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Fancello V, Migliorelli A, Campomagnani I, Morolli F, Stomeo F, Ricci-Maccarini A, Magnani M, Stacchini M. Surgical and Functional Outcomes of Posterior Cordotomy and Partial Arytenoidectomy with CO 2 LASER in the Treatment of Bilateral Vocal Cord Immobility: A Single Institution Experience. J Clin Med 2024; 13:3670. [PMID: 38999236 PMCID: PMC11242032 DOI: 10.3390/jcm13133670] [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: 05/22/2024] [Revised: 06/13/2024] [Accepted: 06/20/2024] [Indexed: 07/14/2024] Open
Abstract
Background/Objectives: The purpose of this study is to investigate surgical and functional outcomes of patients affected by bilateral vocal cord immobility (BVCI) and treated with posterior cordotomy and partial arytenoidectomy. Methods: We performed a retrospective analysis on pre- and postoperative findings on a series of 27 patients affected by BVCI and treated with posterior cordotomy and partial arytenoidectomy from January 2017 to January 2022. Perceptual voice evaluations were performed using the GRBAS scale. The patients were requested to estimate the level of voice handicap experienced in their life using the Italian version of Voice Handicap Index 10 (VHI 10) questionnaire, while swallowing difficulties were self-evaluated through the Italian version of the Eating Assessment Tool (EAT-10) questionnaire. Results: Respiratory distress was evaluated according to the American Medical Research Council Dyspnoea Scale (MRC_DS) before and 1 year after the surgery. The mean of the preoperative values was 3.86 (±0.4), while 1 year after the procedure, we witnessed a significant (p ≤ 0.001) improvement, with a mean value of 1.09 (±0.9). After surgery, an overall worsening in voice quality was perceived, with a worsening in the GRBAS score. In contrast, the VHI10 does not show a statistically significant worsening. EAT 10 did not demonstrated worse scores after the surgery; rather, it showed a trend of improvement (preoperative EAT10 5.5 ± 5.8, postoperative 3.3 ± 2.9, p = 0.064). Conclusions: According to our results, posterior cordotomy plus partial arytenoidectomy is an effective procedure that provides stable and rapid respiratory improvement whilst preserving swallowing and the self-perception of voice quality.
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Affiliation(s)
- Virginia Fancello
- ENT & Audiology Unit, Department of Neurosciences, University Hospital of Ferrara, 44124 Ferrara, Italy
| | - Andrea Migliorelli
- ENT & Audiology Unit, Department of Neurosciences, University Hospital of Ferrara, 44124 Ferrara, Italy
| | - Isotta Campomagnani
- ENT & Audiology Unit, Department of Neurosciences, University Hospital of Ferrara, 44124 Ferrara, Italy
| | | | - Francesco Stomeo
- ENT & Audiology Unit, Department of Neurosciences, University Hospital of Ferrara, 44124 Ferrara, Italy
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El-Sobki A, Elzayat S, El-Deeb ME, Ibrahim RAE, Gehad I, Negm A, Alsobky MEI, Elgendy A. Surgical Management of Bilateral Abductor Paralysis: Diode Laser Versus Coblation; A Prospective Study. J Voice 2023:S0892-1997(23)00318-1. [PMID: 37923654 DOI: 10.1016/j.jvoice.2023.10.008] [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: 08/22/2023] [Revised: 10/04/2023] [Accepted: 10/05/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVES We aimed to compare the results of both diode laser and coblation in the treatment of bilateral vocal fold immobility (BVFI). MATERIALS AND METHODS This prospective clinical study was performed on 80 non-tracheostomised patients with bilateral vocal fold paralysis divided into two groups; Group A: diode laser, Group B: coblation. Medical Research Council "mMRC" Dyspnea scale, maximal phonatory time (MPT), Voice handicap index (VHI), and functional outcome swallowing scale (FOSS) were assessed preoperatively and postoperatively. Also, the VAS pain scale and operative time of both groups are recorded. RESULTS Within each group, there was a statistically significant decrease in the mMRC dyspnea scale and maximum phonation time and a significant increase in VHI (P < 0.001). There was a statistically significant difference between the studied groups postoperative and regarding the percent change of the MPT ( more decrease in the coblation group). Concerning the operative time and the VAS pain score, there was a statistically significant difference between the studied groups regarding operating time and the VAS pain scale (significantly lower in the coblation group) (P < 0.001). CONCLUSION Both Coblation and diode laser are effective tools in the treatment of BVFI with similar minimal voice quality affection. The maximum phonation time decreased more in the coblation group, while the voice handicap index did not significantly differ between both groups. However, Coblation may be superior to diode laser in terms of less operative pain and shorter intraoperative time. Coblation may be more favorable for patients at risk of prolonged general anesthesia duration.
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Affiliation(s)
- Ahmed El-Sobki
- Otorhinolaryngology Department, Faculty of Medicine-Mansoura University, Egypt
| | - Saad Elzayat
- Otorhinolaryngology Department, Faculty of Medicine, Kafrelsheikh University, Egypt
| | - Mohamed E El-Deeb
- Otorhinolaryngology Department, Faculty of Medicine, Kafrelsheikh University, Egypt.
| | - Reham A E Ibrahim
- Phoniatrics Department, Faculty of Medicine, Assiut University, Egypt
| | - Ibrahim Gehad
- Otorhinolaryngology Department, Faculty of Medicine, Kafrelsheikh University, Egypt
| | - Ahmed Negm
- Otorhinolaryngology Department, Faculty of Medicine, Misr University for science and technology, Egypt
| | | | - Ahmed Elgendy
- Otorhinolaryngology Department, Faculty of Medicine, Kafrelsheikh University, Egypt
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Titulaer K, Schlattmann P, Guntinas-Lichius O. Surgery for bilateral vocal fold paralysis: Systematic review and meta-analysis. Front Surg 2022; 9:956338. [PMID: 35937593 PMCID: PMC9354550 DOI: 10.3389/fsurg.2022.956338] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Accepted: 07/08/2022] [Indexed: 11/30/2022] Open
Abstract
Objectives To determine the decannulation rate (DR) and revision surgery rate after surgery for bilateral vocal fold paralysis (BVFP). Data Sources Five databases (MEDLINE, PubMed, Embase, Web of Science, Scopus) were searched for the period 1908-2020. Methods The systematic literature review followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Data were pooled using a random-mixed-effects model. Randomized controlled trials and non-randomized studies (case-control, cohort, and case series) were included to assess DR and revision surgery rate after different surgical techniques for treatment of BVFP. Results The search yielded 857 publications, of which 102 with 2802 patients were included. DR after different types of surgery was: arytenoid abduction (DR 0.93, 95%-confidence interval [CI], 0.86-0.97), endolaryngeal arytenoidectomy (DR 0.92, 95%-CI, 0.86-0.96), external arytenoidectomy (DR 0.94; 95%-CI, 0.71-0.99), external arytenoidectomy and lateralisation (DR 0.87; 95%-CI, 0.73-0.94), laterofixation (DR 0.95; 95%-CI, 0.91-0.97), posterior cordectomy (DR 0.97, 95%-CI, 0.94-0.99), posterior cordectomy and arytenoidectomy (DR 0.98, 95%-CI, 0.93-0.99), posterior cordectomy and subtotal arytenoidectomy (DR 0.98, 95%-CI, 0.88-1.00), posterior cordotomy (DR 0.96, 95%-CI, 0.84-0.99), reinnervation (0.69, 95%-CI, 0.12-0.97), subtotal arytenoidectomy (DR 1.00, 95%-CI, 0.00-1.00) and transverse cordotomy (DR 1.0, 95%-CI, 0.00-1.00). No significant difference between subgroups for DR could be found (Q = 15.67, df = 11, p = 0.1540). The between-study heterogeneity was low (τ2 = 2.2627; τ = 1.5042; I2 = 0.0%). Studies were at high risk of bias. Conclusion BLVP is a rare disease and the study quality is insufficient. The existing studies suggest a publication bias and the literature review revealed that there is a lack of prospective controlled studies. There is a lack of standardized measures that takes into account both speech quality and respiratory function and allows adequate comparison of surgical methods.
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Affiliation(s)
- Kai Titulaer
- Department of Otorhinolaryngology, Jena University Hospital, Jena, Germany
| | - Peter Schlattmann
- Department of Medical Statistics, Computer Sciences and Data Sciences, Jena University Hospital, Jena, Germany
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El-Sobki A, El-Deeb ME, El-Kholy NA, Habaza FR, Shawky MA, Alsobky MEI. Surgical management of laryngeal bilateral abductor palsy: comparative study between carbon dioxide and diode lasers. Lasers Med Sci 2022; 37:3169-3175. [PMID: 35699806 DOI: 10.1007/s10103-022-03589-x] [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: 01/17/2022] [Accepted: 06/04/2022] [Indexed: 11/29/2022]
Abstract
This study aims to compare the results of both CO2 laser and diode laser combined arytenoidectomy with posterior cordectomy in managing patients with bilateral vocal fold paralysis. A prospective study involved 80 bilateral vocal cord immobility patients in adduction. They are divided into two groups according to the laser used, whether CO2 (with a wavelength of 10.6 µm) or diode (with a wavelength of 980 nm). We used mMRC (Modified Medical Research Council) dyspnea scale to assess dyspnea in our patients, while the voice was evaluated by both maximum phonation time and the voice handicap index. Quantitative variables were described using means and standard deviations, while categorical variables were described using frequencies and were compared using the chi-square test, Fisher exact test, and Monte Carlo test. There was a statistically non-significant difference between the studied groups regarding mMRC dyspnea scale and Voice Handicap Index preoperatively and postoperatively. There is a statistically significant difference between the two groups regarding maximum phonation time postoperatively (significantly higher in the CO2 laser group) (p < 0.001). The CO2 laser and diode laser could be used safely for the management of bilateral vocal cord paralysis. The CO2 laser maintains better voice parameters and less postoperative pain, while the diode laser gives less operative time, lower cost, and simplicity of use.
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Affiliation(s)
- Ahmed El-Sobki
- Otorhinolaryngology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Mohamed E El-Deeb
- Otorhinolaryngology Department, Faculty of Medicine, Kafrelsheikh University, Kafrelsheikh, 33155, Egypt.
| | - Noha Ahmed El-Kholy
- Otorhinolaryngology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Fedaey R Habaza
- Otorhinolaryngology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
| | - Mahmoud Ahmed Shawky
- Otorhinolaryngology Department, Faculty of Medicine, Al-Azhar University, Damietta, Egypt
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Rouhani MJ, Morley I, Lovell L, Roe J, Devabalan Y, Bidaye R, Sandhu G, Al Yaghchi C. Assessment of swallow function pre- and post-endoscopic CO2 laser medial arytenoidectomy: a case series. Clin Otolaryngol 2021; 47:347-350. [PMID: 34800322 DOI: 10.1111/coa.13896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 09/14/2021] [Accepted: 11/07/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Maral J Rouhani
- National Centre for Airway Reconstruction, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Isobel Morley
- National Centre for Airway Reconstruction, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Lindsay Lovell
- National Centre for Airway Reconstruction, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Justin Roe
- National Centre for Airway Reconstruction, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Yadsan Devabalan
- National Centre for Airway Reconstruction, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Rohan Bidaye
- National Centre for Airway Reconstruction, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Guri Sandhu
- National Centre for Airway Reconstruction, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Chadwan Al Yaghchi
- National Centre for Airway Reconstruction, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
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Vajpayee D, Vaid D, Saha R, Goyal A. Surgical Management of Bilateral Abductor Palsy: Comparative Study Between Posterior Cordotomy and Partial Arytenoidectomy. Indian J Otolaryngol Head Neck Surg 2021; 73:340-345. [PMID: 34471623 DOI: 10.1007/s12070-021-02556-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Accepted: 04/12/2021] [Indexed: 11/28/2022] Open
Abstract
The aim of this study is to analyse outcome of patients with bilateral abductor palsy undergoing unilateral partial arytenoidectomy and unilateral posterior cordotomy in terms of respiration, phonation and risk of aspiration. Initially tracheostomy was only treatment available to relieve respiratory distress. Now various methods are described e.g. endoscopic posterior cordotomy, arytenoidectomy, suture lateralization of vocal cords, laryngeal reinnervation and muscle transfer procedures. In our study, review of management of 21 cases of bilateral abductor palsy were carried out. Patient assessment included fibre optic laryngoscopy and radiology. Unilateral partial arytenoidectomy was carried out in 9 patients and unilateral posterior cordotomy was carried out in 12 patients. All the 21 cases in our study were tracheotomised. Among the 21 surgically treated patients 90.5% patients were decannulated. The mean increase in VHI 10 score after surgery was of 4.8. The mean increase was 4 in the partial arytenoidectomy group, whereas the mean increase in the posterior cordotomy group was 5. There was no history of aspiration following surgery. The percentage of cases requiring revision surgery was 33% in patients undergoing partial arytenoidectomy and was 25% in patients undergoing posterior cordotomy. Analysis of results after 12 months revealed that both unilateral posterior cordotomy and unilateral partial arytenoidectomy are effective and satisfactory procedures in treatment of bilateral abductor palsy.
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Affiliation(s)
| | - Divya Vaid
- Guru Teg Bahadur Hospital, New Delhi, India
| | - Richa Saha
- Guru Teg Bahadur Hospital, New Delhi, India
| | - Arun Goyal
- Guru Teg Bahadur Hospital, New Delhi, India
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Ghodke A, Tracy LF, Hollis A, Adams K, Shah RN, Buckmire RA. Combined Transverse Cordotomy- Anteromedial Arytenoidectomy for Isolated Glottic Stenosis. Laryngoscope 2021; 131:2305-2311. [PMID: 33577090 DOI: 10.1002/lary.29438] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Revised: 01/22/2021] [Accepted: 01/26/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVES/HYPOTHESIS Glottic stenosis is a discrete cause of airway compromise. We aimed to determine the surgical outcomes of transverse cordotomy with anteromedial arytenoidectomy (TCAMA), performed in the setting of isolated glottic stenosis resulting from two discrete etiologies: bilateral vocal fold paralysis (BVFP) and posterior glottic stenosis (PGS). STUDY DESIGN Retrospective, analytic cohort study. METHODS Twenty-six patients with isolated glottic stenosis were treated with TCAMA between 2006 and 2019. A retrospective analysis determined decannulation rates and intervals, voice outcomes, swallowing outcomes, and reoperation rates postoperatively. Outcomes between the two etiologic cohorts were compared. RESULTS Of the 26 patients, 16/26 patients were diagnosed with PGS and 10/26 with BVFP. Eighteen patients required tracheotomies during their clinical course (11/16 PGS, and 7/10 BVFP), and 100% were ultimately decannulated. The PGS cohort required two-sided interventions more frequently than the BVFP cohort (45.5% vs. 0%, P = .066). Trach-dependent PGS patients required a longer time to achieve decannulation than BVFP patients by a factor of 2.38, although the difference was not statistically significant (102.3 days vs. 42.9 days, respectively, P = .113). Patients demonstrated a significant change in maximum phonation time but no statistically significant differences with preoperative versus postoperative voice outcomes like voice-related quality of life. All patients ultimately returned to their baseline swallow function postoperatively. CONCLUSION TCAMA is an effective treatment for surgical rehabilitation of glottic stenosis caused by both BVFP and PGS. Patient-reported outcomes of postoperative vocal function remain consistent following surgical intervention. Additional, prospective studies with greater power are warranted to validate the contrasting outcomes observed when applying this discrete surgical technique across two distinct diagnostic cohorts in this retrospective study. LEVEL OF EVIDENCE 4. Laryngoscope, 2021.
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Affiliation(s)
- Ameer Ghodke
- University of North Carolina School of Medicine, Chapel Hill, North Carolina, U.S.A
| | - Lauren F Tracy
- Department of Otolaryngology-Head and Neck Surgery, Boston University School of Medicine, Boston, Massachusetts, U.S.A
| | - Alison Hollis
- University of North Carolina School of Medicine, Chapel Hill, North Carolina, U.S.A
| | - Katherine Adams
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, U.S.A
| | - Rupali N Shah
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, U.S.A
| | - Robert A Buckmire
- Department of Otolaryngology-Head and Neck Surgery, University of North Carolina, Chapel Hill, North Carolina, U.S.A
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Maqbool T, Ahmed R, Ali I. Our Experience with Kashimas Procedure for Bilateral Abductor Vocal Cord Palsy. IRANIAN JOURNAL OF OTORHINOLARYNGOLOGY 2020; 32:281-285. [PMID: 33014904 PMCID: PMC7515623 DOI: 10.22038/ijorl.2019.33863.2126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/17/2018] [Accepted: 05/16/2019] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Kashima operation, also known as endoscopic laser cordotomy is used for the treatment of bilateral abductor vocal cord palsy where the glottis chink is made posteriorly, sufficient enough for patient to breathe comfortably without any strider. MATERIALS AND METHODS This Clinical Trial Was Performed On 12 Patients with Bilateral Abductor Vocal Cord Paralysis. All Patients Underwent Kashimas Procedure and Post-Operative Voice, Respiratory and Deglutition Function Were Evaluated. RESULTS 75% of patients were females and the mean age of patients was 40.9 ±9.13 years. In our patients, the most common etiology of bilateral vocal cord palsy was thyroid surgery (n=10, 83.33%).There was a significant improvement in breathing after surgery (P=0.001). After the procedure, 70% of patient had mild voice handicap score, and MPT was in normal range in 91.6% of cases. CONCLUSION Kashimas procedure is a satisfactory surgical treatment for treating bilateral vocal cord palsy in regards to strider. No aspiration was seen in any of the patients post-surgery and voice outcome of these patients was also satisfactory.
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Affiliation(s)
- Tabish Maqbool
- Department of Otorhinolaryngology, Head and Neck Surgery,Govt. Medical College Srinagar, Srinagar, India.
| | - Rauf Ahmed
- Department of Otorhinolaryngology, Head and Neck Surgery,Govt. Medical College Srinagar, Srinagar, India.
| | - Ihsan Ali
- Department of Otorhinolaryngology, Head and Neck Surgery,Govt. Medical College Srinagar, Srinagar, India.
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Endoscopic Partial Arytenoidectomy for Bilateral Vocal Fold Paralysis: Medially Based Mucosal Flap Technique. J Voice 2019; 33:751-758. [DOI: 10.1016/j.jvoice.2018.04.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Accepted: 04/11/2018] [Indexed: 11/30/2022]
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Ma Y, Wang R, Zhang Y, Le J, Zhuang P, Pulvermacher AC. Evaluation of Surgical Strategies for Bilateral Vocal Fold Paralysis Using Excised Canine Larynges. J Voice 2018; 33:33-39. [PMID: 29478709 DOI: 10.1016/j.jvoice.2017.10.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2017] [Revised: 10/11/2017] [Accepted: 10/16/2017] [Indexed: 10/18/2022]
Abstract
OBJECTIVE The objective of this study was to provide a theoretical basis for the selection of optimal surgical procedures in ex vivo simulated bilateral vocal fold paralysis (BVFP). STUDY DESIGN Four surgical stages were sequentially performed on 10 excised canine larynges with simulated BVFP: (1) transverse cordotomy, (2) medial arytenoidectomy, (3) subtotal arytenoidectomy, and (4) total arytenoidectomy. MATERIALS AND METHODS The sound pressure level, the signal-to-noise ratio, the glottal resistance, the glottal airflow (GF), the maximal glottal area (MGA), and spectrograms were measured after each stage. For comparative analysis of variance, a randomized block design and the Student-Newman-Keuls test were performed. RESULTS Under stable phonation, the sound pressure level showed no significant differences among the four stages. The signal-to-noise ratio was significantly different between the preoperative period and stage 1, as well as between stages 2 and 3. Glottal resistance was significantly different between the preoperative period and stage 1 and between stages 1 and 2. GF and MGA were significantly different among all stages, compared with those between stages 3 and 4 for GF and the preoperative period and stage 1 for MGA. The spectrograms indicated that the degree of disorder in the acoustic signals gradually increased. CONCLUSIONS Based on a comprehensive analysis of GF and voice quality in excised canine larynges, which simulated BVFP, our results suggest that the optimal surgical choice for BVFP is either medial or subtotal arytenoidectomy.
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Affiliation(s)
- YanLi Ma
- ENT Department, Xiamen University Zhongshan Hospital, Xiamen, Fujian, China
| | - RuiQing Wang
- ENT Department, Xiamen University Zhongshan Hospital, Xiamen, Fujian, China
| | - Yu Zhang
- Key Laboratory of Underwater Acoustic Communication and Marine Information Technology of the Ministry of Education, Xiamen University, Xiamen, Fujian, China
| | - Jiazhen Le
- ENT Department, Xiamen University Zhongshan Hospital, Xiamen, Fujian, China
| | - PeiYun Zhuang
- ENT Department, Xiamen University Zhongshan Hospital, Xiamen, Fujian, China.
| | - Allyson C Pulvermacher
- Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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Total and Partial Laser Arytenoidectomy for Bilateral Vocal Fold Paralysis. BIOMED RESEARCH INTERNATIONAL 2016; 2016:3601612. [PMID: 27830141 PMCID: PMC5086495 DOI: 10.1155/2016/3601612] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 09/19/2016] [Indexed: 11/23/2022]
Abstract
Introduction. Treatment for bilateral vocal fold paralysis (BVFP) has evolved from external irreversible procedures to endolaryngeal laser surgery with greater focus on anatomic and functional preservation. Since the introduction of endolaryngeal laser arytenoidectomy, certain modifications have been described, such as partial resection procedures and mucosa sparing techniques as opposed to total arytenoidectomy. Discussion. The primary outcome measure in studies on BVFP treatment using total or partial arytenoidectomy is avoidance of tracheotomy or decannulation and reported success ranges between 90 and 100% in this regard. Phonation is invariably affected and arytenoidectomy worsens both aerodynamic and acoustic vocal properties. Recent reports indicate that partial and total arytenoidectomies have similar outcome in respect to phonation and swallowing. We use CO2 laser assisted partial arytenoidectomy with a posteromedially based mucosal flap for primary cases and reserve total arytenoidectomy for revision. Lateral suturing of preserved mucosa provides tension on the vocal fold leading to better voice and leaves no raw surgical field to unpredictable scarring or granulation. Conclusion. Arytenoidectomy as a permanent static procedure remains a traditional yet sound choice in the treatment of BVFP. Laser dissection provides a precise dissection in a narrow surgical field and the possibility to perform partial arytenoidectomy.
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Bruegmann T, van Bremen T, Vogt CC, Send T, Fleischmann BK, Sasse P. Optogenetic control of contractile function in skeletal muscle. Nat Commun 2015; 6:7153. [PMID: 26035411 PMCID: PMC4475236 DOI: 10.1038/ncomms8153] [Citation(s) in RCA: 73] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 04/13/2015] [Indexed: 12/17/2022] Open
Abstract
Optogenetic stimulation allows activation of cells with high spatial and temporal precision. Here we show direct optogenetic stimulation of skeletal muscle from transgenic mice expressing the light-sensitive channel Channelrhodopsin-2 (ChR2). Largest tetanic contractions are observed with 5-ms light pulses at 30 Hz, resulting in 84% of the maximal force induced by electrical stimulation. We demonstrate the utility of this approach by selectively stimulating with a light guide individual intralaryngeal muscles in explanted larynges from ChR2-transgenic mice, which enables selective opening and closing of the vocal cords. Furthermore, systemic injection of adeno-associated virus into wild-type mice provides sufficient ChR2 expression for optogenetic opening of the vocal cords. Thus, direct optogenetic stimulation of skeletal muscle generates large force and provides the distinct advantage of localized and cell-type-specific activation. This technology could be useful for therapeutic purposes, such as restoring the mobility of the vocal cords in patients suffering from laryngeal paralysis.
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Affiliation(s)
- Tobias Bruegmann
- Institute of Physiology I, University of Bonn, Life and Brain Center, Sigmund-Freud-Strasse 25, 53127 Bonn, Germany.,Research Training Group 1873, University of Bonn, 53127 Bonn, Germany
| | - Tobias van Bremen
- Department of Otorhinolaryngology/Head and Neck Surgery, University Hospital of Bonn, Sigmund-Freud-Strasse 25, 53127 Bonn, Germany
| | - Christoph C Vogt
- Institute of Physiology I, University of Bonn, Life and Brain Center, Sigmund-Freud-Strasse 25, 53127 Bonn, Germany
| | - Thorsten Send
- Department of Otorhinolaryngology/Head and Neck Surgery, University Hospital of Bonn, Sigmund-Freud-Strasse 25, 53127 Bonn, Germany
| | - Bernd K Fleischmann
- Institute of Physiology I, University of Bonn, Life and Brain Center, Sigmund-Freud-Strasse 25, 53127 Bonn, Germany
| | - Philipp Sasse
- Institute of Physiology I, University of Bonn, Life and Brain Center, Sigmund-Freud-Strasse 25, 53127 Bonn, Germany
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Jomah M, Jeffery C, Campbell S, Krajacic A, El-Hakim H. Spontaneous recovery of bilateral congenital idiopathic laryngeal paralysis: systematic non-meta-analytical review. Int J Pediatr Otorhinolaryngol 2015; 79:202-9. [PMID: 25555638 DOI: 10.1016/j.ijporl.2014.12.007] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Revised: 12/07/2014] [Accepted: 12/08/2014] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To systematically review the frequency and time to spontaneous recovery in pediatric patients with bilateral congenital idiopathic laryngeal paralysis (BCILP). METHODS The databases of Medline, EMBASE, Scopus, CINAHL, Cochrane Library and Proquest Dissertations were searched for English language articles reporting on laryngeal paralysis in pediatric patients. A bibliography search of the selected studies was done to identify additional articles. We included prospective or retrospective case-series studies of children and neonates diagnosed with BCILP at age <60 days and confirmed by direct laryngoscopy, with sufficient follow up and objective assessment for recovery. Two authors independently extracted the data and assessed the quality of each study. Discrepancies were resolved by consensus and adjudication by a third author. RESULTS Of the 4229 articles identified by the search, only one study met our inclusion criteria. The study was a retrospective case series, and was of low quality. The mean age at diagnosis was fourteen days. Sixty-five percent of the patients recovered spontaneously, and the mean time to recovery was twenty-five months. Tracheostomy was performed in 71% of the patients. CONCLUSIONS The available literature is of low quality and provides weak evidence on the natural history of BCILP in pediatric population.
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Affiliation(s)
- Mohammed Jomah
- Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Caroline Jeffery
- Division of Otolaryngology - Head & Neck Surgery, The Stollery Children's Hospital & The University of Alberta Hospitals, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Sandra Campbell
- John W. Scott Health Science Library, University of Alberta, Edmonton, Alberta, Canada
| | - Aleksandra Krajacic
- Department of Surgery, The Stollery Children's Hospital & The University of Alberta Hospitals, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Hamdy El-Hakim
- Pediatric Otolaryngology Service, Division of Otolaryngology - Head & Neck Surgery, Department of Surgery, The Stollery Children's Hospital & The University of Alberta Hospitals, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada; Pediatric Otolaryngology Service, Division of Pediatric Surgery, Department of Pediatrics, The Stollery Children's Hospital & The University of Alberta Hospitals, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
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14
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Vorasubin N, Vira D, Jamal N, Chhetri DK. Airway management and endoscopic treatment of subglottic and tracheal stenosis: the laryngeal mask airway technique. Ann Otol Rhinol Laryngol 2014; 123:293-8. [PMID: 24671485 DOI: 10.1177/0003489414525340] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES The objective is to present clinical outcomes of subglottic and tracheal stenosis treated by flexible bronchoscopic delivery of carbon dioxide (CO2) laser via laryngeal mask airway (LMA). METHODS All consecutive, nontracheotomy dependent cases of subglottic and tracheal stenosis treated endoscopically over a 4-year period were retrospectively reviewed. The surgical approach consisted of radial incisions using a flexible fiber-based CO2 laser, balloon dilation, and topical application of mitomycin C. Ventilation during the procedure occurred through the LMA, and the CO2 laser fiber was delivered through the working channel of a flexible bronchoscope passed through the LMA. Number of dilations, period between dilations, and operative times were reviewed. RESULTS Eleven patients who underwent airway intervention during the study period were identified. Average follow-up was 28 months. Etiologies of airway stenosis included intubation injury (6), idiopathic (4), or autoimmune disease (1), requiring an average of 1.3, 1.5, and 3 dilations, respectively. Average operative time was 67 minutes. Autoimmune etiology correlated with more frequent dilations. CONCLUSION LMA is an effective way to manage ventilation while simultaneously allowing unencumbered flexible bronchoscopic access for laser surgery, balloon dilation, and mitomycin C application for airway stenosis. Long-term success in treating stenosis is achievable using this technique.
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Affiliation(s)
- Nopawan Vorasubin
- Department of Head and Neck Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California, USA
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15
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Panja S. Management of iatrogenic bilateral vocal cord paralysis by endoscopic transoral CO2 laser surgery – Report of two cases. APOLLO MEDICINE 2014. [DOI: 10.1016/j.apme.2014.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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16
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Gorphe P, Hartl D, Primov-Fever A, Hans S, Crevier-Buchman L, Brasnu D. Endoscopic laser medial arytenoidectomy for treatment of bilateral vocal fold paralysis. Eur Arch Otorhinolaryngol 2013; 270:1701-5. [DOI: 10.1007/s00405-013-2414-3] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Accepted: 02/19/2013] [Indexed: 11/30/2022]
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Abstract
PURPOSE OF REVIEW The pathophysiology of bilateral vocal fold immobility includes two broad categories: mechanical fixation and neurogenic paralysis. A mobile arytenoid can be surgically abducted, and this procedure has been reported as a treatment for patients with bilateral neurogenic laryngeal paralysis. This article reviews the theoretical basis and clinical outcomes of this procedure. RECENT FINDINGS Two concepts form the theoretical basis for arytenoid abduction. First, in most cases of neurogenic paralysis, laryngeal muscles are not denervated; there is considerable residual or regenerated function of adductor muscles. The vocal fold lies near the midline, because there is inadequate force to abduct the vocal fold. Second, the cricoarytenoid joint is multiaxial. The posterior cricoarytenoid (PCA) muscle rotates the arytenoid about an oblique axis to pull the vocal process laterally and superiorly, while the axis of adduction is nearly vertical. Thus, surgical abduction of the arytenoid, by simulating contraction of the PCA muscle, should not preclude active adduction during phonation or swallow. Surgical arytenoid abduction has been reported to improve the airway in many patients with bilateral laryngeal paralysis, with little or no impairment of vocal function. It is less successful in patients with inspiratory adductor muscle activity, long-term immobility, or previous procedures to statically enlarge the glottis. SUMMARY Arytenoid abduction is a promising treatment for selected patients with bilateral neurogenic laryngeal paralysis.
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Yılmaz T. Endoscopic total arytenoidectomy for bilateral abductor vocal fold paralysis: A new flap technique and personal experience with 50 cases. Laryngoscope 2012; 122:2219-26. [DOI: 10.1002/lary.23467] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2012] [Revised: 03/30/2012] [Accepted: 05/04/2012] [Indexed: 11/11/2022]
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19
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[Intraluminal surgical procedures for glottic enlargement in bilateral vocal fold paralysis in adduction]. Chirurg 2010; 82:116, 118-24. [PMID: 21170510 DOI: 10.1007/s00104-010-1973-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Bilateral vocal fold paralysis with paramedian position of the vocal chords can result from iatrogenic or traumatic nerve injuries, neurologic disorders and extralaryngeal malignancies and usually causes significant shortness of breath while the voice is only slightly affected. Only about 10% of the affected patients tolerate the narrowed airway caused by bilateral vocal fold paralysis in adduction, so most patients are candidates for a surgical intervention. Today, a range of intraluminal surgical procedures for enlargement of the glottis in bilateral vocal fold paralysis have been described which intend to avoid or supersede tracheostomy and which have replaced time-consuming external approaches to the glottis. This report provides an overview of the most important intraluminal surgical procedures for bilateral vocal fold paralysis in adduction and comments in detail on indications, surgical techniques, advantages and potential complications of the presented procedures for temporary or definitive enlargement of the glottis.
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20
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Abstract
Objectives I report further experience with arytenoid abduction (AAb), a procedure that enlarges the glottis by external rotation of the arytenoid cartilage and thus moves the vocal process laterally and rostrally, but does not preclude adduction for phonation. Therefore, AAb has the potential to preserve voice in patients with bilateral abductor laryngeal paralysis. Methods I performed a retrospective review of AAb in 11 patients with bilateral laryngeal paralysis and 3 patients with other neurologic causes of glottal airway compromise, ie, adductor breathing dystonia, frequent laryngospasm, and progressive laryngeal breathing dysfunction. Results Seven of the 11 patients with bilateral paralysis had dramatic airway improvement. One patient required a tracheotomy after AAb, and 3 patients with an existing tracheotomy could not be decannulated. Arytenoid abduction relieved airway obstruction in the patient with recurrent laryngospasm and in the child with progressive laryngeal breathing dysfunction, but the patient with adductor breathing dystonia has persistent stridor. The factors associated with a poor airway outcome included prolonged tracheotomy, electromyographic evidence of inspiratory activity of adductor muscles, chronic obstructive pulmonary disease, sleep apnea, and prior cordotomy or arytenoidectomy. Conclusions Arytenoid abduction is most effective in patients with bilateral laryngeal paralysis of less than 1 year's duration who do not have unfavorable laryngeal adductor activity.
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Affiliation(s)
- Gayle Woodson
- Division of Otolaryngology, Southern Illinois University School of Medicine, Springfield, Illinois
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21
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Woodson G. Arytenoid Abduction: Indications and Limitations. Ann Otol Rhinol Laryngol 2010. [DOI: 10.1177/000348941011901117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022]
Abstract
Objectives I report further experience with arytenoid abduction (AAb), a procedure that enlarges the glottis by external rotation of the arytenoid cartilage and thus moves the vocal process laterally and rostrally, but does not preclude adduction for phonation. Therefore, AAb has the potential to preserve voice in patients with bilateral abductor laryngeal paralysis. Methods I performed a retrospective review of AAb in 11 patients with bilateral laryngeal paralysis and 3 patients with other neurologic causes of glottal airway compromise, ie, adductor breathing dystonia, frequent laryngospasm, and progressive laryngeal breathing dysfunction. Results Seven of the 11 patients with bilateral paralysis had dramatic airway improvement. One patient required a tracheotomy after AAb, and 3 patients with an existing tracheotomy could not be decannulated. Arytenoid abduction relieved airway obstruction in the patient with recurrent laryngospasm and in the child with progressive laryngeal breathing dysfunction, but the patient with adductor breathing dystonia has persistent stridor. The factors associated with a poor airway outcome included prolonged tracheotomy, electromyographic evidence of inspiratory activity of adductor muscles, chronic obstructive pulmonary disease, sleep apnea, and prior cordotomy or arytenoidectomy. Conclusions Arytenoid abduction is most effective in patients with bilateral laryngeal paralysis of less than 1 year's duration who do not have unfavorable laryngeal adductor activity.
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Affiliation(s)
- Gayle Woodson
- Division of Otolaryngology, Southern Illinois University
School of Medicine, Springfield, Illinois
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22
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OLIVIERI MASSIMO, VOGHERA SIMONAG, FOSSUM THERESAW. Video-Assisted Left Partial Arytenoidectomy by Diode Laser Photoablation for Treatment of Canine Laryngeal Paralysis. Vet Surg 2009; 38:439-44. [DOI: 10.1111/j.1532-950x.2009.00546.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Katada A, Van Himbergen D, Kunibe I, Nonaka S, Harabuchi Y, Huang S, Billante CR, Zealear DL. Evaluation of a deep brain stimulation electrode for laryngeal pacing. Ann Otol Rhinol Laryngol 2008; 117:621-9. [PMID: 18771081 DOI: 10.1177/000348940811700813] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The purpose of the present study was to evaluate the suitability of a deep brain stimulation electrode for laryngeal pacing. Of interest was whether the smaller and more closely spaced channels could provide sufficient channel redundancy, controlled current distribution, and discrete activation of the posterior cricoarytenoid (PCA) muscle. METHODS A study was conducted in dogs under differing states of PCA muscle innervation representing complete denervation to complete synkinetic reinnervation. In 3 animals, stimulated glottal opening was assessed in the innervated state and after chemical denervation by pancuronium bromide. In 3 additional dogs, the left side of the larynx was surgically denervated and compared to the innervated, right side to study an anatomic model of clinical paralysis. RESULTS The thresholds were lower and the maximum level of abduction was greater for the innervated state. The stimulated glottal opening equaled that of a spontaneously breathing animal. Abductory responses were obtained across all channels in the array, demonstrating its anatomic and physiological compatibility for this application. In the denervated state, responses were only 20% of that of the innervated state with a pulse duration of 0.5 ms. The response could be enhanced to 40% and 60% by increasing the pulse duration to 1 and 2 ms. CONCLUSIONS A deep brain stimulation electrode could effectively reanimate the PCA muscle to a normal level in a case of synkinetic reinnervation and to as much as 60% of the normal level in a case of complete denervation.
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Affiliation(s)
- Akihiro Katada
- Department of Otolaryngology, Medical Center North S2100, Vanderbilt University School of Medicine, Nashville, TN 37232, USA
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Abstract
The application of lasers in microsurgery of the vocal fold has very special requirements. Easy handling as well as a precise cutting quality with a small laser induced thermal necrosis zone are necessary. In this study, an Erbium:YAG laser was evaluated for phonosurgery. For this, vocal folds from the porcine larynx were irradiated with the Erbium laser wavelength of 3 mum. The ablation rate, as well as the mechanical and thermal damage were investigated as a function of pulse duration, repetition rate and laser fluence. The results show that Erbium lasers are well suited for application on the vocal fold. The laser induced thermal damage was restricted to a superficial layer of only about 20-30 microm, resulting in a loss of the multilayered epithelium. Thermal necrosis had a range of about 5 microm. Further investigations on the vocal folds of humans must be performed to determine whether this laser is qualified for clinical applications.
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Affiliation(s)
- K Lüerssen
- Klinik für Phoniatrie und Pädaudiologie, Medizinische Hochschule Hannover, Hannover, Deutschland.
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Misiolek M, Ziora D, Namyslowski G, Misiolek H, Kucia J, Scierski W, Kozielski J, Warmuzinski K. Long-term results in patients after combined laser total arytenoidectomy with posterior cordectomy for bilateral vocal cord paralysis. Eur Arch Otorhinolaryngol 2007; 264:895-900. [PMID: 17415581 DOI: 10.1007/s00405-007-0288-y] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2005] [Accepted: 02/26/2007] [Indexed: 11/24/2022]
Abstract
The problem of ventilation efficiency after total laser arytenoidectomy with posterior cordectomy due to bilateral vocal cord paralysis is discussed. There are a number of views on the usefulness and efficacy of different surgical procedures aimed at widening the glottis, but the studies concerning the long-term functional results are still lacking. The objective of the study is to evaluate the durability of ventilation results in patients after laser arytenoidectomy with posterior cordectomy based on the comparison between the early postoperative results and those assessed after a period of 5 years. Thirty patients (24 females, 6 males) aged between 30 and 80 (mean 58.5) with bilateral vocal cord paralysis after thyroid surgery, who underwent laser arytenoidectomy with posterior cordectomy, were analyzed. Ventilation tests were performed immediately after the operation and 5 years later with Body-Master Laab (Jaeger). The actual and predicted values of FVC, FEF(25), FEF(50), FEF(75), PEF, MMEF(75/25), AREA(Ex), sR(T0T), R(T0T) were compared and analyzed. Also, the values of the inspiratory parameters FIV(1), FIF(50), PIF and the coefficients FEF(50)/FIF(50) and FIV(1)/FEV(1) were assessed. Moreover, subjective evaluation was performed based on a questionnaire. The statistical analysis reveals a significant decrease in FIV(1), FIF(50), PIF and FIV(1)/FEV(1). FEF(50)/FIF(50) and sR(T0T) (actual and predicted values) increased significantly after 5 years from the operation. However, the patients did not complain nor was this tendency reflected in their answers to the questionnaire. The probable reasons for such ventilation results are discussed. The role of phoniatric rehabilitation and the time elapsed is emphasized. In general, it can be concluded that laser arytenoidectomy with posterior cordectomy is a durable and effective procedure, although the objective assessment does not fully match the patient's subjective impression.
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Affiliation(s)
- Maciej Misiolek
- ENT Department, Silesian Medical University, Sklodowskiej-Curie 10, 41-800, Zabrze, Poland.
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