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Kise N, Hirakawa H, Aniya S, Ooshiro T, Kondo S, Tomoda A, Oyakawa Y, Kiyuna A, Suzuki M. Utility of Ultrahigh-Resolution Computed Tomography for Laryngeal Reconstructive Surgery. Laryngoscope 2024. [PMID: 38895821 DOI: 10.1002/lary.31577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2024] [Revised: 05/30/2024] [Accepted: 06/03/2024] [Indexed: 06/21/2024]
Abstract
OBJECTIVE Unilateral vocal fold paralysis (UVFP) presents as incomplete glottal closure and leads to breathy hoarseness. Various treatments, including laryngeal framework surgery (type 1 thyroplasty [TP1] and arytenoid adduction [AA]), have been devised to correct this condition. Ultrahigh-resolution computed tomography (U-HRCT) allows detailed three-dimensional imaging of the larynx, which aids our understanding of vocal fold motion disorders. This study assessed whether U-HRCT is beneficial for correct diagnosis and surgical planning. METHODS The participants were 26 UVFP patients who underwent laryngeal framework surgery (TP1 and/or AA). U-HRCT was used to measure the vocal fold volume (VFV) and level difference (LD). The need to combine AA with TP1 to obtain satisfactory surgical outcomes was evaluated by U-HRCT and various voice function tests. RESULTS VFV was smaller in paralyzed folds than in unaffected folds. LD correlated strongly with voice parameters and showed high intra-rater and inter-rater reliability. The surgical outcome of the laryngeal framework surgery performed was judged to be excellent for improving voice function. Comparison of LD between the TP1 group and TP1 + AA group indicated that LD is an excellent parameter to determine the need to combine AA with TP1. CONCLUSION These findings underscore the value of preoperative U-HRCT, especially LD, in surgical decision-making and afford insights for optimal phonosurgery and individualized intervention. Patients with LD >1.0 mm may benefit from thyroplasty with AA. LEVEL OF EVIDENCE Level 3 (case-control study) Laryngoscope, 2024.
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Affiliation(s)
- Norimoto Kise
- Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Hitoshi Hirakawa
- Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Soya Aniya
- Department of Radiology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Taiyo Ooshiro
- Department of Radiology, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Shunsuke Kondo
- Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Atsushi Tomoda
- Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Yoshiki Oyakawa
- Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Asanori Kiyuna
- Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Mikio Suzuki
- Department of Otorhinolaryngology, Head and Neck Surgery, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
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Motohashi R, Tokashiki R, Sakurai E, Saito Y, Shoji Y, Tsukahara K. Fenestration Approach for Arytenoid Adduction in Unilateral Vocal Fold Paralysis. J Voice 2024:S0892-1997(24)00147-4. [PMID: 38839466 DOI: 10.1016/j.jvoice.2024.04.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2024] [Revised: 04/24/2024] [Accepted: 04/24/2024] [Indexed: 06/07/2024]
Abstract
OBJECTIVE Several surgical techniques have been reported for the treatment of unilateral vocal fold paralysis (UVFP). Although the fenestration approach has recently been applied for arytenoid adduction (AA) in some cases, long-term large-cohort studies on its usefulness are lacking. Therefore, this study aimed to evaluate the long-term voice outcomes of this technique in patients with UVFP. STUDY DESIGN Retrospective study. METHODS A total of 168 patients with UVFP underwent laryngoplasty comprising AA performed through fenestration of the thyroid ala combined with a type I thyroplasty (TPI). The maximum phonation time (MPT) and mean airflow rate (MFR) were measured before and after surgery, and voice analysis included an estimation of shimmer and jitter. Anterior and posterior surgical windows were created in the lower thyroid ala and were used for typical TPI and AA, respectively. The window locations were determined based on three-dimensional computed tomography data. AA was performed by pulling the muscular process of the arytenoid cartilage toward the lateral cricoarytenoid muscle through the posterior window without releasing the cricothyroid joint. All surgeries were performed under local anesthesia, and medialization was endoscopically confirmed. RESULTS Postoperative MPT >10 seconds was achieved in 156 of the 168 patients. Postoperatively, MFR improved to <250 mL/s in all but two patients, and MPT, MFR, jitter, and shimmer significantly improved in all patients. Furthermore, perceptual evaluation using the Grade, Roughness, Breathiness, Asthenia, and Strain scale revealed significant improvement in all patients. CONCLUSIONS The fenestration approach preserves the cricothyroid joint and does not open the cricoarytenoid joint; therefore, the laryngeal cartilage is stabilized, and no distortion of the laryngeal framework occurs. Our results showed that combined AA and TPI via the fenestration approach provided stable long-term postoperative voice improvement in patients with UVFP. LEVEL OF EVIDENCE Level 3.
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Affiliation(s)
- Ray Motohashi
- Department of Otorhinolaryngology, Head and Neck Surgery, Tokyo Medical University, Tokyo, Japan.
| | - Ryoji Tokashiki
- Department of Otorhinolaryngology, Head and Neck Surgery, Tokyo Medical University, Tokyo, Japan; Shinjuku Voice Clinic, Tokyo, Japan
| | - Eriko Sakurai
- Department of Otorhinolaryngology, Head and Neck Surgery, Tokyo Medical University, Tokyo, Japan
| | - Yu Saito
- Department of Otorhinolaryngology, Head and Neck Surgery, Tokyo Medical University, Tokyo, Japan
| | - Yusuke Shoji
- Department of Otorhinolaryngology, Head and Neck Surgery, Tokyo Medical University, Tokyo, Japan
| | - Kiyoaki Tsukahara
- Department of Otorhinolaryngology, Head and Neck Surgery, Tokyo Medical University, Tokyo, Japan
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Sanuki T, Takemoto N, Sumiya S, Iwasaki S. Preliminary Experience with 3-Dimensional Exoscope-Assisted Laryngoplasty. Laryngoscope 2024; 134:1813-1819. [PMID: 37800700 DOI: 10.1002/lary.31086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Revised: 09/14/2023] [Accepted: 09/19/2023] [Indexed: 10/07/2023]
Abstract
OBJECTIVE Laryngoplasty requires the manipulation of the vocal folds, which are not visible during the operation. The widespread use of this technique is limited by the need for adequate knowledge of anatomy, the small surgical field, and the high level of skill required for the procedure. An exoscope has been developed to provide a stereoscopic view similar to that of a microscope while using the same compact endoscopic tool. This study aimed to determine whether the three-dimensional (3D) exoscopic surgical technique could be applied to laryngoplasty and explore its possibility to ultimately replace the current approach. METHODS This was a retrospective case series analysis, which included 28 patients with hoarseness who underwent surgery with (Exoscope; n = 12) or without (Macrosurgery; n = 16) a 3D exoscope between July 2018 and February 2021. The feasibility of performing all surgical steps with the 3D exoscope was evaluated. The Exoscope and Macrosurgery groups were compared for surgical time, vocal function outcomes, and complications. Questionnaires were completed by medical staff regarding the usefulness of medical education. RESULTS No intraoperative or postoperative complications occurred in either procedure. The operative time was similar in both groups. The vocal function outcomes were also comparable between the groups. Questionnaires revealed that the exoscope was useful in terms of sharing information on surgical procedures and anatomy, as well as functioning as an educational tool. CONCLUSION While this was a preliminary study, our results indicated that the exclusive use of the 3D exoscope was feasible for open approaches. LEVEL OF EVIDENCE 4 Laryngoscope, 134:1813-1819, 2024.
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Affiliation(s)
- Tetsuji Sanuki
- Department of Otolaryngology-Head & Neck Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Naoki Takemoto
- Department of Otolaryngology-Head & Neck Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Shogo Sumiya
- Department of Otolaryngology-Head & Neck Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Shinichi Iwasaki
- Department of Otolaryngology-Head & Neck Surgery, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
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Iwanaga K, Fujishima I, Omori K. Combined laryngeal framework surgery and cricopharyngeal muscle-origin transection: a novel effective surgery for dysphagia with pharyngolaryngeal palsy and cricopharyngeal dysfunction under local anesthesia. Eur Arch Otorhinolaryngol 2023; 280:5655-5660. [PMID: 37707618 DOI: 10.1007/s00405-023-08225-0] [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: 04/17/2023] [Accepted: 08/31/2023] [Indexed: 09/15/2023]
Abstract
BACKGROUND Cricopharyngeal myotomy and laryngeal framework surgery can improve swallowing function in patients with severe dysphagia. We developed a novel surgical technique for severe dysphagia associated with pharyngolaryngeal paralysis and cricopharyngeal dysfunction, performed under local anesthesia, and investigated its effectiveness. METHODS We included nine patients who underwent cricopharyngeal muscle-origin transection with laryngeal framework surgery through a horizontal skin incision under local anesthesia. CONCLUSIONS All patients demonstrated significant improvement in the Food Intake LEVEL Scale without complications. Thus, this surgical technique may serve as a useful and less invasive treatment option for patients with severe dysphagia.
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Affiliation(s)
- Ken Iwanaga
- Department of Otolaryngology, Head and Neck Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-Cho, Sakyo-Ku, Kyoto, 606-8507, Japan.
| | - Ichiro Fujishima
- Department of Rehabilitation Medicine, Hamamatsu City Rehabilitation Hospital, Shizuoka, Japan
| | - Koichi Omori
- Department of Otolaryngology, Head and Neck Surgery, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-Cho, Sakyo-Ku, Kyoto, 606-8507, Japan
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Kawai Y, Mizuta M, Tateya I, Kishimoto Y, Fujimura S, Suehiro A, Hiwatashi N, Omori K. Intraoperative computed tomography imaging for laryngoplasty. Auris Nasus Larynx 2023; 50:94-101. [PMID: 35701287 DOI: 10.1016/j.anl.2022.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 05/09/2022] [Accepted: 05/31/2022] [Indexed: 01/28/2023]
Abstract
OBJECTIVES Intraoperative cone beam computed tomography (CBCT) imaging has the potential to facilitate the surgical procedure. The current preliminary retrospective chart review investigated the benefits of intraoperative CBCT during laryngoplasty. METHOD This study examined 26 cases that underwent intraoperative CBCT imaging during laryngoplasty, with one patient who counted twice due to first and revision surgery. The visual quality of structures of interest (glottal shape, thyroid cartilage, arytenoid cartilage, and implants) was determined using intraoperative CBCT during laryngoplasty. Each patient also underwent an aerodynamic assessment. RESULTS CBCT provided unique information, such as surgical landmarks in severe scarring, the subglottal shape, and the rotation angle of the arytenoid cartilage during arytenoid adduction. Nonetheless, 26.9% (7 of 26) of cases were affected by motion artifact, due to the long acquisition time. When motion artifact-negative cases were evaluated, 100% of glottal shape and more than 89% of thyroid cartilage were well visualized. All arytenoids were well-visualized in patients ≥ 50 years of age and without motion artifact, while CBCT failed to visualize the arytenoids in 2 of 4 patients who were < 50 years, due to the lack of calcifications. After medialization surgery, the yields of improved maximal phonation times (MPTs) in the motion artifact-negative and -positive groups were 8.7 sec and 3.4 sec, respectively (p = 0.032; Welch's t test). This comparison indicates intraoperative CBCT would contribute in MPT improvement, if CBCT is taken in measurable quality. CONCLUSION The potential benefits of intraoperative CBCT during laryngoplasty were demonstrated. A corollary, prospective study is warranted to further confirmation.
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Affiliation(s)
- Yoshitaka Kawai
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Masanobu Mizuta
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Ichiro Tateya
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan; Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Fujita Health University, Aichi, Japan.
| | - Yo Kishimoto
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shintaro Fujimura
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Atsushi Suehiro
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Nao Hiwatashi
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Koichi Omori
- Department of Otolaryngology-Head and Neck Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Liu C, Qiu Y, Zhang X, Liu Y, Li G, Huang D. Modified Arytenoid Adduction Operation for the Treatment of Unilateral Vocal Fold Paralysis. ORL J Otorhinolaryngol Relat Spec 2021; 84:205-210. [PMID: 34384083 DOI: 10.1159/000517561] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 05/14/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Unilateral vocal fold paralysis (UVFP) was a relative common glottic insufficiency disease; however, a completely satisfactory treatment of UVFP was elusive. This study was aimed to evaluate the surgical efficacy of modified arytenoid adduction with fenestration of the thyroid cartilage in the management of patients with UVFP, including voice and aspiration outcomes, and to summarize the postoperative complications. METHODS A retrospective analysis was performed on a total of 21 patients who underwent modified arytenoid adduction operation with fenestration of the thyroid cartilage for UVFP from July 2012 to June 2017. The scores of Grade, Roughness, Breathiness, Asthenia, Strain scale (GRBAS), voice self-satisfaction, dynamic laryngoscopy and the voice acoustic data (fundamental frequency [F0], fundamental frequency perturbation [jitter], loudness, amplitude perturbation [shimmer], and maximal phonatory time [MPT], etc.) were statistically analyzed preoperatively and 3-6 months postoperatively. The occurrence of postoperative complications was also summarized. RESULTS The voice subjective perception of 21 patients was significantly improved after operation. The rate of voice self-satisfaction was 90.5%. The mean values of voice acoustics parameters were significantly improved. The MPT was significantly longer (p < 0.001), and the ratings of postoperative aspiration were significantly decreased compared with the preoperation. Among the 21 patients, 15 cases had sense of laryngeal obstruction, 8 cases had of 1-2° laryngemphraxis (recovered after 10-15 days). There were 2 cases of laryngeal stridor, 1 case of incision infection, 1 case of pharyngeal fistula, and 1 case of falsetto (corrected by voice training). No patient had laryngeal hematoma, neck hematoma, or laryngospasm. CONCLUSION The modified arytenoid adduction operation with fenestration of the thyroid cartilage can significantly improve the vocal function of patients with UVFP and effectively reduce the aspiration, with fewer postoperative complications, less trauma, and more convenient advantages.
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Affiliation(s)
- Chao Liu
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital, Central South University, Changsha, China, .,Otolaryngology Major Disease Research Key Laboratory of Hunan Province, Changsha, China, .,Clinical Research Center for Pharyngolaryngeal Diseases and Voice Disorders in Hunan Province, Changsha, China,
| | - Yuanzheng Qiu
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital, Central South University, Changsha, China.,Otolaryngology Major Disease Research Key Laboratory of Hunan Province, Changsha, China.,Clinical Research Center for Pharyngolaryngeal Diseases and Voice Disorders in Hunan Province, Changsha, China
| | - Xin Zhang
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital, Central South University, Changsha, China.,Otolaryngology Major Disease Research Key Laboratory of Hunan Province, Changsha, China.,Clinical Research Center for Pharyngolaryngeal Diseases and Voice Disorders in Hunan Province, Changsha, China
| | - Yong Liu
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital, Central South University, Changsha, China.,Otolaryngology Major Disease Research Key Laboratory of Hunan Province, Changsha, China.,Clinical Research Center for Pharyngolaryngeal Diseases and Voice Disorders in Hunan Province, Changsha, China
| | - Guo Li
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital, Central South University, Changsha, China.,Otolaryngology Major Disease Research Key Laboratory of Hunan Province, Changsha, China.,Clinical Research Center for Pharyngolaryngeal Diseases and Voice Disorders in Hunan Province, Changsha, China
| | - Donghai Huang
- Department of Otolaryngology Head and Neck Surgery, Xiangya Hospital, Central South University, Changsha, China.,Otolaryngology Major Disease Research Key Laboratory of Hunan Province, Changsha, China.,Clinical Research Center for Pharyngolaryngeal Diseases and Voice Disorders in Hunan Province, Changsha, China
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Rovó L, Ambrus A, Tóbiás Z, Wootten CT, Bach Á. A Novel Endoscopic Arytenoid Medialization for Unilateral Vocal Fold Paralysis. Laryngoscope 2020; 131:E903-E910. [PMID: 32790084 DOI: 10.1002/lary.29001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 07/12/2020] [Accepted: 07/19/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS Arytenoid adduction (AA) has been indicated for unilateral vocal fold paralysis (UVFP) patients with vertical vocal fold height mismatch and/or large posterior glottic gaps that are unable to be adequately addressed by anterior medialization techniques. Although AA offers several advantages over other methods, it is technically challenging and involves significant laryngeal manipulation of the cricoarytenoid joint. A novel, minimally invasive endoscopic arytenoid medialization technique is presented for the closure of the posterior commissure. STUDY DESIGN Prospective case series. METHODS Seventeen consecutive patients were diagnosed and treated with unilateral endoscopic arytenoid medialization (EAM) combined with injection laryngoplasty because of unilateral vocal fold paralysis. Jitter, shimmer, harmonics-to-noise ratio (HNR), maximum phonation time (MPT), fundamental frequency (F0 ), Voice Handicap Index (VHI), peak inspiratory flow (PIF), and quality of life (QoL) were evaluated preoperatively, 1 month, and 1 year after EAM. RESULTS Jitter, shimmer, HNR, and MPT significantly improved and remained stable 1 year after the intervention. F0 and PIF remained unchanged. Significant improvements in VHI and QoL demonstrated patient satisfaction with voicing and respiratory functions. CONCLUSIONS Endoscopic arytenoid medialization is a quick, minimally invasive solution for unilateral vocal fold paralysis. With simultaneous augmentation of the vocal fold, it provides a complete glottic closure along the entire vocal fold in UVFP patients. LEVEL OF EVIDENCE 4 Laryngoscope, 131:E903-E910, 2021.
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Affiliation(s)
- László Rovó
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Szeged, Szeged, Hungary
| | - Andrea Ambrus
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Szeged, Szeged, Hungary
| | - Zoltán Tóbiás
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Szeged, Szeged, Hungary
| | - Christopher T Wootten
- Department of Otolaryngology-Head and Neck Surgery, Vanderbilt University Medical Center, Nashville, Tennessee, U.S.A
| | - Ádám Bach
- Department of Otorhinolaryngology-Head and Neck Surgery, University of Szeged, Szeged, Hungary
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Pillutla P, Zhang Z, Chhetri DK. Effects of Arytenoid Adduction Suture Position on Voice Production and Quality. Laryngoscope 2020; 131:846-852. [PMID: 32710654 DOI: 10.1002/lary.28903] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 05/17/2020] [Accepted: 06/09/2020] [Indexed: 11/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS Arytenoid adduction (AA) is performed to treat unilateral vocal fold paralysis with a large posterior glottal gap. However, the voice effects of AA suture position remain unclear. This study aimed to evaluate voice production and quality as a function of AA suture position on the thyroid ala in a neuromuscularly intact in vivo larynx. STUDY DESIGN Animal model. METHODS Unilateral recurrent laryngeal nerve and vagal paralysis were modeled in two canines. AA suture position was varied across five equidistant positions on the anterior inferior thyroid ala, from a paramedian position anteriorly to the oblique line posteriorly. Phonation was performed over 8 × 8 graded level combinations of recurrent and superior laryngeal nerve stimulation per suture position. The primary outcome was percent successful phonatory conditions. Secondary outcomes included fundamental frequency (F0), phonation onset pressure (PTP), cepstral peak prominence (CPP), and laryngeal posture. RESULTS Anterior suture positions resulted in a greater percentage of successful phonatory conditions compared to posterior sutures. Suture position 2, located at the anterior inferior thyroid ala, resulted in the highest percentage of successful phonatory conditions, lowest PTP, and lower muscle activation levels to achieve higher CPP. Posterior sutures resulted in wider glottal gap and more effective F0 and vocal fold strain increase with cricothyroid muscle contraction, but with fewer successful phonatory conditions and higher PTP. Trends were consistent across both paralysis types. CONCLUSIONS AA suture placed in the anterior inferior thyroid ala resulted in the best acoustic, aerodynamic, and voice quality outcomes. This study provides scientific evidence for maintaining current clinical practice. LEVEL OF EVIDENCE NA Laryngoscope, 131:846-852, 2021.
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Affiliation(s)
- Pranati Pillutla
- School of Medicine, Texas Tech University Health Sciences Center, Lubbock, Texas, U.S.A
| | - Zhaoyan Zhang
- Department of Head and Neck Surgery, University of California, Los Angeles, California, U.S.A
| | - Dinesh K Chhetri
- Department of Head and Neck Surgery, University of California, Los Angeles, California, U.S.A
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Matsushima K. Type I Thyroplasty Using a Titanium Implant Combined With Modified Arytenoid Adduction. Laryngoscope 2020; 130:2625-2630. [PMID: 32619273 PMCID: PMC7689740 DOI: 10.1002/lary.28865] [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: 01/08/2020] [Revised: 05/01/2020] [Accepted: 05/19/2020] [Indexed: 11/11/2022]
Abstract
View Video S1Laryngoscope, 2020
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Affiliation(s)
- Koji Matsushima
- Department of Otolaryngology, Toho University School of Medicine, Tokyo, Japan
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10
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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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Ho GY, Leonhard M, Denk-Linnert DM, Schneider-Stickler B. Pre- and intraoperative acoustic and functional assessment of the novel APrevent ® VOIS implant during routine medialization thyroplasty. Eur Arch Otorhinolaryngol 2019; 277:809-817. [PMID: 31845039 PMCID: PMC7031216 DOI: 10.1007/s00405-019-05756-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Accepted: 12/03/2019] [Indexed: 11/27/2022]
Abstract
PURPOSE Persistent unilateral vocal fold paralysis (UFVP) with glottal insufficiency often requires type I medialization thyroplasty (MT). Previous implants cannot be adjusted postoperatively if necessary. The newly developed APrevent® VOIS implant (VOIS) can provide postoperative re-adjustment to avoid revision MT. The objective of this pilot study is to evaluate the VOIS intraoperatively concerning voice improvement, surgical feasibility and device handling. METHODS During routine MT, VOIS was applied short time in eight patients before the regular implantation of the Titanium Vocal Fold Medialization Implant (TVFMI™). In all patients, perceptual voice sound analysis using R(oughness)-B(reathiness)-H(oarseness)-scale, measurement of M(aximum)-P(honation)-T(ime) and glottal closure in videolaryngoscopy were performed before and after implanting VOIS/TVFMI™. Acoustic analyses of voice recordings were performed using freeware praat. Surgical feasibility, operative handling and device fitting of VOIS and TVFMI™ were assessed by the surgeon using V(isual)-A(nalog)-S(cale). Data were statistically analyzed with paired t test. RESULT All patients showed significant improvement of voice sound parameters after VOIS/TVFMI™ implantation. The mean RBH-scale improved from preoperative R = 2.1, B = 2.3, H = 2.5 to R = 0.6, B = 0.3, H = 0.8 after VOIS and R = 0.5, B = 0.3, H = 0.8 after TVFMI™ implantation. The mean MPT increased from preoperative 7.9 to 14.6 s after VOIS and 13.8 s after TVFMI™ implantation. VOIS/TVFMI™ achieved complete glottal closure in 7/8 patients. The satisfaction with intraoperative device fitting and device handling of VOIS was as good as that of TVFMI™. CONCLUSION The novel APrevent® VOIS implant showed similar intraoperative voice improvement compared to routinely used TVFMI™ without adverse device events and with safe device fitting.
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Affiliation(s)
- Guan-Yuh Ho
- Division of Phoniatrics-Logopedics, Department of Otorhinolaryngology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
| | - Matthias Leonhard
- Division of Phoniatrics-Logopedics, Department of Otorhinolaryngology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Doris-Maria Denk-Linnert
- Division of Phoniatrics-Logopedics, Department of Otorhinolaryngology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Berit Schneider-Stickler
- Division of Phoniatrics-Logopedics, Department of Otorhinolaryngology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
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Outcomes in two patients with vocal fold palsy who underwent revision arytenoid adduction surgery. The Journal of Laryngology & Otology 2019; 133:1017-1020. [DOI: 10.1017/s0022215119002081] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
AbstractObjectiveThis study investigated the position of adduction thread attachment, pulling direction and fixation position in revision arytenoid adduction surgery performed in two patients with left vocal fold palsy in whom satisfactory speech improvement had not been obtained by arytenoid adduction and type 1 thyroplasty.MethodsRevision arytenoid adduction surgery was performed with the vocal fold in the midline position in both cases. A type 1 thyroplasty procedure was subsequently added in one case because of worsened quality of speech following arytenoid adduction.Results and conclusionAlthough the arytenoid adduction procedure is conceptually well established, there is still room for debate concerning the actual surgical procedures used. The technique described in this report is effective, suggesting that it is worthy of recognition as an index procedure.
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Zapater E, Basterra J, López I, Oishi N, García-Lliberós A. Use of individual anatomical variations to customise window location in montgomery implant thyroplasty: A case series study. Clin Otolaryngol 2019; 44:1162-1165. [PMID: 31514258 DOI: 10.1111/coa.13429] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2019] [Revised: 08/04/2019] [Accepted: 09/08/2019] [Indexed: 12/01/2022]
Affiliation(s)
- Enrique Zapater
- ENT Department, Valencia Medical School, Valencia University General Hospital, Valencia, Spain
| | - Jorge Basterra
- ENT Department, Valencia Medical School, Valencia University General Hospital, Valencia, Spain
| | - Isabel López
- ENT Department, Valencia University General Hospital, Valencia, Spain
| | - Natsuki Oishi
- ENT Department, Valencia University General Hospital, Valencia, Spain
| | - Ainhoa García-Lliberós
- ENT Department, Valencia University General Hospital and Manises Hospital, Valencia, Spain
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Saito Y, Tokashiki R, Tsukahara K. Study of arytenoid adduction performed under general anesthesia. ACTA OTO-LARYNGOLOGICA CASE REPORTS 2019. [DOI: 10.1080/23772484.2019.1655429] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Affiliation(s)
- Yu Saito
- Department of Otorhinolaryngology, Head and Neck Surgery, Tokyo Medical University, Tokyo, Japan
| | - Ryoji Tokashiki
- Department of Otorhinolaryngology, Head and Neck Surgery, Tokyo Medical University, Tokyo, Japan
- Shinjuku Voice Clinic, Tokyo Medical University Hospital, Tokyo, Japan
| | - Kiyoaki Tsukahara
- Department of Otorhinolaryngology, Head and Neck Surgery, Tokyo Medical University, Tokyo, Japan
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Complications of using Gore-Tex in medialization laryngoplasty: case series and literature review. Eur Arch Otorhinolaryngol 2018; 276:255-261. [DOI: 10.1007/s00405-018-5204-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Accepted: 11/09/2018] [Indexed: 11/26/2022]
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Fukuhara T, Donishi R, Matsuda E, Koyama S, Fujiwara K, Takeuchi H. A Novel Lateral Approach to the Assessment of Vocal Cord Movement by Ultrasonography. World J Surg 2018; 42:130-136. [PMID: 28752427 PMCID: PMC5740199 DOI: 10.1007/s00268-017-4151-z] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Ultrasonography is a non-invasive technique that is commonly used by endocrinologists and endocrine surgeons to examine the thyroid region and could be useful for the assessment of vocal cord movement by these specialists. However, previous studies reported a low rate of successful visualization of vocal cord movement by ultrasonography. To address this issue, we devised a novel ultrasonographic procedure for assessing vocal cord movement indirectly by observing the arytenoid movement from a lateral view. METHODS Subjects were 188 individuals, including 23 patients with vocal cord paralysis and 13 with vocal cord paresis. We performed ultrasonographic assessment of vocal cord movement using two different procedures: the conventional middle transverse procedure and the novel lateral vertical procedure. RESULTS The rate of visualization of vocal cords with the middle transverse procedure was 70.2% and that of the arytenoid cartilage with the lateral vertical procedure was 98.4%. The lateral vertical procedure enabled visualization of all patients with vocal cord paresis/paralysis and detected all 23 patients with vocal paralysis; only one of 13 patients with vocal cord paresis was positively identified. The conventional procedure enabled visualization of 21 of 36 patients with vocal cord paresis/paralysis with high accuracy. There was no false-positive case in either procedure. CONCLUSION The proposed lateral vertical procedure improved the rate of visualization of vocal cord movement by ultrasonography, suggesting that it is a useful technique to screen for vocal cord paralysis by ultrasonography.
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Affiliation(s)
- Takahiro Fukuhara
- Department of Otolaryngology, Head and Neck Surgery, Tottori University Faculty of Medicine, 36-1 Nishicho, Yonago, 683-8504, Japan.
| | - Ryohei Donishi
- Department of Otolaryngology, Head and Neck Surgery, Tottori University Faculty of Medicine, 36-1 Nishicho, Yonago, 683-8504, Japan
| | - Eriko Matsuda
- Department of Otolaryngology, Head and Neck Surgery, Tottori University Faculty of Medicine, 36-1 Nishicho, Yonago, 683-8504, Japan
| | - Satoshi Koyama
- Department of Otolaryngology, Head and Neck Surgery, Tottori University Faculty of Medicine, 36-1 Nishicho, Yonago, 683-8504, Japan
| | - Kazunori Fujiwara
- Department of Otolaryngology, Head and Neck Surgery, Tottori University Faculty of Medicine, 36-1 Nishicho, Yonago, 683-8504, Japan
| | - Hiromi Takeuchi
- Department of Otolaryngology, Head and Neck Surgery, Tottori University Faculty of Medicine, 36-1 Nishicho, Yonago, 683-8504, Japan
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Voice outcome indicators for unilateral vocal fold paralysis surgery: a review of the literature. Eur Arch Otorhinolaryngol 2017; 275:459-468. [PMID: 29264655 DOI: 10.1007/s00405-017-4844-9] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2017] [Accepted: 12/08/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION There is no consensus on which voice outcome indicators (VOIs) should be used to compare the merits of the various surgical treatments for unilateral vocal fold paralysis (UVFP). Authors performed a literature review to identify which VOIs are most frequently used and most relevant, in terms of significant change in pre- and post-operative measurements, to assess UVFP surgical treatments. METHOD A Medline/Pubmed literature review was performed and the most frequently used VOIs were identified using a Pareto diagram. For these most frequently used VOI's, the number of studies that showed a statistically significant change in pre- and post-operative results were compared to the total number of studies found using that same VOI, this portion was expressed in percent. This percentage was defined as the "percentage of significance" and used to assess changes of each VOI. RESULTS Eleven VOIs were identified using the Pareto analysis. These were, in decreasing order of frequency of citation: maximum phonation time (MPT), jitter, Shimmer, video-stroboscopic examination, noise to harmonic ratio (NHR/HNR), mean air flow (MeAF), fundamental frequency (F0), "Infrequent Perceptional Scales", GRBAS scale, mean subglottic pressure (MSGP). MPT, MeAF, factor G of GRBAS-I, Jitter, shimmer and VHI-30 had respective "percentage of significance" of 90, 86, 85, 74, 68 and 64%, respectively. CONCLUSION The results indicate that MPT, MeAF and GRBAS-I, represent the top-three most frequently used and the most relevant VOIs in terms of "percentage of significance". VHI-30 showed a relatively low rate of use and low "percentage of significance". The role of Jitter and Shimmer remains unclear. Finally, MSGP and the F0 appear to be less relevant VOIs for the evaluation of UFVP surgical treatments in terms of significant change in pre- and post-operative measurements.
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Fukuhara T, Morisaki T, Kataoka H, Miyake N, Taira K, Koyama S, Fujiwara K, Kitano H, Takeuchi H. Modifications to the Fenestration Approach for Arytenoid Adduction Under Local Anesthesia. J Voice 2016; 31:490-494. [PMID: 27916331 DOI: 10.1016/j.jvoice.2016.10.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 10/21/2016] [Accepted: 10/26/2016] [Indexed: 11/18/2022]
Abstract
OBJECTIVE We modified the fenestration approach for arytenoid adduction to make it easier to perform the surgery. The aim of this study was to evaluate the usefulness of our modifications, which included (1) use of an Alexis wound retractor (Applied Medical) to secure the surgical field through a small incision, and (2) use of a 12-mm, 1/2 R, insert-molded taper needle with 3-0 nylon suture to prevent damage to the arytenoid cartilage. STUDY DESIGN This is a retrospective non-randomized observational cross-sectional study. METHODS We compared the operative time and skin incision length between the conventional fenestration approach and our modified procedure, and verified the improvement of patients' voice by our procedure. RESULTS Seven patients underwent the conventional fenestration approach for arytenoid adduction with type I thyroplasty, whereas nine patients underwent our modified fenestration approach for arytenoid adduction with type I thyroplasty. The skin incision length with our modifications (median, 3.0 cm; interquartile range [IQR], 3.0-4.0) was significantly shorter than with the conventional procedure (median, 5.0 cm; IQR, 4.3-5.8) (P = 0.001). The operative time with our modifications (median, 95 minutes; IQR, 90-100) was significantly shorter than without our modifications (median, 115; IQR, 100-130) (P = 0.035). All patients who underwent our modified fenestration approach for arytenoid adduction had maximum phonation time greater than 11 seconds after surgery. CONCLUSIONS Our two distinctive modifications reduced the operative time and skin incision length for the fenestration approach, which improved the procedure by making it less invasive.
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Affiliation(s)
- Takahiro Fukuhara
- Department of Otolaryngology-Head and Neck Surgery, Tottori University Faculty of Medicine, Yonago, Japan.
| | - Tsuyoshi Morisaki
- Center for Head and Neck Surgery, Kusatsu General Hospital, Kusatsu, Japan
| | - Hideyuki Kataoka
- Division of Medical Education, Department of Social Medicine, Tottori University Faculty of Medicine, Yonago, Japan
| | - Naritomo Miyake
- Department of Otolaryngology-Head and Neck Surgery, Tottori University Faculty of Medicine, Yonago, Japan
| | - Kenkichiro Taira
- Department of Otolaryngology-Head and Neck Surgery, Tottori University Faculty of Medicine, Yonago, Japan
| | - Satoshi Koyama
- Department of Otolaryngology-Head and Neck Surgery, Tottori University Faculty of Medicine, Yonago, Japan
| | - Kazunori Fujiwara
- Department of Otolaryngology-Head and Neck Surgery, Tottori University Faculty of Medicine, Yonago, Japan
| | - Hiroya Kitano
- Department of Otolaryngology-Head and Neck Surgery, Tottori University Faculty of Medicine, Yonago, Japan
| | - Hiromi Takeuchi
- Department of Otolaryngology-Head and Neck Surgery, Tottori University Faculty of Medicine, Yonago, Japan
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Rosero EB, Ozayar E, Mau T, Joshi GP. A sequential anesthesia technique for surgical repair of unilateral vocal fold paralysis. J Anesth 2016; 30:1078-1081. [PMID: 27522215 DOI: 10.1007/s00540-016-2231-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 08/02/2016] [Indexed: 11/30/2022]
Abstract
Thyroplasty with arytenoid adduction, a combined procedure for treatment of unilateral vocal fold paralysis, is typically performed under local anesthesia with sedation to allow for intraoperative voice assessment. However, the need for patient immobility and suppression of laryngeal responses to surgical manipulation can make sedation-analgesia challenging. We describe our first 26 consecutive cases undergoing thyroplasty and arytenoid adduction with a standardized technique consisting of a combination of general anesthesia with tracheal intubation followed by sedation-analgesia. Most patients (69 %) were women, with age of 53 ± 15 years (mean ± SD). Neck surgery was the cause of vocal fold paralysis in 50 % of patients. Initially, general anesthesia was maintained with desflurane and remifentanil with dexmedetomidine added just before tracheal extubation. During the sedation-analgesia phase, patients received infusions of remifentanil and dexmedetomidine. Duration of general anesthesia and sedation-analgesia phases was 162 ± 68.2 and 79 ± 18.3 min, respectively. Mean (SD) wake-up time was 8.0 ± 4.0 min after desflurane discontinuation. Extubation occurred without coughing, bucking, or agitation in 96 % of patients. All the patients were able to phonate appropriately and remained comfortable after emergence. This technique allowed improved surgical conditions with reduced patient discomfort and may be advantageous for other laryngeal and neck surgeries in which intraoperative patient feedback is required.
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Affiliation(s)
- Eric B Rosero
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, TX, USA.
| | - Esra Ozayar
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Ted Mau
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Girish P Joshi
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Konomi U, Watanabe Y, Komazawa D. Sex Differences in Pitch Range and Speech Fundamental Frequency After Arytenoid Adduction and Thyroplasty. J Voice 2016; 30:362-70. [DOI: 10.1016/j.jvoice.2015.03.011] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 03/18/2015] [Indexed: 10/23/2022]
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Hosokawa K, Iwahashi T, Ogawa M, Kato C, Inohara H. The Principles and Practice of Acoustic Analyses. ACTA ACUST UNITED AC 2016. [DOI: 10.5426/larynx.28.78] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Kiyohito Hosokawa
- Osaka Police Hospital, Department of Otorhinolaryngology
- Osaka University Graduate School of Medicine, Department of Otorhinolaryngology-Head and Neck Surgery
| | - Toshihiko Iwahashi
- Osaka University Graduate School of Medicine, Department of Otorhinolaryngology-Head and Neck Surgery
| | - Makoto Ogawa
- Osaka University Graduate School of Medicine, Department of Otorhinolaryngology-Head and Neck Surgery
| | - Chieri Kato
- Osaka University Graduate School of Medicine, Department of Otorhinolaryngology-Head and Neck Surgery
| | - Hidenori Inohara
- Osaka University Graduate School of Medicine, Department of Otorhinolaryngology-Head and Neck Surgery
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Matsushima K. [Investigation of Type I Thyroplasty Using Titanium Implant]. NIHON JIBIINKOKA GAKKAI KAIHO 2015; 118:1027-36. [PMID: 26548096 DOI: 10.3950/jibiinkoka.118.1027] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE The aim of this study was to describe a new titanium thyroplasty medializing implant and evaluate its usefulness. MATERIAL AND METHOD Retrospective study of 9 male patients with severe unilateral vocal fold paralysis after aortic-aneurysm surgery who underwent type I thyoplasty with arytenoid adduction under general anesthesia. Preoperative and postoperative glottal closure and voice function were evaluated by acoustic analysis (Jitter %, Shimmer %, NHR), stroboscopic findings, maximum phonation time, mean airflow rate, voice handicap index and computed tomography findings. These tests were evaluated before and 3 months after surgery. RESULT All acoustic parameters improved after surgery. In stroboscopic findings, symmetrical mucosal waves were identified in 3 cases. Maximum phonation time prolonged, mean flow rate decreased and voice handicap index improved. In computed-tomography findings, breakage, deformation, dropped and migration of titanium plate were not identified. CONCLUSION In surgery of vocal fold paralyzed patient, it is necessary to reconstruct vocal fold in physiological state at the time of phonation. Using the titanium plate developed for this purpose, all patients obtained good vocal improvement.
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Konomi U, Tokashiki R, Hiramatsu H, Motohashi R, Sakurai E, Toyomura F, Nomoto M, Kawada Y, Suzuki M. Features of Vocal Fold Adductor Paralysis and the Management of Posterior Muscle in Thyroplasty. J Voice 2015; 30:234-41. [PMID: 26183535 DOI: 10.1016/j.jvoice.2015.04.019] [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: 02/18/2015] [Accepted: 04/29/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVE To present the pathologic characteristics of unilateral recurrent nerve adductor branch paralysis (AdBP), and to investigate the management of posterior cricoarytenoid (PCA) muscle on the basis of our experience of surgical treatment for AdBP. STUDY DESIGN This is a retrospective review of clinical records METHODS Four cases of AdBP, in which surgical treatment was performed, are presented. AdBP shows disorders of vocal fold adduction because of paralysis of the thyroarytenoid and lateral cricoarytenoid muscles. The PCA muscle, dominated by the recurrent nerve PCA muscle branch, does not show paralysis. Thus, this type of partial recurrent nerve paresis retains the abductive function and is difficult to distinguish from arytenoid cartilage dislocation because of their similar endoscopic findings. The features include acute onset, and all cases were idiopathic etiology. Thyroarytenoid muscle paralysis was determined by electromyography and stroboscopic findings. The adduction and abduction of paralytic arytenoids were evaluated from 3 dimensional computed tomography (3DCT). RESULTS In all cases, surgical treatments were arytenoid adduction combined with thyroplasty. When we adducted the arytenoid cartilage during inspiration, strong resistance was observed. In the two cases where we could cut the PCA muscle sufficiently, the maximum phonation time was improved to ≥30 seconds after surgery, from 2 to 3 seconds preoperatively, providing good postoperative voices. In contrast, in the two cases of insufficient resection, the surgical outcomes were poorer. CONCLUSIONS Because the preoperative voice in AdBP patients is typically very coarse, surgical treatment is needed, as well as ordinary recurrent nerve paralysis. In our experience, adequate PCA muscle resection might be helpful in surgical treatment of AdBP.
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Affiliation(s)
- Ujimoto Konomi
- Department of Otolaryngology, School of Medicine, Tokyo Medical University, Tokyo, Japan.
| | - Ryoji Tokashiki
- Department of Otolaryngology, School of Medicine, Tokyo Medical University, Tokyo, Japan; Shinjuku Voice Clinic, Tokyo, Japan
| | - Hiroyuki Hiramatsu
- Department of Otolaryngology, School of Medicine, Tokyo Medical University, Tokyo, Japan; Hiramatsu ENT Clinic, Tokyo, Japan
| | - Ray Motohashi
- Department of Otolaryngology, School of Medicine, Tokyo Medical University, Tokyo, Japan
| | - Eriko Sakurai
- Department of Otolaryngology, School of Medicine, Tokyo Medical University, Tokyo, Japan
| | - Fumimasa Toyomura
- Department of Otolaryngology, School of Medicine, Tokyo Medical University, Tokyo, Japan
| | - Masaki Nomoto
- Department of Otolaryngology, School of Medicine, Tokyo Medical University, Tokyo, Japan
| | - Yuri Kawada
- Department of Otolaryngology, School of Medicine, Tokyo Medical University, Tokyo, Japan
| | - Mamoru Suzuki
- Department of Otolaryngology, School of Medicine, Tokyo Medical University, Tokyo, Japan
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Revision laryngeal framework surgery performed by directly pulling the lateral cricoarytenoid muscle. The Journal of Laryngology & Otology 2014; 128:935-8. [PMID: 25120243 PMCID: PMC4195579 DOI: 10.1017/s0022215114001546] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Background: Revision laryngeal framework surgery is usually performed for medialisation laryngoplasty failure, rather than for failure after arytenoid adduction. We describe a new method for revision arytenoid adduction surgery, performed by directly pulling the lateral cricoarytenoid muscle (‘lateral cricoarytenoid muscle pull surgery’). Methods: We describe a case of revision laryngeal framework surgery, present a literature review and describe the advantages of lateral cricoarytenoid muscle pull surgery over the original method of arytenoid adduction using a posterior approach. Results: Medialisation laryngoplasty combined with arytenoid adduction was performed following unilateral vocal fold paralysis from mediastinal surgery, resulting in severe glottic insufficiency. The patient's voice improved after the initial surgery, but had deteriorated 18 months later. Revision surgery was performed using lateral cricoarytenoid muscle pull surgery, and her voice recovered normally in terms of perceptual impression. The post-operative course was uneventful for 10 months following revision surgery. Conclusion: To our knowledge, this is the first case of revision arytenoid adduction performed using a lateral cricoarytenoid muscle pull approach. Lateral cricoarytenoid muscle pull surgery should therefore be considered as a new fenestration approach for arytenoid adduction.
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Kanazawa T, Watanabe Y, Komazawa D, Indo K, Misawa K, Nagatomo T, Shimada M, Iino Y, Ichimura K. Phonological outcome of laryngeal framework surgery by different anesthesia protocols: a single-surgeon experience. Acta Otolaryngol 2014; 134:193-200. [PMID: 24215214 DOI: 10.3109/00016489.2013.847283] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION Similar to combined arytenoid adduction and medialization laryngoplasty (i.e. combined surgery) under local anesthesia, general anesthesia by intubation or by the laryngeal mask airway (LMA) method significantly improves phonological outcome. Thus, laryngeal framework surgery under general anesthesia is a promising surgical approach for selected patients with unilateral vocal cord paralysis (UVCP). OBJECTIVE The advantages of laryngeal framework surgery under local anesthesia have been described, but no studies exist concerning the difference in phonological outcome of laryngeal framework surgery performed under general anesthesia. To add new information, we retrospectively investigated the phonological outcome of the combined surgery performed under three different anesthesia protocols. METHODS Thirty-nine consecutive patients with severe UVCP underwent the combined surgery under three anesthesia protocols performed by a single surgeon: (1) under general anesthesia by intubation, (2) under general anesthesia using LMA, and (3) under local anesthesia. RESULTS Under all anesthesia protocols, the vocal cords of most patients could be positioned such that the best vocal outcome could be expected. Statistical analyses demonstrated improved maximum phonation time and mean airflow rate, and grade, roughness, breathiness, asthenia, and strain (GRBAS) scale in all patients, regardless of their anesthesia protocol. Furthermore, of the three protocols, local anesthesia had the shortest operation time.
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Affiliation(s)
- Takeharu Kanazawa
- Department of Otolaryngology/Head and Neck Surgery, Jichi Medical University, School of Medicine , Shimotsuke , Japan
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Zapater E, García-Lliberós A, López I, Moreno R, Basterra J. A new device to improve the location of a montgomery thyroplasty prosthesis. Laryngoscope 2014; 124:1659-62. [DOI: 10.1002/lary.24545] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2013] [Revised: 11/16/2013] [Accepted: 12/03/2013] [Indexed: 11/11/2022]
Affiliation(s)
| | | | - Isabel López
- ENT Department; University General Hospital; Valencia Spain
| | - Rosa Moreno
- Rehabilitation Department; University General Hospital; Valencia Spain
| | - Jorge Basterra
- ENT Department; University General Hospital; Valencia Spain
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Konomi U, Watanabe Y, Komazawa D. Application of pitch range evaluation subsequent to arytenoid adduction and thyroplasty. J Voice 2013; 28:394.e5-12. [PMID: 24345604 DOI: 10.1016/j.jvoice.2013.10.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2013] [Accepted: 10/23/2013] [Indexed: 11/20/2022]
Abstract
OBJECTIVE The purpose of this study was to figure out the application of pitch range (PR) evaluation subsequent to arytenoid adduction (AA) combined with type 1 thyroplasty (TP1) in unilateral vocal fold paralysis (UVFP). STUDY DESIGN Retrospective review of clinical records. METHODS Subjects were 50 patients with UVFP for whom PR and maximum phonation time (MPT) could be evaluated before and 1 year after AA + TP1. Subjects were divided into two groups based on preoperative PR (pre-PR) (group 1: ≤1 semitone (ST); group 2: ≥2 ST). Correlations among pre-PR and post-PR, MPT, and age were assessed. We also evaluated PRs in subjects with PR deterioration and PRs by causative diseases. RESULTS PR was significantly extended from a median of 17.0-22.0 ST in all subjects. Pre-PR was correlated with post-PR. Post-PR correlated with post-MPT in group 2 but not in group 1. There was no correlation between post-PR and age or causative diseases. The mean change in PR among subjects with PR deterioration (28.0%, 14/50) was -3.6 ST. Pre-PR and the improvement of post-PR were negatively correlated in group 2. CONCLUSION PR evaluation can be useful for predicting post-PR. The effects of age and causative diseases were small compared with other factors, such as pre-PR width and surgical effects. The successful surgery may improve both PR and MPT. However, several cases showed obvious discrepancy of those postoperative improvements. It will be necessary to assess this discrepancy, particularly in subjects with postoperative voice insufficiency.
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Affiliation(s)
- Ujimoto Konomi
- Department of Otolaryngology, International University of Health and Welfare, Mita Hospital, Shinjuku-ku, Tokyo, Japan; Department of Otolaryngology, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan.
| | - Yusuke Watanabe
- Department of Otolaryngology, International University of Health and Welfare, Mita Hospital, Shinjuku-ku, Tokyo, Japan; Tokyo Voice Center, International University of Health and Welfare, Sanno Hospital, Minato-Ku, Tokyo, Japan
| | - Daigo Komazawa
- Department of Otolaryngology, International University of Health and Welfare, Mita Hospital, Shinjuku-ku, Tokyo, Japan
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Kanazawa T, Watanabe Y, Hara M, Shinnabe A, Kusaka G, Murayama T, Iino Y. Arytenoid adduction combined with medialization laryngoplasty under general anesthesia using a laryngeal mask airway. Am J Otolaryngol 2012; 33:303-7. [PMID: 21962288 DOI: 10.1016/j.amjoto.2011.08.008] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2011] [Revised: 07/31/2011] [Accepted: 08/08/2011] [Indexed: 12/01/2022]
Abstract
PURPOSE Laryngeal framework surgery is usually performed under local anesthesia but cannot be tolerated by some patients. To develop a new procedure for these patients, we evaluated voice outcomes after arytenoid adduction combined with medialization laryngoplasty under general anesthesia using a laryngeal mask airway (LMA) for unilateral vocal cord paralysis. MATERIALS AND METHODS Eleven consecutive patients with severe unilateral vocal cord paralysis, with a maximum phonation time of less than 5 seconds, underwent arytenoid adduction combined with medialization laryngoplasty under general anesthesia using an LMA. Each paralyzed vocal cord was observed by intraoperative videolaryngoscopy. The vocal cord was moved to the position where the best vocal outcome could be expected, according to 3 parameters obtained from glottal images. RESULTS All patients achieved a maximum phonation time of more than 11 seconds. The mean airflow rate, which ranged from 550 to 1000 mL/s before surgery, improved to less than 390 mL/s. Perceptual evaluation using the grade, roughness, breathiness, asthenia and strain scale also improved significantly. CONCLUSIONS These results were equivalent to those of previous reports of surgeries performed under local anesthesia. Intraoperative endoscopic vocal cord observation through the LMA may have contributed to the positive results.
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Affiliation(s)
- Takeharu Kanazawa
- Department of Otolaryngology/Head and Neck Surgery, Jichi Medical University Saitama Medical Center, Saitama City, Saitama, Japan.
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Tokashiki R, Hiramatsu H, Shinada E, Motohashi R, Nomoto M, Toyomura F, Suzuki M. Analysis of pitch range after arytenoid adduction by fenestration approach combined with type I thyroplasty for unilateral vocal fold paralysis. J Voice 2012; 26:792-6. [PMID: 22417985 DOI: 10.1016/j.jvoice.2011.11.012] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2011] [Accepted: 11/29/2011] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to determine the postoperative pitch range acquired in cases of unilateral vocal fold paralysis, as well as factors affecting outcomes. SUBJECTS AND METHODS We analyzed 39 cases of unilateral vocal fold paralysis for which surgery was performed between January 2006 and January 2009 and for which pitch ranges and the items listed below were measured preoperatively and 1 year postoperatively. Arytenoid adduction (AA) and type I thyroplasty were performed simultaneously in all cases regardless of preoperative severity. AA was performed by the fenestration approach as previously reported. In this procedure, the cricoarytenoid and cricothyroid joints are not released. Correlations between pitch range acquired postoperatively and the following items were examined: (1) pre- and postoperative maximum phonation time (MPT), (2) pre- and postoperative mean airflow rate (MFR), and (3) preoperative pitch range. Furthermore, patients were surveyed regarding their ability to sing after surgery, and the pitch range cutoff value dividing ability and inability to sing was calculated. RESULTS Pitch range increased significantly from 3±4.47 halftones (mean ± standard deviation) preoperatively to 17.5±5.80 halftones postoperatively. Preoperative MPT, MFR, and pitch range did not correlate with postoperative pitch range. Postoperatively, only MPT correlated with the width of postoperative pitch range. Twenty-three of 39 subjects (59%) responded that they were able to sing, and the pitch range cutoff value dividing the two groups was 22 halftones. CONCLUSION AA and type I thyroplasty significantly expanded postoperative pitch range. There was no correlation between preoperative severity and width of pitch range acquired postoperatively.
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Affiliation(s)
- Ryoji Tokashiki
- Department of Otolaryngology, Tokyo Medical University, Tokyo, Japan.
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Okamoto I, Tokashiki R, Hiramatsu H, Motohashi R, Suzuki M. Detection of passive movement of the arytenoid cartilage in unilateral vocal-fold paralysis by laryngoscopic observation: useful diagnostic findings. Eur Arch Otorhinolaryngol 2011; 269:565-70. [PMID: 21971719 DOI: 10.1007/s00405-011-1787-4] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2011] [Accepted: 09/20/2011] [Indexed: 11/29/2022]
Abstract
In a previous study of patients with unilateral vocal-fold paralysis (UVFP), three-dimensional computed tomography (3DCT) revealed passive movement during phonation, with the arytenoid cartilage on the paralyzed side pushed to the unaffected side and deviated upwards. The present work compares the 3DCT findings with those obtained by 2-dimensional endoscopy to visualize the vertical passive movement of the arytenoid cartilage. The study population consisted of 23 patients with UVFP and two with laryngeal deviation but normal movement of the vocal folds. Two endoscopic findings represented cranial deviation during phonation: posterior deviation of the arytenoid hump and lateral deviation of the muscular process. These two findings were classified into four grades, ranging from 0 (normal) to 3 (severe). Cranial displacement detected by 3DCT was also classified into four grades. Significant correlations were found between the 3DCT-determined grade of cranial displacement of the arytenoid cartilage and the grade assigned based on the two endoscopic findings. Moreover, lateral deviation of the muscular process was more significantly correlated with 3DCT grade than with endoscopic grade. Thus, endoscopic findings may be useful in the diagnosis of vocal-fold paralysis, and passive lateral deviation of the muscular process as an indicator of UVFP.
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Affiliation(s)
- Isaku Okamoto
- Department of Otorhinolaryngology, Tokyo Medical University Hospital, 6-7-1, Shinjuku-ku, Nishi Shinjuku, Tokyo, 160-0023, Japan.
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Hassan MM, Yumoto E, Baraka MA, Sanuki T, Kodama N. Arytenoid rotation and nerve-muscle pedicle transfer in paralytic dysphonia. Laryngoscope 2011; 121:1018-22. [PMID: 21520118 DOI: 10.1002/lary.21657] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS Our objective was to evaluate the efficacy of modified nerve-muscle pedicle (NMP) flap transfer combined with arytenoid adduction (AA) (AA + modified NMP) for treatment of unilateral vocal fold paralysis. The patterns of voice outcome assessed using phonatory function tests and auditory perceptual judgments were followed-up for 2 years. STUDY DESIGN Prospective study. METHODS Thirteen subjects among those presented with paralytic dysphonia between March 2002 and December 2008 were treated with AA + modified NMP. The voice outcomes (six objective and two subjective voice parameters) were evaluated preoperatively and in four different time points postoperatively over 2-years duration. RESULTS All voice parameters showed initial postoperative improvement. Moreover, five parameters showed significant continuous improvement over the 2-year follow-up (maximum phonation time, pitch range, shimmer, and grade overall and breathiness of the grade-roughness-breathiness-asthenia-strain scale (GRBAS), whereas two parameters revealed continuous improvement over the first 12 to 14 months after surgery (mean flow rate and harmonics-to-noise ratio). CONCLUSIONS AA + modified NMP improves both short- and long-term voice outcomes in unilateral vocal fold paralysis patients. Therefore, AA + modified NMP is an effective surgical combination for the treatment of severe paralytic dysphonia.
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Affiliation(s)
- Megahed M Hassan
- Unit of Phoniatrics-Department of Otolaryngology, Faculty of Medicine, Sohag University, Sohag, Egypt
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Murata T, Yasuoka Y, Shimada T, Shino M, Iida H, Takahashi K, Furuya N. A new and less invasive procedure for arytenoid adduction surgery. Laryngoscope 2011; 121:1274-80. [DOI: 10.1002/lary.21762] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2010] [Revised: 01/20/2011] [Accepted: 01/24/2011] [Indexed: 11/10/2022]
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Tokashiki R, Hiramatsu H, Motohashi R, Shinada E, Inoue S. [Recent findings in the treatment of voice disorders]. NIHON JIBIINKOKA GAKKAI KAIHO 2011; 114:491-497. [PMID: 21776621 DOI: 10.3950/jibiinkoka.114.491] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
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Hess M, Schroeder D, Püschel K. Sling arytenoid adduction. Eur Arch Otorhinolaryngol 2011; 268:1023-8. [DOI: 10.1007/s00405-010-1429-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2010] [Accepted: 11/08/2010] [Indexed: 11/28/2022]
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Nito T, Ushio M, Kimura M, Yamaguchi T, Tayama N. Analyses of risk factors for postoperative airway compromise following arytenoid adduction. Acta Otolaryngol 2009; 128:1342-7. [PMID: 18607932 DOI: 10.1080/00016480801958303] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
CONCLUSION This study suggests that placing no drainage tube and postoperative bleeding are risk factors for postoperative airway compromise (PAC) following arytenoid adduction (AA). OBJECTIVES In this study, we aimed to elucidate the risk factors for PAC following AA. PATIENTS AND METHODS The data for 184 consecutive patients who underwent AA were analyzed retrospectively. Univariate and forward stepwise multivariate logistic regression analyses were performed. RESULTS Placing no drainage tube was a significant risk factor for PAC as determined by both univariate and multivariate analyses. Postoperative bleeding was a significant risk factor for severe airway compromise requiring emergency airway treatment.
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Laryngeal function after supracricoid laryngectomy. Otolaryngol Head Neck Surg 2009; 140:487-92. [DOI: 10.1016/j.otohns.2008.12.036] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2008] [Revised: 10/27/2008] [Accepted: 12/16/2008] [Indexed: 11/23/2022]
Abstract
Objective: The purpose of this study was to assess laryngeal function after supracricoid laryngectomy. Study Design: Case series. Subjects and Methods: Supracricoid laryngectomy (SCL) has been performed in our institution for 24 selected patients with laryngeal cancer since December 2000. Reconstruction was performed through cricohyoidoepiglottopexy for 23 patients and cricohyoidopexy for 1 patient. Seven patients had ipsilateral arytenoid removal, and 15 patients underwent SCL as salvage surgery. A retrospective chart review was performed to assess postoperative speech and swallowing function. Stroboscopy and/or fiberscopy of the neoglottis were used to assess postoperative speech kinetics. Acoustic parameters were measured to evaluate vocal function, and several questionnaires were used to evaluate postoperative quality of life (QOL). Results: In the absence of postoperative complications, stoma closure and normal diet intake were achieved 1 month after surgery. The neoglottis comprises the arytenoid(s), epiglottis, and pyriform sinus mucosa. Several different combinations of vibrating regions were observed among patients during phonation. Although vocalization sounded rough and breathy, vocal communication was possible with little inconvenience. Conclusion: Acceptable functional recovery and tolerable QOL can be achieved after SCL.
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Characterization of arytenoid vertical displacement in unilateral vocal fold paralysis by three-dimensional computed tomography. Eur Arch Otorhinolaryngol 2008; 266:97-104. [PMID: 18437409 DOI: 10.1007/s00405-008-0682-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2008] [Accepted: 04/11/2008] [Indexed: 10/22/2022]
Abstract
The paralyzed arytenoid is not immobile and is subjected to passive movement during phonation. If anatomical changes during inspiration and phonation are compared by three-dimensional computed tomography (3D CT), it is possible to observe vertical movement of the paralyzed arytenoid. Our aim was to use 3D CT to examine the characteristics of 3D arytenoid movement in unilateral vocal fold paralysis (UVFP). This is a prospective study. A total of 61 patients (18 females and 43 males) with UVFP who had undergone 3D CT imaging between April 2005 and January 2007 were included. Cricoid and arytenoid cartilage was imaged by 3D CT. We detected the movements of the paralyzed side when comparing inspiration and phonation. The degree of cranial displacement of the paralyzed arytenoids was classified into three grades (I for mild to III for severe). The mean flow rate (MFR) was calculated for each grade. By comparing the MFR of each grade with the normal control group, we determined whether cases would worsen according to grade. Passive gliding movement of the paralyzed arytenoids was found in 90.7% of cases. In all cases, the paralyzed arytenoids were displaced cranially compared to the unaffected side. MFR worsened significantly as the grade became more severe. We believe that the passive gliding movements observed when comparing inspiration and phonation are characteristic of paralysis. Even in mild cases, the paralyzed arytenoids are passively displaced cranially during phonation, and the degree of this displacement is one indicator that can be used to evaluate the severity of UVFP.
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