Phonosurgery Training in Human Larynx Preserved with Thiel's Embalming Method.

BACKGROUND: To describe the suitability of larynges preserved with Thiel's embalming method for phonosurgery training. METHODS: A training model for phonosurgery techniques simulating vocal pathology and glottal insufficiency is developed to compare and evaluate the perception of embalmed vocal cords through a voluntary and anonymous survey rated on a scale of 1-5. A total of 10 residents and young otolaryngologists participated in the surgical training in phonosurgery. RESULTS: Ten larynges preserved in formalin and 10 Thiel's embalmed larynges were used for the investigation. Phonosurgery procedures were performed following microflap and injection laryngoplasty techniques. The larynges preserved with Thiel's method demonstrated vocal cords that maintain their pliability and good tissue quality allowing a sensation of realism compared to the living body and providing suitable conditions for realistic laryngeal training. Participants held a positive experience, believed them to be useful and that these models of embalmed larynges were similar to the clinical setting and improved skills and confidence in performing phonosurgery. CONCLUSIONS: The human larynges embalmed with Thiel's method maintain the pliability of the vocal cords, thus representing a unique model to practice and reproduce training for endolaryngeal procedures without the risks of contamination, anatomical variation, or rigidity of other models.

Papilomas y papilomatosis laríngea. Tratamiento con láser CO2. Nuestra experiencia en 15 años / Papillomas & laryngeal papillomatosis. Treatment with CO2 laser surgery. Our experience over 15 years

Objetivo: Mostrar la experiencia con microcirugía láser CO2 como tratamiento de la papilomatosis laríngea. Analizamos parámetros diversos, entre ellos: edad media, género, tasa de recidiva, serotipo viral. Material y método: Se realiza un estudio descriptivo retrospectivo, recogiendo 29 casos diagnosticados y tratados de papiloma laríngeo mediante microcirugía asistida con láser CO2, entre 1995 y 2010. Resultados: Esta patología es más prevalente en el sexo masculino, 65,5%; con leve predominio de única localización laríngea frente a multilocalización de lesiones. Se detectó DNA vírico del Virus del Papiloma Humano (HPV) en el 75,8% de los casos, predominaron los subgrupos 6 y 11, entre otros. Presentaron recidiva el 44,8% de los casos, con una media de recidiva de 2–3 episodios por paciente. Se encuentran en remisión (sin recidiva en últimos 2 meses) el 20,7% de casos; en aclaramiento (sin recidiva aparente en últimos 3 años) el 34,5% y en curación (sin recidiva en últimos 5 años) el 41,3%. Presentó malignización un caso. Conclusión: La papilomatosis se caracteriza por ser una patología de curso impredecible, con probabilidad baja de malignizar y en la que la microcirugía láser carbónico ha supuesto una revolución con respecto a su tratamiento sintomático, porque aún no se ha descubierto el tratamiento curativo (AU)

Objectives: The study goal was to evaluate the efficacy of CO2 laser surgery in the treatment of laryngeal papillomatosis. We analysed several parameters such as gender, average age, relapse rate and viral serotype. Material and methods: A total of 26 diagnosed patients were included in this retrospective descriptive review. All of them were treated with CO2 laser for laryngeal papillomas between 1995 and 2010. Results: This pathology was more prevalent in males (65.5%), with a slight predominance of a single larynx localisation over multiple lesion locations. Human papillomavirus (HPV) DNA was detected in 75.8% of the cases; genotypes 6 and 11 prevailed. Of the patients in this review, 44.8% relapsed; the relapse average was 2–3 episodes per patient. A total of 20.7% of cases were in remission (no relapse in the last 2 months); 34.5%, clearing (no apparent relapse in the last 3 years); and 41.3% in the healing stage (without relapse in the last 5 years). There was only one case that showed malignancy. Conclusion: Papillomatosis is characterised as a pathology with an unpredictable course and with a low probability of malignancy. CO2 laser surgery has meant a revolution in symptomatic treatment, but there is presently no curative treatment (AU)

[Papillomas & laryngeal papillomatosis. Treatment with CO2 laser surgery. Our experience over 15 years]. / Papilomas y papilomatosis laríngea. Tratamiento con láser CO2. Nuestra experiencia en 15 años.

OBJECTIVES: The study goal was to evaluate the efficacy of CO2 laser surgery in the treatment of laryngeal papillomatosis. We analysed several parameters such as gender, average age, relapse rate and viral serotype. MATERIAL AND METHODS: A total of 26 diagnosed patients were included in this retrospective descriptive review. All of them were treated with CO2 laser for laryngeal papillomas between 1995 and 2010. RESULTS: This pathology was more prevalent in males (65.5%), with a slight predominance of a single larynx localisation over multiple lesion locations. Human papillomavirus (HPV) DNA was detected in 75.8% of the cases; genotypes 6 and 11 prevailed. Of the patients in this review, 44.8% relapsed; the relapse average was 2-3 episodes per patient. A total of 20.7% of cases were in remission (no relapse in the last 2 months); 34.5%, clearing (no apparent relapse in the last 3 years); and 41.3% in the healing stage (without relapse in the last 5 years). There was only one case that showed malignancy. CONCLUSION: Papillomatosis is characterised as a pathology with an unpredictable course and with a low probability of malignancy. CO2 laser surgery has meant a revolution in symptomatic treatment, but there is presently no curative treatment.

Hypothyroidism in patients treated with total laryngectomy. A multivariate study.

One of the complications of the treatment of head and neck carcinoma patients is hypothyroidism. The objective of our study was to quantify the prevalence of hypothyroidism in patients with laryngeal or hypopharyngeal cancer treated with a total laryngectomy and to evaluate the importance of different variables in the appearance of hypothyroidism in this group of patients. A transversal study in 182 patients treated with total laryngectomy between 1986 and 1998 was carried out. TSH and FT4 were determined in all patients. Hypothyroidism was classified as subclinical (increased TSH and normal T4 levels) and clinical (increased TSH and decreased T4 levels). Univariate and multivariate analysis was carried out to examine the relationship between hypothyroidism and different variables. Our results showed that the prevalence of hypothyroidism in our group of patients was 52% (27% subclinical and 25% clinical). Sex, initial extension of the tumour, hemithyroidectomy, use of chemotherapy and radiotherapy were variables associated with the appearance of hypothyroidism in the univariate analysis (P < 0.05). When all these variables were included in a multivariate study, only hemithyroidectomy (RR 3,6; CI 95% 1,7-7,2) and combined treatment with radiotherapy (RR 3,4; CI 95% 1,2-9,6) appeared as prognostic factors. In conclusion, hypothyroidism is a frequent complication in patients treated with a total laryngectomy (52%), especially when this treatment includes hemithyroidectomy and/or radiotherapy. We consider that it is important to check the thyroid function periodically in these patients to obtain early diagnosis and appropriate treatment.