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Şahin A, Gündoğmuş CA, Üçkuyulu Eİ, Oysu Ç, Enver N. Laryngeal Framework Surgical Anatomy: A Radiological Study. J Voice 2023; 37:801.e9-801.e15. [PMID: 34175169 DOI: 10.1016/j.jvoice.2021.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 04/07/2021] [Accepted: 04/15/2021] [Indexed: 11/18/2022]
Abstract
PURPOSE Awareness of variations in laryngeal anatomy among different age and gender groups is crucial during laryngeal framework surgery. The aim of this study is to demonstrate the relationship between gender and laryngeal radiologic morphometrics among different age groups and the applicability of important anatomical landmarks of laryngeal surgery. METHODS Laryngeal images of 180 adult patients older than 18 years of age were obtained by computed tomography and assessed. A total of 11 measurements of important laryngeal landmarks were taken from the patients' computed tomography images. Results were subgrouped according to gender and age, and these groups were compared for each measurement. RESULTS The majority of laryngeal measurements obtained in the study were higher in males than females, with the exception of the interlaminar angle. The mean interlaminar angle value was 88.27°± 14.99 for males and 103.04°± 14.81 for females (P <0.005). The distance from the anterior commissure to the inferior border of the thyroid cartilage was 10.46 ± 2.5 mm for males and 7.72 ± 1.9 mm for females. The anterior commissure locates slightly higher than the midpoint of the distance from the thyroid notch to the thyroid inferior border. The shortest distance between the muscular process of the arytenoid cartilage and the thyroid cartilage was found to be 9.60 ± 3.47 mm for males and 7.72 ± 2.33 mm for females (P <0.001). CONCLUSION Observation of obvious diversities in the size and distance of the important laryngeal structures between the gender groups is an important factor to be considered for successful laryngeal framework surgery. Also, using the midpoint of the thyroid cartilage as a landmark for anterior commissure is a practical method during surgery, especially for thyroplasty.
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Affiliation(s)
- Akin Şahin
- Department of otorhinolaryngology, Ardahan state hospital, Ardahan, Turkey; Department of otorhinolaryngology, Marmara university school of medicine, Istanbul, Turkey.
| | | | - Esin İrem Üçkuyulu
- Department of otorhinolaryngology, Marmara university school of medicine, Istanbul, Turkey
| | - Çağatay Oysu
- Department of otorhinolaryngology, Marmara university school of medicine, Istanbul, Turkey
| | - Necati Enver
- Department of otorhinolaryngology, Marmara university school of medicine, Istanbul, Turkey
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2
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Shah AA, Kong KA, Yeakel HA, Jaworek AJ, Sataloff RT. Overmedialization of Thyroplasty Implants and the Role for Anterior-Posterior Laryngeal Compression as a Diagnostic Tool. EAR, NOSE & THROAT JOURNAL 2022:1455613221136676. [PMID: 36341532 DOI: 10.1177/01455613221136676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2023] Open
Affiliation(s)
- Arnav A Shah
- Lewis Katz School of Medicine at Temple University, Philadelphia, PA, USA
| | - Keonho A Kong
- Department of Otolaryngology-Head and Neck Surgery, University of Mississippi Medical Center, Jackson, MS, USA
| | - Heather A Yeakel
- Department of Otolaryngology-Head & Neck Surgery, St. Luke's University Health Network, Bethlehem, PA, USA
| | - Aaron J Jaworek
- Department of Otolaryngology-Head & Neck Surgery, St. Luke's University Health Network, Bethlehem, PA, USA
| | - Robert T Sataloff
- Department of Otolaryngology, Head and Neck Surgery, Drexel University College of Medicine, Philadelphia, PA, USA
- Lankenau Institute for Medical Research, Wynnewood, PA, USA
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Silvia N, Lim C, Aguirre A, Guisado G, Schneider GT. 3D Printed Cutting Rig for Creating Silicone Carving Templates for Medialization Laryngoplasty. Laryngoscope 2020; 131:E885-E889. [PMID: 32717110 DOI: 10.1002/lary.28899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 05/30/2020] [Accepted: 06/11/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Nathaniel Silvia
- University of Rochester Department of Biomedical Engineering, Rochester, New York, U.S.A
| | - Chantelle Lim
- University of Rochester Department of Biomedical Engineering, Rochester, New York, U.S.A
| | - Abril Aguirre
- University of Rochester Department of Biomedical Engineering, Rochester, New York, U.S.A
| | - Gabriel Guisado
- University of Rochester Department of Biomedical Engineering, Rochester, New York, U.S.A
| | - Glenn T Schneider
- University of Rochester Medical Center Department of Otolaryngology, Rochester, New York, U.S.A
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Nerurkar NK, Pawar SM, Dighe SN. A comprehensive 6-year retrospective study on medialisation thyroplasty in the Indian population. Eur Arch Otorhinolaryngol 2016; 273:1835-40. [PMID: 27002319 DOI: 10.1007/s00405-016-3982-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2016] [Accepted: 03/10/2016] [Indexed: 12/01/2022]
Abstract
The purpose of this paper is to describe a series of patients who have undergone medialisation thyroplasty (with or without arytenoid adduction) at our centre with respect to demographics, aetiology for unilateral vocal fold paralysis, pre- and postoperative maximum phonation time, amount of anterior and posterior medialisation required and complications. A comparative analysis with international studies was also performed. A retrospective analysis was performed on 67 patients, who underwent medialisation thyroplasty at our centre from August 2008 to August 2014. All the medialisation thyroplasty were performed using Netterville's technique. The average anterior medialisation needed was 2.25 mm (SD 1.05 mm) while the average posterior medialisation needed was 6.75 mm (SD 1.79 mm). Our study is the first to determine the amount of anterior and posterior medialisation needed in the Indian population. Mean anterior and posterior medialisation required was found to be the same, regardless of the age, gender of the patient and side of surgery.
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Affiliation(s)
- Nupur Kapoor Nerurkar
- Department of ENT, Bombay Hospital, Room No.213, Second floor, New Wing, 12 Marine Lines, Mumbai, 400020, Maharashtra, India.
| | - Shweta Mahadev Pawar
- Department of ENT, Bombay Hospital, Room No.213, Second floor, New Wing, 12 Marine Lines, Mumbai, 400020, Maharashtra, India
| | - Shalaka Nilesh Dighe
- Department of ENT, Bombay Hospital, Room No.213, Second floor, New Wing, 12 Marine Lines, Mumbai, 400020, Maharashtra, India
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White JR, Orbelo DM, Noel DB, Pittelko RL, Maragos NE, Ekbom DC. Thyroplasty in the previously irradiated neck: A case series and short-term outcomes. Laryngoscope 2015; 126:1849-53. [PMID: 26526375 DOI: 10.1002/lary.25770] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/02/2015] [Indexed: 11/09/2022]
Affiliation(s)
- James R. White
- Department of Otolaryngology-Head and Neck Surgery; Mayo Clinic; Rochester Minnesota U.S.A
| | - Diana M. Orbelo
- Department of Otolaryngology-Head and Neck Surgery; Mayo Clinic; Rochester Minnesota U.S.A
| | - Daniel B. Noel
- Department of Otolaryngology-Head and Neck Surgery; Mayo Clinic; Rochester Minnesota U.S.A
| | - Rebecca L. Pittelko
- Department of Otolaryngology-Head and Neck Surgery; Mayo Clinic; Rochester Minnesota U.S.A
| | - Nicolas E. Maragos
- Department of Otolaryngology-Head and Neck Surgery; Mayo Clinic; Rochester Minnesota U.S.A
| | - Dale C. Ekbom
- Department of Otolaryngology-Head and Neck Surgery; Mayo Clinic; Rochester Minnesota U.S.A
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Daniero JJ, Garrett CG, Francis DO. Framework Surgery for Treatment of Unilateral Vocal Fold Paralysis. CURRENT OTORHINOLARYNGOLOGY REPORTS 2014; 2:119-130. [PMID: 24883239 DOI: 10.1007/s40136-014-0044-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Laryngeal framework surgery is the current gold standard treatment for unilateral vocal fold paralysis. It provides a permanent solution to glottic insufficiency caused by injury to the recurrent laryngeal nerve. Various modifications to the original Isshiki type I laryngoplasty procedure have been described to improve voice and swallowing outcomes. The success of this procedure is highly dependent on the experience of the surgeon as it epitomizes the intersection of art and science in the field. The following article reviews the evidence, controversies, and complications related to laryngoplasty for unilateral vocal fold paralysis. It also provides a detailed analysis of how and when arytenoid-positioning procedures should be considered, and summarizes the literature on postoperative outcomes.
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Affiliation(s)
- James J Daniero
- Vanderbilt Voice Center, Department of Otolaryngology, Bill Wilkerson Center
| | - C Gaelyn Garrett
- Vanderbilt Voice Center, Department of Otolaryngology, Bill Wilkerson Center
| | - David O Francis
- Vanderbilt Voice Center, Department of Otolaryngology, Bill Wilkerson Center ; Center for Surgical Quality & Outcomes Research, Institute for Medicine and Public Health, Vanderbilt University Medical Center
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Abstract
Recent advancements in skull base surgery to remove or diminish the size of cranial base tumors allow more to be done than ever before to preserve life for patients who have tumors in anatomic locations once considered unreachable without causing massive functional impairment or death. Nonetheless, the resulting outcome has a direct and serious impact on the quality of life of the patient. In this article on palliation, the authors focus on the rehabilitative techniques used in patients who have undergone extensive cranial base resection. These techniques can also be used to improve the life of patients who have not undergone surgery but suffer from poor quality of life because of the natural growth of the tumor.
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Aerodynamic, Acoustic, and Vibratory Comparison of Arytenoid Adduction and Adduction Arytenopexy. Laryngoscope 2008; 118:552-8. [DOI: 10.1097/mlg.0b013e31815acaf9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Friedrich G, Remacle M, Birchall M, Marie JP, Arens C. Defining phonosurgery: a proposal for classification and nomenclature by the Phonosurgery Committee of the European Laryngological Society (ELS). Eur Arch Otorhinolaryngol 2007; 264:1191-200. [PMID: 17647008 DOI: 10.1007/s00405-007-0333-x] [Citation(s) in RCA: 62] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2006] [Accepted: 01/09/2007] [Indexed: 11/30/2022]
Abstract
The term phonosurgery (PS) refers to any operation designed primarily for the improvement or restoration of voice. It is defined by the intended operative goal, which pertains to quality of life rather than its preservation, and informed consent needs to account for this emphasis. Since the aim is improvement or maintenance of vocal function, it is essential to document voice accurately pre-operatively. As important as the surgery itself is a team approach to perioperative care and rehabilitation. Although not a new concept, the PS portfolio of operations continues to grow rapidly, making this one of the most dynamic field in Laryngology. However, this has also led to confusion regarding terminology and classification, with the result that it is presently difficult to compare results between institutions. The aim of this paper is to establish a practical classification system for PS and to thereby establish a common language for reporting results. We propose four groups of operation: vocal fold surgery (VFS), laryngeal framework surgery (LFS), neuromuscular surgery (NHS) and reconstructive surgery (RCS) (for either partial or total laryngeal replacement).
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Affiliation(s)
- Gerhard Friedrich
- Ear, Nose and Throat University Hospital, Department of Phoniatrics, Speech and Swallowing, Medical University of Graz, Auenbruggerplatz 26-28, 8036, Graz, Austria.
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Leydon C, Bielamowicz S, Stager SV. Perceptual ratings of vocal characteristics and voicing features in untreated patients with unilateral vocal fold paralysis. JOURNAL OF COMMUNICATION DISORDERS 2005; 38:163-185. [PMID: 15748722 DOI: 10.1016/j.jcomdis.2004.08.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/03/2003] [Revised: 08/03/2004] [Accepted: 08/03/2004] [Indexed: 05/24/2023]
Abstract
UNLABELLED This study used visual analog scales to obtain perceptual ratings of features of voice production in subjects with unilateral vocal fold paralysis (UVFP), including clarity of laryngeal articulation, consistency of loudness across the utterance and the voiced/voiceless distinction. Recordings of repeated /i/, /isi/, and /izi/ from subjects diagnosed with UVFP and control subjects were randomly re-recorded, and then rated by five listeners. Significant differences in ratings (Smirnov test, p < 0.01) were found between groups for "aphonia", "severity", "clarity of articulation", "overall loudness", "consistency of loudness" and "amount of effort". Four of five raters agreed on the accuracy of /s/ or /z/ productions for only 54% of the samples from the subjects with UVFP. Voiceless and voiced cognates were equally likely to be rated as inaccurate. Results suggested that these variables were sensitive to changes in voice production resulting from paralysis, and may be useful in measuring treatment outcomes and spontaneous recovery of function. LEARNING OUTCOMES As a result of reading this manuscript the reader will (1) gain an understanding of types of perceptual scales and how to develop the set of vocal characteristics to be used in distinguishing patients with UVFP and those without, (2) learn which vocal characteristics listeners are able to use to successfully distinguish between patients with UVFP and those without and (3) understand the possible role for perceptual ratings in tracking changes in vocal characteristics in subjects over time following treatment or spontaneous recovery of function.
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Affiliation(s)
- Ciara Leydon
- Department of Communication Sciences and Disorders, Northwestern University, Evanston, IL, USA
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Halum S, Patel N, Hoffman RG, Simpson CB, Merati AL. Medialization Thyroplasty Window Creation Using an Ultrasonic Surgical Aspirator. Laryngoscope 2005; 115:155-8. [PMID: 15630385 DOI: 10.1097/01.mlg.0000150687.93011.00] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES/HYPOTHESIS The aim of the study was to investigate the use of an ultrasonic surgical aspirator for creation of the laryngeal cartilage window during medialization thyroplasty. STUDY DESIGN Basic science. METHODS Forty thyroplasty windows were constructed in fresh, unpreserved cadaver larynges. A 6 x 13-mm rectangular window and a 4 x 4-mm round window were created on each side of the larynges in a symmetrical fashion. A standard surgical drill with a 3-mm cutting burr was used on one side; the ultrasonic surgical aspirator was used on the contralateral side. The time required for window construction was recorded, as was the status of the inner perichondrium at window completion. RESULTS For creation of the 6 x 13-mm window, a mean time of 128 seconds was required using a standard surgical drill. The mean time using the ultrasonic aspirator device was 91 seconds for the window of the same size (P < .008). For the 4-mm round window, drilling completed the task in a mean time of 63 seconds, compared with 40 seconds (P < .016) for the ultrasonic aspirator. On creation of the 6 x 13-mm window, there were 4 of 10 perichondrial violations in the drilled specimens, and there were no violations in creation of the window of the same size with the ultrasonic aspirator (P = .12). The 4-mm round window had no perichondrium violations in the standard drill group and only 1 of 10 violations in the ultrasonic aspirator group (P = .99). CONCLUSION The study suggested that the ultrasonic surgical aspirator device may be an effective, efficient alternative to the standard drill for medialization thyroplasty window creation. Prospective clinical trials are warranted to better characterize its applicability.
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Affiliation(s)
- Stacey Halum
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, WI, USA
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12
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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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Abraham MT, Bains MS, Downey RJ, Korst RJ, Kraus DH. Type I thyroplasty for acute unilateral vocal fold paralysis following intrathoracic surgery. Ann Otol Rhinol Laryngol 2002; 111:667-71. [PMID: 12184585 DOI: 10.1177/000348940211100802] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Patients who undergo intrathoracic operative procedures for malignancy may require sacrifice of a recurrent laryngeal nerve. Postoperative vocal fold paralysis may lead to diminished cough with secretion retention, aspiration, and life-endangering pneumonia. This study retrospectively reviews our institution's experience of 23 patients who underwent type I thyroplasty within the 2-week (acute) period after thoracic surgery. Primary lung cancer (n = 16) was the most common disease. Upper lobectomy (n = 9) and pneumonectomy (n = 7) were the most frequent surgical procedures. Silicone medialization alone (n = 11) or with arytenoid adduction (n = 12) was performed. There were no significant postoperative complications. Improvements in hoarseness (86%), dyspnea (72%), dysphagia (50%), and aspiration (79%) were noted. Pulmonary status improved after vocal fold medialization, as reflected by decreased need for therapeutic bronchoscopy in the majority of patients in the postoperative period. Type I thyroplasty for vocal fold paralysis in the acute phase following thoracic surgery is well tolerated and is associated with improved patient outcome with no postoperative deaths in this high-risk patient population.
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Affiliation(s)
- Manoj T Abraham
- Head and Neck Service and Speech, Hearing and Rehabilitation Center, New York, New York, USA
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14
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Intraoperative flexible scope holder used during thyroplasty. Curr Opin Otolaryngol Head Neck Surg 2002. [DOI: 10.1097/00020840-200206000-00001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Shaw GY, Searl JP. Electroglottographic and acoustic changes following type I thyroplasty or autologous fat injection. Ann Otol Rhinol Laryngol 2001; 110:1000-6. [PMID: 11713908 DOI: 10.1177/000348940111001102] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
This study identified the electroglottographic (EGG) and acoustic measures that were most predictive of change in the glottic gap size of patients undergoing type I thyroplasty or autologous fat injection. Simultaneous EGG and acoustic recordings were made before and after autologous fat injection in 23 patients and type I thyroplasty in 45 patients. Relative measures of glottic gap size were obtained before and after operation from videostroboscopic images. Regression and correlation analysis was used to determine the strength of associations between the EGG or acoustic measures and glottic gap changes. A significant regression equation for both patient groups was constructed. The strongest predictors of glottic gap size change were changes in the EGG open quotient, signal-to-noise ratio, and mean fundamental frequency. Glottography provided a clinically useful means of evaluating glottic gap changes in patients undergoing vocal fold medialization procedures. Preoperative-postoperative differences in signal-to-noise ratio and mean fundamental frequency also were correlated to glottic gap size changes, but to a lesser degree.
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Affiliation(s)
- G Y Shaw
- Voice and Swallowing Laboratory, Research Medical Center, Kansas City, Missouri 64131, USA
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Billante CR, Spector B, Hudson M, Burkard K, Netterville JL. Voice outcome following thyroplasty in patients with cancer-related vocal fold paralysis. Auris Nasus Larynx 2001; 28:315-21. [PMID: 11694375 DOI: 10.1016/s0385-8146(01)00101-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Medialization laryngoplasty restores voice in patients with unilateral laryngeal paralysis. Of question was whether patients with vocal fold paralysis resulting from cancer or its treatment had as good a post-operative voice result as patients with vocal fold paralysis of benign etiology. The purpose of the present study was to compare post-operative perceptual, acoustic, aerodynamic, and quality of life data in these two patient groups. Twenty-eight patients with vocal fold paralysis secondary to malignancy or its treatment were age and gender-matched with patients with paralysis resulting from benign origin. Pre- and post-operative perceptual judgments of pitch, loudness and quality were rated independently by two speech-language pathologists. A digital audiotape of the patient's voice was analyzed using Soundscope software. Fundamental frequency, conversational intensity and perturbation were evaluated. Glottal flow rates in propositional speech, phonation times and extent of pitch and loudness ranges were also measured. Three quality of life surveys, the Short Form-36 general health survey, the Voice Handicap Index, and the Voice Outcomes Study were administered. Results of voice testing indicated that perceptual, acoustic and aerodynamic data were significantly improved 3 months after thyroplasty in all patients regardless of whether they had a history of cancer. Quality of life data, however, distinguished the two groups. In particular, the general health measure found a significant difference in physical functioning and overall vitality, although satisfaction with improved voice was equally appreciated in both patient groups. Of clinical significance is that though general health may differ, patients with cancer-related laryngeal paralysis can expect to have as good a voice outcome following thyroplasty as patients with paralysis of benign etiology.
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Affiliation(s)
- C R Billante
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, TN, USA.
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Sniezek JC, Sabri AN, Netterville JL. Paraganglioma surgery: complications and treatment. Otolaryngol Clin North Am 2001; 34:993-1006, vii. [PMID: 11557451 DOI: 10.1016/s0030-6665(05)70359-5] [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: 11/18/2022]
Abstract
Paragangliomas are vasculature in nature and are surrounded by vital neurovascular structures. The extirpation of these lesions requires careful preoperative evaluation, meticulous surgical technique, and the aid of experienced skull base surgical and rehabilitative teams. When surgery is performed in this way, complications can be minimized, and the function of the upper aerodigestive tract can be protected.
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Affiliation(s)
- J C Sniezek
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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Spector BC, Netterville JL, Billante C, Clary J, Reinisch L, Smith TL. Quality-of-life assessment in patients with unilateral vocal cord paralysis. Otolaryngol Head Neck Surg 2001; 125:176-82. [PMID: 11555751 DOI: 10.1067/mhn.2001.117714] [Citation(s) in RCA: 122] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Our objective was to identify the impact of unilateral vocal cord paralysis (UVCP) on an individual's quality of life both before and after thyroplasty. STUDY DESIGN AND SETTING This was a prospective observational outcome study of consecutive patients presenting to a laryngology clinic with UVCP. Participants received The Medical Outcomes Study Short Form 36-Item Health Survey (SF-36), the Voice Handicap Index (VHI), and the Voice Outcome Survey (VOS). Patients underwent medialization laryngoplasty with silastic, with or without arytenoid adduction. Outcome measures were repeated after surgery. RESULTS A review of 45 patients at presentation revealed statistically significant reductions in quality of life as measured by each survey. Marked improvements were noted after surgery. CONCLUSIONS Our preoperative data support a profile of significant general health-related and voice-related limitations caused by UVCP. Patient perceptions improved significantly after the surgical treatment of glottal insufficiency. SIGNIFICANCE The SF-36, VHI, and VOS provide an important complement to traditional endpoints in the analysis of patients with UVCP.
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Affiliation(s)
- B C Spector
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee 37232-2559, USA.
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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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Abstract
We present a previously unreported late complication of medialization laryngoplasty (ML), also described as a thyroplasty, type 1. Five years following ML with Silastic, a 64-year-old female presented with dysphonia and a mass in the laryngeal ventricle on the ipsilateral side of the ML. A computed tomography scan of the larynx revealed migration of the thyroid cartilage window into the ventricle without migration of the Silastic implant. These findings were confirmed on surgical exploration. Following removal of the Silastic implant and the thyroid cartilage window fragment, the patient was successfully remedialized with autologous lipoinjection. Migration of the thyroid cartilage window appears to be a late complication of ML when the thyroid cartilage window is left intact and not removed. Complications of ML are discussed; specifically, difficulties resulting from retention of the thyroid cartilage window at the time of the ML are addressed.
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Affiliation(s)
- C A Rosen
- Department of Otolaryngology, University of Pittsburgh, School of Medicine, Pennsylvania, USA
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Coleman JR, Miller FR, Netterville JL. Teflon granuloma excision via a lateral laryngotomy. ACTA ACUST UNITED AC 1999. [DOI: 10.1016/s1043-1810(99)80046-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Friedrich G. Titanium vocal fold medializing implant: introducing a novel implant system for external vocal fold medialization. Ann Otol Rhinol Laryngol 1999; 108:79-86. [PMID: 9930545 DOI: 10.1177/000348949910800112] [Citation(s) in RCA: 68] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
With the increasing worldwide spread of the Isshiki technique for external vocal fold medialization, some disadvantages and limitations have also emerged. and an increasing demand for a ready-made and standardized implant system can be observed. For this reason. I started experimental and clinical investigations with the goal of replacing the silicone with a safer material, and also simplifying and standardizing the surgical procedure. In particular, the danger of implant dislocation should be excluded with greater certainty. As a result, I have developed an implant made of medical-grade titanium. My surgical experiences in 20 patients with this newly developed titanium vocal fold medializing implant revealed that vocal fold medialization could be performed easily and that no perioperative complications occurred in any case. The major advantage was a significant reduction of operative time due to the preformed implant. This is not only more convenient for both the surgeon and the patient, but is also critical for obtaining optimal results due to the reduced intralaryngeal swelling and hematoma. The reduction of the glottic gap by the operation was statistically significant. Significant improvement of all voice parameters was achieved and demonstrated by a statistically significant reduction of the voice dysfunction index. Compared to the current techniques and implant systems, I see the following additional advantages: 1) titanium is a relatively safe implant material with excellent biocompatibility: 2) the design of the implant ensures optimal fixation and stabilization: 3) the implantation technique and handling is simple and time-saving; 4) the titanium sheet is easy to shape and adapt to the individual situation: and 5) only 2 sizes of implants, and no expensive instruments, are required.
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Affiliation(s)
- G Friedrich
- ENT-University Hospital, University Medical School Graz, Austria
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Abstract
The voice is the primary means of communication for humans socially and in the workplace. Although rarely life-threatening, voice problems cause tremendous alteration in daily living and should not be underestimated as a medical disorder. Besides affecting useful communication, voice problems may also signify the presence of more serious medical illnesses, such as malignancy or airway compromise. This article describes normal vocal anatomy and physiology and outlines a practical approach in evaluating patients with voice disorders.
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Affiliation(s)
- C G Garrett
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
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26
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Abstract
OBJECTIVE Medialization laryngoplasty (ML) and arytenoid adduction (AA) have become common treatments for vocal fold paralysis. The widespread use of these procedures has required many surgeons to learn these new surgeries through postgraduate education sources. Little is known regarding the efficacy of the learning methods and the types and incidence of complications in a large number of surgeons' experience. METHOD A survey consisting of 23 questions regarding complications of ML and AA was sent to 7364 otolaryngologists. RESULTS A 33% response rate resulted in 2436 returned surveys of which 43% stated they performed ML and/or AA (n = 1039). The survey represents 14,621 cases of ML. The average respondent performed 12 ML in the past 5 years. Forty-two percent of the respondents reported experience with one or more major complication. Airway complications requiring intervention occurred more frequently following AA than ML. The most common major complications were implant migration and failure to improve voice quality. The ML revision rate was 5.4% and the reported voice quality following revision was positive in 90% of cases. A statistically significant difference in major ML complication rate was found between surgeons with experience doing fewer than 10 MLs and those with experience doing more than 10 MLs. Similar findings showed that a higher major complication rate occurred for surgeons performing fewer than two MLs per year compared with counterparts who average two or more MLs per year. A near 1% implant extrusion rate was found. Most of the extrusions occurred into the airway. CONCLUSIONS This is a study of the use and complications of ML/AA based on more than 14,000 procedures. Wide-spread use of ML for vocal fold paralysis was found. A notable rate of poor voice quality following ML/AA was identified and led to a 5.5% revision rate for ML. Revision ML resulted in an improved voice quality in more than 90% of the reported cases. There appears to be a "learning curve" for performing ML as well as an increased complication rate for those surgeons who perform fewer than two MLs per year and have a total career experience of fewer than 10 procedures. These findings suggest that ML may result in increased complications if the surgeon is not experienced or does not perform the surgery regularly.
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Affiliation(s)
- C A Rosen
- Department of Otolaryngology, University of Pittsburgh School of Medicine, Pennsylvania, USA
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27
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Abstract
OBJECTIVES To present indications, techniques, and results of bilateral medialization laryngoplasty (BML). STUDY DESIGN Retrospective review of 39 consecutive patients who had BML for correction of glottal insufficiency attributable to presbylaryngis (n = 16), bilateral vocal fold paresis (n = 13), unilateral paralysis with contralateral bowing (n = 4), and other miscellaneous neurologic diseases (n = 6). METHODS Complete preoperative and postoperative clinical and acoustical data were analyzed for 74% (29/39) of the subjects. All 39 subjects completed a patient survey to assess their long-term outcomes. RESULTS Overall, 90% (35/39) of the patients who had BML experienced significant improvement in voice and swallowing function. Subsequently, 36% (14/39) of the patients underwent adjunctive lipoinjection for closure of small residual glottal gaps (vocal "fine-tuning"). Of the BML patients (with or without lipoinjection) who had complete preoperative and postoperative voice data, 83% (24/29) had complete glottal closure after surgery, resulting in normal or near-normal voices. Eighty-five percent (33/39) of the patients responded that they "would have surgery again." Of the six patients who said that they would not have surgery again, three had good results and one had progressive neurologic disease. The mean duration of follow-up was 17 months. CONCLUSIONS BML is an effective rehabilitative surgical treatment for symptomatic vocal fold bowing. In addition, lipoinjection is useful as an adjunct to BML to enhance the voice outcome in selected cases.
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Affiliation(s)
- G N Postma
- Center for Voice Disorders of Wake Forest University, Winston-Salem, North Carolina 27157-1034, USA
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Netterville JL, Coleman JR, Chang S, Rainey CL, Reinisch L, Ossoff RH. Lateral laryngotomy for the removal of Teflon granuloma. Ann Otol Rhinol Laryngol 1998; 107:735-44. [PMID: 9749541 DOI: 10.1177/000348949810700901] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Teflon injection has been used for vocal fold medialization following paralysis. Recently, numerous articles have discussed the complications of Teflon injection, including overinjection, airway obstruction. Teflon granuloma, and an abnormal mass effect creating a decreased vibratory character of the true vocal fold. Multiple techniques for Teflon removal have been described. This report details our experience with complete Teflon granuloma removal via a lateral laryngotomy under local anesthesia. Microscopic dissection of the entire granuloma and the paraglottic space was accomplished in all patients. Due to extensive destruction caused by the granuloma, the vocal ligament was resected in 3 patients; it was partially resected and reanastomosed in 1 case, and spared in 6 patients. Laryngeal reconstruction was accomplished with an inferiorly based sternohyoid muscle rotation flap and arytenoid adduction. Effortful speech secondary to pressed vocal quality resolved in all patients. Near-normal to normal vocal quality was obtained in 4 patients, with the average "voice desirability" improving 60% and the effective glottic width increasing 29%. Factors that contributed to a successful outcome included noninvolvement of the vocal ligament and sparing of the mucosal cover.
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Affiliation(s)
- J L Netterville
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee 37232-2559, USA
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Netterville JL, Civantos FJ. Rehabilitation of cranial nerve deficits after neurotologic skull base surgery. Laryngoscope 1993; 103:45-54. [PMID: 8231593 DOI: 10.1002/lary.1993.103.s60.45] [Citation(s) in RCA: 61] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
Damage to any one of these nerves results in sufficient morbidity to warrant therapy; however, most patients will compensate for isolated loss of function. It is with multiple nerve injuries, as often seen in glomus surgery with the resection of cranial nerves IX, X, and XII that the full efforts of the rehabilitation team are called on. After vocal cord medialization and palatal adhesion, younger healthier patients will eventually resume adequate oral intake. However, the time it requires to return to a reasonably enjoyable diet often extends up to 1 year postoperatively. A few never attain the goal of enjoyable intake and continue to struggle to maintain adequate nutrition. The latter situation is the rule, not the exception, in the elderly population. Our experience over the years has led us to a more conservative treatment of glomus tumors in the elderly debilitated patient.
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Affiliation(s)
- J L Netterville
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, Tenn
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