Disfunción de cuerdas vocales post tiroidectomía, reporte de un caso

Objetivo: Describir un caso de disfunción glótica post tiroidectomía, hecho infrecuente asociado a esta cirugía. Material y Método: Revisión de caso clínico y de la literatura. Caso clínico: Mujer con cáncer de tiroides que evoluciona post tiroidectomía, con disfunción de cuerdas vocales. Se decide su intubación e ingreso a UCI. Luego de 48 horas evoluciona favorablemente y logra ser extubada. Discusión: Se discuten las causas, formas de presentación y manejo de esta condición. Conclusión: El diagnóstico de disfunción glótica debe sospecharse ante disnea y estridor inspiratorio en el postoperatorio de una tiroidectomía.

Objective: To describe a case of post thyroidectomy glottic dysfunction, an infrequent event associated with this surgery. Material and Method: review of clinical case and literature Clinical Case: Woman with thyroid cancer that evolves after thyroidectomy with vocal cord dysfunction. Her intubation and admission to the ICU is decided. After 48 hours, the patient evolved favorably and was extubated. Discussion the causes, forms of presentation and management of this condition are discussed. Conclusion: The diagnosis of glottic dysfunction should be suspected in the presence of dyspnea and inspiratory stridor in the postoperative period of a thyroidectomy.

Sub-millisecond 2D MRI of the vocal fold oscillation using single-point imaging with rapid encoding.

OBJECTIVE: The slow spatial encoding of MRI has precluded its application to rapid physiologic motion in the past. The purpose of this study is to introduce a new fast acquisition method and to demonstrate feasibility of encoding rapid two-dimensional motion of human vocal folds with sub-millisecond resolution. METHOD: In our previous work, we achieved high temporal resolution by applying a rapidly switched phase encoding gradient along the direction of motion. In this work, we extend phase encoding to the second image direction by using single-point imaging with rapid encoding (SPIRE) to image the two-dimensional vocal fold oscillation in the coronal view. Image data were gated using electroglottography (EGG) and motion corrected. An iterative reconstruction with a total variation (TV) constraint was used and the sequence was also simulated using a motion phantom. RESULTS: Dynamic images of the vocal folds during phonation at pitches of 150 and 165 Hz were acquired in two volunteers and the periodic motion of the vocal folds at a temporal resolution of about 600 µs was shown. The simulations emphasize the necessity of SPIRE for two-dimensional motion encoding. DISCUSSION: SPIRE is a new MRI method to image rapidly oscillating structures and for the first time provides dynamic images of the vocal folds oscillations in the coronal plane.

The value of 1.5T MRI in the evaluation of vocal fold mobility in patients with goiter.

The laryngoscopic examination remains the gold standard in the perioperative evaluation of the mobility of the vocal folds in patients with goiter. During the COVID-19 pandemic, many medical procedures, including laryngoscopy are optimized in terms of epidemiological safety. Therefore, it seems deeply justified to implement methods like i.e. ultrasound or MRI which can provide the diagnostic information usually obtained via laryngoscopic examination. AIM OF THE STUDY: To determine the value of dynamic MRI examination in the 1.5 T field in the assessment of the mobility of vocal folds in patients with goiter compared to healthy people and in relation to ultrasound examinations and routine laryngoscopy. MATERIALS AND METHODS: 35 healthy volunteers and 44 patients with goiter were subjected to videolaryngoscopy, dynamic examinations of the vocal folds during respiration and phonation using ultrasound and the MRI sequences: generic gradient echo (GRE) and true fast imaging with steady-state precession (TRUFI). The qualitative and quantitative data were analyzed, i.e. the angles of deviation from the midline of the vocal folds and the area of the right and left rima glottidis compartments. RESULTS: No statistically significant differences were found between the groups of healthy volunteers and patients with goiter in the values of the angles of deviation of the vocal folds with the use of ultrasound and two MRI dynamic sequences - GRE and TRUFI. There were also no statistically significant differences in the areas of the rima glottidis compartments between these two groups with the use of two MRI dynamic sequences - GRE and TRUFI. Among the analyzed parameters, the maximum size of each rima glottidis compartment was the only one to show features of sexual dimorphism and was significantly higher in men (GRE p < 0.001 and TRUFI p = 0.001). There was no correlation between the size of the minimum and maximum rima glottidis compartment and the total volume of the thyroid lobes in patients with goiter for the GRE and TRUFI sequences. CONCLUSIONS: MRI is a promising tool for the objective assessment of the mobility of the vocal folds in patients with goiter, as well as for the qualification for treatment and monitoring its effects. It is particularly important during an epidemiological emergency due to its safety compared to laryngoscopy. The presence of the goiter and its volume do not limit the possibility of performing dynamic imaging studies of the vocal folds and do not affect the surface area of the glottis.

Antoine Ferrein (1693-1769)-His Life and Contribution to Anatomy and Physiology: The Description of the Vocal Chords and Their Function.

The purpose of this study is to summarize the life and work of the French anatomist and surgeon Antoine Ferrein (1693-1769). Ferrein made an impact in the history of anatomy and physiology through his work and especially with the description of phonation, renal anatomy, and liver and biliary structure. He also made an impact on ophthalmology with the description of the eyelid and its diseases. After a thorough review of the literature, we present in this review his life and his main discoveries with special emphasis on the anatomic description of the vocal chords resembling the chords of a violin tempered by the air exhaled from the lungs and how the physiology of phonation and the surgery of the larynx were revolutionized after that.