Surgical Management of Bilateral Abductor Paralysis: Diode Laser Versus Coblation; A Prospective Study.

OBJECTIVES: We aimed to compare the results of both diode laser and coblation in the treatment of bilateral vocal fold immobility (BVFI). MATERIALS AND METHODS: This prospective clinical study was performed on 80 non-tracheostomised patients with bilateral vocal fold paralysis divided into two groups; Group A: diode laser, Group B: coblation. Medical Research Council "mMRC" Dyspnea scale, maximal phonatory time (MPT), Voice handicap index (VHI), and functional outcome swallowing scale (FOSS) were assessed preoperatively and postoperatively. Also, the VAS pain scale and operative time of both groups are recorded. RESULTS: Within each group, there was a statistically significant decrease in the mMRC dyspnea scale and maximum phonation time and a significant increase in VHI (P < 0.001). There was a statistically significant difference between the studied groups postoperative and regarding the percent change of the MPT ( more decrease in the coblation group). Concerning the operative time and the VAS pain score, there was a statistically significant difference between the studied groups regarding operating time and the VAS pain scale (significantly lower in the coblation group) (P < 0.001). CONCLUSION: Both Coblation and diode laser are effective tools in the treatment of BVFI with similar minimal voice quality affection. The maximum phonation time decreased more in the coblation group, while the voice handicap index did not significantly differ between both groups. However, Coblation may be superior to diode laser in terms of less operative pain and shorter intraoperative time. Coblation may be more favorable for patients at risk of prolonged general anesthesia duration.

Evaluation of swallowing in children with higher grades glottic web.

PURPOSE: to evaluate the swallowing function in children with higher grades of glottic web and to detect the impact of surgical division of the glottic web on the swallowing parameters. We also performed a voice analysis as a secondary objective in this study. METHODS: This prospective case series study included 12 children with higher grades of the glottic web; grades 3 and 4. Evaluation of the swallowing function was done by clinical swallowing evaluation including symptoms and signs of swallowing dysfunction during feeding, such as vomiting, coughing, choking, or cyanosis, and bedside swallowing assessment using the 3-oz water swallow test. Instrumental evaluation of swallowing function was performed using flexible endoscopic evaluation of swallowing (FEES). The evaluation was performed both preoperatively and postoperatively. RESULTS: The number of children suffering from swallowing difficulties significantly increased during the postoperative evaluation where 6 (50%) children demonstrated choking during feeding after the surgical division of the web in comparison to only 3 (25%) preoperatively. Also, coughing and choking during the 3-oz water swallow test significantly increased following the division of the web with P < 0.001. CONCLUSION: Swallowing assessment is mandatory as children with higher grades of the glottic web, requiring reconstructive surgeries, are at risk of swallowing deficit which can be aggravated postoperatively. With improvement in the airway and surgery-specific outcomes, swallowing function is an important secondary outcome that has a significant impact on the lives of these kids and their families.

A refashioned foley catheter: novel cost-effective available stent in pediatric laryngotracheal reconstruction.

PURPOSE: Pediatric laryngotracheal reconstruction (LTR) for laryngotracheal stenosis (LTS) mandates stenting in certain situations. This study presents a novel commercially available and cost-effective stent, a refashioned foley catheter. METHODS: This prospective clinical study was performed on pediatric cases with LTS up to 8 years. The study was performed in a tertiary referral center. The selection of the proper foley catheter size for age was explained. The atraumatic insertion maneuver of the stent was also shown in detail in different situations of LTS. The endoscopic removal of the stent was also described. The mean follow-up was 6.45 ± 1.3 months. RESULTS: The study included 31 cases using the refashioned foley catheter stents. The study included 17 males and 14 females with a mean age of 3.45 ± 1.09. Subglottic stenosis was the most common cause of LTR in the study (74.2%) cases. The mean duration of stenting was 40.5 ± 3.7 days. Decannulation was achieved in 96.8% of cases. No stent complications were encountered like stent migration, excess granulation tissue, intractable aspiration, or pressure necrosis. CONCLUSION: The refashioned foley catheter is a novel, available, and inexpensive stent that can be utilized for LTR cases for pediatric LTS. The newly described stent is soft, pliable with atraumatic insertion and easy endoscopic removal with minimal complications.

Surgical management of laryngeal bilateral abductor palsy: comparative study between carbon dioxide and diode lasers.

This study aims to compare the results of both CO2 laser and diode laser combined arytenoidectomy with posterior cordectomy in managing patients with bilateral vocal fold paralysis. A prospective study involved 80 bilateral vocal cord immobility patients in adduction. They are divided into two groups according to the laser used, whether CO2 (with a wavelength of 10.6 µm) or diode (with a wavelength of 980 nm). We used mMRC (Modified Medical Research Council) dyspnea scale to assess dyspnea in our patients, while the voice was evaluated by both maximum phonation time and the voice handicap index. Quantitative variables were described using means and standard deviations, while categorical variables were described using frequencies and were compared using the chi-square test, Fisher exact test, and Monte Carlo test. There was a statistically non-significant difference between the studied groups regarding mMRC dyspnea scale and Voice Handicap Index preoperatively and postoperatively. There is a statistically significant difference between the two groups regarding maximum phonation time postoperatively (significantly higher in the CO2 laser group) (p < 0.001). The CO2 laser and diode laser could be used safely for the management of bilateral vocal cord paralysis. The CO2 laser maintains better voice parameters and less postoperative pain, while the diode laser gives less operative time, lower cost, and simplicity of use.