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1.
Int. arch. otorhinolaryngol. (Impr.) ; 24(1): 53-61, Jan.-Mar. 2020. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1090553

RESUMO

Abstract Introduction The increase in life expectancy is an incentive to the development of researches with the elderly population aiming at actions that may ensure healthy and active aging. Objective To analyze the profile of laryngeal microsurgery performed in patients > 60 years old. Methods A retrospective observational study, with a cross-sectional design. A retrospective analysis of the medical records of elderly patients submitted to laryngeal microsurgery was performed at a private hospital in Curitiba, state of Paraná, Brazil, between January 2004 and December 2016. Were included all of the patients > 60 years old that underwent laryngeal microsurgery during this period. Results During the studied period, 213 laryngeal microsurgeries were performed in 181 patients > 60 years old. There was a preponderance of male patients. The mean age was 67.6 years old. Squamous cell carcinoma (SCC) was the most prevalent disorder (26%), followed by Reinke edema (20%), papillomatosis (14%), polyps (11%), leukoplakia (8%), minor structural alterations (8%), associated lesions (9%), and others (4%). Men presented a higher probability of SCC diagnosis, regardless of the age group, while Reinke edema was more frequently observed in women. A directly proportional relation between the frequency of laryngeal cancer and age increase was also observed. No significant differences were observed in professional voice users. Conclusion Further researches are required to properly comprehend the factors associ- ated with laryngeal lesions and determine prevention and treatment approaches.


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Doenças da Laringe/cirurgia , Doenças da Laringe/epidemiologia , Laringe/cirurgia , Microcirurgia , Papiloma/cirurgia , Riscos Ocupacionais , Envelhecimento/fisiologia , Carcinoma de Células Escamosas/cirurgia , Carcinoma de Células Escamosas/radioterapia , Carcinoma de Células Escamosas/epidemiologia , Fatores Sexuais , Edema Laríngeo/cirurgia , Edema Laríngeo/epidemiologia , Neoplasias Laríngeas/cirurgia , Neoplasias Laríngeas/epidemiologia , Registros Médicos , Estudos Transversais , Estudos Retrospectivos , Fatores Etários
2.
BMJ Case Rep ; 12(9)2019 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-31570357

RESUMO

Vallecular cysts are a rare entity but can complicate the airway management due to the physical impediment and distortion of the laryngeal inlet. It can lead to fatal life-threatening airway obstruction postinduction of anaesthesia. Infancy compounds the risks due to lack of cooperation and physiological reserves. The literature review suggested most anaesthesiologists avoided muscle relaxants and aspiration of the cyst was used as a rescue technique. The present case report illustrates the successful airway management of an infant with a huge vallecular cyst using fibre-optic intubation by a 'three-person' technique after paraglossal videolaryngoscopy failed to secure the airway.


Assuntos
Manuseio das Vias Aéreas/métodos , Obstrução das Vias Respiratórias/cirurgia , Cistos/cirurgia , Tecnologia de Fibra Óptica , Doenças da Laringe/cirurgia , Laringoscopia/instrumentação , Obstrução das Vias Respiratórias/diagnóstico por imagem , Cistos/complicações , Cistos/diagnóstico por imagem , Humanos , Lactente , Doenças da Laringe/complicações , Doenças da Laringe/diagnóstico por imagem , Masculino , Resultado do Tratamento
3.
Vestn Otorinolaringol ; 84(4): 48-50, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31579058

RESUMO

Amyloidosis of the larynx is rare in the pediatric age group. We present a clinical case of laryngeal amyloidosis manifesting as false vocal fold bulging in a thirteen-year-old girl with hoarseness and with initial suspicion of laryngeal tumor. Computed tomography and ultrasound scanning of the larynx were useful in determining the laryngeal process size along with fibro laryngoscopy. There was performed a microsurgical removal of the larynx formation. The results of Congo red staining of the formation were characteristic of amyloid. Systemic manifestations of the disease were not revealed.


Assuntos
Amiloidose , Doenças da Laringe , Adolescente , Amiloidose/complicações , Amiloidose/diagnóstico , Amiloidose/cirurgia , Criança , Diagnóstico Diferencial , Feminino , Rouquidão , Humanos , Doenças da Laringe/complicações , Doenças da Laringe/diagnóstico , Doenças da Laringe/cirurgia , Neoplasias Laríngeas/diagnóstico , Laringoscopia
5.
Eur Arch Otorhinolaryngol ; 276(11): 3165-3171, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31473780

RESUMO

OBJECTIVE: To investigate the presence of sulcus vocalis in patients who underwent phonomicrosurgery due to benign vocal cord lesions. METHODS: Between January 2013 and June 2018, the records of 133 patients who underwent operations for benign vocal fold pathology were retrospectively reviewed. Intraoperative findings of the patients were noted. Patients were divided into two groups: patients with only benign vocal fold lesions (BVFL) and patients with benign vocal fold lesions and accompanying sulcus vocalis (SV + BVFL). RESULTS: In total, 67 patients (50.4%; 38 females, 29 males) had BVFL and 66 (49.6%; 37 females, 29 males) had SV + BVFL. The patients in the SV + BVFL group were significantly younger than those in the BVFL group (p = 0.039). The sulcus was unilateral in 60.6% of the patients. The presence of sulcus vocalis was 49% and 47.6% in patients with a diagnosis of polyps (n = 51) and cysts (n = 42), respectively. A total of 12 of 13 patients with multiple benign vocal fold lesions had accompanying sulcus vocalis. CONCLUSION: Approximately half of the patients who underwent operations for benign vocal fold lesions had accompanying sulcus vocalis. More than half of the sulcus associated with benign lesions was unilateral.


Assuntos
Cistos , Pólipos , Prega Vocal , Adulto , Correlação de Dados , Cistos/patologia , Cistos/cirurgia , Feminino , Humanos , Doenças da Laringe/patologia , Doenças da Laringe/cirurgia , Músculos Laríngeos/patologia , Masculino , Pessoa de Meia-Idade , Pólipos/patologia , Pólipos/cirurgia , Estudos Retrospectivos , Prega Vocal/patologia , Prega Vocal/cirurgia
6.
Int J Pediatr Otorhinolaryngol ; 126: 109604, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31369973

RESUMO

This case series aims to determine the optimal surgical approach for pediatric laryngeal saccular cysts. A retrospective chart review of patients who underwent surgical treatment for laryngeal saccular cysts was completed; 5 patients were diagnosed and surgically treated. Treatment approaches included aspiration, supraglottoplasty, injection of bleomycin, endoscopic subtotal resection (marsupialization with the laser or endoscopic instrumentation of the cyst), endoscopic extended subtotal excision (subtotal resection plus removal of false vocal fold with lasering or coblation of the inner cyst wall), and transcervical approaches for resection. Based on our outcomes, an endoscopic extended subtotal resection of the cyst will achieve the best outcomes for cysts confined to the larynx or for Type 1 cysts. A transcervical approach for resection of the cyst will achieve the best outcomes for Type 2 cysts that extend into the neck or are extralaryngeal.


Assuntos
Cistos/cirurgia , Endoscopia , Doenças da Laringe/cirurgia , Humanos , Lactente , Recém-Nascido , Terapia a Laser , Lasers de Gás , Masculino , Estudos Retrospectivos
7.
Vet J ; 250: 24-27, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31383416

RESUMO

Epiglottic entrapment is a condition in racing horses, associated with abnormal respiratory noises and exercise intolerance. Epiglottic entrapment has been linked to both poor and superior athletic performance, leading to concerns regarding whether surgery is indicated, and whether surgical correction may have a deleterious effect on future race performance. The objective of the current study was to assess the race-day performance of horses racing with epiglottic entrapment and the effect of surgical correction on performance outcomes using an intra-oral technique in anaesthetised horses. A case-control study was conducted at the Singapore Turf Club from 2008 to 2011. Controls were selected 1:1 to cases, based on Malaysian Racing Authority number. The performance of horses racing with epiglottic entrapment was recorded and post-surgery race performance was described. Further, post-surgery race performance was compared between cases and with non-case controls. Twenty horses raced with epiglottic entrapment were retrospectively enrolled. There was a significant difference in racing performance in case horses racing with and without epiglottic entrapment (P < 0.001). Fourteen horses finished in the top three post-surgery, compared to one horse finishing in the top three when running with epiglottic entrapment present. There was no significant difference between the performance of case horses (n = 33) post-surgery and controls (number of wins P = 0.20; and places P = 0.62). The intra-oral release of epiglottic entrapment is a suitable technique to resolve epiglottic entrapment. This study may assist veterinarians advising clients in the decision-making process when epiglottic entrapment is diagnosed in a racehorse.


Assuntos
Doenças dos Cavalos/fisiopatologia , Doenças dos Cavalos/cirurgia , Cavalos/fisiologia , Doenças da Laringe/veterinária , Condicionamento Físico Animal/fisiologia , Esportes , Animais , Estudos de Casos e Controles , Feminino , Cavalos/cirurgia , Doenças da Laringe/fisiopatologia , Doenças da Laringe/cirurgia , Masculino , Estudos Retrospectivos , Corrida , Singapura
8.
Int J Pediatr Otorhinolaryngol ; 125: 147-152, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31323352

RESUMO

OBJECTIVE: Despite the fact that vocal nodules are the most common cause of chronic dysphonia in children, uncertainty and lack of consensus complicates practically every diagnostic and management decision. Selecting an optimal staging system is fundamental to understanding a disease process, mandatory for uniform reporting, and crucial to predicting natural history and treatment outcomes. The ideal prognostic model for vocal nodules is under intense debate. The purpose of this study was to analyze the predictive power of vocal nodule grade to severity of voice metrics in children. METHODS: Seventy-nine patients diagnosed with vocal cord nodules between 2006 and 2012 were drawn from UPMC Children's Hospital of Pittsburgh Voice, Resonance and Swallowing Center Research Registry. Subject age at time of diagnosis, nodule grade, relevant co-morbidities, scores on The Consensus Auditory-Perceptual Evaluation of Voice (CAPE-V), parent-reported Pediatric Voice Handicap Index (pVHI), the phonotraumatic behaviors profile, habitual speaking pitch fundamental frequencies, pitch range, volume intensity, and s/z ratio were recorded and compiled into a de-identified database for analysis. RESULTS: Based on the Kruskal-Wallis H Test, there was no statistically significant correlation between nodule grade and total pitch range (p = .21), s/z ratio (p = .50), volume intensity (p = .33), overall CAPE-V Scores (p = .15), or pVHI Scores (p = .29). Chi-squared tests also revealed no significant associations between nodule grade and abnormality in habitual speaking pitch (p = .14 for fundamental frequency while sustaining a vowel sound, p = .37 for fundamental frequency while speaking structured tasks i.e. counting, or p = .76 while speaking in conversation). CONCLUSION: The current "gold-standard" for grading vocal nodule size suggests that the nodules themselves are not driving the standard dysphonic metrics that are most commonly collected and monitored in such children. This outcome is consistent with other studies reporting similar findings and was expected based on the inconsistencies in the reported literature to date. By extension, the conventional wisdom of avoiding surgical treatment of vocal nodules in children seems prudent as there is little evidence to suggest that the nodules themselves are "driving" the severity of the dysphonia. Ultimately identifying the true "drivers" of dysphonia in children will suggest alternative therapies that are more specific and directed to the pathophysiology. Most pediatric voice care professionals will welcome such discoveries as those in the front line of patient care are often rendered helpless and frustrated.


Assuntos
Disfonia/diagnóstico , Disfonia/etiologia , Doenças da Laringe/complicações , Doenças da Laringe/diagnóstico , Pólipos/complicações , Pólipos/diagnóstico , Adolescente , Criança , Pré-Escolar , Estudos de Coortes , Disfonia/terapia , Feminino , Humanos , Doenças da Laringe/cirurgia , Masculino , Pólipos/cirurgia , Valor Preditivo dos Testes , Índice de Gravidade de Doença , Qualidade da Voz
9.
Otolaryngol Head Neck Surg ; 161(4): 652-657, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31184262

RESUMO

OBJECTIVES: To compare the clinical outcomes of patients with prophylactic petiole suspension (PPS) at the time of laryngofissure and patients without PPS. STUDY DESIGN: Retrospective case series. SETTING: Tertiary pediatric hospital from May 2003 to August 2017. SUBJECTS AND METHODS: Patients included those undergoing airway reconstruction with complete laryngofissure. Patients in the study group had PPS at the time of laryngofissure, while control group patients did not. RESULTS: Eighty-one patients underwent complete laryngofissure (22 study patients, 59 controls) at a median age of 4.8 years (interquartile range, 2.1-9.7). Patients in the control group were younger at the time of the surgery (3.7 vs 6.5 years, P = .04). Other demographic and clinical data, including subglottic stenosis (SGS) grades, were similar. For patients with SGS, 53.8% and 46.2% in the study group had a grade 1-2 and 3-4 SGS, respectively, as compared with 46.2% and 53.8% in the control group (P = .65). Manifestations of petiole prolapse included failure of decannulation (8.6%), exercise intolerance (16.0%), and obstructive sleep apnea (11.1%). After 4 years of follow-up, 4.5% of the study group versus 27.1% of the control group had prolapse of the petiole (P = .04). Petiole prolapsed affected >50% of patients with no PPS after 10 years of follow-up. Patients with petiole prolapse at the first surveillance microlaryngoscopy and bronchoscopy after stent removal had an odds ratio of 10.2 (95% CI, 1.1-94.8; P = .04) of becoming symptomatic. CONCLUSION: Patients with PPS had significantly fewer symptoms after complete laryngofissure as compared with patients without PPS. PPS should be considered when a complete laryngofissure is being performed during airway reconstruction.


Assuntos
Epiglote/cirurgia , Doenças da Laringe/cirurgia , Laringoplastia/métodos , Broncoscopia , Estudos de Casos e Controles , Criança , Pré-Escolar , Remoção de Dispositivo , Feminino , Humanos , Lactente , Laringoscopia , Masculino , Complicações Pós-Operatórias , Procedimentos Cirúrgicos Reconstrutivos/métodos , Estudos Retrospectivos , Resultado do Tratamento
10.
Artigo em Chinês | MEDLINE | ID: mdl-31163557

RESUMO

Objective: To compare the short-term outcomes of CO2 laser and conventional laryngeal microsurgery for vocal cord cyst. Method: Patients with vocal cord cyst were divided randomly into two groups. One group was treated with CO2 laser (laser group) and the other underwent Micro-flap surgery(Micro-flap group). For the objective assessment, Amulti-dimensional voice program module for voice spectrum analysis was used. Result: In the laser group, there were no significant differences between the preoperative and 1 week postoperative parameters of Jitter, Shimmer and HNR(P>0.05). However,the parameters of G and VHI-10 were significantly different between the laser group and Micro-flap group(P<0.05). The objective data of the laser group pre-and post-surgery showed that the voice recovery of the laser group was significantly better than that of the Micro-flap group after 1 to 3 months of follow-up(P<0.05). But no significant differences of the parameters of G and VHI-10 was noted between the laser group and Micro-flap group(P>0.05). Conclusion: CO2 laser laryngeal microsurgery for vocal cord cyst can significantly improve pronunciation quality.


Assuntos
Cistos/cirurgia , Doenças da Laringe/cirurgia , Lasers de Gás , Microcirurgia , Prega Vocal/patologia , Qualidade da Voz , Acústica , Humanos , Resultado do Tratamento
11.
Lakartidningen ; 1162019 May 15.
Artigo em Sueco | MEDLINE | ID: mdl-31192393

RESUMO

The main, but not sole, indication for an Ex-utero Intrapartum Treatment (EXIT) delivery is an airway obstruction due to either laryngeal atresia or tumors in the head and neck region. Here we present our Institution's experience with eleven cases: three teratomas, four lymphatic malformations, two laryngeal atresias and two dermoid cysts. The EXIT procedure was used to secure the fetal airway while maintaining uteroplacental gas exchange and fetal hemodynamic stability through the umbilical circulation. Five fetuses required tracheostomy. Only one fetal death occurred due to extensive growth of a teratoma preventing us from establishing an airway. No other fetal or major maternal complication occurred. The EXIT procedure is a complex procedure and these rare cases should be referred to a center with a dedicated and experienced multidisciplinary team.


Assuntos
Obstrução das Vias Respiratórias , Histerotomia/métodos , Laparotomia/métodos , Adulto , Obstrução das Vias Respiratórias/congênito , Obstrução das Vias Respiratórias/cirurgia , Cesárea , Malformação Adenomatoide Cística Congênita do Pulmão/cirurgia , Feminino , Neoplasias de Cabeça e Pescoço/congênito , Neoplasias de Cabeça e Pescoço/cirurgia , Hospitais Universitários , Humanos , Recém-Nascido , Intubação Intratraqueal/métodos , Doenças da Laringe/congênito , Doenças da Laringe/cirurgia , Laringe/anormalidades , Laringe/cirurgia , Anormalidades Linfáticas/cirurgia , Equipe de Assistência ao Paciente , Gravidez , Resultado da Gravidez , Diagnóstico Pré-Natal , Estudos Retrospectivos , Região Sacrococcígea/patologia , Região Sacrococcígea/cirurgia , Suécia , Teratoma/congênito , Teratoma/cirurgia , Traqueotomia/métodos
13.
Fetal Diagn Ther ; 46(1): 75-80, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31238308

RESUMO

We present a case of prenatal hydrops secondary to congenital high airway obstruction syndrome (CHAOS) that was treated with fetoscopy-assisted needle decompression. A 22-year-old G3P2 woman presented after a 21-week ultrasound demonstrated CHAOS. The fetus developed hydrops at 25 weeks, characterized by abdominal ascites, pericardial effusion, and scalp edema. Fetal MRI showed complete obstruction of the glottis and subglottic airway, suggestive of laryngeal atresia. At 27 weeks, due to the progression of the hydrops, operative fetoscopy was proposed and performed. Fetal laryngoscopy confirmed fusion of the vocal cords and laryngeal atresia. The atretic segment was a solid cartilaginous block, preventing intubation. Using the fetoscope to stabilize the fetal head and neck, we performed ultrasound-guided percutaneous needle drainage of the cervical trachea through the anterior fetal neck. We removed 17 mL of viscous fluid from the lower trachea, resulting in immediate lung decompression. Two weeks later, ultrasound confirmed hydrops resolution. The patient was delivered and tracheostomy performed at 30 weeks via an ex utero intrapartum treatment (EXIT) procedure after progression of preterm labor. At 27 days of life, the infant was stable on minimal ventilator support. To our knowledge, this is the first successful report of an ultrasound-guided percutaneous tracheal decompression through the anterior neck of a fetus with CHAOS secondary to laryngeal atresia.


Assuntos
Obstrução das Vias Respiratórias/cirurgia , Hidropisia Fetal/diagnóstico por imagem , Doenças da Laringe/cirurgia , Traqueia/diagnóstico por imagem , Obstrução das Vias Respiratórias/complicações , Feminino , Sofrimento Fetal/complicações , Sofrimento Fetal/diagnóstico por imagem , Sofrimento Fetal/cirurgia , Fetoscopia , Humanos , Lactente , Recém-Nascido , Doenças da Laringe/complicações , Pulmão/diagnóstico por imagem , Gravidez , Traqueostomia , Ultrassonografia Pré-Natal
14.
Vet Surg ; 48(5): 803-819, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31111521

RESUMO

OBJECTIVE: To report intraoperative and major postoperative complications in dogs treated surgically for epiglottic retroversion (ER), compare the incidence of major postoperative complications between procedures, and report survival of surgically treated dogs. STUDY DESIGN: Multi-institutional retrospective study. SAMPLE POPULATION: Fifty dogs treated with 78 procedures. METHODS: Medical records of dogs diagnosed and surgically treated for ER from 2003 to 2017 at 11 institutions were reviewed. Complications were divided into intraoperative and major postoperative complications. RESULTS: Intraoperative complications occurred during 2 of 78 (2.6%) procedures. Thirty-six major postoperative complications were documented in 22 dogs after 36 of 74 (48.7%) procedures. Postoperative complications occurred after 7 of 12 (58.3%) nonincisional epiglottopexy, 23 of 43 (53.5%) incisional epiglottopexy, 2 of 4 (50%) partial epiglottectomy, 2 of 12 (16.7%) subtotal epiglottectomy, and 2 of 3 (66.7%) other surgical procedures. Epiglottopexy failure was the most common major postoperative complication. The incidence of major postoperative complications did not differ between procedures (P = .1239), although, when combined, epiglottopexy procedures (30/55) had a higher incidence of complications than epiglottectomy procedures (4/16; P = .048). Thirty (60%) dogs were alive at a median of 928 days (range, 114-2805), 8 (16%) were lost to follow-up after 411 days (range, 43-1158), and 12 (24%) were dead/euthanized after 301.5 days (range, 3-1212). Median survival time was not reached after a median of 716 days. CONCLUSION: Although intraoperative complications were uncommon, major postoperative complications were common, especially after epiglottopexy procedures. CLINICAL SIGNIFICANCE: Although surgical treatment of ER is associated with a high rate of major postoperative complications, especially epiglottopexy procedures, long-term survival can be achieved.


Assuntos
Doenças do Cão/cirurgia , Complicações Intraoperatórias/veterinária , Doenças da Laringe/veterinária , Complicações Pós-Operatórias/veterinária , Animais , Cães , Epiglote , Feminino , Doenças da Laringe/cirurgia , Masculino , Período Pós-Operatório , Estudos Retrospectivos , Resultado do Tratamento
15.
Eur Arch Otorhinolaryngol ; 276(7): 2007-2013, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31134359

RESUMO

PURPOSE: To evaluate voice outcome after bilateral vocal fold injection with autologous fat in patients with non-paralytic glottic insufficiency due to vocal fold atrophy with or without sulcus. METHODS: This is a retrospective cohort study from September 2012 to December 2017 including 23 patients undergoing bilateral vocal fold injection with autologous fat (24 procedures) for vocal fold atrophy (15 procedures) or atrophy with sulcus (Ford type II or III) (9 procedures). Voice data were collected and analyzed for the preoperative and the 3- and 12-month postoperative time points according to a standardized protocol, including Voice Handicap Index (VHI)-30 and perceptive, acoustic and aerodynamic parameters. Failure rate was defined as non-relevant improvement (< 10 points) in VHI-30 at 12 months and number of revisions within 12 months. RESULTS: There was a clinically relevant (≥ 15 points) and statistically significant improvement in the VHI-30 (preoperative: 49.1 points; postoperative at 12 months: 29.7 points). Change in dynamic range was also statistically significant over time (p = 0.028). There were no differences in voice parameters between patients with atrophy only and atrophy with sulcus, although grade tended to be lower in patients with atrophy only over all time points. CONCLUSION: This study shows that bilateral vocal fold injection with autologous fat is a beneficial treatment not only for patients with atrophy but also for patients with sulcus. A comparison of the results with those reported from other forms of sulcus surgery confirmed this finding. However, there is a need for further prospective studies comparing the short- and long-term effects of different techniques.


Assuntos
Gordura Abdominal/transplante , Doenças da Laringe , Prega Vocal , Qualidade da Voz , Adulto , Atrofia , Feminino , Humanos , Injeções/métodos , Doenças da Laringe/patologia , Doenças da Laringe/fisiopatologia , Doenças da Laringe/cirurgia , Masculino , Pessoa de Meia-Idade , Países Baixos , Assistência Perioperatória/métodos , Estudos Retrospectivos , Resultado do Tratamento , Prega Vocal/patologia , Prega Vocal/fisiopatologia , Prega Vocal/cirurgia
16.
Vet Surg ; 48(5): 820-824, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31066076

RESUMO

OBJECTIVE: To report an epiglottopexy technique for the treatment of epiglottic retroversion (ER) in 2 horses. STUDY DESIGN: Case report. ANIMALS: A 2-year-old thoroughbred gelding and a 6-year-old standardbred gelding, both with ER. METHODS: Epiglottic retroversion was diagnosed via exercising endoscopic examination in both horses. Epiglottopexy technique was performed in both cases. RESULTS: Both horses returned to previous racing class within 1 year after surgery. Repeat exercising endoscopy of 1 horse 6 months postoperatively revealed resolution of the ER. CONCLUSION: Epiglottopexy should be considered for treatment of ER in the equine athlete. CLINICAL SIGNIFICANCE: Previously reported surgical techniques for ER in the equine athlete have not resulted in horses returning to previous performance level. The technique reported here resulted in both horses achieving athletic status.


Assuntos
Endoscopia/veterinária , Epiglote/cirurgia , Doenças dos Cavalos/cirurgia , Doenças da Laringe/veterinária , Laringoplastia/veterinária , Animais , Cavalos , Doenças da Laringe/cirurgia , Masculino , Período Pós-Operatório
17.
Eur Arch Otorhinolaryngol ; 276(5): 1431-1438, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30879190

RESUMO

PURPOSE: To study the damaging effect of different diode laser settings on vocal folds 7 days after injury in a rabbit model. METHODS: Twenty-one male New Zealand white rabbits were randomized into three groups with seven animals per group. A 980-nm diode laser was used to create a single spot injury in each vocal fold. Different modulation frequencies (10 Hz versus 1000 Hz) in pulsed mode, different powers (3 W versus 5 W), and distinct wave modes of radiation (pulsed versus continuous) were compared. RESULTS: The extent of the inflammatory infiltrate and ablation crater were greater when using 5-W optical power compared with 3 W. The extent and depth of the inflammatory infiltrate, and the width and depth of the ablation crater were greater with continuous wave mode compared with pulsed mode. The density of collagen fibers only increased when using the laser in continuous wave mode. CONCLUSION: The use of the 980-nm diode laser with an output power of 5 W produced an increased extent of thermal injury compared to an output power of 3 W and, more importantly, using continuous rather than pulsed wave mode significantly increased the extent and depth of thermal injury in rabbit vocal folds.


Assuntos
Doenças da Laringe/cirurgia , Lasers Semicondutores/uso terapêutico , Prega Vocal/cirurgia , Animais , Masculino , Coelhos , Distribuição Aleatória , Prega Vocal/lesões , Prega Vocal/patologia , Cicatrização
18.
Laryngoscope ; 129(S2): S1-S9, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30887529

RESUMO

OBJECTIVES/HYPOTHESIS: Describe the preoperative evaluation of patients with glottic diastasis who are candidates for endoscopic posterior cricoid reduction (EPCR) and their perioperative and postoperative surgical and voice outcomes, and validate the aerodynamic benefit of EPCR using computation fluid dynamics (CFD)-based modeling from computed tomography (CT) scans. STUDY DESIGN: Retrospective case series. METHODS: Thirteen patients who underwent EPCR were followed from 2013 to 2017. They received a preoperative voice evaluation, microlaryngoscopy and bronchoscopy, dynamic voice CT (performed on patients seen from 2014 to study completion), and postoperative voice evaluation (n = 12). Postoperative inpatient days, complications, and postoperative endoscopic intervention were collected. To validate the aerodynamic benefit of EPCR, CFD modeling was carried out on one patient. RESULTS: Thirteen patients (nine females, nine with intubation injury, and four with post-airway reconstruction dysphonia) underwent EPCR at a mean age of 11.0 years. The mean preoperative and postoperative Pediatric Voice handicap Index scores were 53.8 and 33.8, respectively (P = .006). Mean maximum phonation time preoperatively and postoperatively was 5.3 and 6.7, respectively (P = .04). Of eight patients who underwent preoperative CT imaging, all demonstrated a posterior gap. Modeling demonstrated a change in flow and pressure. The mean hospital stay was 2.4 days. Nine patients underwent postoperative endoscopic intervention, and one experienced a complication that resolved with intervention. CONCLUSIONS: Patients who underwent EPCR for dysphonia following intubation or airway reconstruction showed improvements in vocal efficiency, loudness, and perceived voice handicapping. Their hospital stay was brief, with few complications. CFD modeling corroborated these clinical findings. EPCR thus warrants consideration in the management of patients with posterior glottic diastasis. LEVEL OF EVIDENCE: 4 Laryngoscope, 129:S1-S9, 2019.


Assuntos
Cartilagem Cricoide/cirurgia , Glote , Doenças da Laringe/cirurgia , Laringoscopia/métodos , Adolescente , Criança , Simulação por Computador , Feminino , Humanos , Hidrodinâmica , Imageamento Tridimensional , Masculino , Período Pré-Operatório , Estudos Retrospectivos , Resultado do Tratamento
19.
Otolaryngol Clin North Am ; 52(3): 537-557, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30922560

RESUMO

With fiber-based lasers that may be passed via the working channel of a flexible laryngoscope, in-office laser laryngeal surgery has become possible. The potassium-titanyl-phosphate laser has several features that make it ideal for laryngeal surgery, and it is now the laser of choice for in-office management of a variety of laryngeal lesions. Its applications have expanded significantly since its introduction, with reports of new indications continuing to appear in the literature. This article provides a comprehensive review of the indications and technical details of in-office potassium-titanyl-phosphate laser laryngeal surgery, and a summary of the existing literature regarding outcomes of these procedures.


Assuntos
Procedimentos Cirúrgicos Ambulatórios , Doenças da Laringe/cirurgia , Laringe/cirurgia , Terapia a Laser , Humanos , Lasers de Estado Sólido/uso terapêutico , Infecções por Papillomavirus/cirurgia , Infecções Respiratórias/cirurgia
20.
Artigo em Chinês | MEDLINE | ID: mdl-30813701

RESUMO

Objective:To explore the clinical value of nasal endoscope combined with supporting laryngoscope surgery in the treatment of polyps of vocal cord. Method:Ninety-four patients with vocal cord polyps were randomly divided into the control group (47 cases) and the observation group (47 cases). The patients in the control group were treated with simply supporting laryngoscope surgery while the patients in the observation group were treated with nasal endoscope combined with supporting laryngoscope. The therapeutic effects, voice function changes before and after operation, complications and recurrence of the two groups were observed. Result:The total effective rate was 93.62% in the observation group, compared to 78.72% in the control group, the difference was statistically significant (P<0.05). The incidence of postoperative complications in the observation group was 8.51%, compared with 25.53% in the control group, the difference was statistically significant (P<0.05). Six months after operation, there was no recurrence in the observation group, but the recurrence rate in the control group was 4.26%. There was no significant difference between the two groups (P>0.05). 12 months after operation, the recurrence rate of the observation group was 2.13%, compared with 14.89% of the control group, the difference was statistically significant (P<0.05). Conclusion:Nasal endoscope combined with supporting laryngoscope for vocal cord polyps has a definite effect and can significantly improve the voice function of patients with high safety and low recurrence rate, which is worthy of promotion..


Assuntos
Doenças da Laringe , Laringoscopia , Pólipos , Prega Vocal , Humanos , Doenças da Laringe/cirurgia , Laringoscópios , Pólipos/cirurgia , Qualidade da Voz
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