Isolated vagus nerve paralysis associated with internal carotid artery dissection.

Dysphagia and hoarseness caused by laryngopharyngeal paralysis associated with internal carotid artery (ICA) dissection is rare. We reported a case which recovered spontaneously. A 57-year old man visited our hospital complaining of dysphagia and hoarseness lasting for two weeks. Paralysis of right vocal fold and rotational movement of the posterior pharyngeal wall toward the left side during swallowing were observed. Magnetic resonance imaging was performed under diagnosis of isolated right vagus nerve paralysis, and dissection of the right ICA was revealed. He was treated conservatively, and both of laryngopharyngeal movement and the ICA dissection were improved completely. There is a possibility that laryngeal paralysis caused by ICA dissection has been misdiagnosed as an idiopathic paralysis.

Resolution of vocal fold polyps with conservative treatment.

OBJECTIVES: Vocal fold polyp is generally thought to require surgical removal. However, a certain proportion of polyps resolve with conservative treatment. This study was performed to clarify the frequency of spontaneous resolution of vocal fold polyp and identify features associated with polyps that are likely to resolve without surgery. STUDY DESIGN: Retrospective study. METHODS: A review of the medical records of patients diagnosed with vocal fold polyps in Tokyo Voice Center from January 2001 to December 2008. RESULTS: Of 644 patients with the diagnosis of vocal fold polyp, 132 received conservative treatment, 433 were treated surgically, and 79 dropped out without attending for further consultation after the initial visit. Of those treated conservatively, 55 experienced complete resolution after a mean of 5.1 months of follow-up from the outset, and 29 showed lesion shrinkage after a mean of 4.1 months of follow-up. Polyps that resolved with conservative therapy were more likely than those that remained unchanged or enlarged to occur in women, be smaller, and have a shorter duration of symptoms. We could not determine the superiority of voice therapy. CONCLUSIONS: At least 9.7% of vocal fold polyps might resolve without surgery. Conservative treatment should be considered as an option for selected patients with smaller and more recent-onset polyps.

[Use of the buccal fat pad for vocal fold injection].

In recent years, autologous fat has been increasingly used for intracordal injection as a means of vocal rehabilitation in patients with deficient glottal closure, and the dipose tissue used has for the most part been harvested from the lower abdomen. However, patients differ considerably in the amount of fat available in the lower abdomen, and obtaining sufficient fat is often difficult in patents with a low body mass index (BMI). To overcome this problem we tried adopting a method that uses the buccal fat pad, as practiced in plastic surgery. The details of the method and the postoperative course are reported. The intracordal fat injection method for buccal fat pad tissue was performed in 10 cases during the 1-year from January 2005 to December 2005, and the patients' postoperative course was carefully monitored for more than 6 months after surgery. With the exception of one case, no signs of complications, such as swelling, infection, etc., were seen at the site of fat collection or in the vocal cord after the operation. Phonation was markedly improved after the injection, and the improvement was maintained throughout the observation period. Treatment of unilateral recurrent nerve paralysis by intracordal injection of autologous fat harvested from the buccal fat pad was successful.

Laryngeal carcinoma presenting as a large anterior neck abscess.

Laryngeal carcinoma presenting as a cervical abscess is rare, so that its diagnosis is not easy. We described a case of laryngeal squamous cell carcinoma presenting as a prelaryngeal large abscess. Markedly swollen false vocal fold inhibited fiberscopic examination of the vocal folds. CT scan indicated destruction of the thyroid cartilage. Although biopsies from the abscess did not reveal malignancy, laryngeal squamous cell carcinoma was confirmed by laryngomicrosurgery with laryngeal vestibulectomy. The patient was treated by total laryngectomy with neck dissection followed by radiotherapy. The abscess was thought to be formed not by direct extension and necrosis of the tumor, but by the leakage of air and mucus through the fistula on the destroyed thyroid cartilage. Precise observation and biopsy under directscopic vestibulectomy played an important role in diagnosis of malignancy inherent in severe inflammatory tissues.

Cervical emphysema secondary to pneumomediastinum as a complication of childbirth.

Pneumomediastinum and cervical emphysema usually occur following esophageal or chest trauma. Rarely do they occur as a complication of childbirth, and only approximately 200 such cases have been reported in the literature worldwide. We describe a new case, and we review the clinical picture, pathophysiology, and management of these conditions. In view of the head and neck symptoms of pneumomediastinum and cervical emphysema during labor--which include dyspnea, cough, sore throat, pain on swallowing, and dysphagia--otolaryngologists might be consulted and should therefore be aware of these conditions in order to recognize and treat them.