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胡 守, 赵 畅. [Clinical research of unilateral posterior glottic cleft dilatation in the treatment of bilateral vocal cord paralysis dyspnea]. LIN CHUANG ER BI YAN HOU TOU JING WAI KE ZA ZHI = JOURNAL OF CLINICAL OTORHINOLARYNGOLOGY, HEAD, AND NECK SURGERY 2022; 36:105-109. [PMID: 35172546 PMCID: PMC10128302 DOI: 10.13201/j.issn.2096-7993.2022.02.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Indexed: 06/14/2023]
Abstract
Objective:The aim of this study is to evaluate the efficacy of unilateral posterior glottic cleft dilatation with low-temperature plasma under the endoscope in the treatment of bilateral vocal cord paralysis dyspnea. Methods:Forty-one patients with bilateral vocal cord paralysis were recruited, and they were all admitted to the Department of Otorhinolaryngology Head and Neck Surgery, the First Affiliated Hospital of Zhengzhou University from March 2014 to June 2019. Those 41 patients were all treated with low-temperature plasma to completely resect unilateral arytenoid cartilage and the posterior 1/3 of the ipsilateral vocal cord. Fiber laryngoscopy was performed before and after operation. The clinical efficacy of the operation was evaluated by the size of glottis cleta, the improvement rate of dyspnea, voice satisfaction, swallowing function, the tracheal cannula removal rate and postoperative complication rate. Results:Forty-one patients were followed up for 24-88 months. The rate of one-pass extubation was 88.57%(31/35). The satisfaction rate of voice was 92.11%(35/38). The recovery rate of swallowing function was 97.56%(40/41). Conclusion:This study demonstrated that the application of low-temperature plasma in unilateral posterior glottic cleft dilatation could significantly improved the ventilation function of patients with bilateral vocal cord paralysis, with a reliable curative effect and a high extubation rate. It is a safe, reliable, simple and minimally invasive treatment option for the treatment of bilateral vocal cord paralysis.
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Affiliation(s)
- 守森 胡
- 郑州大学第一附属医院耳鼻咽喉头颈外科(郑州,450052)Department of Otorhinolaryngology Head and Neck Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
| | - 畅 赵
- 郑州大学第一附属医院耳鼻咽喉头颈外科(郑州,450052)Department of Otorhinolaryngology Head and Neck Surgery, the First Affiliated Hospital of Zhengzhou University, Zhengzhou, 450052, China
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Rovó L, Matievics V, Sztanó B, Szakács L, Pálinkó D, Wootten CT, Pfiszterer P, Tóbiás Z, Bach Á. Functional results of endoscopic arytenoid abduction lateropexy for bilateral vocal fold palsy. Eur Arch Otorhinolaryngol 2021; 279:1995-2002. [PMID: 34854971 PMCID: PMC8930937 DOI: 10.1007/s00405-021-07199-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 11/22/2021] [Indexed: 11/29/2022]
Abstract
Purpose Endoscopic arytenoid abduction lateropexy (EAAL) is a reliable surgical solution for the minimally invasive treatment of bilateral vocal fold palsy (BVFP), providing a stable airway by the lateralization of the arytenoid cartilages with a simple suture. The nondestructive manner of the intervention theoretically leads to higher regeneration potential, thus better voice quality. The study aimed to investigate the respiratory and phonatory outcomes of this treatment concept. Methods 61 BVFP patients with significant dyspnea associated with thyroid/parathyroid surgery were treated by unilateral EAAL. Jitter, Shimmer, Harmonics to Noise Ratio, Maximum Phonation Time, Fundamental frequency, Voice Handicap Index, Dysphonia Severity Index, Friedrich’s Dysphonia Index, Global-Roughness-Breathiness scale, Quality of Life, and Peak Inspiratory Flow were evaluated 18 months after EAAL. Results All patients had a stable and adequate airway during the follow-up. Ten patients (16.4%) experienced complete bilateral motion recovery with objective acoustic parameters in the physiological ranges. Most functional results of the 13 patients (21.3%) with unilateral recovery also reached the normal values. Fifteen patients (24.6%) had unilateral adduction recovery only, with slightly impaired voice quality. Eleven patients (18.0%) had false vocal fold phonation with socially acceptable voice. In 12 patients (19.7%) no significant motion recovery was detected on the glottic level. Conclusion EAAL does not interfere with the potential regeneration process and meets the most important phoniatric requirements while guaranteeing the reversibility of the procedure—therefore serving patients with transient palsy. Further, a socially acceptable voice quality and an adequate airway are ensured even in cases of permanent bilateral vocal fold paralysis.
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Affiliation(s)
- László Rovó
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, University of Szeged, Tisza Lajos krt. 111, Szeged, 6725, Hungary
| | - Vera Matievics
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, University of Szeged, Tisza Lajos krt. 111, Szeged, 6725, Hungary
| | - Balázs Sztanó
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, University of Szeged, Tisza Lajos krt. 111, Szeged, 6725, Hungary
| | - László Szakács
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, University of Szeged, Tisza Lajos krt. 111, Szeged, 6725, Hungary
| | - Dóra Pálinkó
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, University of Szeged, Tisza Lajos krt. 111, Szeged, 6725, Hungary
| | - Christopher T Wootten
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Péter Pfiszterer
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, University of Szeged, Tisza Lajos krt. 111, Szeged, 6725, Hungary
| | - Zoltán Tóbiás
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, University of Szeged, Tisza Lajos krt. 111, Szeged, 6725, Hungary
| | - Ádám Bach
- Department of Otorhinolaryngology-Head and Neck Surgery, Faculty of Medicine, University of Szeged, Tisza Lajos krt. 111, Szeged, 6725, Hungary.
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Sindeeva OA, Prikhozhdenko ES, Schurov I, Sedykh N, Goriainov S, Karamyan A, Mordovina EA, Inozemtseva OA, Kudryavtseva V, Shchesnyak LE, Abramovich RA, Mikhajlov S, Sukhorukov GB. Patterned Drug-Eluting Coatings for Tracheal Stents Based on PLA, PLGA, and PCL for the Granulation Formation Reduction: In Vivo Studies. Pharmaceutics 2021; 13:pharmaceutics13091437. [PMID: 34575513 PMCID: PMC8469052 DOI: 10.3390/pharmaceutics13091437] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Revised: 09/02/2021] [Accepted: 09/04/2021] [Indexed: 01/25/2023] Open
Abstract
Expandable metallic stent placement is often the only way to treat airway obstructions. Such treatment with an uncoated stent causes granulation proliferation and subsequent restenosis, resulting in the procedure’s adverse complications. Systemic administration of steroids drugs in high dosages slows down granulation tissue overgrowth but leads to long-term side effects. Drug-eluting coatings have been used widely in cardiology for many years to suppress local granulation and reduce the organism’s systemic load. Still, so far, there are no available analogs for the trachea. Here, we demonstrate that PLA-, PCL- and PLGA-based films with arrays of microchambers to accommodate therapeutic substances can be used as a drug-eluting coating through securely fixing on the surface of an expandable nitinol stent. PCL and PLA were most resistant to mechanical damage associated with packing in delivery devices and making it possible to keep high-molecular-weight cargo. Low-molecular-weight methylprednisolone sodium succinate is poorly retained in PCL- and PLGA-based microchambers after immersion in deionized water (only 9.5% and 15.7% are left, respectively). In comparison, PLA-based microchambers retain 96.3% after the same procedure. In vivo studies on rabbits have shown that effective granulation tissue suppression is achieved when PLA and PLGA are used for coatings. PLGA-based microchamber coating almost completely degrades in 10 days in the trachea, while PLA-based microchamber films partially preserve their structure. The PCL-based film coating is most stable over time, which probably causes blocking the outflow of fluid from the tracheal mucosa and the aggravation of the inflammatory process against the background of low drug concentration. Combination and variability of polymers in the fabrication of films with microchambers to retain therapeutic compounds are suggested as a novel type of drug-eluting coating.
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Affiliation(s)
- Olga A. Sindeeva
- Skolkovo Innovation Center, Skolkovo Institute of Science and Technology, 3 Nobel Str., 143005 Moscow, Russia
- Correspondence: (O.A.S.); (G.B.S.)
| | - Ekaterina S. Prikhozhdenko
- Science Medical Center, Saratov State University, 83 Astrakhanskaya Str., 410012 Saratov, Russia; (E.S.P.); (E.A.M.); (O.A.I)
| | - Igor Schurov
- Innovative Engineering Technologies Institute, Peoples Friendship University of Russia (RUDN University), 6 Mikluho-Maklaya Str., 117198 Moscow, Russia; (I.S.); (N.S.); (S.G.); (A.K.); (L.E.S.); (R.A.A.); (S.M.)
| | - Nikolay Sedykh
- Innovative Engineering Technologies Institute, Peoples Friendship University of Russia (RUDN University), 6 Mikluho-Maklaya Str., 117198 Moscow, Russia; (I.S.); (N.S.); (S.G.); (A.K.); (L.E.S.); (R.A.A.); (S.M.)
| | - Sergey Goriainov
- Innovative Engineering Technologies Institute, Peoples Friendship University of Russia (RUDN University), 6 Mikluho-Maklaya Str., 117198 Moscow, Russia; (I.S.); (N.S.); (S.G.); (A.K.); (L.E.S.); (R.A.A.); (S.M.)
| | - Arfenya Karamyan
- Innovative Engineering Technologies Institute, Peoples Friendship University of Russia (RUDN University), 6 Mikluho-Maklaya Str., 117198 Moscow, Russia; (I.S.); (N.S.); (S.G.); (A.K.); (L.E.S.); (R.A.A.); (S.M.)
| | - Ekaterina A. Mordovina
- Science Medical Center, Saratov State University, 83 Astrakhanskaya Str., 410012 Saratov, Russia; (E.S.P.); (E.A.M.); (O.A.I)
| | - Olga A. Inozemtseva
- Science Medical Center, Saratov State University, 83 Astrakhanskaya Str., 410012 Saratov, Russia; (E.S.P.); (E.A.M.); (O.A.I)
| | - Valeriya Kudryavtseva
- Nanoforce Ltd., School of Engineering and Materials Science, Queen Mary University of London, Mile End Road, London E1 4NS, UK;
| | - Leonid E. Shchesnyak
- Innovative Engineering Technologies Institute, Peoples Friendship University of Russia (RUDN University), 6 Mikluho-Maklaya Str., 117198 Moscow, Russia; (I.S.); (N.S.); (S.G.); (A.K.); (L.E.S.); (R.A.A.); (S.M.)
| | - Rimma A. Abramovich
- Innovative Engineering Technologies Institute, Peoples Friendship University of Russia (RUDN University), 6 Mikluho-Maklaya Str., 117198 Moscow, Russia; (I.S.); (N.S.); (S.G.); (A.K.); (L.E.S.); (R.A.A.); (S.M.)
| | - Sergey Mikhajlov
- Innovative Engineering Technologies Institute, Peoples Friendship University of Russia (RUDN University), 6 Mikluho-Maklaya Str., 117198 Moscow, Russia; (I.S.); (N.S.); (S.G.); (A.K.); (L.E.S.); (R.A.A.); (S.M.)
| | - Gleb B. Sukhorukov
- Nanoforce Ltd., School of Engineering and Materials Science, Queen Mary University of London, Mile End Road, London E1 4NS, UK;
- Correspondence: (O.A.S.); (G.B.S.)
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Emergency management in epidermolysis bullosa: consensus clinical recommendations from the European reference network for rare skin diseases. Orphanet J Rare Dis 2020; 15:142. [PMID: 32505191 PMCID: PMC7276067 DOI: 10.1186/s13023-020-01403-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 05/07/2020] [Indexed: 11/10/2022] Open
Abstract
Epidermolysis bullosa (EB) comprises a group of genetic disorders with the hallmark of fragility of the skin and mucosal surfaces. The severity of different types of EB varies markedly as does the occurrence of extra-cutaneous involvement and complications. A number of emergency situations may occur in the context of EB including obstruction to oral intake from oral or esophageal blisters or scarring, acute airway obstruction, acute urinary retention, sepsis and corneal erosions. Whilst general management principles apply in each of these settings, specific considerations are essential in managing EB to avoid undue trauma or damage to delicate tissues. These recommendations have been developed from a literature review and consensus from experts of the European Network for Rare Skin Disorders (ERN-Skin) to aid decision-making and optimize clinical care by non-EB expert health professionals encountering emergency situations in babies, children and adults with EB.
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Bourhis T, Buche S, Fraitag S, Fayoux P. Laryngeal lesion associated with epidermolysis bullosa secondary to congenital plectin deficiency. Eur Ann Otorhinolaryngol Head Neck Dis 2019; 136:203-205. [PMID: 30880037 DOI: 10.1016/j.anorl.2019.02.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
INTRODUCTION Epidermolysis bullosa (EB) is a congenital disease characterized by fragility of epithelial structures. The skin is the organ primarily affected, resulting in the formation of skin blisters. Some forms of EB may also present mucosal lesions. CASE REPORT We report the case of a girl with epidermolysis bullosa simplex (EBS) associated with muscular dystrophy secondary to congenital plectin deficiency. She presented severe respiratory tract lesions extending from the oral cavity to the larynx. In particular, we describe our medical and surgical management of the laryngeal lesions, responsible for several episodes of respiratory distress and feeding difficulties. DISCUSSION Epidermolysis bullosa simplex associated with muscular dystrophy is a rare hereditary form of EB, as fewer than 50 cases have been reported in the literature. This form is characterized by mucosal lesions involving the upper aerodigestive tract, with consequences for feeding, phonation and breathing. Special care must be taken when performing diagnostic and therapeutic procedures to avoid worsening the lesions of this very fragile mucosa. Tracheotomy is a harmful procedure in these patients and should only be considered as a last resort.
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Affiliation(s)
- T Bourhis
- ORL et chirurgie cervicofaciale pédiatrique, hôpital Jeanne-de-Flandre, CHRU Lille, avenue Eugène-Avinée, 59037 Lille cedex, France
| | - S Buche
- Service de dermatologie, hôpital Claude-Huriez, CHRU Lille, 59037 Lille, France
| | - S Fraitag
- Service d'anatomie et cytologie pathologiques, hôpital Necker-Enfants malades, AP-HP, 75015 Paris, France
| | - P Fayoux
- ORL et chirurgie cervicofaciale pédiatrique, hôpital Jeanne-de-Flandre, CHRU Lille, avenue Eugène-Avinée, 59037 Lille cedex, France.
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Enyuan Q, Mingpeng X, Luoman G, Jinghua G, Yu L, Wentao L, Changchun H, Lihua L, Xiaoyan M, Lei Z, Guangnan L. Erythromycin combined with corticosteroid reduced inflammation and modified trauma-induced tracheal stenosis in a rabbit model. Ther Adv Respir Dis 2019; 12:1753466618773707. [PMID: 29781361 PMCID: PMC5966843 DOI: 10.1177/1753466618773707] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Background: Patients with endotracheal intubation or tracheostomy are subject to benign tracheal stenosis (TS), for which current therapies are unsatisfactory. We conducted a preliminary investigation of drugs and drug combinations for the prevention and treatment of TS in a rabbit model. Methods: Fifty-four rabbits were apportioned into nine groups according to treatment: sham-operated control; untreated TS model; amikacin; budesonide; erythromycin; penicillin; amikacin + budesonide; erythromycin + budesonide; and penicillin + budesonide. TS was induced by abrasion during surgery. The drugs were applied for 7 days before and 10 days after the surgery. Rabbits were killed on the eleventh day. Tracheal specimens were processed for determining alterations in the thicknesses of tracheal epithelium and lamina propria via hematoxylin and eosin. The tracheal mRNA (assessed by real-time quantitative polymerase chain reaction) expressions of the following fibrotic-related factors were determined: transforming growth factor-β1 (TGF- β1), collagen type I (COL1A1), collagen type III (COL3A1), and interleukin-17 (IL-17). The protein levels of TGF-β1, COL1A1, and COL3A1 were determined through immunohistochemistry and integrated optical densities. Results: Compared with all other groups, the untreated TS model had significantly thicker tracheal epithelium and lamina propria, and higher mRNA and protein levels of all targeted fibrotic factors. The mRNA and protein levels of the targeted fibrotic factors in all the drug-treated groups were lower than those of the untreated TS model, and differences were most significant in the erythromycin + budesonide group. Conclusions: Erythromycin combined with budesonide may reduce inflammation and modify fibrosis progression in TS after tracheal injury.
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Affiliation(s)
- Qin Enyuan
- Department of Respiratory Medicine, Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Xu Mingpeng
- Fourth People's Hospital of Nanning, Nanning, China
| | - Gan Luoman
- Department of Respiratory Medicine, Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Gan Jinghua
- Department of Respiratory Medicine, Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Li Yu
- Department of Respiratory Medicine, Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Li Wentao
- Department of Respiratory Medicine, Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Hou Changchun
- Department of Respiratory Medicine, Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Li Lihua
- Department of Respiratory Medicine, Fourth Affiliated Hospital of Guangxi Medical University, Liuzhou, China
| | - Meng Xiaoyan
- Department of Respiratory Medicine, Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Zhou Lei
- Department of Respiratory Medicine, Second Affiliated Hospital of Guangxi Medical University, Nanning, China
| | - Liu Guangnan
- Department of Respiratory Medicine, Second Affiliated Hospital of Guangxi Medical University, Nanning, 530007, China
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Hu Y, Cheng L, Liu B, Ming H, Tian A, Ma M. The assistance of coblation in arytenoidectomy for vocal cord paralysis. Acta Otolaryngol 2019; 139:90-93. [PMID: 30707045 DOI: 10.1080/00016489.2018.1542160] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND There are many causes for vocal cord paralysis, which can cause difficulty in breathing in serious cases. The common surgical methods for solving vocal cord paralysis include laryngeal splitting or laser surgery, but there are limitations. Plasma radiofrequency ablation is a new treatment with good achievements in clinical applications. OBJECTIVE To investigate the effect of coblation-assisted arytenoidectomy (CSA) in the treatment of bilateral vocal cord paralysis (BVCP). METHODS All patients had undergone preoperative electrolaryngoscopic examination of the glottidis rima; electronic laryngoscopy can assess the width of the glottis. The purpose of preoperative electronic laryngoscopic evaluation is to assess the width of the glottis, and arytenoid cartilage movement. Unilateral arytenoid cartilage and a section of the vocal cords were removed in all cases. RESULTS Of the 14 patients, 13 were successfully extubated after CSA; 1 patient could not be extubated and underwent a second CSA of the contralateral arytenoid cartilage, after which extubation was achieved. All patients were continuously followed up (6 months to 2 years), and all achieved satisfactory results. CONCLUSIONS AND SIGNIFICANCE CSA can effectively relieve post-CSA dyspnea in patients with BVCP. More patients underwent tracheal cannula extubation after tracheotomy compared with other surgeries.
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Affiliation(s)
- Yuqiang Hu
- Department of Otolaryngology, Xuzhou Central Hospital, Xuzhou, China
| | - Liangjun Cheng
- Department of Otolaryngology, Xuzhou Central Hospital, Xuzhou, China
| | - Bing Liu
- Department of Otolaryngology, Xuzhou Central Hospital, Xuzhou, China
| | - Hao Ming
- Department of Otolaryngology, Xuzhou Central Hospital, Xuzhou, China
| | - Aimin Tian
- Department of Otolaryngology, Xuzhou Central Hospital, Xuzhou, China
| | - Mei Ma
- Department of Otolaryngology, Xuzhou Central Hospital, Xuzhou, China
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