C02 Laser-assisted Phonosurgery for Benign Glottic Lesions

2008 ◽  
Vol 139 (2_suppl) ◽  
pp. P48-P48
Author(s):  
Marcel Geyer ◽  
Gian-Peppino Ledda ◽  
Neil C Tan ◽  
Roberto Puxeddu Consultant
Keyword(s):  
Co2 Laser ◽  
Vocal Fold ◽  
Voice Quality ◽  
Case Series ◽  
Functional Results ◽  
Disease Recurrence ◽  
Wilcoxon Test ◽  
Control Group ◽  
Retrospective Case ◽  
False Vocal

Objective (1) To determine glottic function following carbon dioxide (CO2) laser-assisted phonosurgery of benign laryngeal disease. (2) To evaluate post-operative glottic morphology and disease recurrence rate. Methods Comparative retrospective case series of patients with benign glottic pathology treated by laser-assisted phonosurgery over 10 years. 235 consecutive patients had pre- and postoperative data collected from objective laryngeal examination, videostroboscopy recording of vocal fold mucosal wave movement, electroacoustic voice analysis of fundamental frequency, jitter, shimmer, and harmonics to noise ratio, as well as perceptual voice evaluation. This data was also compared to that of 20 healthy volunteers. (Statistical analysis: Wilcoxon test and Mann-Whitney test respectively). Definitive voice and morphologic evaluation was completed after 6 months. Results Evaluation of the pre- and postoperative functional results demonstrated a statistically significant improvement in all spectrographically analysed objective voice parameters (p<0.001), with a restored voice quality as good as the control group (p<0.001). Postoperative morphological analysis using videostroboscopic examination confirmed 3 recurrences of granuloma and 1 of Reinke's oedema. Recurrence was estimated objectively if the lesion was analogous to the original pathology. Glottic closure was complete in 96.5% of cases. False vocal fold adduction was normal in 88.5% of cases, with forced hyper-adduction being present in 11.5%. Phonatory vibration was cord-cord type in 100% of cases. Conclusions Our study demonstrates a statistically significant improvement in all acoustic parameters recorded. Postoperative vocal fold function and mucosal wave morphology were largely restored. CO2 laser-assisted voice restoration for benign glottic disease is effective.

scholarly journals Functional results of endoscopic arytenoid abduction lateropexy for bilateral vocal fold palsy

2021 ◽  
Author(s):  
László Rovó ◽  
Vera Matievics ◽  
Balázs Sztanó ◽  
László Szakács ◽  
Dóra Pálinkó ◽  
...  
Keyword(s):  
Vocal Fold ◽  
Voice Quality ◽  
Functional Results ◽  
Severity Index ◽  
Invasive Treatment ◽  
Maximum Phonation Time ◽  
Motion Recovery ◽  
Bilateral Vocal Fold Paralysis ◽  
Vocal Fold Palsy ◽  
False Vocal

Abstract Purpose Endoscopic arytenoid abduction lateropexy (EAAL) is a reliable surgical solution for the minimally invasive treatment of bilateral vocal fold palsy (BVFP), providing a stable airway by the lateralization of the arytenoid cartilages with a simple suture. The nondestructive manner of the intervention theoretically leads to higher regeneration potential, thus better voice quality. The study aimed to investigate the respiratory and phonatory outcomes of this treatment concept. Methods 61 BVFP patients with significant dyspnea associated with thyroid/parathyroid surgery were treated by unilateral EAAL. Jitter, Shimmer, Harmonics to Noise Ratio, Maximum Phonation Time, Fundamental frequency, Voice Handicap Index, Dysphonia Severity Index, Friedrich’s Dysphonia Index, Global-Roughness-Breathiness scale, Quality of Life, and Peak Inspiratory Flow were evaluated 18 months after EAAL. Results All patients had a stable and adequate airway during the follow-up. Ten patients (16.4%) experienced complete bilateral motion recovery with objective acoustic parameters in the physiological ranges. Most functional results of the 13 patients (21.3%) with unilateral recovery also reached the normal values. Fifteen patients (24.6%) had unilateral adduction recovery only, with slightly impaired voice quality. Eleven patients (18.0%) had false vocal fold phonation with socially acceptable voice. In 12 patients (19.7%) no significant motion recovery was detected on the glottic level. Conclusion EAAL does not interfere with the potential regeneration process and meets the most important phoniatric requirements while guaranteeing the reversibility of the procedure—therefore serving patients with transient palsy. Further, a socially acceptable voice quality and an adequate airway are ensured even in cases of permanent bilateral vocal fold paralysis.

scholarly journals Laser arytenoidectomy in children with bilateral vocal fold immobility

2006 ◽  
Vol 121 (1) ◽  
pp. 25-27 ◽  
Author(s):  
G Worley ◽  
Y Bajaj ◽  
L Cavalli ◽  
B Hartley
Keyword(s):  
Vocal Fold ◽  
Voice Quality ◽  
Case Series ◽  
Challenging Problem ◽  
Retrospective Case ◽  
Voice Outcome ◽  
Vocal Fold Immobility ◽  
The Voice ◽  
Bilateral Vocal Fold Immobility ◽  
Better Than

Bilateral vocal fold immobility in children is a challenging problem because a balance between good airway and voice quality has to be achieved. Surgery to improve the airway is often postponed or avoided because of fear of losing the voice. In this study our results of laser arytenoidectomy in children are described. This was a retrospective case notes review at a tertiary level paediatric ENT department. The six patients in this case series ranged from nine to 16 years old at the time of laser arytenoidectomy. Post-operative airway and voice quality were assessed. All children in the series had an adequate post-operative airway. Four of these patients had tracheostomies pre-operatively and achieved decannulation. All six patients rated their post-operative voice as better than pre-operatively. This is principally due to increased loudness associated with increased airflow through the larynx, particularly after tracheostomy decannulation. It is recommended that special care should be taken not to disturb the anterior two thirds of the vocal fold during the surgery in order to achieve a good post-operative voice outcome.

Down-Expression of Kinin Receptors in Allergic Nasal Polyps Epithelia: An Immunohistochemistry Study

2020 ◽  
Vol 162 (3) ◽  
pp. 375-381
Author(s):  
Meir Warman ◽  
Yonatan Lahav ◽  
Monica Huszar ◽  
Liad Hadad ◽  
Doron Halperin ◽  
...  
Keyword(s):  
Immunohistochemical Staining ◽  
Nasal Polyps ◽  
Expression Patterns ◽  
Case Series ◽  
Control Group ◽  
Retrospective Case ◽  
Kinin Receptors ◽  
Immunohistochemistry Staining ◽  
Academic Center ◽  
B2 Receptors

Objectives To investigate the expression of B1 and B2 receptors in patients with nasal polyps (NPs) compared to controls. Study Design Retrospective case series. Settings Single academic center. Subjects and Methods Nasal biopsies of patients with NPs were compared to inferior turbinates of control patients. Comparisons included basic demographics and comorbidities, intensity of inflammation, and immunohistochemical staining of B1 and B2 receptors measured by immunohistochemistry staining scores (ISSs). Results A total of 41 patients were enrolled, with 21 patients (51.2%) in the NP group and 20 patients as controls. No differences were found in the prevalence of allergic comorbidities and smoking between the groups. The NP group demonstrated significantly higher prevalence of moderate and severe mononuclear infiltrates compared to the control group (57.1% vs 5.3%, P < .001). The NP group had significantly lower B1 expression in smooth muscle compared to the control group (mean ISS 0.22 vs 1.56, P < .001, respectively) and significantly more B2 expression in epithelial cells (mean ISS 1.81 vs 0, P < .001, respectively). Conclusion Patients with NPs exhibit different expression patterns of B1 and B2 compared to control patients. This implies that bradykinin receptor regulation participates in the pathogenesis of NPs.

scholarly journals Limited Open Reduction and Internal Fixation of Calcaneal Fractures

2019 ◽  
Vol 41 (1) ◽  
pp. 57-62 ◽  
Author(s):  
Anne K. Bremer ◽  
Lukas Kraler ◽  
Lars Frauchiger ◽  
Fabian G. Krause ◽  
Martin Weber
Keyword(s):  
Wound Healing ◽  
Internal Fixation ◽  
Open Reduction ◽  
Case Series ◽  
Functional Results ◽  
High Rate ◽  
Calcaneal Fractures ◽  
Retrospective Case ◽  
Level Of Evidence

Background: The treatment of displaced intra-articular calcaneal fractures remains a challenge and the optimal approach is still controversial. The main reason to avoid the extended lateral approach is the high complication rate due to wound healing problems. We report on 16 years of experience with a standardized limited open reduction and internal fixation technique. Methods: Between 2001 and 2017, we prospectively followed 240 consecutive patients operatively treated for a displaced intra-articular calcaneal fracture. Patients with open, multiple, bilateral, extra-articular, and Sanders IV fractures and those lost to follow-up were excluded. A lateral subtalar approach was used, with a cast for 8 weeks and full weightbearing allowed after 12 weeks. Follow-up examinations were scheduled until 24 months. Subjective and clinical assessment included gait abnormality, subtalar and ankle range of motion, and stability and alignment. The American Orthopaedic Foot & Ankle Society (AOFAS) hindfoot score was calculated. Alignment was analyzed on standard radiographs. In total, 131 patients were excluded. The remaining 109 patients were followed for a minimum of 24 months (34.4 ± 14.2 [range, 24-102] months). Results: The mean AOFAS score was 87 ± 13 (range, 32-100). “Excellent” and “good” results, as well as hindfoot motion with “normal/mild” and “moderate” restrictions, were seen in 80% of patients. Early reoperations were performed for insufficient reduction (2 patients), delayed wound healing (debridement, 3 patients), and hematoma (1 patient). Late revisions were arthrodesis (3 patients), medializing calcaneal osteotomy (1 patient), and implant removal (53 patients; 49%). Conclusion: The presented approach has remained unmodified for 16 years and resulted in consistently good functional results. The main disadvantage was the high rate of heel screw removal. Level of Evidence: Level IV, retrospective case series.

Chiari pelvic osteotomy does affect hip survival: a long-term follow-up study

2020 ◽  
pp. 112070002090183
Author(s):  
Josko Jelicic ◽  
Antea Buterin ◽  
Goran Vrgoc ◽  
Zeljko Butorac ◽  
Anton Tudor ◽  
...  
Keyword(s):  
Case Series ◽  
Hip Osteoarthritis ◽  
Pelvic Osteotomy ◽  
Functional Results ◽  
Retrospective Case ◽  
Case Series Study ◽  
Median Period ◽  
Chiari Pelvic Osteotomy

Background: The modern indications for Chiari pelvic osteotomy (CPO) have narrowed and the number of such operations performed has diminished markedly. So far published long-term experience with CPO indicate the fact that in selected patients satisfactory functional results can be achieved. The aim of this study was to investigate the parameters which influence CPO survival and its conversion into total hip arthroplasty (THA). Methods: This is a single-centre retrospective case-series study. In the period from 1976 to 2012, it included 172 CPO in 158 patients. Of those, in 43 patients (48 hips) the follow-up was discontinued, leaving 115 patients (124 hips) for final analyses. The median age at the time of the surgery was 34 years, and the mean duration of the follow-up was 19 years. Results: In 115 patients (124 CPO) included in the study, a total of 51 THA was performed in 49 patients. The median period between CPO and THA was 14 years. Conclusion: Supporting our results, we suggest that CPO should still be indicated in a selected group of younger patients even with advanced stage of hip osteoarthritis who prefer a joint-conserving procedure and consent to a predicted less optimal outcome.

Effectiveness of Calcium Hydroxylapatite Paste in Vocal Rehabilitation

2009 ◽  
Vol 118 (8) ◽  
pp. 546-551 ◽  
Author(s):  
M. Boyd Gillespie ◽  
Thomas S. Dozier ◽  
Terry A. Day ◽  
Bonnie Martin-Harris ◽  
Shaun A. Nguyen
Keyword(s):  
Soft Tissue ◽  
Vocal Fold ◽  
Case Series ◽  
Soft Tissue Defects ◽  
Retrospective Case ◽  
Vocal Rehabilitation ◽  
Calcium Hydroxylapatite ◽  
The Voice ◽  
Tissue Defects

Objectives We determined the effectiveness of calcium hydroxylapatite (CaHA) paste in vocal rehabilitation. Methods We examined a retrospective case series of 39 adult patients who underwent CaHA paste injection for vocal fold rehabilitation over a 5-year period. The outcomes included the change in the Voice Handicap Index (VHI) score; procedure-related complications; and the need for follow-up voice procedures. Results The VHI scores demonstrated overall improvement, with a decrease from the preoperative mean of 61.2 ± 24.0 to a postoperative mean of 35.9 ± 26.3 (p = 0.0001) after a mean follow-up time of 17.8 ± 13.6 months. The procedure was more likely to succeed in patients with paralysis and/or paresis than in patients with glottic soft tissue defects. After injection, the VHI scores worsened in 3 of 7 patients (43%) in the soft tissue defect group, compared to only 2 of 28 (7%) in the paralysis and/or paresis group (p = 0.04). Four of 7 patients with soft tissue defects (57%) required secondary vocal procedures to improve the voice, compared to only 2 of 32 (6%) in the paralysis and/or paresis group (p = 0.006). Conclusions Injection of CaHA paste results in significantly improved vocal scores in the majority of patients. Use of the paste was less satisfactory in patients with soft tissue defects because of poor retention of the paste in the scarred vocal fold remnant.

scholarly journals A systematic review on conservative and non-operative treatment options for Osgood-Schlatter disease

2020 ◽  
Author(s):  
Cornelia Neuhaus ◽  
Christian Appenzeller-Herzog ◽  
Oliver Faude
Keyword(s):  
Systematic Review ◽  
Operative Treatment ◽  
Treatment Options ◽  
Grey Literature ◽  
Case Series ◽  
Outcome Data ◽  
Control Group ◽  
Retrospective Case ◽  
Review Articles ◽  
Knee Pathology

Background: Osgood-Schlatter disease (OSD) is a sport- and growth-associated knee pathology with painful osteochondrosis around the tibial tuberosity. Up to 10% of adolescents are affected by OSD. Treatment is primarily conservative or non-operative and includes injections, ice, braces, casts, tape and/or physiotherapy. However, treatment outcomes are often insufficiently described and there is lack of evidence for current best practice.Objective: The aims of this systematic review are to comprehensively identify conservative or non-operative treatment options for OSD, to compare their effectiveness in selected outcomes, and to describe potential research gaps. and to describe potential research gaps.Methods: This systematic review was conducted according to the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. CENTRAL, CINAHL, EMBASE and MEDLINE via Ovid, and PEDro were searched through to January 6, 2020. In addition, ongoing and unpublished clinical studies, dissertations, and other grey literature on OSD were retrieved. We included prospective, retrospective, case control, randomised, and non-randomised studies reporting on the effectiveness of any conservative or non-operative treatment of 6- to 28-year-old OSD patients. Studies written in English, German, or French were included. The quality of the included studies was assessed using the PEDro scale and extracted outcome data were narratively synthesized. In addition, we also systematically retrieved review articles for extraction of treatment recommendations.Results: Of 767 identified studies, thirteen were included: two randomised controlled trials (RCTs), two prospective and eight retrospective observational studies, and one case series. Eight studies had no control group. The included studies were published from 1948 to 2019 and included 747 patients (563 male, 119 female, 65 sex not reported) with 937 affected knees. The study quality was poor to moderate. The two included RCTs examined the effectiveness of surplus dextrose-injection in OSD patients treated with local anaesthetics injection and came to opposite conclusions. Other than that, inter-study heterogeneity prohibited any descriptive cumulative analyses. Among the 15 review articles, the most prevalent treatment recommendations were activity modification (15/15), quadriceps and hamstring stretching (13/15), medication (11/15), ice (11/15), strengthening of the quadriceps (9/15), and knee straps or brace (8/15).Conclusion: Conflicting evidence exists to support the use of dextrose injections. Certain therapeutic approaches, such as stretching, seem to work, but no RCT comparing specific exercises with sham or usual care treatment exists. Carefully controlled studies on well- described treatment approaches are needed to establish which conservative or non-operative treatment options are most effective for patients with OSD.

Candidiasis Causing Vocal Fold Leukoplakia: Review of Clinical and Pathological Results of 289 Cases With Vocal Fold Leukoplakia

2019 ◽  
Vol 128 (10) ◽  
pp. 903-910 ◽  
Author(s):  
Murat Gumussoy ◽  
Ulku Kucuk
Keyword(s):  
Vocal Fold ◽  
Inhaled Corticosteroids ◽  
Medical Center ◽  
Age Groups ◽  
Significant Risk ◽  
Case Series ◽  
Predisposing Factors ◽  
Retrospective Case ◽  
Vocal Fold Leukoplakia

Objective: In laryngology practice, vocal fold leukoplakia is frequently evaluated by suspension laryngoscopy and biopsy examination upon the patient’s complaints of hoarseness and dysphonia. The purpose of the present study is to investigate and analyze risk factors, diagnosis, treatment, and follow-up results of cases with Candida leukoplakia. Study Design: Retrospective case control study. Setting: Tertiary medical center. Subjects and Methods: Patients with a diagnosis of vocal fold leukoplakia who underwent direct laryngoscopy and biopsy between 2007 and 2017 and diagnosed as candida or noncandida in their histopathology were assigned into 2 groups. Then they were compared in terms of their demographic characteristics, predisposing factors, diagnosis, treatment, and follow-up results. Results: Of the 289 vocal fold leukoplakia cases, 36 were candida, and 253 were noncandida. The mean age of the patients with Candida leukoplakia was 60.86 years. As for the age groups, the largest group (26.1%) was in the seventh decade ( P < .001). The use of inhaled corticosteroids was a significant risk factor ( P < .001). For their medical therapy, the patients were administered fluconazole 200 mg per day for 3 weeks, and the treatment yielded successful results in 91.66% of them. In 5 of the patients, candida leukoplakia and superficial epithelial dysplasia were observed, and no malignant transformation was observed during a mean follow-up of 28 ± 13 months. Conclusion: Candidiasis causing vocal fold leukoplakia is rare, and we report the findings of the largest published case series to date. Eliminating predisposing factors and administrating oral fluconazole 200 mg for 3 weeks are sufficient for medical treatment.

Preliminary Outcomes of Calcaneal Lengthening in Adolescent Flatfoot in Müller-Weiss Disease

2019 ◽  
Vol 40 (7) ◽  
pp. 803-807 ◽  
Author(s):  
Abdel-Salam Abdel-Aleem Ahmed ◽  
Mahmoud Ibrahim Kandil ◽  
Eslam Abdelshafi Tabl
Keyword(s):  
Treatment Options ◽  
Case Series ◽  
Deformity Correction ◽  
Functional Results ◽  
The Body ◽  
Retrospective Case ◽  
Level Of Evidence ◽  
Duration Of Symptoms ◽  
The Mean ◽  
Calcaneal Lengthening

Background: Müller-Weiss disease (MWD) remains a controversial painful foot condition without consensus on its pathogenesis or a gold standard treatment modality. The aim of the study was to evaluate the outcomes of calcaneal lengthening in adolescent patients with symptomatic MWD with flatfoot. Methods: The study included 13 feet of 7 patients including 5 females and 2 males who were treated from March 2012 until June 2015 by calcaneal lengthening. The mean age was 15.6 years. The mean duration of symptoms was 13.5 months. The body mass index (BMI) averaged 28.9 kg/m2 at presentation. The patients were followed up for a mean of 37.8 months. Results: The osteotomy healed in all cases after a mean of 7.2 weeks. The second foot was operated on after an average of 11.5 months. The mean talometatarsal-1 angle improved from 39.8 degrees preoperatively to 5.9 degrees. The mean preoperative calcaneal pitch angle of 7.5 degrees increased to an average of 17.8 degrees postoperatively. The mean American Orthopaedic Foot & Ankle Society (AOFAS) Ankle-Hindfoot Score was improved from 61.9 preoperatively to 94.2 postoperatively. Four patients had occasional exertional pain. Four feet had mild residual forefoot abduction. Arthrodesis was not needed in any case by the last follow-up. Conclusion: Early diagnosis of MWD with flatfoot was important and allowed for nonfusion treatment options. Calcaneal lengthening osteotomy in selected MWD cases achieved satisfactory outcomes with pain control, deformity correction, and improvement of the functional results. Level of Evidence: Level IV, retrospective case series.

Medialization Laryngoplasty in Pediatric Patients With Unilateral Vocal Fold Immobility: A Case Series

2018 ◽  
Vol 128 (2) ◽  
pp. 145-151 ◽  
Author(s):  
Nikolaus E. Wolter ◽  
Nohamin Ayele ◽  
Kosuke Kawai ◽  
Anne Hseu ◽  
Roger Nuss
Keyword(s):  
Vocal Fold ◽  
Pediatric Population ◽  
Voice Quality ◽  
Case Series ◽  
Swallowing Function ◽  
Age At Surgery ◽  
Significant Difference ◽  
Vocal Fold Immobility ◽  
The Impact ◽  
Medialization Laryngoplasty

Objectives: The aims of this study were to describe the impact of laryngoplasty in pediatric unilateral vocal fold immobility (UVFI) and to determine the impact of etiology and technique on voice and swallowing. Methods: A retrospective review was conducted of all children with UVFI undergoing medialization laryngoplasty at a pediatric hospital (2010-2017). Data including demographics, etiology, subjective voice quality, and swallowing function were collected. Results: The median age at first surgery among 25 patients with UVFI was 11 years (range, 1.2-25 years). The causes of UVFI were iatrogenic (76%), congenital (16%), and idiopathic (8%). A total of 38 laryngoplasties (24 injections, 11 Silastic implants, 3 Gore-Tex) were performed. Postoperatively, 78% of patients reported improvements in voice and 81% in swallowing. The median duration of voice improvement was 1.0 years (range, 0.1-10 years), with no significant difference by etiology or laryngoplasty technique. Patients who were ⩾10 years of age at surgery reported voice improvement significantly more often than patients <10 years of age at surgery (94% vs 61%, P = .04). Conclusions: UVFI has a significant impact on health and quality of life. In this study we found that laryngoplasty is an effective way to address both voice and swallowing in pediatric UVFI. A greater proportion of children with improved voice quality were older at injection. Surprisingly, there was no difference in duration of voice improvement between permanent and absorbable materials. Although this duration would be considered acceptable for many injectable materials, the limited duration in permanent implantation techniques may represent the challenges of managing UVFI in the growing larynx of the pediatric population. Injection laryngoplasty with absorbable materials may serve as an adequate method of addressing UVFI in this population.

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