical examination, an acoustic and aerodynamic analysis, as well as patient self-assessment, were performed both before and after medialization (14 fat injections, 4 thyroplasties) to evaluate voice and both phonatory breath control and respiratory function outcome. Preoperative and postoperative results, at short, middle, and long term, were compared to data from 14 control subjects and evaluated by statistical analysis. Preoperative acoustic and aerodynamic parameters were significantly disturbed in comparison to controls. Independently of the pulmonary status, medialization induced an improvement in most of the parameters at short and long terms, whereas a diminished effect was observed at middle term. Phonatory breath control, as evaluated by maximum phonation time, mean flow rate, and expired volume, was statistically improved, with the best results being obtained in women. From the questionnaire, it was clear that voice, as well as phonatory breath control and respiratory function, showed considerable improvement, although some difficulties persisted during effort. This study demonstrates that there is a disturbance of phonatory breath control and respiratory function in adult unilateral vocal fold paralysis. Improvement following medialization supports the concept that the respiratory dysfunction seen beforehand is most probably the result of air escape rather than laryngeal obstruction. Although medialization may provoke an extrathoracic obstruction, its feature of variability appears to improve breath control.
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Affiliation(s)
- Sophie Périé
- Service d'Oto-Rhino-Laryngologie et de Chirurgie Cervico-Faciale, Faculté de Médecine Saint Antoine, Université Paris VI, Hĵpital Tenon, Paris, France
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Hoffman H, McCabe D, McCulloch T, Jin SM, Karnell M. Laryngeal collagen injection as an adjunct to medialization laryngoplasty. Laryngoscope 2002; 112:1407-13. [PMID: 12172253 DOI: 10.1097/00005537-200208000-00015] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES/HYPOTHESIS Dysphonia associated with laryngeal paralysis may be identified in the short term postoperatively or may develop years after successful medialization laryngoplasty. In selected cases, laryngeal collagen injection permits further medialization of one or both vocal folds by small increments to improve phonation after medialization thyroplasty. The study seeks to determine whether collagen injections result in measurable improvements in voice quality and vocal function when offered to select patients who have received medialization thyroplasty. STUDY DESIGN Retrospective review of patient charts and voice database. METHODS Seven patients were treated with Zyderm II collagen using indirect mirror laryngoscopy and a curved injection apparatus. Changes in voice quality and function were assessed by comparing measures obtained before treatment (mean period, 5.6 d), shortly after treatment (mean period, 38.1 d), and in the long term after treatment (mean period, 226 d). RESULTS Mean self-ratings of the patient, clinician's ratings, and objective measures demonstrated measurable improvement in vocal function after collagen injection. CONCLUSIONS The office-based procedure offers a simple, efficient adjunct to open techniques of medialization laryngoplasty. Techniques of anesthesia, injection, and patient selection are discussed.
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Affiliation(s)
- Henry Hoffman
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa 52242, USA
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McCulloch TM, Andrews BT, Hoffman HT, Graham SM, Karnell MP, Minnick C. Long-term follow-up of fat injection laryngoplasty for unilateral vocal cord paralysis. Laryngoscope 2002; 112:1235-8. [PMID: 12169905 DOI: 10.1097/00005537-200207000-00017] [Citation(s) in RCA: 90] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The objective of the study was to evaluate the results of autologous fat injection laryngoplasty in the long-term management of unilateral vocal cord paralysis. STUDY DESIGN A retrospective chart review and clinical voice re-evaluation of patients treated for unilateral vocal cord paralysis with autologous fat injection at the University of Iowa Hospitals and Clinics (Iowa City, IA) between May 1992 and September 1999. METHODS The data analyzed included patient demographics, early and long-term vocal outcomes, additional surgical treatments, and patient survival. RESULTS Fifty patients were treated with fat injection laryngoplasty, which included 44 treated for unilateral vocal cord paralysis. Thirty-one of the patients had fat injection as their primary procedure for permanent voice restoration. Eight patients treated had preoperative and postoperative voice data available. Using the GRBAS subjective voice assessment scale (0, normal; 3, severely abnormal), mean grade improved from 2.1 to 1.3 and breathiness improved from 1.4 to 0.5, at a mean period of 52 days. Thirteen of the 31 patients (41%) required additional procedures to achieve acceptable vocal outcomes. The median time to failure for these patients was 163 days. The initial treatment failure rate at 2 years was 30%, and the rate reached 45% by 4 years. CONCLUSION Although fat injection laryngoplasty reliably improves the voice over the short term, the long-term voice outcome is unpredictable. Additional surgeries to deal with subsequent vocal deterioration are common. The role of autologous fat injection laryngoplasty in the modern era is limited.
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Affiliation(s)
- Timothy M McCulloch
- Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, Iowa City, Iowa 52242-1078, U.S.A.
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Su CY, Lui CC, Lin HC, Chiu JF, Cheng CA. A new paramedian approach to arytenoid adduction and strap muscle transposition for vocal fold medialization. Laryngoscope 2002; 112:342-50. [PMID: 11889395 DOI: 10.1097/00005537-200202000-00026] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To develop a prosthesis-free medialization laryngoplasty for the treatment of glottal incompetence. STUDY DESIGN Twenty-two consecutive patients with glottal incompetence underwent vocal fold medialization using a new paramedian approach to arytenoid adduction and/or strap muscle transposition. METHODS Under local anesthesia, the thyroid lamina on the involved side was parasagittally separated 5 mm off the midline. The inner perichondrium was carefully freed from the overlying thyroid cartilage. After dividing the thyrohyoid and cricothyroid membranes, the lamina was retracted laterally, the inner perichondrium was opened, and the lateral cricoarytenoid muscle identified. Tracing the muscle fibers posterosuperiorly, the muscular process of the arytenoid was identified. A 2-0 or 3-0 Prolene suture was placed through the muscular process and tied to the cricoid cartilage at the origin of the lateral cricoarytenoid muscle. A bipedicled strap muscle flap was then transposed into the space between the lamina and the inner perichondrium and the thyroid cartilages sutured back into place. Pre- and postoperative voice evaluations measured mean fundamental frequency, jitter, shimmer, noise-to-harmonic ratio, and maximal phonation time, as well as assessments of voice quality. RESULTS Vocal improvement was obtained in 95% (21 of 22) of patients. There was a significant improvement (P <.05) in all parameters except shimmer. No major complications were noted in any patient, except for dyspnea in one patient resulting from arytenoid overrotation. CONCLUSION The results suggest that a paramedian approach to arytenoid adduction combined with strap muscle transposition is a safe and effective method for treating glottal incompetence, particularly in patients with unilateral paralytic dysphonia.
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Affiliation(s)
- Chih-Ying Su
- Department of Otolaryngology, Chang Gung University, Chang Gung Memorial Hospital, Kaohsiung, Taiwan.
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37
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Abstract
OBJECTIVES/HYPOTHESIS Unilateral vocal fold paralysis resulting in glottal incompetence can cause significant morbidity attributable to impaired speech, swallowing, and ability to protect the airway. Type I thyroplasty in combination with arytenoid adduction is a proven technique for medialization of the paralyzed vocal fold but must be evaluated in light of potential complications following laryngeal framework surgery. STUDY DESIGN AND METHODS The charts of 237 patients who underwent unilateral vocal fold medialization surgery between July 1, 1991, and August 30, 1999, at a tertiary care cancer referral center were retrospectively reviewed. RESULTS There were 98 cases of type I thyroplasty alone and 96 cases of type I thyroplasty with arytenoid adduction. The two groups had similar patient characteristics. Mean time of surgery (45 vs. 73 min, P <.0001) and length of hospital stay (1.1 vs. 1.8 d, P <.0001) were increased when arytenoid adduction was performed. Overall improvement of symptoms was similar in both groups (93%-94%), but posterior glottic closure appeared subjectively improved when arytenoid adduction was used (P =.0054). Overall complication rates were slightly higher in the arytenoid adduction group (14% vs. 19%), primarily because of transient vocal fold edema and wound complications (9 vs. 19 cases), but the increase was not statistically significant (P =.1401). Complications warranting medical or surgical intervention occurred in 8% of cases. Two patients who underwent type I thyroplasty with arytenoid adduction required tracheotomy as a consequence of postoperative complications. The three patients who had extrusion of the implant underwent type I thyroplasty alone. CONCLUSION Using the appropriate technique, the potential benefits of improved glottic function following type I thyroplasty with arytenoid adduction outweigh the small risk of significant complications observed.
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Affiliation(s)
- M T Abraham
- Department of Otolaryngology, New York University School of Medicine, New York, NY, U.S.A
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León X, Venegas MP, Orús C, Quer M, Maranillo E, Sañudo JR. [Glottic immobility: retrospective study of 229 cases]. ACTA OTORRINOLARINGOLOGICA ESPANOLA 2001; 52:486-92. [PMID: 11692963 DOI: 10.1016/s0001-6519(01)78240-4] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
A retrospective study of the unilateral and bilateral vocal fold immobility cases diagnosed at our hospital between 1985 and 1998 was carried out. Of the 229 cases studied, vocal fold immobility was bilateral in 58 patients (25%), unilateral right in 60 (26%), and unilateral left 111 (49%). The most frequent etiologies in the bilateral cases were thyroid surgery (38%) and prolonged intubation (31%); idiopathic cases (32%) and thyroid surgery (23%) in the unilateral right cases; and idiopathic cases (28%) and extralaryngeal tumors (22%) in the unilateral left cases. Clinical compensation was achieved in more than 85% of cases of unilateral immobility when the etiology was idiopathic or due to surgical damage to the recurrent or vagus nerves, 70% when it was a prolonged intubation, 56% in neurological patients and 38% in extralaryngeal tumors. In patients with bilateral vocal fold immobility, 14% did not require any treatment, 34% had a permanent tracheostomy, and 52% recovered adequate naso-oral ventilation after surgery (tracheostomy only in 12 patients and arytenoidectomy in 18 patients).
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Affiliation(s)
- X León
- Servicio ORL, Hospital de la Santa Creu I Sant Pau, Avda. San Antoni M. Claret, 167, 08025 Barcelona
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39
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Hartl DM, Hans S, Vaissière J, Riquet M, Laccourreye O, Brasnu DF. Objective voice analysis after autologous fat injection for unilateral vocal fold paralysis. Ann Otol Rhinol Laryngol 2001; 110:229-35. [PMID: 11269766 DOI: 10.1177/000348940111000305] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study was designed to objectively compare a patient's voice after onset of unilateral vocal fold paralysis (UVFP) to his or her own normal voice, and to compare the results after treatment by intrafold injection of autologous fat. Acoustic recordings were obtained for 2 male patients before thoracic surgery and after the onset of iatrogenic left UVFP. Vocal fold augmentation was performed 10 days after UVFP. The acoustic recordings were repeated within 3 days and at 1 month. The phonation quotient, pitch perturbation quotient, amplitude perturbation quotient, harmonics-to-noise ratio, cepstral peak prominence, and long-term average spectrum were analyzed. All parameters improved after treatment, with a return to preparalytic values for most. During the first month, some deterioration was noted. This is the first study comparing a subject's own normal voice to his or her voice after vocal fold augmentation. We recommend overinjection of fat if vocal fold atrophy is expected.
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Affiliation(s)
- D M Hartl
- Voice, Biomaterials and Head and Neck Oncology, Research Laboratory, CNRS-UPRESA 7018, University Paris V, Georges Pompidou European Hospital, France
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40
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Laryngoplastic phonosurgical reconstruction of unilateral vocal fold paralysis. Curr Opin Otolaryngol Head Neck Surg 2000. [DOI: 10.1097/00020840-200012000-00012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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41
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Hartl DM, Brasnu DF. Recurrent Laryngeal Nerve Paralysis: Current Concepts and Treatment: Part I-Phylogenesis and Physiology. EAR, NOSE & THROAT JOURNAL 2000. [DOI: 10.1177/014556130007901109] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Dana M. Hartl
- Laboratory of voice, biomaterials and cervicofacial oncology, CNRS-UPRESA 7018, University of Paris V, Laennec Hospital, 42 rue de Sevres, 75007 Paris, France
| | - Daniel F. Brasnu
- Laboratory of voice, biomaterials and cervicofacial oncology, CNRS-UPRESA 7018, University of Paris V, Laennec Hospital, 42 rue de Sevres, 75007 Paris, France
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Hajioff D, Rattenbury H, Carrie S, Carding P, Wilson J. The effect of Isshiki type 1 thyroplasty on quality of life and vocal performance. CLINICAL OTOLARYNGOLOGY AND ALLIED SCIENCES 2000; 25:418-22. [PMID: 11012657 DOI: 10.1046/j.1365-2273.2000.00395.x] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Type 1 thyroplasty for unilateral vocal cord palsy improves many vocal outcome measures but there is little information on quality of life despite its increasingly recognized importance. Our prospective study examined its effect on a range of subjective and objective measures and quality of life. Twenty-seven patients underwent thyroplasty. Before and after surgery they completed a vocal performance questionnaire and the Nottingham Health Profile (NHP); instrumental analyses of jitter, shimmer and noise-harmonic ratio (NHR); and perceptual analyses of grade, roughness, breathiness, aesthenia and strain (GRBAS) were also performed. Significant improvements were found in instrumental, perceptual and self-assessment of voice and the energy, social and emotional dimensions of the NHP. Three patients had initially poor results but were successfully revised. These results of type 1 thyroplasty compare favourably with those previously published. The improvement in quality of life appears to result directly from improved voice. Many thyroplasty patients have limited life expectancy: early surgical intervention should be considered.
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Affiliation(s)
- D Hajioff
- Departments of Otolaryngology and Speech Therapy, Freeman Hospital, Newcastle, UK
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Yin S, Qiu WW, Stucker FJ, Batchelor BM. Critical evaluation of neurolaryngological disorders. Ann Otol Rhinol Laryngol 2000; 109:832-8. [PMID: 11007086 DOI: 10.1177/000348940010900909] [Citation(s) in RCA: 21] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Otolaryngological examinations, videostroboscopic image analysis, and laryngeal electromyography were used as a test battery for a critical evaluation in 80 patients. Vocal fold movements were categorized into mobility, restricted mobility, immobility with different positions, and overactive movement. Laryngeal electromyographic examinations were conducted in all patients, and the results were classified into normal, neuropathic, and myopathic patterns. The electromyographic data were integrated with videostroboscopic findings, interpreted with knowledge of biomechanical and electrophysiological mechanisms of the larynx, and correlated clinically with underlying diseases. It is suggested that neurolaryngological procedures are most clinically useful when dictated by a decision-making algorithm.
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Affiliation(s)
- S Yin
- Department of Otolaryngology-Head and Neck Surgery, Louisiana State University Medical Center, Shreveport 71130-3932, USA
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44
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McCulloch TM, Hoffman HT, Andrews BT, Karnell MP. Arytenoid adduction combined with Gore-Tex medialization thyroplasty. Laryngoscope 2000; 110:1306-11. [PMID: 10942131 DOI: 10.1097/00005537-200008000-00015] [Citation(s) in RCA: 106] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To describe the technique of combined Gore-Tex medialization thyroplasty with arytenoid adduction and to determine the long-term vocal outcome of patients treated for unilateral vocal cord paralysis with this procedure. STUDY DESIGN A retrospective chart review and patient reevaluation for patients treated at The University of Iowa Hospitals and Clinics between May 1995 and June 1999. METHODS The review addressed patient demographics, perioperative and long-term complications, and voice outcomes. Details of the surgical technique are provided within the manuscript. RESULTS Seventy-two Gore-Tex medialization procedures were completed. Arytenoid adduction was included in 22 of these procedures. This subset of patients was compared with the patients treated with Gore-Tex alone. No major postoperative complications occurred in either group. Preoperative and postoperative voice and videostroboscopy data were available for 19 arytenoid adduction patients and 25 Gore-Tex alone patients. On a seven-point scale (6 [severely abnormal] --> 0 [normal voice]), the average patient rating of voice dysfunction improved from 4.2 to 1.6 (arytenoid adduction) and 4.5 to 2.8 (Gore-Tex alone). Maximum phonation time improved from 6.9 seconds to 16.7 seconds in the arytenoid adduction group. Subjective voice assessment employing the four-point GRBAS scale (3 [severely abnormal] --> 0 [normal]) identified average improvement from an overall grade of 2.1 to 0.8 arytenoid adduction and 2.2 to 1.5 in the Gore-Tex alone group. Improvement was identified in the vocal quality of breathiness from 1.9 to 0.2 (arytenoid adduction) and 1.9 to 0.9 (Gore-Tex alone). CONCLUSIONS The combined technique of Gore-Tex medialization thyroplasty and arytenoid adduction provide functional results that appear to exceed the improvement attained with medialization alone.
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Affiliation(s)
- T M McCulloch
- University of Iowa Hospitals and Clinics, Department of Otolaryngology--Head and Neck Surgery, Iowa City 52242-1078, USA
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Périé S, Coiffier L, Laccourreye L, Hazebroucq V, Chaussade S, St Guily JL. Swallowing disorders in paralysis of the lower cranial nerves: a functional analysis. Ann Otol Rhinol Laryngol 1999; 108:606-11. [PMID: 10378531 DOI: 10.1177/000348949910800614] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Deficits of the lower cranial nerves (nerves IX, X, XI, and XII) occurring after treatment of skull base tumors may cause disabling swallowing disorders. To assess the mechanisms of swallowing disorders involved in such cases, we performed functional examinations: a videoendoscopic swallowing study and simultaneous manometry and videofluoroscopy in 7 patients. This study shows that the main mechanism of the swallowing disorders was a disturbance of the pharyngeal stage, including a decrease of pharyngeal propulsion, reduced laryngeal closure, and cricopharyngeal dysfunction, which led to aspiration. Decreased pharyngeal propulsion was found in 6 patients, with a very high correlation between fiberoscopy and simultaneous manometry-fluoroscopy. The responsibility of the upper esophageal sphincter in swallowing disorders was more difficult to assess. The role of the upper esophageal sphincter and pharyngeal propulsion in the onset of the problem is discussed in regard to the cricopharyngeal myotomy.
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Affiliation(s)
- S Périé
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculté de Médecine, Saint Antoine, Université Paris VI, Hôpital Tenon, France
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Laccourreye O, Hans S, Ménard M, Hacquart N, Brasnu D, Crevier-Buchman L. [Results of intracordal injection of autologous fat in postoperative laryngeal paralysis]. CHIRURGIE; MEMOIRES DE L'ACADEMIE DE CHIRURGIE 1999; 124:283-7. [PMID: 10429302 DOI: 10.1016/s0001-4001(99)80094-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
OBJECTIVES An analysis of the results achieved with intracordal autologous fat injection for unilateral laryngeal nerve paralysis after surgery. PATIENTS AND METHOD A study group of 46 patients with unilateral laryngeal nerve paralysis was treated by intracordal injection of autologous fat with a minimum follow-up of eight months. All patients had severe dysphonia and 39 had breathlessness. Twenty-nine patients had aspiration problems with difficulties in swallowing. RESULTS The only adverse side-effect was a subcutaneous abdominal hematoma in two patients and the development of an intracordal cyst in two patients. Aspiration disappeared immediately after the intracordal injection. Immediate improvement of speech, cough, and breathlessness was achieved in all patients. Over time, speech and voice, and swallowing remained stable in 67% and 80% of patients, respectively. CONCLUSION Such data suggest that the intracordal injection of autologous fat is a valuable method in patients with unilateral laryngeal nerve paralysis after surgery.
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Affiliation(s)
- O Laccourreye
- Service d'oto-rhino-laryngologie et de chirurgie cervicofaciale, Assistance publique des hôpitaux de Paris, Université Paris V, France
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48
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Abstract
Medialization laryngoplasty was performed in 25 patients between 1993 and 1997. The underlying pathology resulting in glottal incompetence was vocal cord paralysis in 22 patients and vocal cord bowing in 3 patients. Two types of implants were used: self-carved Proplast in 19 patients and prefabricated hydroxyapatite prostheses in 6 patients. Preoperative and postoperative results were compared in terms of dysphagia, vocal quality as graded by three experienced voice specialists, and computer measurements of the glottal gap. All patients showed improvement both subjectively and on the objective measurements used. Swallowing returned to normal in all patients who had isolated recurrent laryngeal nerve paralysis. The voice improved in all patients but was rarely judged as entirely normal.
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Affiliation(s)
- P Dulguerov
- Department of Otolaryngology-Head and Neck Surgery, Geneva University Hospital, Switzerland
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49
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Laccourreye O, Crevier-Buchman L, Le Pimpec-Barthes F, Garcia D, Riquet M, Brasnu D. Recovery of function after intracordal autologous fat injection for unilateral recurrent laryngeal nerve paralysis. J Laryngol Otol 1998; 112:1082-4. [PMID: 10197150 DOI: 10.1017/s0022215100142513] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
The present report documents the successful outcome in three patients with a unilateral recurrent laryngeal nerve paralysis managed with an intracordal injection of autologous fat who ultimately experienced a complete recovery of function. Such data demonstrates the safety of intracordal autologous fat injection in patients who ultimately recover function.
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Affiliation(s)
- O Laccourreye
- Department of Otorhinolaryngology-Head and Neck Surgery, Laënneck Hospital, AP-HP, University of Paris V, France
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McCulloch TM, Hoffman HT. Medialization laryngoplasty with expanded polytetrafluoroethylene. Surgical technique and preliminary results. Ann Otol Rhinol Laryngol 1998; 107:427-32. [PMID: 9596223 DOI: 10.1177/000348949810700512] [Citation(s) in RCA: 96] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Symptomatic unilateral laryngeal paralysis may be treated successfully by a wide variety of surgical techniques. These techniques share the concept that stabilization of the paralyzed vocal fold in a median position will improve glottic function. Medialization laryngoplasty with expanded polytetrafluoroethylene (ePTFE) incorporates the general principles of established medialization procedures, yet is unique in its simplicity. The technique does not require special instrumentation, employs incremental adjustment of vocal fold position, and utilizes an implantable material with a long history of patient safety. We describe this new technique and report on the outcome of our first 16 patients treated. No surgical or implant-related complications have occurred. Voice results were measured from preoperative and postoperative video and voice recordings by four independent observers using a standardized assessment tool. Voice grade and breathiness were evaluated on a four-point scale (0 = normal and 3 = abnormal, extreme). The mean overall grade improved from 2.3 +/- 0.6 to 1.1 +/- 0.6, and breathiness from 2.0 +/- 0.8 to 0.4 +/- 0.4. The technique is simple, the implant material has been in clinical use for decades, and the voice results are good to excellent.
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Affiliation(s)
- T M McCulloch
- Department of Otolaryngology-Head and Neck Surgery, The University of Iowa Hospitals and Clinics, Iowa City 52242-1078, USA
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