ABSTRACT
Introdução: A tireoplastia tipo I é o tratamento de escolha nas paralisias unilaterais das pregas Análise de custo-bene-vocais que não se recuperam espontaneamente. fício. Objetivos: Comparar o uso de implante de Silastic® com o uso de titânio pré-fabricado TVFMI® (Titanium Vocal Fold Medializing Implant) na tireoplastia tipo I para o tratamento da paralisia unilateral das pregas vocais com relação à melhora subjetiva e objetiva da voz, às alterações endoscópicas nas pregas vocais, ao tempo de cirurgia e à relação custo-benefício. Método: Trata-se de um estudo prospectivo com 40 pacientes portadores de paralisia unilateral das pregas vocais submetidos à tireoplastia tipo I com implante de silastic® ou TVFMI®. A avaliação e comparação estatística foram realizadas antes e quatro semanas depois da cirurgia por meio de videolaringoscopia, estroboscopia, análise perceptiva (escala GRBAS-Grade, Roughness, Breathiness, Asthenia, Strain) e subjetiva (IDV-índice de desvantagem vocal) da voz e avaliação eletroglotográfica e avaliação acústica computadorizada. Também foram observados o tempo de cirurgia e o custo do implante. Resultados: Embora os dois implantes mostrem melhora na qualidade da voz após a tireoplastia, o TVFMI® teve um resultado ligeiramente melhor na análise objetiva da voz. O TVFMI® levou menos tempo de cirurgia para ser inserido, porém foi mais caro. Conclusão: O TVFMI® poderá ser preferencial na tireoplastia de medialização, já que possui melhores resultados vocais e leva menos tempo de cirurgia, porém é mais caro que o implante de Silastic®. .
Introduction: Type I thyroplasty is the treatment of choice for unilateral vocal cord palsy with no spontaneous recovery. Objectives: To compare the use of silastic implant with titanium vocal fold medializing implant (TVFMI®) in type I thyroplasty for unilateral vocal cord palsy with respect to subjective and objective improvement in voice, endoscopic changes in vocal cords, surgical time, and cost effectiveness. Methodology: This was a prospective study conducted on 40 patients with unilateral vocal cord paralysis who underwent type I thyroplasty with either silastic implant or TVFMI®. Pre-operative and four-week post-operative assessment and statistical comparison were performed by videolaryngoscopy, stroboscopy, perceptual assessment (GRBAS), subjective (voice handicap index) analysis of voice, and computer-assisted acoustic and electroglottographic assessment. The duration of surgery and cost of implant were also recorded. Results: Although both implants showed improvement in quality of voice following thyroplasty, TVFMI® presents slightly better results in objective voice analysis. The surgery time for TVFMI®insertion was shorter, but the costs were higher. Conclusion: TVFMI® may be preferred for medialization thyroplasty as it presents better voice results and demands less surgical time; however, it is costlier than silastic implant. .
Subject(s)
Adolescent , Adult , Female , Humans , Male , Middle Aged , Young Adult , Dimethylpolysiloxanes/therapeutic use , Laryngoplasty/methods , Prostheses and Implants , Titanium/therapeutic use , Vocal Cord Paralysis/surgery , Dimethylpolysiloxanes/economics , Laryngoplasty/economics , Prospective Studies , Prostheses and Implants/economics , Time Factors , Treatment Outcome , Titanium/economics , Voice QualityABSTRACT
We describe a case of corrosive tracheo-esophageal fistula following button battery ingestion in a 1-year old nonverbal pediatric patient. The delay in diagnosis was caused by failure to obtain correct history and failure to detect opacity of the battery in the neck at the first visit. The large fistula was successfully treated with division and repair with non absorbable sutures, with interposition of strap muscles between separated trachea and esophagus.
Subject(s)
Electric Power Supplies/adverse effects , Esophagus , Foreign Bodies/complications , Trachea , Tracheoesophageal Fistula/etiology , Foreign Bodies/diagnostic imaging , Humans , Infant , Male , RadiographyABSTRACT
BACKGROUND: External dacryocystorhinostomy (DCR) has been the standard surgery for nasolacrimal duct obstruction before the development of endoscopic DCR. METHODS: This retrospective study included 103 patients with 109 cases (6 cases with bilateral disease) of nasolacrimal duct obstruction, of which 55 were treated with external DCR and 54 with endoscopic DCR. They were followed up for a minimum period of six months for surgical outcome. RESULT: The mean age of the patients in both the groups was 30 years. The success rate defined as absence of epiphora in the external DCR group was 90.9% and 95 % in the endoscopic DCR group. Majority of the recurrence, 5 out of the 6 (83.3%) in the external DCR group occurred in the first two months of surgery, while one reported four months after the surgery. The problem of intraoperative hemorrhage encountered in the external DCR group was not faced in the endoscopic DCR group. Revision of DCR was indicated in 9.1 % of cases in external DCR group as compared to 5.5 % in the endoscopic group. Serious complications like keloid formation and cosmetically unacceptable scar were not noticed in the external DCR group. Cerebrospinal fluid (CSF) rhinorrhoea was not encountered in the endoscopic group. CONCLUSION: Both the external DCR and the endoscopic DCR are effective surgical approaches for nasolacrimal duct obstruction with comparable success rate.
ABSTRACT
BACKGROUND: Stage III and IV cancers of larynx and hypopharynx often require total laryngectomy which leaves the patient with severe communication handicap. In such laryngectomised patients tracheo-esophageal puncture is the best way for voice rehabilitation using either Blom-Singer® prosthesis or Provox® indwelling valve. METHODS: A prospective comparative study of Blom-Singer® prosthesis and Provox® indwelling valves placed in Tracheo-esophageal Punctures (TEP) for voice rehabilitation following total laryngectomy was carried out at the Tata Memorial Hospital, Mumbai and Malignant Diseases Treatment Centre of Armed Forces, to assess their efficacy. This report comprises of our experience in 41 (39 males and two females) laryngtectomees who underwent TEP of which 15 patients were fitted with low pressure Blom-Singer® prostheses and 26 with Provox® indwelling prostheses. RESULTS: Prostheses related problems like granuloma formation, leakage, candidal growth over the valves and prosthetic decay were significantly less in the patients fitted with Provox® prosthesis. Dislodgement of prosthesis with closure of the tract or persistent fistula formation and creation of false passage, while reinsertion were problems encountered in the Blom-Singer group. After three months, speech assessment revealed a better quality of voice production and patient compliance in maintaining the prosthesis in the case of Provox® indwelling valve. CONCLUSION: In Indian scenario where illitracy amongst the patients hinders in maintainence of Blom-Singer® prosthesis, Provox® indwelling value is an appropriate choice for voice rehabilitation.
