Transient Recurrent Laryngeal Nerve Palsy after Interventional Therapy.

BACKGROUND: Hoarseness due to laryngeal nerve injury is a known complication after cardiothoracic surgery involving the aortic arch. However, this complication is only rarely reported after catheter interventions. RESULTS: In this article we present the unusual case of a left-sided vocal cord paralysis in four patients after primary stenting of a re-coarctation, re-dilatation of a stented coarctation, a primary stenting of the left pulmonary artery (LPA), and prestenting for percutaneous pulmonary valve implantation with dilation of the LPA. After implanting bare metal stents, it is common practice, whilst contemplating the diameters of the adjacent structures, to optimize the stent diameter in a two-step procedure and dilate the stent until a maximum diameter is achieved and there is no residual gradient after applying this technique. Four of our patients experienced hoarseness after the intervention and a vocal cord paralysis was diagnosed. Angiography revealed no signs of extravasation or dissection. Clinical symptoms improved over the course of the following 6 months; patients with interventions at the aortic arch showed a complete remission, patients with procedures involving the LPA showed only mild regression of the symptoms. CONCLUSION: To our knowledge, this complication (Ortner's syndrome, cardiovocal syndrome) after such interventions has rarely been reported before. Although a rare complication, the recognition of these symptoms may support colleagues in managing affected patients. In addition, awareness for hoarseness after interventional therapies and systematic screening for this complication might help to identify patients at risk in the future.

Injection laryngoplasty under ultrasonographic control.

BACKGROUND: Cervical ultrasound allows real-time visualization of the laryngeal structures. We describe its application for injection laryngoplasty in the voice clinic. METHODS: Hyaluronic acid infiltration of the vocal fold under ultrasonographic control. CONCLUSIONS: With this technique, the position of the needle in the depth of the vocal fold and its spatial relations with nearby structures can be assessed. This allows for an accurate infiltration of the material in contrast to other techniques and avoids discomfort related to the gag reflex with nasofibrolaryngoscopy. No specific complications have been observed so far, however, this technique may be difficult in cases with calcified cartilages or uncooperative patients.

ENT infection caused by Raoultella ornithinolytica.

Raoultella ornithinolytica is an encapsulated gram-negative aerobic bacillus belonging to the Enterobacteriaceae family. It is one of the three species of Raoultella. Human infections related to R. ornithinolytica are exceedingly rare. This case report describes an ENT infection caused by R. ornithinolytica successfully treated with antibiotic therapy.

A computational framework for patient-specific surgical planning of type 1 thyroplasty.

A computational framework is proposed for virtual optimization of implant configurations of type 1 thyroplasty based on patient-specific laryngeal structures reconstructed from MRI images. Through integration of a muscle mechanics-based laryngeal posturing model, a flow-structure-acoustics interaction voice production model, a real-coded genetic algorithm, and virtual implant insertion, the framework acquires the implant configuration that achieves the optimal acoustic objectives. The framework is showcased by successfully optimizing an implant that restores acoustic features of a diseased voice resulted from unilateral vocal fold paralysis (UVFP) in producing a sustained vowel utterance. The sound intensity is improved from 62 dB (UVFP) to 81 dB (post-correction).

Sagittal sinus dural arteriovenous fistula manifesting as unilateral vocal fold paresis.

We present a case of a sagittal sinus dural arteriovenous fistula manifesting as dysphonia secondary to vocal fold paresis. The patient presented with a 6-week history of hoarseness. Imaging studies demonstrated findings suggestive of a dural arteriovenous fistula affecting the superior sagittal sinus. Direct laryngoscopy demonstrated paresis of the right vocal fold. We hypothesized that pressure on the vagus nerve from a dilated and arterialized internal jugular vein within the jugular foramen was responsible for the cranial neuropathy. The patient's dysphonia resolved with embolization of the fistula, and repeat laryngoscopy showed resolution of the vocal fold paresis.

Endovascular management of hoarseness due to a thoracic aneurysm: case report and review of the literature.

Although uncommon, hoarseness can be a presenting symptom of a thoracic aneurysm. We present a case of a 67-year-old man with hoarseness, subsequently found to have left vocal paralysis. On workup, a computed tomography scan demonstrated a saccular thoracic aneurysm compressing the recurrent laryngeal nerve at the aortopulmonary window. About 6 months after treatment with an endovascular stent graft, the aneurysm sac decreased in size and hoarseness resolved without further surgical intervention. Although uncommonly mentioned as an indication for surgery, hoarseness from a thoracic aneurysm can be successfully managed with endovascular stent grafting.

Diffuse Idiopathic Hyperostosis Manifesting as Dysphagia and Bilateral Cord Paralysis: A Case Report and Literature Review.

BACKGROUND: Diffuse idiopathic hyperostosis (DISH) is characterized by calcifications affecting mainly the spinal anterior longitudinal ligament. This disease is mainly asymptomatic but cervical osteophytes can sometimes cause dysphagia (DISHphagia), hoarseness, and even dyspnea. CASE DESCRIPTION: We report, for the first time in the medical literature, a case of a 76-year-old patient with DISH causing an important dysphagia as well as bilateral vocal cord paralysis causing critical dyspnea. The patient was surgically treated by anterior resection of the osteophytes and application of bone wax, with significant clinical improvement and no radiologic recurrence after 2 years of follow-up. DISCUSSION AND CONCLUSION: A thorough literature review didn't yield any article reporting on bilateral vocal cord paralysis caused by DISH. Management of this condition is typically multidisciplinary, and treatment of cervical osteophyte-associated dysphagia or respiratory compromise is primarily medical, after performing necessary tests to rule out other causes of dysphagia. Surgical intervention is warranted when medical treatment fails, when there is weight loss, a significant airway compromise or sleeping alterations. A treatment algorithm is proposed in the end of this review for symptomatic anterior osteophytes caused by DISH in the mobile cervical spine.

Endovascular repair of a penetrating thoracic aortic ulcer presenting with left recurrent laryngeal nerve palsy.

Endovascular repair offers minimally invasive management of otherwise complex thoracic aneurysms. Here, a case is reported of a 74-year-old man, a known hypertensive and ex-smoker, who underwent fiberoptic bronchoscopy for gradually progressing intermittent hoarseness of voice, which revealed incomplete left vocal cord palsy with no visible mass; however, computerized tomography and subsequent arteriography demonstrated a penetrating thoracic aortic ulcer with an associated false aneurysm (5 x 4 cm) from the distal inferior aortic arch just beyond the left subclavian origin, possibly compressing the left recurrent laryngeal nerve. Successful repair of the pseudoaneurysm was undertaken by endovascular technique with marked resolution of hoarseness after 1 year of follow-up.

Three-dimensional laryngeal model for planning of laryngeal framework surgery.

CONCLUSION: The three-dimensional prototype model was useful for planning of laryngeal framework surgery. OBJECTIVE: To discuss the usefulness of a three-dimensional laryngeal model for laryngeal framework surgery. MATERIALS AND METHODS: A three-dimensional laryngeal model was created based on the postoperative helical computed tomography (CT) data of the larynx (case 1) which underwent lateral cricoarytenoid muscle (LCA) pull surgery. LCA pull surgery is a kind of arytenoid adduction for unilateral vocal cord paralysis. A three-dimensional model of case 1 larynx was prototyped using a selective laser sintering method. In case 1, the patient's voice did not improve after LCA pull surgery. The three-dimensional model revealed that the original surgical procedure was not appropriate to obtain optimal arytenoid adduction. According to the analysis of this three-dimensional model, we changed the surgical approach and performed this new refined LCA pull surgery on another patient with unilateral vocal cord paralysis (case 2). RESULTS: We were able to pull LCA precisely in case 2. Three-dimensional CT of case 2 after refined LCA pull surgery allowed the correct pulling of LCA and complete adduction of arytenoid. The postoperative voice improved remarkably.

Aortic aneurysm: a rare cause of Ortner's syndrome.

A young man presented with hoarseness of voice and was found to have left vocal cord paralysis and a large opacity on chest X-ray in the left upper zone. CT angiography showed a giant aneurysm of the aortic arch involving the left subclavian artery. Using a dual perfusion system, with the femoral bypass circuit taking care of the spinal protection and the aortic bypass circuit providing the cerebral protection, the aneurysm was excised and a 16 mm Dacron graft was anastomosed to the aortic arch and the left subclavian artery was anastomosed to the interposition graft. He had a smooth postoperative course and his hoarseness subsided in next 6 months.