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Avhad A, Wilson A, Sayce L, Li Z, Rousseau B, Doyle JF, Luo H. An Integrated Experimental-Computational Study of Vocal Fold Vibration in Type I Thyroplasty. J Biomech Eng 2024; 146:041006. [PMID: 38319186 PMCID: PMC11005858 DOI: 10.1115/1.4064662] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 01/30/2024] [Accepted: 01/31/2024] [Indexed: 02/07/2024]
Abstract
Subject-specific computational modeling of vocal fold (VF) vibration was integrated with an ex vivo animal experiment of type 1 thyroplasty to study the effect of the implant on the vocal fold vibration. In the experiment, a rabbit larynx was used to simulate type 1 thyroplasty, where one side of the vocal fold was medialized with a trans-muscular suture while the other side was medialized with a silastic implant. Vocal fold vibration was then achieved by flowing air through the larynx and was filmed with a high-speed camera. The three-dimensional computational model was built upon the pre-operative scan of the laryngeal anatomy. This subject-specific model was used to simulate the vocal fold medialization and then the fluid-structure interaction (FSI) of the vocal fold. Model validation was done by comparing the vocal fold displacement with postoperative scan (for medialization), and by comparing the vibratory characteristics with the high-speed images (for vibration). These comparisons showed the computational model successfully captured the effect of the implant and thus has the potential for presurgical planning.
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Affiliation(s)
- Amit Avhad
- Department of Mechanical Engineering, Vanderbilt University, Nashville, TN 37221
- Vanderbilt University
| | - Azure Wilson
- Department of Communication Science and Disorders, University of Pittsburgh, Pittsburgh, PA 15260
- University of Pittsburgh
| | - Lea Sayce
- Department of Communication Science and Disorders, University of Pittsburgh, Pittsburgh, PA 15260
- University of Pittsburgh
| | - Zheng Li
- Mechatronics Engineering Department, Morgan State University, Baltimore, MD 21251
- Morgan State University
| | - Bernard Rousseau
- Doisy College of Health Sciences, Saint Louis University, Saint Louis, MO 63103
- Saint Louis University
| | - James F Doyle
- School of Aeronautics and Astronautics, Purdue University, West Lafayette, IN 47907
- Purdue University West Lafayette
| | - Haoxiang Luo
- Department of Mechanical Engineering, Vanderbilt University, Nashville, TN 37235-1592
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Lin YH, Wang CT. Salvage Treatments for Poor Voice Outcomes Following Autologous Fat Injection Laryngoplasty. Ann Otol Rhinol Laryngol 2023; 132:1200-1205. [PMID: 36510646 DOI: 10.1177/00034894221140777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Fat injection laryngoplasty (FIL) is a common procedure used to correct glottic insufficiency. Nevertheless, few studies have discussed potential treatments for cases with poor voice recovery after FIL. METHODS Eighteen patients with unfavorable vocal outcomes from FIL were analyzed. Each of these patients presented persistent dysphonia for more than 2 months following FIL, together with bulging vocal folds and poor mucosal wave. We applied microsurgery as the standard treatment to remove excessive fat. Vocal fold steroid injection (VFSI) was administered to patients that were hesitant or declined to undergo microsurgery. Voice outcomes were evaluated using the Voice Handicap Index-10 (VHI-10), grade-roughness-breathiness (GRB) scores, and smoothed cepstral peak prominence (CPPs). RESULTS Six patients underwent microsurgery directly, 6 patients received only VFSIs as a salvage treatment, and the remaining 6 patients received 1 to 3 courses of VFSIs before the decision to undergo microsurgery. Pathology reports were available for 10 patients, and contained 5 instances of adipose tissues, 3 of fat necrosis, 1 of chronic inflammation, and 1 of fibrosis. Seventeen patients reported satisfactory or improved outcomes. We found remarkable improvements in VHI-10, GRB, and CPPs (all P < .05) after salvage treatments for FIL. Subgroup analyses showed comparable voice outcomes for patients undergoing direct microsurgery, VFSI alone, and VFSI followed by microsurgery (P > .05). CONCLUSIONS This study demonstrated that fat overinjection and/or fibrotic change in the injected vocal folds may cause poor voice outcomes after FIL. Both microsurgery and VFSI could be applied as salvage treatments with good voice recovery profiles. LEVEL OF EVIDENCE Level 4.
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Affiliation(s)
- Yu-Hsuan Lin
- Department of Otolaryngology Head and Neck Surgery, Kaohsiung Veterans General Hospital, Kaohsiung
- Institute of Biomedical Sciences, National Sun Yat-Sen University, Kaohsiung
- School of Medicine, National Yang Ming Chiao Tung University, Taipei
- School of Medicine, Chung Shan Medical University, Taichung
| | - Chi-Te Wang
- Department of Otolaryngology Head and Neck Surgery, Far Eastern Memorial Hospital, Taipei
- Department of Electrical Engineering, Yuan Ze University, Taoyuan
- Department of Special Education, University of Taipei, Taipei
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Gao WZ, Paoletti MF, Bensoussan Y, Bhatt NK, Shuman EA, Grant N, O'Dell K, Johns MM. Prospective >12 Months Outcomes After Vocal Fold Injection Medialization With Silk Microparticle-Hyaluronic Acid Material. Laryngoscope 2023. [PMID: 37676072 DOI: 10.1002/lary.31039] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 07/11/2023] [Accepted: 08/22/2023] [Indexed: 09/08/2023]
Abstract
OBJECTIVE Vocal fold injection medialization (VFIM) is widely used as an initial treatment for unilateral vocal fold paralysis (UVFP). Current practices employ materials that share the limitation of temporary clinical effect from variable resorption rates. A novel silk protein microparticle-hyaluronic acid-based material (silk-HA) has demonstrated cellular infiltration and tissue deposition that may portend a durable medialization effect. We report on ≥12 months outcomes after VFIM with silk-HA. METHODS Prospective open-label study of patients with UVFP that elected treatment with VFIM with silk-HA. Blinded experts rated laryngeal stroboscopic exams. RESULTS Seventeen patients with UVFP underwent VFIM with silk-HA. Twelve of the 17 patients have ≥12 months follow-up. Seven patients demonstrated durable treatment benefit ≥12 months after injection with median improvement of 19 (p = 0.0156) in VHI-10. There was no significant change in VHI-10 between 1 and 12 months for these patients. Blinded ratings indicated that 5/7 patients with sustained improvements in VHI-10 exhibited complete or touch glottal closure at 12 months. Two of the seven patients exhibited a small (<1 mm) glottal gap at 12 months. Seven patients experienced initial benefit with later regression 3-4 months after injection. CONCLUSION VFIM with silk-HA can offer durable improvement in voice-related outcomes for UVFP past 12 months. A subset of patients treated with silk-HA experienced early loss of effect around 3-4 months postinjection. Clinical factors predictive of sustained treatment response to silk-HA injection require further exploration. LEVEL OF EVIDENCE 3 Laryngoscope, 2023.
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Affiliation(s)
- William Z Gao
- UChicago Voice Center, Department of Surgery, Section of Otolaryngology-Head & Neck Surgery, University of Chicago, Chicago, Illinois, U.S.A
| | - Marcus F Paoletti
- Keck School of Medicine of University of Southern California, Los Angeles, California, U.S.A
| | - Yael Bensoussan
- USF Health Voice Center, Department of Otolaryngology-Head & Neck Surgery, University of Southern Florida, Tampa, Florida, U.S.A
| | - Neel K Bhatt
- Division of Laryngology, Department of Otolaryngology-Head & Neck Surgery, University of Washington School of Medicine, Seattle, Washington, U.S.A
| | - Elizabeth A Shuman
- USC Voice Center, Department of Otolaryngology-Head & Neck Surgery, University of Southern California, Los Angeles, California, U.S.A
| | - Nazaneen Grant
- Department of Otolaryngology-Head & Neck Surgery, Georgetown University Medical Center, Washington, DC, U.S.A
| | - Karla O'Dell
- USC Voice Center, Department of Otolaryngology-Head & Neck Surgery, University of Southern California, Los Angeles, California, U.S.A
| | - Michael M Johns
- USC Voice Center, Department of Otolaryngology-Head & Neck Surgery, University of Southern California, Los Angeles, California, U.S.A
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Marvin K, Coulter M, Johnson C, Friesen T, Morris K, Brigger MT. Dysphagia Outcomes Following Surgical Management of Unilateral Vocal Fold Immobility in Children: A Systematic Review. Otolaryngol Head Neck Surg 2023; 168:602-610. [PMID: 35290106 DOI: 10.1177/01945998221084891] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 02/15/2022] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To assess dysphagia outcomes following surgical management of unilateral vocal fold immobility in children. DATA SOURCES Ovid Medline, Embase, Web of Science, and CENTRAL databases. REVIEW METHODS A systematic review of the medical literature was performed following the PRISMA guidelines. An a priori protocol was defined to identify all articles that presented quantifiable outcome data in children aged <18 years who underwent surgical treatment to improve glottal competence for dysphagia. Two authors independently determined references meeting the inclusion criteria, extracted data, and assigned levels of evidence. Data were pooled via a random effects model where possible. The quality of studies was graded with the MINORS criteria. RESULTS An overall 398 publications were screened, with 9 meeting inclusion criteria. A total of 115 patients were included. Of these, 75% had preoperative swallowing symptoms. Surgical intervention for dysphagia included 61 injection laryngoplasties, 11 medialization laryngoplasties, and 10 reinnervations (ansa cervicalis to recurrent laryngeal nerve). The articles consistently reported success in improving dysphagia symptoms, and limited meta-analysis demonstrated a mean improvement after surgical intervention in 79% (95% CI, 67%-91%) of children. The reported rate of minor and major complications was 15% (95% CI, 1%-29%). The MINORS scores ranged from 5 to 12. CONCLUSION Surgical management of unilateral vocal fold immobility in properly selected children can be an effective treatment for dysphagia when symptoms are present. Selection of surgical modalities relies on patient- and surgeon-related factors, and the rate of success is high across different interventions in treating these complex children.
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Affiliation(s)
- Kastley Marvin
- Department of Otolaryngology-Head and Neck Surgery, Naval Medical Center Camp Lejeune, North Carolina, USA
| | - Michael Coulter
- Department of Otolaryngology-Head and Neck Surgery, Naval Hospital Camp Pendleton, California, USA
| | - Christopher Johnson
- Department of Otolaryngology-Head and Neck Surgery, Naval Medical Center San Diego, California, USA
| | - Tzyynong Friesen
- Division of Pediatric Otolaryngology, Rady Children's Hospital, San Diego, California, USA
- Department of Otolaryngology-Head and Neck Surgery, University of California San Diego, San Diego, California, USA
| | - Kimberly Morris
- Department of Speech Pathology, Rady Children's Hospital, San Diego, California, USA
| | - Matthew T Brigger
- Division of Pediatric Otolaryngology, Rady Children's Hospital, San Diego, California, USA
- Department of Otolaryngology-Head and Neck Surgery, University of California San Diego, San Diego, California, USA
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5
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Coulter M, Marvin K, Brigger M, Johnson CM. Dysphagia Outcomes Following Surgical Management of Unilateral Vocal Fold Immobility: A Systematic Review and Meta-analysis. Otolaryngol Head Neck Surg 2023; 168:14-25. [PMID: 35021908 DOI: 10.1177/01945998211072832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2021] [Accepted: 12/20/2021] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To assess dysphagia outcomes following surgical management of unilateral vocal fold immobility (UVFI) in adults. DATA SOURCES Ovid MEDLINE, Embase, Web of Science, and Cochrane Central. REVIEW METHODS A structured literature search was utilized, and a 2-researcher systematic review was performed following PRISMA guidelines. Extractable data were pooled, and a quantitative analysis was performed with a random effects model to analyze treatment outcome and complications by procedure. RESULTS A total of 416 publications were screened and 26 met inclusion criteria. Subjects encompassed 959 patients with UVFI who underwent 916 procedures (n = 547, injection laryngoplasty; n = 357, laryngeal framework surgery; n = 12, laryngeal reinnervation). An overall 615 were identified as having dysphagia as a result of UVFI and had individually extractable outcome data, which served as the basis for a quantitative meta-analysis. In general, dysphagia outcomes after all medialization procedures were strongly positive. Quantitative analysis demonstrated a success rate estimate of 90% (95% CI, 75%-100%) for injection laryngoplasty and 92% (95% CI, 87%-97%) for laryngeal framework surgery. The estimated complication rate was 7% (95% CI, 2%-13%) for injection laryngoplasty and 15% (95% CI, 10%-20%) for laryngeal framework surgery, with minor complications predominating. Although laryngeal reinnervation could not be assessed quantitatively due to low numbers, qualitative analysis demonstrated consistent benefit for a majority of patients for each procedure. CONCLUSION Dysphagia due to UVFI can be improved in a majority of patients with surgical procedures intended to improve glottal competence, with a low risk of complications. Injection laryngoplasty and laryngeal framework surgery appear to be efficacious and safe, and laryngeal reinnervation may be a promising new option for select patients.
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Affiliation(s)
- Michael Coulter
- Department of Otolaryngology-Head and Neck Surgery, Naval Hospital Camp Pendleton, California, USA
| | - Kastley Marvin
- Department of Otolaryngology-Head and Neck Surgery, Naval Medical Center Camp Lejeune, North Carolina, USA
| | - Matthew Brigger
- Division of Pediatric Otolaryngology, Rady Children's Hospital-San Diego, San Diego, California, USA.,Department of Otolaryngology-Head and Neck Surgery, University of California-San Diego, San Diego, California, USA
| | - Christopher M Johnson
- Department of Otolaryngology-Head and Neck Surgery, Naval Medical Center, San Diego, California, USA
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Weingart P. Trust or attention? Medialization of science revisited. Public Underst Sci 2022; 31:288-296. [PMID: 35491918 DOI: 10.1177/09636625211070888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The article traces the intensifying media orientation of universities and research organizations first by referring to early diagnoses of the spread of mutual observation and attention seeking as defining societies after WWII. This development provides the background for the unlikely, yet massive turn of scientific organizations to the general public, the media and more recently social media. Details are analyzed on the interactional, organizational and systems levels, and are followed with a focus on the reasons motivating universities. A closer look reveals the self-referentiality of institutional communication deriving its rationale from 'imagined publics'. The politically sponsored 'engagement of the public' has been derailed to become marketing, branding and public relations exercises. The unintended consequences of the establishment of communication units and the blurring of science communication and persuasion are conflicts between faculty and management and possibly a loss of trust in science.
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Affiliation(s)
- Peter Weingart
- Bielefeld University, Germany; Stellenbosch University, South Africa
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Alaryani RA, Alhedaithy RA. Preventive Measures of Middle Turbinate Lateralization After Endoscopic Sinus Surgery: An Updated Review. Cureus 2021; 13:e15763. [PMID: 34290939 PMCID: PMC8289224 DOI: 10.7759/cureus.15763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2021] [Indexed: 11/29/2022] Open
Abstract
Introduction: The middle turbinate (MT) is the most important anatomical structure inside the nasal cavity and a landmark in the identification of skull base, ethmoid cells, and lamina papyracea. Postoperatively, lateralizationof the MT can cause synechia and obstruction of the middle meatus and the maxillary, ethmoid, or frontal sinuses. Objective: To review the current literature about the outcome of different techniques used intraoperatively to prevent lateralization of MT after functional endoscopic sinus surgery (FESS). Materials and methods: This retrospective narrative literature review provides a summary of current and past research publications about different techniques used intraoperatively to prevent MT lateralization after FESS. Results: Many methods have been described to prevent the lateralization of MT and synechiae formation. These methods include controlled synechiae, suture lateralization, metal clips, partial resection of MT, middle meatus implants, and steroid-eluting implants and stents. Conclusion: The ideal FESS should include preservation of the MT, reducing its lateralization, and preventing synechia formation.Different techniques have been discovered in an attempt to prevent this complication.
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Kobayashi M, Ohya J, Onishi Y, Kunogi J, Kawamura N. Medialization of Common Carotid Artery Is Associated with Cervical Kyphosis. Spine Surg Relat Res 2020; 5:144-148. [PMID: 34179549 PMCID: PMC8208955 DOI: 10.22603/ssrr.2020-0153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 09/29/2020] [Indexed: 11/05/2022] Open
Abstract
Introduction Reportedly, the medialization of the common carotid artery (MCCA) to be a vascular anomaly with a potential risk of intraoperative carotid artery injury. Nevertheless, among spine surgeons, the presence of MCCA has not been well recognized. Methods We retrospectively reviewed consecutive patients who underwent cervical radiographs and magnetic resonance imaging (MRI) examinations in a single spine center. Using MRI, the MCCA grade was classified into grades 1 to 3 in order of severity. Radiographic measurement included C2-C7 angles as cervical lordosis, cervical sagittal vertical axis (C-SVA), T1 slope (T1S), and T1S-cervical lordosis mismatch. We compared each patient's background and radiographic parameters between patients with each of the three MCCA grades. The continuous variables were compared using the Jonckheere-Terpstra trend test and the proportions were compared using the Cochran-Armitage trend test to investigate the trend of variables in three grades. Results The present study included data from 133 eligible patients (65 males and 68 females) with a mean age of 63.7 (±14.2) years. The details of MCCA grading were as follows: grade 1, n=101; grade 2, n=27; and grade 3, n=5. With an increasing MCCA grade, age (61.9±14.0, 68.2±13.8, and 76.4±9.4 years for grades 1, 2, and 3, respectively, p=0.005) and proportion of female (p<0.001) had an increasing trend, whereas cervical lordosis had a decreasing trend (11.7±13.5°, 7.0±14.5°, and −10.0±19.2° for grades 1, 2, and 3, respectively, p=0.011). Conclusions Several patient backgrounds including the female gender, older age, and kyphotic alignment were determined as MCCA risk factors. Careful preoperative neck vasculature assessment would avoid a catastrophic complication during anterior cervical surgery.
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Affiliation(s)
- Motoya Kobayashi
- Department of Spine and Orthopedic Surgery, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Junichi Ohya
- Department of Spine and Orthopedic Surgery, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Yuki Onishi
- Department of Spine and Orthopedic Surgery, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Junichi Kunogi
- Department of Spine and Orthopedic Surgery, Japanese Red Cross Medical Center, Tokyo, Japan
| | - Naohiro Kawamura
- Department of Spine and Orthopedic Surgery, Japanese Red Cross Medical Center, Tokyo, Japan
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Nassimizadeh A, El-Shummar S, Emery K, Costello D. Vocal fold medialization-A 5-year series of single surgeon consecutive medialization with review of literature. J Eval Clin Pract 2020; 26:281-289. [PMID: 31168894 DOI: 10.1111/jep.13169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 04/15/2019] [Accepted: 04/18/2019] [Indexed: 11/29/2022]
Abstract
INTRODUCTION ENT UK released guidelines in 2010 detailing the requisite structure for the creation of a laryngeal intervention clinic. The senior author's practice is the only one regionally that offers this service, and our objective was to review this to determine whether vocal cord medialization injections were showing an improvement in quality of voice for patients. MATERIALS AND METHODS Patients were reviewed in a specialist voice clinic prior to being offered vocal cord injection under local anaesthetic in a separate dedicated weekly clinic. They would be assessed by the senior author and a dedicated voice specialist speech and language therapist (SALT). This would include a preinjection grade, roughness, breathiness, asthenia, and strain (GRBAS), Voice Handicap Index (VHI)-10, and the measuring of maximum phonation time (MPT) with the aid of Opera Vox Apple iPad application. RESULTS Data were available for 186 injections, on patients with a median age of 66 years (interquartile range [IQR]: 51-75), of whom 61% were male. VHI-10 score improved significantly, from a mean of 26.7 to 12.5 (P < .001). A significant improvement in MPT was also observed, from a median of 3.0 to 6.3 (N = 66, P < .001). Improvements in all components of the GRBAS score were also observed (all P < .001), with between 43% and 88% of cases reporting reductions after the procedure. Patients receiving a repeat procedure saw a significantly smaller improvement in VHI-10 than those where it was the primary treatment (mean reduction: 9.8 vs 15.5, P = .018). Analysis of MPT found a significant correlation between the quantity of injection material used and the degree of improvement observed (rho = 0.355, P = .004). CONCLUSION Vocal Cord local anaesthetic medialization injection is a swift, safe, and effective short-term method of improving dysphonia.
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Affiliation(s)
- Abdul Nassimizadeh
- Department of Otolaryngology, University Hospital Birmingham, Birmingham, UK
| | - Suliman El-Shummar
- Department of Otolaryngology, University Hospital Birmingham, Birmingham, UK
| | - Katrina Emery
- Department of Otolaryngology, University Hospital Birmingham, Birmingham, UK
| | - Declan Costello
- Department of Otolaryngology, University Hospital Birmingham, Birmingham, UK
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Chau SM, Kim CM, Vahabzadeh-Hagh A, Verma SP, Chhetri DK. Safety of outpatient unilateral medialization laryngoplasty across two academic institutions. Laryngoscope 2018; 129:1647-1649. [PMID: 30588641 DOI: 10.1002/lary.27688] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 09/22/2018] [Accepted: 10/22/2018] [Indexed: 11/08/2022]
Abstract
OBJECTIVES/HYPOTHESIS Unilateral ML is a commonly performed surgery for dysphonia secondary to glottic insufficiency. The safety of this procedure performed in the outpatient setting has not been extensively examined. The purpose of the study was to assess the safety of outpatient unilateral ML in adults and determine the incidence and timing of postoperative complications across two tertiary-care academic medical centers. STUDY DESIGN Retrospective chart review, METHODS: A review of patients undergoing unilateral ML at two tertiary-care academic centers from 2011 to 2017 was performed. Patients undergoing bilateral medialization laryngoplasty, revision surgery, or those undergoing additional laryngeal framework procedures including arytenoid adduction were excluded. Patient demographics, operative details, and perioperative and postoperative complications were recorded. Comparisons were made between those individuals who underwent inpatient versus outpatient ML. RESULTS One hundred three total procedures met inclusion criteria. Fifty-seven were performed as outpatient procedures, and 46 individuals were observed for at least 23 hours following surgery. Silastic or Gore-Tex implants were used in all but two surgeries. There were no postoperative complications in either setting, including hematoma, dyspnea, wound infections or seromas. CONCLUSIONS The incidence of adverse events during and immediately following unilateral ML is very low. Patients can be discharged safely the day of surgery without geographic restrictions. LEVEL OF EVIDENCE 4 Laryngoscope, 129:1647-1649, 2019.
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Affiliation(s)
- Steven M Chau
- Department of Otolaryngology-Head and Neck Surgery, University Voice and Swallowing Center, University of California Irvine, Irvine, California
| | - Christine M Kim
- Department of Head and Neck Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, U.S.A
| | - Andrew Vahabzadeh-Hagh
- Department of Head and Neck Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, U.S.A
| | - Sunil P Verma
- Department of Otolaryngology-Head and Neck Surgery, University Voice and Swallowing Center, University of California Irvine, Irvine, California
| | - Dinesh K Chhetri
- Department of Head and Neck Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, U.S.A
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Ferrier A, Blasco L, Marcoin A, De Boissieu P, Siboni R, Nérot C, Ohl X. Geometric modification of the humeral position after total reverse shoulder arthroplasty: what is the optimal lowering of the humerus? J Shoulder Elbow Surg 2018; 27:2207-13. [PMID: 30041944 DOI: 10.1016/j.jse.2018.05.027] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Revised: 05/03/2018] [Accepted: 05/13/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND The main mechanical effect after reverse shoulder arthroplasty (RSA) is the lowering of the glenohumeral rotation center. The optimal value of the humeral lowering after RSA is still debated. The main objective of our study was to determine the lowering and medialization of the humerus and to correlate these parameters with short-term functional results. MATERIALS AND METHODS The study included 70 patients with complete radiographic and clinical data. A multivariate analysis was used to compare the clinical and radiographic outcomes with the humeral lowering. RESULTS The mean humeral lowering was 25.4 mm (range, 6-38 mm), and the mean medialization was 9.2 mm (range, 0-20 mm). Humeral lowering significantly influenced active forward elevation and the rate of scapular notching. DISCUSSION The best clinical results and the lowest incidence of scapular notching were found after a lowering of more than 24 mm in our series. We recommend humeral lengthening of at least 24 mm after implanting a total reverse shoulder prosthesis.
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12
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Enea D, Canè PP, Fravisini M, Gigante A, Dei Giudici L. Distalization and Medialization of Tibial Tuberosity for the Treatment of Potential Patellar Instability with Patella Alta. Joints 2018; 6:80-84. [PMID: 30051102 PMCID: PMC6059852 DOI: 10.1055/s-0038-1661340] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Purpose The aim of the study was to test the distalization and medialization of the tibial tuberosity (DMTT) for the treatment of patellar instability associated with patella alta, focusing on residual instability and pain. Methods Twenty-four consecutive patients (26 knees) suffering from patellofemoral instability and patella alta were treated by DMTT. Two groups were identified, which differed for documented history of frank patella dislocation. The groups were named objective patellar instability (OPI) (history of dislocation) and potential patella instability (PPI) (no dislocation). Outcome was measured with visual analogue scale (VAS), Kujala score, and Tegner score. Comparison between groups was performed using Student's t -test, Wilcoxon rank score, and Fisher's exact test (significance at p < 0.05). Results At 50 ± 18 and 41 ± 18 months of follow-up, respectively, both PPI and OPI groups obtained a significant pain reduction and functional improvement. The PPI group showed a significant decrease of the subjective instability. No procedure-related complications were reported. Conclusion This study suggests that DMTT is a viable option for PPI patients with patella alta. The outcome was comparable between PPI and OPI cases; however, decrease in subjective instability was significantly greater in PPI patients. Level of Evidence Level III, retrospective comparative study.
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Affiliation(s)
- Davide Enea
- Orthopaedic Unit, Casa di Cura "Villa Igea" Hospital, Ancona, Italy
| | - Pier Paolo Canè
- Department of Orthopaedic, "Sol et Salus" Hospital, Torre Pedrera, Italy
| | - Marco Fravisini
- Department of Orthopaedic, "Sol et Salus" Hospital, Torre Pedrera, Italy
| | - Antonio Gigante
- Clinical Orthopaedics, Department of Clinical and Molecular Science (DISCLIMO), Polytechnic University of Marche, Ancona, Italy
| | - Luca Dei Giudici
- Orthopaedic Unit, Casa di Cura "Villa Igea" Hospital, Ancona, Italy
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Abstract
BACKGROUND The purpose of this study was to evaluate the functional outcomes of medialized rotator cuff repair and the continuity of repaired tendon in chronic retracted rotator cuff tears. METHODS Thirty-five consecutive patients were selected from 153 cases that underwent arthroscopic rotator cuff repair for more than medium-sized posterosuperior rotator cuff tears between July 2009 and July 2012 performed with the medialized repair. All cases were available for at least 2 years of postoperative follow-up. The visual analog scale of pain, muscle strength, Constant score, American Shoulder and Elbow Surgeons (ASES) score, and University of California-Los Angeles score were evaluated. RESULTS At the final follow-up, all clinical outcomes were significantly improved. The visual analog scale score for pain improved from 6 ± 1 preoperatively to 2 ± 1 postoperatively. The range of motion increased from preoperatively to postoperatively: active forward elevation, from 134° ± 49° to 150° ± 16°; active external rotation at the side, from 47° ± 15° to 55° ± 10°; and active internal rotation, from L3 to L1. The shoulder score also improved: Constant score, from 53.5 ± 16.7 to 79 ± 10; American Shoulder and Elbow Surgeons score, from 51 ± 15 to 82 ± 8; and University of California-Los Angeles score, from 14 ± 4 to 28 ± 4. The retear cases at the final follow-up were 6 (17%). CONCLUSIONS Medialized repair may be useful in cases in which anatomic bone-to-tendon repair would be difficult because of the excessive tension of the repaired tendon and a torn tendon that does not reach the anatomic insertion.
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Affiliation(s)
- Young-Kyu Kim
- Department of Orthopaedic Surgery, Gil Medical Center, Gachon University, Incheon, Republic of Korea
| | - Kyu-Hak Jung
- Department of Orthopaedic Surgery, CM General Hospital, Seoul, Republic of Korea.
| | - Jun-Sung Won
- Department of Orthopaedic Surgery, Veterans Hospital of Seoul, Seoul, Republic of Korea
| | - Seung-Hyun Cho
- Department of Orthopaedic Surgery, Seonam Hospital, Seoul, Republic of Korea
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Agrawal P, Gaba S, Das S, Singh R, Kumar A, Yadav G. Dynamic hip screw versus proximal femur locking compression plate in intertrochanteric femur fractures (AO 31A1 and 31A2): A prospective randomized study. J Nat Sci Biol Med 2017; 8:87-93. [PMID: 28250681 PMCID: PMC5320830 DOI: 10.4103/0976-9668.198352] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Intertrochanteric fractures are common in elderly population and pose a significant financial burden to the society. Anatomically contoured proximal femur locking compression plate (PFLCP) is the latest addition in the surgeons' armamentarium to deal with these fractures. It creates an angular stable construct, which will theoretically lessen the risk of failure by screw cut-out and varus collapse, the common mode of DHS failure. We compared DHS with PFLCP in AO type 31A1 and 31A2 intertrochanteric fractures. MATERIALS AND METHODS A randomized prospective study was carried out between June 2011 and June 2013. 26 cases each of DHS and PFLCP were included. RESULTS Functional and radiological outcome was similar in both groups. CONCLUSION Both DHS and PFLCP are good choices for stable intertrochanteric fractures, and both lead to excellent functional outcomes, but non-union might be more common with PFLCP.
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Affiliation(s)
- Prabhat Agrawal
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | - Sahil Gaba
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | - Saubhik Das
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | - Ranjit Singh
- Department of Orthopaedics, Patna Medical College and Hospital, Patna, Bihar, India
| | - Arvind Kumar
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
| | - Gajanand Yadav
- Department of Orthopaedics, All India Institute of Medical Sciences, New Delhi, India
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15
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Chirilă M, Ţiple C, Dinescu FV, Mureşan R, Bolboacă SD. Voice rehabilitation with tragal cartilage and perichondrium after vertical partial laryngectomy for glottic cancer. J Res Med Sci 2015; 20:323-8. [PMID: 26109985 PMCID: PMC4468445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/31/2014] [Revised: 02/24/2015] [Accepted: 03/01/2015] [Indexed: 11/03/2022]
Abstract
BACKGROUND The goal of the study is to test medialization of the neocord after oncological surgery for glottic cancer, using autologous tragal cartilage and perichondrium by the direct approach. MATERIALS AND METHODS Sixteen patients underwent comprehensive assessment including auditory perceptual assessment, videostrobolaryngoscopy, and acoustic voice analysis. The cartilage graft was inserted into a pocket created in the tyroarytenoid - lateral cricoarytenoid muscle complex or the excavated musculomembranous part of the neocord, and fixed by placing the perichondrium by the direct approach. The patients were evaluated preoperatively, and at 14 days, 60 days, and 6 months later. RESULTS Improvement of voice and breathiness was correlated with the increase of closed quotient and harmonic-to-noise ratio; the acoustic voice parameters studied showed significant differences between preoperative and postoperative voices, and these objective measurements of voice changes provided accurate and documentary evidence of the results of surgical treatment. CONCLUSION This method may be considered a safe and efficient phonosurgical procedure for voice restoration.
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Affiliation(s)
- Magdalena Chirilă
- Department of ENT, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania,Address for correspondence: Dr. Magdalena Chirilă, Department of ENT, Iuliu Haţieganu University of Medicine and Pharmacy, Cluj-Napoca, 13 Emil Isac, 400023, Cluj-Napoca, Romania. E-mail:
| | - Cristina Ţiple
- Department of ENT, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | | | - Rodica Mureşan
- Department of Phoniatry, Emergency County Hospital, Cluj-Napoca, Romania
| | - Sorana D. Bolboacă
- Department of Phoniatry, Emergency County Hospital, Cluj-Napoca, Romania
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Abstract
Scientific debates in modern societies often blur the lines between the science that is being debated and the political, moral, and legal implications that come with its societal applications. This manuscript traces the origins of this phenomenon to professional norms within the scientific discipline and to the nature and complexities of modern science and offers an expanded model of science communication that takes into account the political contexts in which science communication takes place. In a second step, it explores what we know from empirical work in political communication, public opinion research, and communication research about the dynamics that determine how issues are debated and attitudes are formed in political environments. Finally, it discusses how and why it will be increasingly important for science communicators to draw from these different literatures to ensure that the voice of the scientific community is heard in the broader societal debates surrounding science.
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17
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Ruddy BH, Pitts TE, Lehman J, Spector B, Lewis V, Sapienza CM. Improved voluntary cough immediately following office-based vocal fold medialization injections. Laryngoscope 2014; 124:1645-7. [PMID: 24258681 DOI: 10.1002/lary.24529] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2013] [Revised: 10/28/2013] [Accepted: 11/18/2013] [Indexed: 11/10/2022]
Abstract
OBJECTIVES/HYPOTHESIS This study examined changes in voluntary cough airflow measures immediately following in-office injection of Radiesse in patients diagnosed with glottic insufficiency. Due to significant comorbidities, these patients were poor candidates for medialization under general anesthesia. Each patient presented with dysphonia and dysphagia and ineffective voluntary cough, resulting in a poor clearing of secretions and a presence of ingested fluids on examination. STUDY DESIGN Prospective cohort and case series study. METHODS Three patients with a diagnosis of glottic insufficiency were included for study based on flexible endoscopy and laryngostroboscopic examination. Voluntary cough airflow measures were obtained approximately 30 minutes before and after the Radiesse injections. The airflow measures were: compression phase duration (CPD), expiratory rise time (EPRT), expiratory phase peak airflow (EPPF), and cough volume acceleration (CVA). RESULTS Injection of Radiesse was found to improve voluntary cough airflow measures. CONCLUSION The immediate increase in the objective airflow measures obtained from voluntary cough production after Radiesse injections can be used to document airway protection improvements. Cough airflow is a straightforward measure to obtain and is considered an objective measure of cough function. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Bari H Ruddy
- Department of Communication Sciences and Disorders, University of Central Florida, Orlando; The Ear Nose and Throat Surgical Associates, Orlando
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