RESUMO
At the beginning of 2023, there have been significant changes to the regulations for outpatient surgery in Germany, which were set out in a trilateral self-administration agreement between the umbrella association of statutory health insurance companies, the German Hospital Association and the Federal Association of Statutory Health Insurance Physicians. Among other things, a catalog stated circumstances under which an operation should not be carried out on an outpatient basis or should only be carried out with doubt. This catalog explains the patient's age: up to the first year of life, inpatient performance of a service can be justified. This formulation in itself means that children from one year of age on should regularly undergo outpatient surgery.In the german scientific societies for otolaryngology, head and neck surgery as well as for anesthesiology and intensive care medicine, doubts arose as to whether this age limit could also be scientifically justified for operations in the throat such as adenotomy or tonsillotomy.A search was carried out in international guidelines and in the international literature and the statements were evaluated. The results of this literature search were discussed with representatives of the Pediatric Otorhinolaryngology Working Group (AG PädHNO) of the German Society for Otorhinolaryngology, Head and Neck Surgery (DGHNO-KHC) and the scientific working group for pediatric anesthesia (WAKKA) of the German Society for Anesthesiology and Intensive Care Medicine (DGAI) in conferences.The consensus revealed that a strict age limit of the first year of life is not appropriate for the outpatient performance of adenotomies and tonsillotomies. First of all, specifying a strict age limit is questionable because, regardless of age, a number of other medical and social factors influence the responsible performance of outpatient operations. Furthermore, the age limit of one year is not considered appropriate in view of literature, guidelines and practical experience in the international area. The assessment of the literature and the consideration of the implementation in the international area make an age limit in the range of 2-3 years seem more appropriate.This review provides the responsible doctors with a variety of insights, aspects and arguments so that they can make their decision to carry out these operations on an outpatient or inpatient basis appropriately and responsibly.
Assuntos
Pacientes Ambulatoriais , Humanos , Criança , Pré-Escolar , AlemanhaRESUMO
BACKGROUND: Incurable head and neck cancer causes distressing symptoms that significantly reduce patients' quality of life. OBJECTIVE: The aim of this article is to present the surgical possibilities and their limitations in a palliative setting. MATERIALS AND METHODS: A literature review was performed and supplemented with the authors' own experiences. RESULTS: Smaller endoscopic procedures for tumor debulking or hemostasis are possible to reduce symptoms and improving quality of life, which should be the aim of palliative care. To preserve swallowing function and breathing, the insertion of stents is a feasible alternative to tracheotomy. However, even larger tumor resections with reconstruction by pedicled or free grafts may be justified. CONCLUSION: Especially in the palliative setting, patients and their individual complaints are the primary focus. Therefore, the indications for surgery should be discussed with the patient and his relatives, preferentially interdisciplinarily. Due to considerable progress, particularly in the field of systemic tumor therapy, extended surgical procedures with reconstruction are losing some of their importance in the palliative situation.
Assuntos
Neoplasias de Cabeça e Pescoço , Cuidados Paliativos , Neoplasias de Cabeça e Pescoço/cirurgia , Humanos , Qualidade de Vida , StentsRESUMO
BACKGROUND: Morbidity following tonsil surgery is widely determined by pain, odynophagia, and bleeding. Detailed information about postoperative care in pediatric patients in Germany in the context of otolaryngologic interventions is currently lacking. MATERIALS AND METHODS: A questionnaire including eight questions to clarify trends and traditions in hospitalization strategies for pediatric patients was sent via email on January 14, 2019, to all heads of ENT departments who were also members of the German Society of Otorhinolaryngology, Head and Neck Surgery (DGHNO). The electronic survey was designed by the Pediatric Working Group of the DGHNO. RESULTS: The response rate was 72.9% (120/166), one response was excluded because it was not provided via the online tool. Children are currently transferred to pediatric clinics after surgery in 64 of 120 otorhinolaryngology departments, a tradition in existence for at least 5 years in 48 of the 64 departments. In the remaining 56 institutions, children remained in the otorhinolaryngology department despite 30 having specialized pediatric clinics or clinics for pediatric surgery. This strategy is expected to be discontinued in 5 of the 56 hospitals in due course. A separate pediatric ENT clinic within the same institution is uncommon (27/120). The average travel time of on-call physicians in cases of postoperative bleeding is 3.4â¯min; transportation of the child to the emergency operation room takes 5.4â¯min on average. The nursing staff is predominantly responsible for transportation of pediatric emergency patients (109/120). The wards and operation rooms are commonly located in the same building, but on different floors (83/120). CONCLUSION: There is currently no uniform hospitalization strategy for postoperative care of children who undergo typical otorhinolaryngologic interventions in Germany.
Assuntos
Hospitalização , Tonsilectomia , Tonsilite , Criança , Alemanha , Humanos , Tonsila Palatina , Tonsilectomia/efeitos adversos , Tonsilite/cirurgiaRESUMO
Background: The German multicenter randomized phase II larynx organ preservation (LOP) trial DeLOS-II was carried out to prove the hypothesis that cetuximab (E) added to induction chemotherapy (IC) and radiotherapy improves laryngectomy-free survival (LFS; survival with preserved larynx) in locally advanced laryngeal/hypopharyngeal cancer (LHSCC). Patients and methods: Treatment-naïve patients with stage III/IV LHSCC amenable to total laryngectomy (TL) were randomized to three cycles IC with TPF [docetaxel (T) and cisplatin (P) 75 mg/m2/day 1, 5-FU (F) 750 mg/m2/day days 1-5] followed by radiotherapy (69.6 Gy) without (A) or with (B) standard dose cetuximab for 16 weeks throughout IC and radiotherapy (TPFE). Response to first IC-cycle (IC-1) with ≥30% endoscopically estimated tumor surface shrinkage (ETSS) was used to define early responders; early salvage TL was recommended to non-responders. The primary objective was 24 months LFS above 35% in arm B. Results: Of 180 patients randomized (July 2007 to September 2012), 173 fulfilled eligibility criteria (A/B: larynx 44/42, hypopharynx 41/46). Because of 4 therapy-related deaths among the first 64 randomized patients, 5-FU was omitted from IC in the subsequent 112 patients reducing further fatal toxicities. Thus, IC was TPF in 61 patients and TP in 112 patients, respectively. The primary objective (24 months LFS above 35%) was equally met by arms A (40/85, 47.1%) as well as B (41/88, 46.6%). One hundred and twenty-three early responders completed IC+RT; their overall response rates (TPF/TP) were 94.7%/87.2% in A versus 80%/86.0% in B. The 24 months overall survival (OS) rates were 68.2% and 69.3%. Conclusions: Despite being accompanied by an elevated frequency in adverse events, the IC with TPF/TP plus cetuximab was feasible but showed no superiority to IC with TPF/TP regarding LFS and OS at 24 months. Both early response and 24 months LFS compare very well to previous LOP trials and recommend effective treatment selection and stratification by ETSS. Clinical trial information: NCT00508664.
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Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Quimiorradioterapia/mortalidade , Neoplasias Hipofaríngeas/terapia , Neoplasias Laríngeas/terapia , Laringectomia/mortalidade , Radioterapia/mortalidade , Terapia de Salvação , Adulto , Idoso , Cetuximab/administração & dosagem , Cisplatino/administração & dosagem , Terapia Combinada , Docetaxel/administração & dosagem , Feminino , Fluoruracila/administração & dosagem , Seguimentos , Humanos , Neoplasias Hipofaríngeas/patologia , Quimioterapia de Indução , Neoplasias Laríngeas/patologia , Masculino , Pessoa de Meia-Idade , Tratamentos com Preservação do Órgão , Prognóstico , Taxa de SobrevidaRESUMO
Laryngomalacia is the most common cause of stridor in infants. The stridor is caused by an inward collapse of supraglottic structures during inspiration resulting in an inspiratory stridor. The exact etiology still remains unclear. The surgical procedure of choice for laryngomalacia is supraglottoplasty. From 2009 to 2016 a total of 71 children were treated by supraglottoplasty in the department for pediatric otorhinolaryngology of the Stuttgart Hospital. The indications for supraglottoplasty were laryngomalacia with severe inspiratory stridor, oxygen desaturation, suprasternal or chest retraction, feeding difficulties and/or failure to thrive. The overall success rate was 86 % but there was a clear difference between children with isolated laryngomalacia and the group with associated comorbidities. The success rate for patients with isolated laryngomalacia was 98 % and for patients with associated comorbidities 57 %. Supraglottoplasty is therefore an effective and safe treatment for symptomatic laryngomalacia and a reduction in the success rate showed a clear correlation with the presence of congenital comorbidities.
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Epiglote/cirurgia , Insuficiência de Crescimento/prevenção & controle , Laringomalácia/diagnóstico , Laringomalácia/cirurgia , Laringoplastia/métodos , Laringoscopia/métodos , Pré-Escolar , Insuficiência de Crescimento/diagnóstico , Insuficiência de Crescimento/etiologia , Feminino , Humanos , Lactente , Laringomalácia/complicações , Masculino , Procedimentos de Cirurgia Plástica/métodos , Sons Respiratórios/diagnóstico , Sons Respiratórios/etiologia , Resultado do TratamentoAssuntos
Ingestão de Alimentos , Corpos Estranhos/terapia , Trato Gastrointestinal , Inalação , Comunicação Interdisciplinar , Colaboração Intersetorial , Sistema Respiratório , Anestesia Geral , Broncoscopia , Pré-Escolar , Estudos Transversais , Esofagoscopia , Feminino , Corpos Estranhos/diagnóstico , Corpos Estranhos/epidemiologia , Humanos , Lactente , Laringoscopia , MasculinoRESUMO
Adult and pediatric laryngotracheal stenoses (LTS) comprise a wide array of various conditions that require precise preoperative assessment and classification to improve comparison of different therapeutic modalities in a matched series of patients. This consensus paper of the European Laryngological Society proposes a five-step endoscopic airway assessment and a standardized reporting system to better differentiate fresh, incipient from mature, cicatricial LTSs, simple one-level from complex multilevel LTSs and finally "healthy" from "severely morbid" patients. The proposed scoring system, which integrates all of these parameters, may be used to help define different groups of LTS patients, choose the best treatment modality for each individual patient and assess distinct post-treatment outcomes accordingly.
Assuntos
Consenso , Laringoestenose/classificação , Otolaringologia , Sociedades Médicas , Estenose Traqueal/classificação , Endoscopia , Europa (Continente) , Humanos , Laringoestenose/diagnóstico , Laringoestenose/cirurgia , Índice de Gravidade de Doença , Estenose Traqueal/diagnóstico , Estenose Traqueal/cirurgiaRESUMO
Idiopathic subglottic stenosis is causing a narrowing of the central airway at the laryngotracheal junction. Etiology is remaining unclear at large. There is a marked preponderance for women in the fertile age, an association to estrogene or progesterone metabolism remains doubtful. Suggested treatment varies from repeated endoscopic interventions to primary open resection. Therapy selection in this heterogeneous condition should be based on the individual patient situation as well as surgeon's expertise. This complex entity is prone to complications and should preferably be managed in a referral center.
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Laringoestenose/etiologia , Adulto , Asma/diagnóstico , Doença Crônica , Tosse/complicações , Cartilagem Cricoide/cirurgia , Diagnóstico Diferencial , Progressão da Doença , Dispneia/etiologia , Feminino , Humanos , Laringoscopia , Laringoestenose/diagnóstico , Laringoestenose/cirurgia , Fatores Sexuais , Traqueia/cirurgiaRESUMO
Pathologies in the larynx and trachea in the pediatric age can be characterized in 4 main groups: airway stenosis, acute infections, benign neoplasia and foreign body aspiration. In this review main diagnostic strategies and therapeutic options are presented. Laryngomalazia is the most frequent condition of supraglottic stenosis. The term supraglottoplasty summarizes all different techniques used for it's repair using an endoscopic approach. Glottic stenosis is rare in children. Usually a compromise between voice preservation and airway restoration has to be sought. Type of reconstruction and timing are varying considerably in individual cases, endoscopic approaches should be preferred. Subglottic stenosis remains the largest group in paediatric airway pathology, with cicatrial stenosis being predominant. Today, cricotracheal resection is the most successful treatment option, followed by the classical laryngotracheal reconstruction with autologous cartilage. In early infancy subglottic stenosis is particularly demanding. Endoscopic treatment is possible in selected patients, but open reconstruction is superior in more severe cases. Tracheostomy is not a safe airway in early infancy, it's indication should be strict. Foreign body aspiration needs to be managed according to a clear algorhythm. Recurrent respiratory papillomatosis should be treated with emphasis on function preservation. The role of adjuvant medication remains unclear. Infectious diseases can be managed conservatively by a pediatrician in the majority of cases.
Assuntos
Doenças da Laringe/diagnóstico , Doenças da Laringe/cirurgia , Neoplasias Laríngeas/diagnóstico , Neoplasias Laríngeas/cirurgia , Doenças da Traqueia/diagnóstico , Doenças da Traqueia/cirurgia , Neoplasias da Traqueia/diagnóstico , Neoplasias da Traqueia/cirurgia , Obstrução das Vias Respiratórias/diagnóstico , Obstrução das Vias Respiratórias/patologia , Obstrução das Vias Respiratórias/cirurgia , Criança , Pré-Escolar , Contraindicações , Comportamento Cooperativo , Diagnóstico Diferencial , Endoscopia , Corpos Estranhos/diagnóstico , Corpos Estranhos/patologia , Corpos Estranhos/cirurgia , Humanos , Lactente , Recém-Nascido , Comunicação Interdisciplinar , Doenças da Laringe/patologia , Neoplasias Laríngeas/patologia , Laringoestenose/diagnóstico , Laringoestenose/patologia , Laringoestenose/cirurgia , Doenças da Traqueia/patologia , Neoplasias da Traqueia/patologia , TraqueostomiaRESUMO
BACKGROUND: Within the last years the injection laryngoplasty is a common method in treating patients with a unilateral vocal cord paralysis. The augmentation with VOX-Implants is an option for a permanent treatment. The aim was to evaluate the quality of voice as well as the quality of life in this patients and especially if it is comparable to other methods. METHODS: We analyzed prospectively 20 patients who underwent injection laryngoplasty with VOX-Implants in general anesthesia. To verify the glottic closure we examined each patient pre- and postoperative using the rigid stroboscope and the flexible videoendoscope. To measure the voice related quality of life the voice handicap index (VHI-12) had to be answered. Maximum phonation time, RBH-Scale, Voice-Range, "Goettinger hoarsness diagram" (GHD) and the "Friedrich's Dysphonia Index" (FDI) were examined to investigate the quality of voice. RESULTS: The VHI-12 decreased from 30.4 pts. to 13.6 pts. The maximum phonation time was 6.45 s before and 13.95 s after the operation. The RBH-Scale the was lowered form 2.5 preoperative to 1.1 postoperative. The voice range increased 3.5 semi tones. Concerning the GHD the irregularity increased as well as the noise factor (1.79 pts., respective 0.86 pts.). The FDI declined 1.1 pts. CONCLUSION: Using VOX-Implants is a useful material to better the quality of life. The injection laryngoplasty with polydimethylsiloxane improves considerably the quality of voice. No complication concerning the material itself could be seen within 6 months. The results are comparable to other techniques (e.g. Thyroplasty). The decision of which material or which technique is to use must be an individual one.
Assuntos
Materiais Biocompatíveis , Dimetilpolisiloxanos , Laringoplastia/métodos , Laringoplastia/psicologia , Implantação de Prótese/métodos , Qualidade de Vida/psicologia , Paralisia das Pregas Vocais/cirurgia , Qualidade da Voz , Terapia Combinada , Humanos , Injeções , Laringoscopia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/psicologia , Estudos Prospectivos , Espectrografia do Som , Gravação em Vídeo , Paralisia das Pregas Vocais/diagnóstico , Paralisia das Pregas Vocais/psicologia , Treinamento da VozRESUMO
Branchio-oto-renal (BOR) syndrome is characterized by ear malformations associated with sensorineural or mixed hearing loss. In addition, preauricular tags, preauricular pits, branchial cleft fistulas and cysts, as well as renal dysplasia are seen. A genetic mutation on chromosome 8, either autosomal dominantly inherited or occuring as a spontaneous mutation, is the cause in the majority of cases. Using array-based comparative genomic hybridization (CGH), it is possible to detect even the smallest genetic changes. Salivary gland choristoma in the middle ear is very rare. Surgical removal and histological clarification are required.
Assuntos
Síndrome Brânquio-Otorrenal/genética , Coristoma/genética , Hibridização Genômica Comparativa/métodos , Otopatias/genética , Orelha Média/cirurgia , Predisposição Genética para Doença/genética , Glândulas Salivares/cirurgia , Síndrome Brânquio-Otorrenal/cirurgia , Coristoma/cirurgia , Otopatias/cirurgia , Humanos , Lactente , Masculino , Mutação/genética , Análise de Sequência com Séries de Oligonucleotídeos/métodos , Resultado do TratamentoRESUMO
Intralesional use of cidofovir (Vistide(®)) has been one of the mainstays of adjuvant therapy in patients with recurrent respiratory papillomatosis (RRP) since 1998. In 2011, a communication provided by the producer of cidofovir addressed very serious side effects concerning its off-label use. As this was a general warning, it was inconclusive whether this would account for its use in RRP. The aim of this study is to determine whether nephrotoxic, neutropenic, or oncogenic side effects have occurred after intralesional use of cidofovir in patients with RRP. Update of recent developments in RRP, a multicentre questionnaire and a multicentre retrospective chart review. Sixteen hospitals from eleven countries worldwide submitted records of 635 RRP patients, of whom 275 were treated with cidofovir. RRP patients received a median of three intralesional injections (interquartile range 2-6). There were no statistical differences in occurrence of neutropenia or renal dysfunction before and after cidofovir. There was no statistical difference in occurrence of upper airway and tracheal malignancies between the cidofovir and the non-cidofovir group. In this retrospective patient chart review, no clinical evidence was found for more long-term nephrotoxicity, neutropenia or laryngeal malignancies after the administration of intralesional cidofovir in RRP patients.
Assuntos
Antivirais/efeitos adversos , Citosina/análogos & derivados , Neoplasias de Cabeça e Pescoço/induzido quimicamente , Neutropenia/induzido quimicamente , Organofosfonatos/efeitos adversos , Infecções por Papillomavirus/tratamento farmacológico , Insuficiência Renal/induzido quimicamente , Infecções Respiratórias/tratamento farmacológico , Cidofovir , Terapia Combinada , Citosina/efeitos adversos , Feminino , Humanos , Injeções Intralesionais , Masculino , Uso Off-Label , Infecções por Papillomavirus/cirurgia , Infecções por Papillomavirus/virologia , Infecções Respiratórias/cirurgia , Infecções Respiratórias/virologia , Estudos Retrospectivos , Resultado do TratamentoAssuntos
Obstrução das Vias Respiratórias/complicações , Dispneia/etiologia , Emergências , Laringoestenose/cirurgia , Complicações Pós-Operatórias/diagnóstico , Edema Pulmonar/diagnóstico , Estenose Traqueal/cirurgia , Adulto , Obstrução das Vias Respiratórias/diagnóstico , Obstrução das Vias Respiratórias/terapia , Cuidados Críticos , Dispneia/terapia , Parada Cardíaca/etiologia , Parada Cardíaca/terapia , Humanos , Laringoscopia , Masculino , Complicações Pós-Operatórias/etiologia , Complicações Pós-Operatórias/terapia , Edema Pulmonar/etiologia , Edema Pulmonar/terapia , ReoperaçãoRESUMO
Subglottic stenosis of congenital origin or acquired within the first 12 months of life are challenging in many aspects. Surgical reconstruction is difficult due to the small anatomic dimensions. Tracheostomy is an additional risk factor attributing to mortality and should be avoided, if possible. In this paper, the most important types of subglottic stenosis in the first year of life are discussed. Conservative, endoscopic, and open surgical treatment options are presented and evaluated. Laryngotracheal reconstruction with autologous thyroid cartilage is the treatment of choice for the majority of significant subglottic stenosis cases in this age group. This technique is comparatively less invasive, versatile, and allows all options for open reconstruction using other techniques in case of recurrent stenosis. Subglottic stenosis in early infancy requires expertise and experience in diagnosis and treatment. Considering the limited incidence, these cases should be managed in a referral center.
Assuntos
Endoscopia/métodos , Laringectomia/métodos , Laringoestenose/diagnóstico , Laringoestenose/cirurgia , Procedimentos de Cirurgia Plástica/métodos , Traqueostomia/métodos , Feminino , Humanos , Lactente , Recém-Nascido , MasculinoRESUMO
Laryngotracheal stenosis in infancy and childhood is challenging in many aspects. Diagnosis and therapy require specific expertise and must be tailored to the individual case. The most important presentations of airway pathology in children are presented in this paper. Conservative, endoscopic and surgical treatment options are discussed. Laryngomalazia is the most frequent condition of supraglottic stenosis. The term supraglottoplasty summarizes all different techniques used for it's repair using an endoscopic approach.Glottic stenosis is rare in children. Usually a compromise between voice preservation and airway restoration has to be sought. Type of reconstruction and timing are varying considerably in individual cases, endoscopic approaches should be preferred.Subglottic stenosis remains the largest group in paediatric airway pathology, with cicatrial stenosis being predominant. Today, cricotracheal resection is the most successful treatment option, followed by the classical laryngotracheal reconstruction with autologous cartilage. In early infancy subglottic stenosis is particularly demanding. Endoscopic treatment is possible in selected patients, but open reconstruction is superior in more severe cases. Subglottic stenosis in children requires expertise and experience in diagnosis and treatment. Considering the limited incidence these cases should be managed in a referral center.
Assuntos
Laringoestenose/cirurgia , Estenose Traqueal/cirurgia , Cartilagem Aritenoide/cirurgia , Broncoscopia , Cartilagem/transplante , Criança , Pré-Escolar , Cartilagem Cricoide/cirurgia , Diagnóstico Diferencial , Dilatação , Fibrose/diagnóstico , Fibrose/etiologia , Fibrose/cirurgia , Humanos , Lactente , Laringomalácia/diagnóstico , Laringomalácia/etiologia , Laringomalácia/cirurgia , Laringoscopia , Laringoestenose/diagnóstico , Laringoestenose/etiologia , Terapia a Laser , Procedimentos Cirúrgicos Minimamente Invasivos , Prognóstico , Sons Respiratórios/etiologia , Fatores de Risco , Prevenção Secundária , Estenose Traqueal/diagnóstico , Estenose Traqueal/etiologiaRESUMO
The most common cause of stridor in newborns is instability of the upper larynx, called laryngomalacia. In approximately 10% of children normal development is impaired. The diagnostics and therapy must follow a clear plan that is also comprehensible to the parents. The obstruction should be localized endoscopically, the anatomical characteristics determined, and the surgical possibilities evaluated. Additional pathological changes of the upper airway (e.g., vocal fold paresis) need to be excluded. Surgery for laryngomalacia, called supraglottoplasty, allows reduction of excess mucus, transectioning of aryepiglottic folds that are too short, and in some cases epiglottic fixation to the base of the tongue. In extreme cases tracheotomy is unavoidable. Surgery is only recommended for severe cases; when carried out correctly according to the medical indications, the success rate is over 90%.
Assuntos
Endoscopia/métodos , Laringectomia/métodos , Laringomalácia/diagnóstico , Laringomalácia/cirurgia , Humanos , Laringomalácia/complicações , Sons Respiratórios/etiologiaRESUMO
There is a wide variety of devices and materials to be implanted into the human larynx. Some are intended to remain only for a period of time, like laryngeal stents. If removal is not intended the device meets the definition for a medical implant. The majority of implants is used for the treatment of unilateral vocal fold immobility. There a 2 types of implants serving this purpose: Implants in a stricter sense are devices of solid material, which are brought into the paraglottic space through a window in the laryngeal framework (medialization thyroplasty). Several different products are presented in this review. In contrast, there are different substances available for endoscopic injection into the paralyzed vocal fold (injection laryngoplasty). Since some of these substances show a corpuscular consistency and a high viscosity they need to be deposited into the lateral paraglottic space. Therefore, the term "injectable implants" has been coined for these materials. The different substances available are discussed in detail in this review. Laryngeal stents are primarily used in the early postoperative phase after open reconstruction of the larynx. The different devices available on the market are described with their specific characteristics and intended use.
Assuntos
Laringe Artificial , Stents , Paralisia das Pregas Vocais/reabilitação , Dimetilpolisiloxanos , Durapatita , Humanos , Injeções , Laringoplastia/métodos , Laringoscopia , Politetrafluoretileno , Desenho de Prótese , Implantação de Prótese , Titânio , ViscosidadeRESUMO
Unilateral recurrent nerve paralysis leads to glottic insufficiency, significantly reducing vocal ability. Due to its unusually long course, the recurrent laryngeal nerve is prone to iatrogenic lesions involves many medical fields generally with little expertise in voice disorders. Whenever the etiology is uncertain, a complete diagnostic work-up is mandatory. Indirect laryngoscopy confirms the diagnosis. Laryngeal electromyography is of great value because it differentiates between paralysis and ankylosis of the cricoarytenoid joint. Moreover in many cases laryngeal electromyography yields a reliable prognosis of clinical outcome. While unfavorable results can be predicted with high accuracy, correct prognosis of complete recovery is more difficult. Speech therapy is the treatment of choice in cases of unilateral recurrent nerve palsy. Patients with persistent glottal gap may express the wish for surgical voice rehabilitation. Nowadays a broad spectrum of endoscopic and open approaches are available for this purpose. This review describes advanced techniques of voice-improving surgery available in specialized centers today.
Assuntos
Laringoscopia , Paralisia das Pregas Vocais/cirurgia , Tecido Adiposo/transplante , Colágeno/administração & dosagem , Dimetilpolisiloxanos/administração & dosagem , Eletromiografia , Humanos , Ácido Hialurônico/administração & dosagem , Injeções , Próteses e Implantes , Espectrografia do Som , Medida da Produção da Fala , Paralisia das Pregas Vocais/diagnóstico , Paralisia das Pregas Vocais/etiologiaRESUMO
BACKGROUND: It is difficult to precisely localise the extent of the diseased segment on the external aspect of a stenotic trachea. A technique has been developed of marking the upper margin of stenosis, in order to open the airway at the appropriate level during segmental resection. MATERIALS AND METHODS: Prior to the open reconstructive procedure, the stenosis is visualised using microlaryngoscopy. An endo-extraluminal technique is used to drive a suture from inside out through the skin; this then serves to mark the exact top margin of the stenotic segment. This suture serves as a guide for the surgeon during the open approach to tracheal resection. RESULTS: This technique was performed in 16 cases, and allowed precise localisation of the stenosis in each case. CONCLUSION: Transcutaneous localisation of laryngotracheal stenosis, using the Lichtenberger device, is an easy and reliable technique requiring a minimum of additional time.
Assuntos
Laringoestenose/cirurgia , Procedimentos Cirúrgicos Otorrinolaringológicos/métodos , Estenose Traqueal/cirurgia , Endoscopia , Humanos , Laringoscopia , Agulhas , SuturasRESUMO
Chondrosarcomas of the larynx are rare malignant tumors usually diagnosed with significant delay due to their nonspecific symptoms. We report a 50-year-old male presenting with progressive dyspnea. Indirect laryngoscopy revealed a subglottic stenosis. The cricoid cartilage was shown on CT to be massively damaged. Histologic differentiation between chondroma and highly differentiated chondrosarcoma was very difficult. Therefore, an organ-preserving treatment concept using partial cricoid resection and staged endoscopic arytenoidectomy was chosen. Total laryngectomy and permanent tracheostomy could be avoided. Due to the risk of recurrence, early follow-up with endoscopy and CT is mandatory.