Unilateral vocal fold paralysis post-thyroidectomy: does early intervention allow for better voice recovery?

OBJECTIVE: Thyroidectomy is the primary cause of unilateral vocal fold paralysis (UVFP). A delay in rehabilitation may cause dysfunctional phenomena and worsen dysphonia. The main aim is to investigate the impact of early Speech Therapy (ST) on voice recovery in UVFP post-thyroidectomy and propose an appropriate treatment schedule. PATIENTS AND METHODS: 93 patients with UVFP were analysed. 72 presented transient paralysis and 21 permanent ones. Individuals with permanent paralysis were retrospectively divided in two groups. Group A was composed of 11 patients (8 F, 3 M; mean age: 50.5 ± 8.6) who received ST within 8 weeks; Group B comprised 10 patients (7 F, 3 M; mean age: 57 ± 11.5) treated after more than 8 weeks. Videolaryngostroboscopy (VLS) was assessed and both objective and subjective voice parameters were collected. The non-parametric Wilcoxon test was applied to the sample. RESULTS: The resolution of supraglottic compensations was observed in 91% of cases in Group A, whereas in only 40% of cases in Group B. A functional glottal closure occurred in 73% of patients in group A, while it was completely absent in group B. Group A showed a statistically significant difference between the values of Jitter, NHR, TMF and VHI collected pre-ST compared to that collected after 1 year. Conversely, a statistically significant difference was found only for VHI values in group B. CONCLUSIONS: Early ST brings benefits to patients with permanent UVFP, both on voice recovery and on quality of life. A ST protocol should be applied both before and after thyroidectomy. The ST treatment should start early after surgery.

Surgical treatment of T1b glottic tumor, 10-years follow-up.

BACKGROUND: The TNM classification of glottic tumors defined T1b as a tumor involving both vocal cords with normal mobility of such. In the last fifteen years, in the medical literature, the role of open surgery for management of laringeal cancer has decreased considerably owing to the development of transoral laser microsurgery which is an oncologically and functionally reliable treatment particularly for early glottic cancers. AIM: Report the efficacy of different surgical techniques (laser CO2 cordectomy or supracricoid partial laryngectomy) in T1b glottic cancers treatment with a 10-years follow-up. PATIENTS AND METHODS: 92 patients with T1b glottic cancer undergoing surgery between 1986 and 2002, of which 39 were treated with CO2 laser cordectomy while 53 with supracricoid partial laryngectomy (14 crico-hyoid-pexy and 39 crico-hyoid-epiglotto-pexy). Each of the three groups was recalled and evalued with the aim to calculate the survival, initially at 3 and 5 years and thereafter, provide a 10 years follow-up, including local recurrence. RESULTS: 10 years absolute survival of the 39 patient treated with CO2 laser was 56.25%, while that of the two groups subjected to supracricoid partial laryngectomy was respectively of 66.6% for crico-hyoid-pexy and 58.82% for crico-hyoid-epiglotto-pexy. CONCLUSIONS: Our data suggest an excellent absolute survival also after 10 years follow-up. Since both the CO2 laser and supracricoid partial laryngectomy show similar local control and survival rates we can't determine with certainty the best therapeutic approach as claimed by a great number of literature studies.

[A case of recurrent pharyngocele: treatment and literature review]. / Un caso di faringocele bilaterale recidivato come mediano e rioperato con successo.

Congenital or acquired pharyngocele is a rare disease characterized by a herniation of the pharyngeal mucosa through a "locus minoris resistentiae" of the lateral wall of the pharynx. Generally the pharyngocele does not present specific clinical signs or symptoms which makes it necessary to resort to radiological examination for the diagnosis. Our case is particular for primitive bilaterality and the single and median recurrence eight years later. After surgical excision the symptoms completely disappeared. The radiological examinations following surgery were negative.

The long styloid process syndrome or Eagle's syndrome.

Eleven cases of Eagle's syndrome or long styloid process syndrome are presented. It is a rare entity, which is not commonly suspected in clinical practice. Symptoms were dull and persistent pharyngeal pain, dysphagia, and facial pain. In addition to careful clinical examination, the use of plain radiographs, orthopantomograms or CT scan has allowed accurate preoperative diagnosis of this syndrome. Surgical treatment has positively resolved the symptoms in these cases. The International literature is discussed regarding anatomy, symptoms and treatment of the long styloid process syndrome.

Prolonged mivacurium-induced neuromuscular block. Case report.

A 38-year-old white male patient was admitted to the hospital for elective surgery. General anesthesia was performed with propofol, alfentanil, nitrous oxide and mivacurium as neuromuscular blocker. Seven months before he had the same surgery without anesthetic problems (he received: propofol, vecuronium bromide, fentanil, nitrous oxide). Neuromuscular monitoring was carried out because the patient was included in a study assessing the clinical effect of mivacurium in microlaryngoscopy surgery. After mivacurium administration the first signs of recovery from neuromuscular block were observed after 255 min. The tracheal tube was withdrawn after 410 min from mivacurium administration, at this time the T1 was 80% of the control values and 7 min later the T1 reached 98%.

Giant cell tumor and temporal bone.

Giant cell tumor is a tumor consisting of osteoclastic multinucleated giant cells surrounded by mononuclear round, oval cells. This tumor rarely occur in the skull base, usually originating in the sphenoid bone. This report describes a case of giant cell tumor of temporal bone and lateral skull base with diagnosis and therapeutic options.

Facial neuroma and magnetic resonance imaging.

The aim of this paper is to present a new case of facial neuroma. Its clinical appearance was uncommon, displaying symptoms characterized by sudden facial paralysis. Diagnostic armamentarium is discussed emphasizing the importance of magnetic resonance imaging (MRI). Therapeutical strategy with the techniques of facial rehabilitation are contemplated.

[Comments on organization and activity of ENT day hospital department: three years of experience]. / Riflessioni su ...organizzazione ed attività di un reparto di day hospital in O.R.L.: esperienza di un triennio.

The authors deal with organizational and technical aspects concerning otorhinolaryngological day hospital's management. They explain purposes and reasons leading to the establishment of this sort of service; they analyse related problems and the adopted methodologies for simplifying admission procedures. They report a statistical survey regarding the period from May 1991 to May 1994, concerning surgical and medical operations, and instrumental diagnostic researches performed at the IV ENT Department of "La Sapienza" University of Rome. The statistical analysis concerning the 1526 patients sent to this department, shows the downright prevalence of surgical operations performed in operating room (52%). Ambulatory operations and instrumental diagnostic researches account respectively for 39.6% and for 29.3% of all hospitalizations. Among all surgery operations performed in operating room stand out the notice incidence of therapeutical and diagnostic microlaryngoscopies. The most frequent ambulatory operations were the removal of tracheal cannula (21%), while TC was the most frequent of all instrumental diagnostic researches. A careful selection of patients, on the basis of their general condiction, account for the low incidence of subjects not discharged within 24 hours. After having analyzed the survey's data, the authors underline advantages and finalities of day hospital: a shorter hospital stay, reduction of hospitalization's costs, and a larger related number of patients to be contented. Finally they hope that this sort of service will spread more.

Acoustic neuroma in the pregnant patient.

We report the case history of a 24-year-old woman with an acoustic neuroma diagnosed during the 24th week of pregnancy. Diagnostic steps and surgical management of this uncommon condition, which represents a therapeutic challenge, are discussed.