scholarly journals Laryngeal varices: an atypical cause of globus

2021 ◽  
Vol 14 (12) ◽  
pp. e246413
Author(s):  
Tom Ringrose ◽  
Jamie Patel ◽  
Aria Amir Ghasemi
Keyword(s):  
Vocal Cord ◽  
Atypical Presentation ◽  
Venous Plexus ◽  
Posterior Commissure ◽  
Documented Case ◽  
Increased Risk ◽  
Thyroid Goitre

Laryngeal varices are rare and are usually associated with vocal cord trauma secondary to excessive use of voice. This report is the first documented case of laryngeal varices secondary to thyroid goitre. This is a report of an 83-year-old woman with a known retrosternal goitre chiefly with symptoms of globus. Retrosternal goitre was found to be compressing the pharyngeal venous plexus causing laryngeal venous structures bilaterally to be engorged along the aryepiglottic folds, arytenoids, posterior commissure and extending in to the postcricoid region. The presence of laryngeal varices carries a significant increased risk of haemorrhage. This case presents an atypical presentation of globus and the first reported case in the literature of laryngeal varices secondary to a thyroid goitre.

Posterior Glottic Laryngeal Stenosis

1980 ◽  
Vol 88 (6) ◽  
pp. 765-772 ◽  
Author(s):  
Ronald S. Bogdasarian ◽  
Nels R. Olson
Keyword(s):  
Airway Obstruction ◽  
Vocal Cord ◽  
Endotracheal Intubation ◽  
Vocal Cord Paralysis ◽  
Voice Quality ◽  
Posterior Commissure ◽  
Muscle Scar ◽  
Laryngeal Stenosis ◽  
Scar Contracture ◽  
Laryngoscopic Examination

Posterior glottic laryngeal stenosis most commonly results from endotracheal intubation and less commonly from external trauma or from infection. Following extubation, the patient may have immediate or delayed onset of symptoms of airway obstruction. Often, as in bilateral vocal cord paralysis, voice symptoms are minimal. Indirect laryngoscopic examination usually establishes the diagnosis. Movement of the arytenoids is seen but is limited, and is reflected in poor mobility of the vocal cords. Direct laryngoscopic examination and palpation of the arytenoids for passive mobility confirms the diagnosis and rules out vocal cord paralysis from recurrent laryngeal nerve injury. With the establishment of stenosis, scarring and web formation occurs over the posterior cricoid lamina and may extend into one or both cricoarytenoid joints and into the interarytenoid muscle. Scar contracture in the posterior commissure causes medial fixation of the vocal processes of the arytenoid cartilages. When caused by endotracheal intubation, the initial injury is usually to the mucosa of the posterior cricoid lamina, vocal processes of the arytenoids, or both. Perichondritis may ensue, its location and severity determining the ultimate functional extent of scarring. When airway obstruction results, treatment is by laryngofissure, scar resection, grafting, and stenting. If bilateral cricoarytenoid joint fibrosis is discovered, arytenoidectomy, and in some cases laryngeal lumen augmentation, is invariably required to reestablish the airway, with probable detrimental effects on voice quality. Five of ten patients are presented to illustrate the etiology, pathogenesis, symptoms, management, and sequelae of this problem.

Laryngeal Dysfunction following Prolonged Intubation

1979 ◽  
Vol 88 (4) ◽  
pp. 474-478 ◽  
Author(s):  
Robert E. Whited
Keyword(s):  
Vocal Cord ◽  
Medical Center ◽  
Recovery Phase ◽  
Clinical Findings ◽  
Posterior Commissure ◽  
Prolonged Intubation ◽  
Vocal Cord Paresis ◽  
The Many ◽  
The University

Prolonged endotracheal intubation in the adult is becoming more popular with the advent of “soft” tubes and cuffs. The many deleterious effects of such long-term intubation on the laryngotrachea have been extensively discussed in the literature. However, only sporatic attention has been given to vocal cord paresis or paralysis. The University of Cincinnati Medical Center experience with postintubation patients has shown that cord mobility disturbances are relatively common. Sixteen patients are presented who have had similar clinical findings and course following extubation. The clinical picture is that of a symmetrical vocal cord paresis or paralysis associated with arytenoid and posterior commissure edema and erythema. Vocal cord position is most often median or paramedian. A spontaneous recovery over days to weeks is the usual course. During the recovery phase cord movement most often remains symmetrical; however, full motion may occur in one cord before the other. In all patients abduction was most limited and slowest to return. In this series the most significant effect has been aspiration. Two patients developed a posterior commissure stenosis. This entity is believed to be due to inflammation initiated by the tube and its movement against the posterior half of the endolarynx. In particular, inflammatory involvement of the cricoarytenoid joints and interarytenoid region best explain the clinical course. When mucosal ulcerations and granulation tissue are superimposed on the immobilized cords interarytenoid scarring may lead to chronic stenosis.

scholarly journals Bilateral Vocal Cord Carcinoma in a Sarcoidosis Patient during Infliximab Therapy

2013 ◽  
Vol 2013 ◽  
pp. 1-3
Author(s):  
Adriane D. M. Vorselaars ◽  
Elisabeth V. Sjögren ◽  
Coline H. M. van Moorsel ◽  
Jan C. Grutters
Keyword(s):  
Vocal Cord ◽  
A Priori ◽  
Tumor Development ◽  
Infliximab Therapy ◽  
Rapid Progression ◽  
Infliximab Treatment ◽  
Sarcoidosis Patient ◽  
Larynx Carcinoma ◽  
Increased Risk

Introduction. Although the role of TNF-αin tumor development is not fully understood, an increased risk of malignancy with TNF-α-inhibitors, such as infliximab, has been suggested.Case Presentation. We present a 54-year-old nonsmoking female sarcoidosis patient. After seven months of infliximab therapy a T1aN0M0 larynx carcinoma of the right vocal cord was found and excised. Within a year, whilst still on treatment, a second larynx carcinoma of the opposite vocal cord appeared.Discussion. A bilateral vocal cord tumor is rare, especially in a never smoker. Evidence on the role of infliximab in carcinogenesis is inconclusive. To date, there are no follow-up studies evaluating malignancy risk of infliximab therapy in sarcoidosis patients. No studies in other diseases focus on laryngeal carcinomas during infliximab use. We argue that infliximab treatment might have attributed to the rapid progression of vocal cord carcinomas in this patient with an a priori low risk tumor profile. This case illustrates that caution remains warranted in patients with previous malignancies when considering initiation of TNF-α-inhibitors.

Laser Surgery for Vocal Cord Carcinoma Involving the Anterior Commissure

1989 ◽  
Vol 98 (2) ◽  
pp. 105-109 ◽  
Author(s):  
Yosef P. Krespi ◽  
Charles J. Meltzer
Keyword(s):  
Radiation Therapy ◽  
Vocal Cord ◽  
Laser Surgery ◽  
Anterior Commissure ◽  
Thyroid Cartilage ◽  
Increased Risk ◽  
Endoscopic Laser ◽  
Benign Laryngeal Lesions ◽  
Endoscopic Laser Surgery ◽  
Glottic Tumors

Endoscopic laser surgery is an established means of treatment for benign laryngeal lesions. Laser surgery for early (stages I and II) squamous cell carcinoma is still being tested. Treatment of glottic tumors extending to the anterior commissure is in itself controversial. Approximately 20% of all glottic tumors involve the anterior commissure, with only 1% of these lesions being purely anterior commissure tumors. The anatomy of the anterior commissure is such that an apparent T1 lesion may actually be a T4 lesion if it involves the thyroid cartilage. The distance between the anterior commissure ligament and the thyroid cartilage is only 2 to 3 mm. A preoperative computed tomographic scan can aid us in evaluating this space. Therefore, tumors of the anterior commissure present as a therapeutic challenge. Radiation therapy has proven to be inadequate, with a high rate of recurrence and increased risk for radiochondronecrosis. The literature with regard to radiotherapy varies widely as to survival rates. Conservation surgery has consistently demonstrated an 80% survival in T1 lesions. Recently, it has been suggested that laser surgery in the region of the anterior commissure might offer satisfactory results. We have found the opposite. We will report on five patients who underwent endoscopic laser surgery on T1 vocal cord lesions involving the anterior commissure. All of these patients had tumor recurrence and subsequently have undergone salvage surgery and/or radiation therapy. The difficulties associated with endoscopic laser surgery of the anterior commissure will be discussed with a supporting animal study.

scholarly journals Atypical Ataxia Presentation in Variant Ataxia Telangiectasia: Iranian Case-Series and Review of the Literature

2022 ◽  
Vol 12 ◽  
Author(s):  
Tannaz Moeini Shad ◽  
Reza Yazdani ◽  
Parisa Amirifar ◽  
Samaneh Delavari ◽  
Marzieh Heidarzadeh Arani ◽  
...  
Keyword(s):  
T Cells ◽  
Ataxia Telangiectasia ◽  
Late Onset ◽  
Case Series ◽  
Atypical Presentation ◽  
Missense Mutations ◽  
Multisystem Disorder ◽  
Atypical Form ◽  
Increased Risk ◽  
Risk Of Cancer

Ataxia-telangiectasia (AT) is a rare autosomal recessive neurodegenerative multisystem disorder. A minority of AT patients can present late-onset atypical presentations due to unknown mechanisms. The demographic, clinical, immunological and genetic data were collected by direct interview and examining the Iranian AT patients with late-onset manifestations. We also conducted a systematic literature review for reported atypical AT patients. We identified three Iranian AT patients (3/249, 1.2% of total registry) with later age at ataxia onset and slower neurologic progression despite elevated alpha-fetoprotein levels, history of respiratory infections, and immunological features of the syndrome. Of note, all patients developed autoimmunity in which a decrease of naïve T cells and regulatory T cells were observed. The literature searches also summarized data from 73 variant AT patients with atypical presentation indicating biallelic mild mutations mainly lead to an atypical phenotype with an increased risk of cancer. Variant AT patients present with milder phenotype or atypical form of classical symptoms causing under- or mis- diagnosis. Although missense mutations are more frequent, an atypical presentation can be associated with deleterious mutations due to unknown modifying factors.

A MULTI-INSTITUTIONAL SURVEY OF THE WISKOTT-ALDRICH SYNDROME

PEDIATRICS ◽  
1996 ◽  
Vol 98 (2) ◽  
pp. 348-349
Author(s):  
John M. James
Keyword(s):  
High Risk ◽  
Diagnostic Tests ◽  
Autoimmune Disorders ◽  
Atypical Presentation ◽  
Laboratory Findings ◽  
Wiskott Aldrich Syndrome ◽  
Platelet Counts ◽  
Risk Of Bleeding ◽  
Increased Risk ◽  
Study Population

Many patients with WAS have an atypical presentation, lack consistent laboratory findings, and a panel of diagnostic tests is often required to establish the diagnosis. Two high-risk subgroups were identified in the study population: patients with platelet counts < 10 000/mm3 at the time of diagnosis were at high-risk of bleeding, and patients with autoimmune disorders were at increased risk of having a malignancy.

Endoscopic Laser Medial Arytenoidectomy for Airway Management in Bilateral Laryngeal Paralysis

1993 ◽  
Vol 102 (2) ◽  
pp. 81-84 ◽  
Author(s):  
Roger L. Crumley
Keyword(s):  
Vocal Cord ◽  
Phrenic Nerve ◽  
Carbon Dioxide Laser ◽  
Recent Experience ◽  
Posterior Commissure ◽  
Laryngeal Paralysis ◽  
Nerve Transfers ◽  
Posterior Cricoarytenoid Muscle ◽  
Endoscopic Laser ◽  
Posterior Cricoarytenoid

A review of our recent experience in patients with bilateral laryngeal paralysis is described. While we continue to use phrenic nerve transfers in patients with mobile arytenoids, patients with fixed arytenoids generally require some sort of vocal cord lateralization, either by arytenoidectomy and arytenoidopexy or by partial vocal cord resection. The endoscopic laser medial arytenoidectomy is a convenient and effective method for opening the posterior glottic airway. One arytenoid is reduced medially with the carbon dioxide laser. After about 3 months the opposite arytenoid can be treated similarly, if necessary. The procedure does not appear to affect arytenoid mobility, as the posterior commissure mucosa and underlying interarytenoid muscle are protected and hence unaffected by the procedure. Those patients with at least one mobile arytenoid cartilage are candidates for posterior cricoarytenoid muscle reinnervation. Although ansa cervicalis and phrenic nerve techniques have been described, the author has concentrated efforts on the phrenic nerve. This report describes the endoscopic laser medial arytenoidectomy procedure, while the phrenic nerve patients will be reported in a subsequent manuscript.

scholarly journals Atypical Presentation of Systemic Arthritis in a Toddler with Down Syndrome

2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
Emily Worley ◽  
Weijie Li ◽  
Jordan T. Jones
Keyword(s):  
Down Syndrome ◽  
Case Report ◽  
Broad Spectrum ◽  
Systemic Juvenile Idiopathic Arthritis ◽  
Chronic Inflammatory Disease ◽  
Atypical Presentation ◽  
Increased Risk ◽  
Macular Rash ◽  
Life Threatening ◽  
Atypical Presentations

Systemic juvenile idiopathic arthritis (sJIA) is a chronic, inflammatory disease of childhood, which is characterized by the combination of arthritis, serositis, daily, high-spiking fevers, and evanescent macular rash and can present with the life-threatening complication of macrophage activation syndrome (MAS). Children with Down syndrome (DS) have complex medical challenges related to abnormalities in their immune system, which can cause a broad spectrum of disease manifestations, which can occur atypically. Children with DS are at increased risk for arthritis and interstitial lung disease (ILD) associated with sJIA that has high mortality. This case report outlines an atypical presentation of sJIA in a 21-month-old male with DS in which fever was not part of the initial presentation of sJIA and then later developed MAS and ILD. Due to broad spectrum of disease and atypical presentation in children with DS, this case report was created to increase awareness of atypical presentations of rheumatic disease in children with DS.

Thyroplasty: A New Approach

1993 ◽  
Vol 102 (8) ◽  
pp. 571-579 ◽  
Author(s):  
William W. Montgomery ◽  
Stanley M. Blaugrund ◽  
Mark A. Varvares
Keyword(s):  
Vocal Cord ◽  
Precise Measurement ◽  
Lateral Displacement ◽  
Posterior Commissure ◽  
Measuring Device ◽  
New Approach ◽  
Rectangular Window ◽  
Proper Size ◽  
New Type ◽  
Saw Blade

A new type of thyroplasty implant (prosthesis) has been designed to be used as part of a surgical operation that accomplishes medial displacement of a paralyzed vocal cord. The implant is inserted through a rectangular window fashioned in the thyroid lamina on the side of the vocal cord paralysis. Instruments for measuring the location and outline of the window in the thyroid lamina are presented. A thyroplasty saw blade is introduced. By using this blade, a window of precise measurement can be constructed without injury to the underlying perichondrium. The implant is constructed from a biocompatible, medical-grade polymer. Four sizes each are available for the male and female larynges. The proper-size implant can be selected with a measuring device. It is not necessary to alter the implant at the time of surgery; it snaps into place and suturing is not necessary. Once the implant is inserted, its medial or lateral displacement is not possible; on the other hand, the implant can be easily removed if vocal cord function returns, or if a change to a different-size implant is indicated. The design of the implant will close the posterior commissure.

scholarly journals Recurrent laryngeal nerve palsy due to displacement of a gastric band

2016 ◽  
Vol 98 (8) ◽  
pp. e152-e153 ◽  
Author(s):  
JM Fussey ◽  
F Ahsan
Keyword(s):  
Recurrent Laryngeal Nerve ◽  
Vocal Cord ◽  
Gastric Band ◽  
Recurrent Laryngeal Nerve Palsy ◽  
Vocal Cord Palsy ◽  
Laryngeal Nerve ◽  
Increased Risk ◽  
Left Recurrent Laryngeal Nerve ◽  
Long Course ◽  
Oesophageal Pathology

The left recurrent laryngeal nerve is at increased risk of compression by oesophageal pathology due to its long course through the neck and thorax. Here we report a case of left vocal cord palsy secondary to displacement of a gastric band, resulting in oesophageal dilatation and neuropraxia of the left recurrent laryngeal nerve. Vocal cord function partially improved following removal of the gastric band.

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