scholarly journals Vocal cord surgery and pharmacological treatment of a patient with HPV and recurrent respiratory papillomatosis

2019 ◽  
Vol 12 (11) ◽  
pp. e231117 ◽  
Author(s):  
Francesco Galletti ◽  
Francesco Freni ◽  
Francesco Gazia ◽  
Andrea Gallo
Keyword(s):  
Human Papillomavirus ◽  
Surgical Technique ◽  
Vocal Cord ◽  
Anterior Commissure ◽  
Free Edge ◽  
Respiratory Epithelium ◽  
Recurrent Respiratory Papillomatosis ◽  
Vocal Cords ◽  
The Voice

Recurrent respiratory papillomatosis (RRP) is caused by persistent infection of the respiratory epithelium by human papillomavirus (HPV), especially HPV 6 and 11. We present a case of surgically treated RRP. The main purpose of our protocol is to remove the lesions with a non-aggressive surgical technique and prevent recurrences with the use of cidofovir for local infiltrations in multiple sessions. We use low-power energy CO2 laser, directed towards the upper part of the vocal cord, to determine a retraction of the mucosa with consequent coverage of the epithelium of the free edge. The aim of this technique is to treat and stop the formation of synechia of the anterior commissure and the free margin of the vocal cords in the anterior commissure. After 8 years follow-up, there are no signs of recurrence of the disease. The voice had a net improvement confirming the effectiveness of the protocol.

Distribution Characteristics of Juvenile-Onset Recurrent Respiratory Papillomatosis at First-Time Surgery

2021 ◽  
pp. 014556132110498
Author(s):  
Xiaoli Qu ◽  
Yang Xiao ◽  
Lijing Ma ◽  
Jun Wang
Keyword(s):  
Vocal Cord ◽  
Disease Severity ◽  
Recurrent Respiratory Papillomatosis ◽  
Age At Diagnosis ◽  
Juvenile Onset ◽  
Vocal Cords ◽  
Younger Age ◽  
False Vocal ◽  
The Impact ◽  
First Time

Objectives The lesion distribution of juvenile-onset recurrent respiratory papillomatosis (JORRP) during first-time surgery has been rarely reported. The purpose of this study was to describe the anatomical distribution of papilloma across 25 Derkay sites during initial surgery and to assess the impact of the lesion distribution on disease severity. Methods Surgical videos and medical records of 106 patients with JORRP (27 aggressive and 79 nonaggressive cases) were retrospectively reviewed. Lesion locations were recorded using Derkay anatomical sites. Logistic regression was used to analyze the effect of the lesion distribution on disease severity. Results Among the 106 patients, the true vocal cords (90.6% left, 84.0% right) were the most frequently involved site, followed by the false vocal cords (39.6% left, 35.8% right) and the anterior commissure (26.4%). Two patients (1.9%) had tracheal involvement. Patients with false vocal cord involvement (odds ratio [OR] = 3.425, 95% confidence interval [CI] [1.285, 9.132], P = .014) and a younger age at diagnosis (OR = .698, 95% CI [.539, .905], P = .007) were more likely to require more than 4 procedures in the year following first-time surgery. Conclusions Lesions were most common on the true vocal cords. False vocal cord involvement and a younger age at diagnosis were risk factors for disease severity.

Identification of 11 Different HPV Subtypes in Adult Patients With Recurrent Respiratory Papillomatosis

2020 ◽  
Vol 163 (4) ◽  
pp. 785-790
Author(s):  
Rebecca C. Hoesli ◽  
Melissa L. Wingo ◽  
Brent E. Richardson ◽  
Robert W. Bastian
Keyword(s):  
Human Papillomavirus ◽  
Patient Outcomes ◽  
Clinical Course ◽  
Adult Population ◽  
Tertiary Care ◽  
Recurrent Respiratory Papillomatosis ◽  
Definition Of ◽  
Large Adult

Objective To define the human papillomavirus (HPV) subtypes seen in a large adult population with traditionally defined recurrent respiratory papillomatosis. Study Design Retrospective review. Setting Tertiary care laryngology practice. Subjects and Methods All patients had a firm diagnosis of recurrent respiratory papillomatosis defined by (1) visually obvious papillomas, (2) recurrence requiring multiple surgeries, and (3) pathology diagnosis of “papilloma.” Each patient had also undergone HPV subtyping. Age, sex, presence of malignancy, and HPV subtypes were tabulated and correlated with long-term patient outcomes. Results A total of 184 patients were identified who fulfilled the above criteria. In total, 87.0% (160) had a low risk subtype; 9.2% had an alternative subtype. These consisted of subtypes 16, 18, 31, 44, 45, 55, and 70. Four patients (2.2%) had combinations of subtypes, with 1 patient with HPV 11 and 16, 1 patient with HPV 11 and 76, 1 patient with 11 and 84, and 1 patient with 18 and 45. Finally, 3.8% of patients were HPV negative, despite fulfilling all 3 criteria listed above. Conclusion In the patient population above, almost 10% of patients had an HPV subtype other than 6 and 11. This suggests that traditionally defined recurrent respiratory papillomatosis (RRP) can be caused by HPV subtypes other than 6 and/or 11. In addition, the clinical course of persons with this definition of RRP appears to vary by subtype, and this information may offer the ability to nuance follow-up instructions, reducing in particular the burden placed upon patients who have RRP caused by subtypes 6 and 11.

Injection and Removal of Teflon for Unilateral Vocal Cord Paralysis

1992 ◽  
Vol 101 (1) ◽  
pp. 81-86 ◽  
Author(s):  
Herbert H. Dedo
Keyword(s):  
Vocal Cord ◽  
Vocal Cord Paralysis ◽  
Thyroid Cartilage ◽  
Indirect Laryngoscopy ◽  
Air Leak ◽  
Vocal Cords ◽  
Laryngeal Framework Surgery ◽  
The Voice ◽  
Major Defect ◽  
Unilateral Vocal Cord Paralysis

For over 70 years, reinnervation attempts have been unsuccessful in restoring motion to paralyzed vocal cords, in spite of occasional claims to the contrary. Fortunately, the major defect of unilateral vocal cord paralysis, a soft and breathy voice, can be eliminated if the edge of the paralyzed vocal cord is moved to the midline. This permits the mobile vocal cord to adduct and therefore to vibrate firmly against the edge of the paralyzed vocal cord during phonation, eliminating the air leak between the vocal cords. Teflon injection of the paralyzed vocal cord does this effectively. It is accomplished most easily and reliably via indirect laryngoscopy under local anesthesia, so the effect on the voice can be monitored during the injection. Teflon can be easily removed from the vocal cord via direct laryngoscopy. The disadvantages of trying to medialize the edge of a paralyzed vocal cord via a window in the thyroid cartilage (laryngeal framework surgery) will be discussed.

Quantitative and Objective Evaluation of Vocal Cord Function

1983 ◽  
Vol 92 (5) ◽  
pp. 421-423 ◽  
Author(s):  
Eugene Rontal ◽  
H. John Jacob ◽  
Michael Rontal ◽  
Michael I. Rolnick
Keyword(s):  
Vocal Cord ◽  
Screening Tool ◽  
Cost Effective ◽  
Objective Evaluation ◽  
Vocal Cord Dysfunction ◽  
Vocal Cords ◽  
Vocal Cord Function ◽  
Objective Basis ◽  
High Degree

Objective and quantitative evaluation of vocal cord function is a goal that has been difficult for voice clinicians to obtain. To be useful as a clinical screening tool it must be easy to perform, it must produce numerical storable data, it must have a high degree of accuracy, and it must be cost-effective. The results of this study have shown that using the perturbation factor and the equipment described, a successful rate of greater than 93% can be obtained in evaluating vocal cord dysfunction. The results further indicate that this equipment can be used much in the same way as an audiogram to follow-up and clinically evaluate on an objective basis the function of the vocal cords.

Midline Lateralization Thyroplasty for Adductor Spasmodic Dysphonia

2000 ◽  
Vol 109 (2) ◽  
pp. 187-193 ◽  
Author(s):  
Nobuhiko Isshiki ◽  
Yukiko Yamamoto ◽  
Domingos H. Tsuji ◽  
Yasukimi Iizuka
Keyword(s):  
Anterior Commissure ◽  
Thyroid Cartilage ◽  
Composite Graft ◽  
Spasmodic Dysphonia ◽  
Type Ii ◽  
Postoperative Course ◽  
Adductor Spasmodic Dysphonia ◽  
The Voice

Midline lateralization thyroplasty was successfully performed on a patient with adductor spasmodic dysphonia. The thyroid cartilage was incised at the midline, and a 3 × 2-mm perforation was made at the anterior commissure to widen it. The perforation was closed with a free composite graft taken from the upper edge of the thyroid ala, and the incised thyroid cartilage edges were kept separated 4 mm apart with silicone wedges. A part of the sternohyoid muscle was rotated to seal any leak from the perforation. The postoperative course was uneventful. The voice has been restored to normal, and there is no sign of recurrence of the symptom so far, as of 1 year 5 months postoperative. Although a longer follow-up is needed, this case indicates that midline type II thyroplasty could be a useful treatment for adductor spasmodic dysphonia.

Surgical Therapy of Dysphonia Plica Ventricularis

1973 ◽  
Vol 82 (3) ◽  
pp. 386-388 ◽  
Author(s):  
F. Kosokovic ◽  
I. Lenarcic-Cepelja
Keyword(s):  
Surgical Technique ◽  
Vocal Cord ◽  
Local Anesthesia ◽  
Neuroleptic Drugs ◽  
True Vocal Cord ◽  
The One ◽  
Ventricular Folds ◽  
Mucosal Hypertrophy ◽  
Point Of Reference

The authors report their experience in the use of surgery for the treatment of dysphonia plica ventricularis, the vocal disorder which results when enlargement of the ventricular folds impairs true vocal cord apposition. Diagnosis was made by means of microlaryngoscopy under local anesthesia applying neuroleptic drugs. Surgery was reserved for those patients whose mucosal hypertrophy did not respond to medications, psychotherapy and persistent speech exercises. The surgical technique employed consisted of grasping the central portion of the ventricular fold, pulling it medially, and excising the triangular portion of mucosa thus exposed. The underlying vocal cord was used as a point of reference for the excision. The raw surface was observed to reepithelialize rapidly. Cortisone inhalations were administered postoperatively in order to decrease the chance of scar formation. The 25 patients treated in this manner have done well during the one to four year follow-up period.

scholarly journals CLINICAL EVALUATION OF VOICE IN CHILDREN WITH DYSPHONIA

World Science ◽  
2018 ◽  
Vol 1 (10(38)) ◽  
pp. 25-27
Author(s):  
Nadjimutdinova N. Sh. ◽  
Amonov Sh. E. ◽  
Alieva M. U.
Keyword(s):  
Comparative Analysis ◽  
Clinical Study ◽  
Vocal Cord ◽  
Vocal Folds ◽  
Healthy Children ◽  
Organic Disease ◽  
Functional Disorders ◽  
Vocal Cords ◽  
Vocal Apparatus ◽  
The Voice

Objective: make a comparative analysis of the voice of the index (VHI) and endoscopic studies in the pathology of the voice of children.Material and Methods: The study involved 87 children, from 6 months to 14 years. The clinical study included fibrorinolaryngoscopy with video fixation (C-MAC, K. Storz, Ø-2,7 mm) and a survey of parents (or guardians) of children at the Uzbek version of the voice handicap index (pVHI), with sub- sections (functional - F, the physical - P and emotional - E).Results: endoscopic diagnosed laryngitis 20,6% (n = 18), functional 16,1% (n = 14) and mutational 9,2% (n = 8), dysphonia, benign larynx (respiratory papillamatosis) - 18.4 % (n = 16), the vocal cords paresis - 5.7% (n = 5), the vocal folds nodules 26.4% (n = 23), throat structure anomalies (acquired) 3,4% (n = 3). The survey revealed pVHI average points total pVHI and its sub-group of patients were as follows: F - 13,94, P - 15.48, E - 12.15 and T - 41.58, which is significantly higher than the group of healthy children and children with functional disorders of voice.Conclusions: Fibrolaryngoscopy with the smallest diameter of the lumen of the laryngoscope with video fixation allowed to quickly ascertain the diagnosis of organic disease of the larynx in children. In addition, the survey pVHI allowed to differentiate the severity of the vocal apparatus, to conduct timely special endoscopic diagnosis of vocal cord diseases.

scholarly journals Stroboscopy: an evolving tool for voice analysis in vocal cord pathologies

2017 ◽  
Vol 3 (4) ◽  
pp. 927 ◽  
Author(s):  
Sneha D. Rajput ◽  
Mittal J. Poriya
Keyword(s):  
Vocal Cord ◽  
Preoperative Evaluation ◽  
Neck Surgery ◽  
Significant Difference ◽  
Reinke’S Edema ◽  
Common Causes ◽  
Almost All ◽  
Laryngeal Anatomy ◽  
The Voice

<p class="abstract"><strong>Background:</strong> Benign vocal fold disease, such as vocal polyp, vocal nodule, intracordal cyst or Reinke’s edema is one of the most common causes which deteriorate the voice. Since 1854 when Manuel Garcia first observed the movement of his own vocal cords using a laryngeal mirror and sunlight as the light source, a number of techniques for demonstrating laryngeal anatomy have evolved. Preoperative evaluation of these lesions initially by indirect laryngoscopy or direct rigid laryngoscopy, gave way to the use of transnasal flexible fibreoptic endoscopy in the eighties. The introduction of the video stroboscope into Otorhinolaryngology practice has revolutionized the assessment of vocal cord pathology.</p><p class="abstract"><strong>Methods:</strong> The present study includes a 50 cases of subjects with complain of change of voice coming at department of E.N.T and Head and Neck surgery, at our hospital. A detailed history was taken following which a thorough examination of larynx using appropriate techniques were carried out. Further investigations were done as and when required.  </p><p class="abstract"><strong>Results:</strong> On stroboscopic examination patients were analyzed on four parameters like, symmetry, amplitude, periodicity and mucosal wave. Observations of periodicity and mucosal wave were significantly different in preoperative and post-operative analysis. Stroboscopic evaluation suggested that preoperatively 50% of the patient were having asymmetricity, decreased amplitude, aperiodicity and absent mucosal wave. On postoperative follow-up at 15 days and 2 months interval almost all the patients got all the parameters near normal.</p><p><strong>Conclusions:</strong> It was observed that statistical significant difference in pre and postoperative findings of different parameters of voice evaluated using it. We can draw the probable conclusion that video stroboscope proved to be useful and reliable tool for evaluation of the patients with benign vocal cord pathologies as it reflects the change in the all the parameters of voice postoperatively most accurately and promptly. </p>

scholarly journals The Tale of Stridor and Wheezing in an Infant

2021 ◽  
Vol 2021 ◽  
pp. 1-3
Author(s):  
Umer Muhammad ◽  
Marcus Shaffer ◽  
John Bishara
Keyword(s):  
Intensive Care Unit ◽  
Intensive Care ◽  
Human Papillomavirus ◽  
Respiratory Failure ◽  
Pediatric Intensive Care ◽  
Recurrent Respiratory Papillomatosis ◽  
Debulking Surgery ◽  
Vocal Cords ◽  
Pediatric Otolaryngology ◽  
Rsv Infection

Recurrent respiratory papillomatosis is a respiratory disease caused by human papillomavirus and can infect any part of the aerodigestive tract, but the larynx is most involved (Derkay et al. 2010). This report is a discussion about a 7-month-old male that presented to our institution for respiratory distress. He was admitted to the Pediatric Intensive Care Unit (PICU) for stabilization, observation, and further treatment and management due to an acute RSV infection. Initial efforts failed to improve his respiratory failure. A bronchoscopy was performed and showed various flesh-colored lesions throughout the larynx, vocal cords, and tracheal tree just above the carina. Pediatric otolaryngology performed an emergent debulking surgery to alleviate his respiratory failure. He has had multiple exacerbations of his condition since then and has required frequent debulking procedures with a few trials of intralesional bevacizumab therapies.

585-NM Pulsed Dye Laser Treatment of Glottal Papillomatosis

2002 ◽  
Vol 111 (6) ◽  
pp. 486-492 ◽  
Author(s):  
Ramon A. Franco ◽  
William A. Farinelli ◽  
Steven M. Zeitels ◽  
R. Rox Anderson
Keyword(s):  
Anterior Commissure ◽  
Vocal Folds ◽  
Spot Size ◽  
Recurrent Respiratory Papillomatosis ◽  
Dye Laser ◽  
Pulsed Dye Laser ◽  
Depth Of Penetration ◽  
Efficacious Treatment ◽  
Superficial Lamina

Treatment of recurrent respiratory papillomatosis of the glottis is often challenging. The surgeon and patient must cooperatively balance decisions regarding airway safety, effects of multiple general anesthesias, employment disturbance, and vocal dysfunction. A pilot study was done in 41 adult cases (23 patients; 78 vocal folds) without complication to evaluate the effectiveness of a 585-nm pulsed dye laser (PDL; 450-μs pulse width; fluence of 38 to 255 J/cm2; 1- to 2-mm spot size) in the treatment of this disorder. Thirty-seven of the 41 cases (90%) were bilateral disease. Twenty-six of the 41 cases (63%; including 20 cases with involvement of the anterior commissure) were treated by bilateral photocoagulation of the lesions' microcirculation without microflap resection of tissue. Clinical observation revealed that irradiated but unresected disease involuted without development of an anterior commissure web. In the initial 13 of the 41 cases (32%), PDL treatment was followed by cold instrument microflap resection. The PDL enhanced the epithelial excision by improving hemostasis and by creating an optimal dissection plane between the basement membrane and the underlying superficial lamina propria. The PDL at 585 nm was less effective in the management of exophytic lesions because of its limited depth of penetration (approximately 2 mm). In this initial trial, the PDL was a relatively safe and efficacious treatment for glottal recurrent respiratory papillomatosis. Since the lesions involute without complete resection of the diseased epithelium, the anterior commissure can be treated to minimize the number of procedures. To study patterns of recurrence will require longer follow-up.

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