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1.
Artigo em Chinês | MEDLINE | ID: mdl-33541000

RESUMO

Objective:The aim of this study is to evaluate the efficacy of CO2 laser and CO2 laser combined with microsuture in the treatment of bilateral sessile polyps of vocal cords. Methods:Forty-eight patients with bilateral sessile polyps of vocal cords were randomly divided into CO2 laser group and CO2 laser combined with microsuture group. The surgical effect of each group and the difference between the two groups were evaluated by subjective score and objective voice analysis. Results:One month and three month after operation, Jitter, Shimmer, dysphonia severity index(DSI), the maximum phonation time(MPT), the parameters of G and voice handicap index(VHI-10) in the two groups were significantly different from pre-operation(P<0.05). There were also significant differences in Jitter, Shimmer, DSI and MPT between the two groups one month and three month after operation respectively(P<0.05). But no significant differences of the parameters of G and VHI-10 was noted between two groups(P>0.05). The incidence of postoperative vocal cord adhesion was 8.3% and 0 in two groups respectively, and there was no significant difference between the two groups(P>0.05). Conclusion:The CO2 laser combined with microsuturing technique can effectively improve the voice quality of patients with bilateral wide-based vocal cord polyps, and the effect is better than that of using CO2 laser alone.


Assuntos
Disfonia , Doenças da Laringe , Pólipos , Humanos , Doenças da Laringe/cirurgia , Fonação , Pólipos/cirurgia , Resultado do Tratamento , Prega Vocal/cirurgia , Qualidade da Voz
2.
BMJ Case Rep ; 14(2)2021 Feb 05.
Artigo em Inglês | MEDLINE | ID: mdl-33547119

RESUMO

We report an ex utero intrapartum therapy-to-airway procedure in which obstetric factors dramatically influenced the sequence of events necessary to complete the procedure.


Assuntos
Obstrução das Vias Respiratórias/congênito , Obstrução das Vias Respiratórias/cirurgia , Doenças da Laringe/congênito , Doenças da Laringe/cirurgia , Traqueostomia , Adulto , Cesárea , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Complicações do Trabalho de Parto , Gravidez , Diagnóstico Pré-Natal
3.
BMJ Case Rep ; 13(12)2020 Dec 13.
Artigo em Inglês | MEDLINE | ID: mdl-33318277

RESUMO

A 59-year-old man presented to the emergency department with recent onset biphasic stridor, dyspnoea and increased work of breathing on the background of prolonged intubation for the novel COVID-19 2 months previously. Flexible laryngoscopy revealed bilateral vocal fold immobility with a soft tissue mass in the interarytenoid region. The patient's symptoms improved with oxygen therapy, nebulised epinephrine (5 mL; 1:10 000) and intravenous dexamethasone (3.3 mg). The following morning, the patient was taken to theatre, underwent suspension microlaryngoscopy and found to have bilateral fixation of the cricoarytenoid joints and a large granuloma in the interarytenoid area. He underwent cold steel resection of the granuloma and balloon dilatation between the arytenoids, with the hope of mobilising the joints. This failed and CO2 laser arytenoidectomy was performed on the left side. The stridor had resolved postoperatively, with normalisation of work of breathing and the patient was discharged home on the first postoperative day.


Assuntos
/terapia , Granuloma/cirurgia , Intubação Intratraqueal/efeitos adversos , Doenças da Laringe/cirurgia , Constrição Patológica/etiologia , Constrição Patológica/cirurgia , Dispneia/etiologia , Emergências , Granuloma/etiologia , Humanos , Doenças da Laringe/etiologia , Laringe/patologia , Masculino , Pessoa de Meia-Idade , Sons Respiratórios , Trabalho Respiratório
4.
BMJ Case Rep ; 13(12)2020 Dec 17.
Artigo em Inglês | MEDLINE | ID: mdl-33334763

RESUMO

A 29-year-old male patient presented with a history of voice change and feeling of a lump in throat for the last 20 years. He was tracheostomised at the age of 10 years. Endolaryngeal examination showed a mucosal bulge in supraglottic region arising predominantly from right side. He had multiple healed scar marks on neck, arms and elbows, and had dystrophic nail changes. MRI of the neck showed a supraglottic cyst covering glottis. The patient was diagnosed as a case of laryngo-onycho-cutaneous syndrome which is also known as Shabbir syndrome. He underwent supraglottic cyst excision via transoral ultrasonic surgery. Glottic scarring along with subglottic stenosis was found intraoperatively, which was released using carbon dioxide laser and finally Montgomery (MT) tube was inserted. The patient got his tracheostomy tube removed for the first time in 20 years. He tolerated corking of MT tube. He was able to breathe through nose and phonate using false cords.


Assuntos
Obstrução das Vias Respiratórias/etiologia , Doenças da Túnica Conjuntiva/diagnóstico , Cistos/diagnóstico , Doenças da Laringe/diagnóstico , Adulto , Obstrução das Vias Respiratórias/cirurgia , Doenças da Túnica Conjuntiva/complicações , Doenças da Túnica Conjuntiva/cirurgia , Consanguinidade , Cistos/complicações , Cistos/cirurgia , Glote/diagnóstico por imagem , Glote/cirurgia , Humanos , Doenças da Laringe/complicações , Doenças da Laringe/cirurgia , Imagem por Ressonância Magnética , Masculino , Cirurgia Endoscópica por Orifício Natural , Traqueostomia , Resultado do Tratamento
5.
Medicine (Baltimore) ; 99(27): e21014, 2020 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-32629721

RESUMO

INTRODUCTION: Multiple symmetric lipomatosis (MSL) is an uncommon medical condition characterized by symmetric fat accumulation mainly in the neck and other upper body regions. The involvement of the larynx is rare according to the literature, and we present a case of MSL with larynx involvement treated with a surgical approach. PATIENT CONCERNS: A 55-year-old male was admitted to our hospital due to progressively aggravated breathing difficulty, and tracheotomy was performed before transfer. When he tried to block the cannula, the breathing difficulty returned. The patient's neck had been thickening for the past 2 years. DIAGNOSIS: Pathological examination confirmed the diagnosis of MSL. INTERVENTIONS: The patient underwent lumpectomy and neck exploration. OUTCOMES: The lipoma was removed, the patient was free of any dyspnea symptoms and recovered well, and the tracheal cannula was removed at a local hospital. CONCLUSION: MSL can infiltrate the larynx and grow into the preepiglottic space and paraglottic spaces, resulting in breathing difficulties. Lipomas present in the spaces described above must be removed at the same time; otherwise, symptoms of dyspnea cannot be alleviated.


Assuntos
Doenças da Laringe/diagnóstico , Lipomatose Simétrica Múltipla/diagnóstico , Obstrução das Vias Respiratórias/etiologia , Progressão da Doença , Humanos , Doenças da Laringe/etiologia , Doenças da Laringe/patologia , Doenças da Laringe/cirurgia , Lipomatose Simétrica Múltipla/complicações , Lipomatose Simétrica Múltipla/patologia , Lipomatose Simétrica Múltipla/cirurgia , Masculino , Pessoa de Meia-Idade
6.
Int J Pediatr Otorhinolaryngol ; 134: 110042, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32302883

RESUMO

OBJECTIVES: In pediatric airway surgery, SponTaneous Respiration using IntraVEnous anesthesia and Hi-flow nasal oxygen (STRIVE Hi) has not been well explored. Here, we report our experience of using STRIVE Hi in endoscopic evaluations and surgeries of the pediatric airway. METHODS: This retrospective review was based on 45 airway procedures conducted under STRIVE Hi, performed by a single surgeon at a single institute from May 2017 to September 2018. After induction of anesthesia, continuous infusion with propofol and remifentanil was provided to ensure an adequate level of anesthesia and supply of humidified oxygen via a nasal cannula. Monitoring was conducted using a transcutaneous CO2 sensor and a pulse oximeter, and the oxygen reserve and bispectral indexes were measured. No muscle relaxant was administered. RESULTS: The median age of the patients was 16.0 months (range: 1-215 months) and the median weight was 10.2 kg (range: 2.4-38.5 kg). The median duration of spontaneous respiration was min 40 (range: 10-140 min). The airway procedures included diagnostic microlaryngoscopy, tracheocutaneous fistula excision, balloon dilation, supraglottoplasty, laryngeal cleft repair, injection laryngoplasty, papilloma excision, and subglottic cyst removal. During these procedures, STRIVE Hi facilitated evaluation of dynamic obstruction of the airway and the immediate outcome of surgical treatment and provided a good surgical view. Intubation and the termination of spontaneous respiration were required in only five patients. CONCLUSIONS: STRIVE Hi is an effective and feasible anesthesia option in pediatric airway surgery. It provides unobstructed surgical access and is applicable to a wide range of procedures.


Assuntos
Anestesia Intravenosa/métodos , Cânula , Doenças da Laringe/cirurgia , Oxigenoterapia/métodos , Doenças da Traqueia/cirurgia , Adolescente , Analgésicos Opioides/uso terapêutico , Anestésicos Intravenosos/uso terapêutico , Monitorização Transcutânea dos Gases Sanguíneos , Criança , Pré-Escolar , Dilatação , Feminino , Humanos , Lactente , Recém-Nascido , Intubação Intratraqueal/estatística & dados numéricos , Laringoplastia/métodos , Laringoscopia/métodos , Masculino , Oximetria , Propofol/uso terapêutico , Remifentanil/uso terapêutico , Respiração , Estudos Retrospectivos
7.
Ann Thorac Surg ; 110(1): 251-257, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32199826

RESUMO

BACKGROUND: Airway management during repair of laryngotracheal stenosis is demanding, and there is currently no accepted standard of care. Recently an increasing number of airway centers have started to use a laryngeal mask until the airway is surgically exposed and cross-table ventilation can be initiated. However detailed data on this approach are missing in the literature. METHODS: Patients receiving laryngotracheal surgery from November 2011 until October 2018 were retrospectively included in this single-center study, except for patients who presented with a preexisting tracheostomy at time of surgery. Airway management uniformly consisted of laryngeal mask ventilation until cross-table ventilation was established. Clinical variables, perioperative complications, and airway complications were analyzed. RESULTS: One hundred eight patients (65 women, 43 men) receiving tracheal resection (n = 50), cricotracheal resection (n = 49), or single-stage laryngotracheal reconstruction (n = 9) were included in the analysis. Of the included patients 23 (21.3%) had malignant disease and 85 (78.7%) a benign pathology. In the subgroup of patients with subglottic disease 85.1% had high-grade stenosis (Myer-Cotton III°). Airway management with a laryngeal mask was successful in all except 1 patient (99.1%). Mean pulse oximetry and mean end-tidal CO2 during laryngeal mask ventilation was 98.7% ± 2.4% and 34.8 ± 7.6 mm Hg, respectively. At the end of surgery 95 patients (88%) were successfully weaned from the respirator using the laryngeal mask. CONCLUSIONS: The laryngeal mask as the primary airway device is feasible and safe in patients undergoing laryngotracheal surgery even in cases with high-grade stenosis.


Assuntos
Doenças da Laringe/cirurgia , Máscaras Laríngeas , Doenças da Traqueia/cirurgia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Viabilidade , Feminino , Humanos , Doenças da Laringe/complicações , Doenças da Laringe/patologia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Doenças da Traqueia/complicações , Doenças da Traqueia/patologia , Resultado do Tratamento , Adulto Jovem
8.
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
10.
J Med Case Rep ; 14(1): 2, 2020 Jan 04.
Artigo em Inglês | MEDLINE | ID: mdl-31900189

RESUMO

BACKGROUND: Among the most common benign laryngeal lesions are vocal nodules and polyps. Their etiology is related to vocal abuse. Gastroesophageal reflux disease is a common condition presenting with a broad spectrum of symptoms, among which are extraesophageal manifestations such as laryngeal polyps. CASE PRESENTATION: A 24-year-old Middle Eastern woman presented to the author's institution with dysphonia and dyspepsia. She underwent endoscopy and was diagnosed with severe reflux disease. In addition, laryngoscopy revealed a polyp at the left vocal cord, and the patient underwent polypectomy. Histopathological examination revealed a laryngeal polyp of telangiectatic type characterized by hyperplastic epithelial covering with reactive atypia, prominent superficial acanthosis with neutrophils, and prominent chronic inflammation and thrombosed vessels in the stroma. CONCLUSION: This report focuses on the pathological findings associated with a laryngeal polyp in a young patient diagnosed with severe reflux disease. Acknowledging such characteristic changes in a laryngeal polyp could aid in the diagnosis of gastroesophageal reflux disease.


Assuntos
Refluxo Gastroesofágico/complicações , Doenças da Laringe/etiologia , Laringe/patologia , Pólipos/etiologia , Prega Vocal/patologia , Dispepsia/etiologia , Disfonia/etiologia , Endoscopia , Feminino , Humanos , Hiperplasia/patologia , Doenças da Laringe/cirurgia , Laringoscopia , Laringe/cirurgia , Pólipos/cirurgia , Telangiectasia/patologia , Prega Vocal/cirurgia , Adulto Jovem
11.
Acta Otolaryngol ; 140(1): 72-78, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31762355

RESUMO

Background: Closed reduction is an effective treatment for arytenoid dislocation. The treatment is usually given more than once to obtain normal voice. However, when to perform the next closed reduction remains controversial.Objective: This study aimed to observe the regularity of the voice recovery and the arytenoid motion in patients with arytenoid dislocation after closed reduction.Material and methods: Thirty-one patients were recruited from September 2017 to April 2019. Results of their clinical data were reviewed retrospectively.Results: Among the thirty-one patients, their VHI scores, F0, jitter%, shimmer%, glottal-to-noise excitation %(GNE), maximum phonation time (MPT) and GRBAS Scale (G, R, B, A) improved significantly (p < .05), but there was no statistically significant difference for GRBAS Scale (S) (p>.05). The duration between last closed reduction and the restoring normal voice ranged from 1-8 days, with a mean of 4.65 ± 0.57 days, at the same time the glottis was completely closed.Conclusions and significance: Closed reduction for patients with arytenoid dislocation is an effective procedure. A time window between 4.08th and 5.22th day (at a confidence level of 95%) after the last closed reduction was identified to be critical for voice recovery.


Assuntos
Cartilagem Aritenoide/lesões , Cartilagem Aritenoide/fisiopatologia , Doenças da Laringe/cirurgia , Voz , Adulto , Idoso , Cartilagem Aritenoide/diagnóstico por imagem , Feminino , Humanos , Doenças da Laringe/diagnóstico por imagem , Doenças da Laringe/etiologia , Laringoscopia , Masculino , Pessoa de Meia-Idade , Recuperação de Função Fisiológica , Estudos Retrospectivos , Tempo para o Tratamento , Resultado do Tratamento , Adulto Jovem
12.
Otolaryngol Head Neck Surg ; 162(2): 234-240, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31842676

RESUMO

OBJECTIVE: To discuss the presentation, evaluation, and management of pediatric laryngeal web. STUDY DESIGN: Retrospective case series. SETTING: Single tertiary care center. SUBJECTS: All patients with laryngeal web at Boston Children's Hospital in the past 22 years. METHODS: No exclusion criteria. Charts mined for age at presentation, presenting symptoms, degree/location of web, associated syndromes, number/type of surgical procedures, and postoperative outcomes. RESULTS: Thirty-seven patients were included (13 male, 24 female). Average age at diagnosis was 3.7 years (0-19.5 years). Mean follow-up was 4.4 years (range, 0-16.4 years). There were 26 congenital webs (70.2%) and 11 acquired webs (29.8%). Presenting symptoms were vocal (29 patients, 78.4%) and respiratory (22 patients, 60%). Underlying syndromes or synchronous airway lesions included the following: premature (n = 5), congenital heart disease (n = 18), subglottic stenosis (n = 5), 22q11.2 deletion syndrome (n = 10), and recurrent respiratory papillomatosis (n = 4). There were 20 type 1 webs, 6 type 2 webs, 8 type 3 webs, and 3 type 4 webs; 10 had subglottic extension of the laryngeal web. Twelve patients were managed conservatively with observation. Eighty-four interventions were performed: 18 open and 66 endoscopic (sharp division, 32; dilation, 33; mitomycin C, 14; laser, 5; keel, 6; triamcinolone injection, 8; stent, 15; removal of granulation tissue, 5). Tracheotomy was required in 11 patients, and 5 patients were decannulated. Voice improved in 12 patients, with respiratory symptoms in 12 patients. Web recurred in 17 patients. One patient died due to airway complications. CONCLUSIONS: Pediatric laryngeal web is an uncommon but challenging lesion. Patients need to be evaluated for comorbid syndromes and synchronous airway lesions. Management includes open and endoscopic procedures. Procedures should be tailored to the child's presentation.


Assuntos
Gerenciamento Clínico , Doenças da Laringe/cirurgia , Laringoscopia/métodos , Laringe/diagnóstico por imagem , Procedimentos Cirúrgicos Otorrinolaringológicos/métodos , Adolescente , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Lactente , Recém-Nascido , Doenças da Laringe/diagnóstico , Laringe/cirurgia , Masculino , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
13.
Vet Surg ; 49(3): 600-606, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31750568

RESUMO

OBJECTIVE: To report dynamic laryngeal collapse (DLC) associated with poll flexion as a potential complication of the laryngeal tie-forward procedure (LTFP) in harness racehorses. STUDY DESIGN: Short case series. ANIMALS: Three harness racehorses. METHODS: Preoperative and postoperative medical records of all harness racehorses that underwent the LTFP were reviewed, as were high-speed treadmill videoendoscopy recordings of 35 horses that returned for upper airway evaluation postoperatively. RESULTS: One standardbred and two Norwegian coldblooded trotters in which dorsal displacement of the soft palate had been initially diagnosed were found to have bilateral arytenoid cartilage and vocal fold collapse associated with poll flexion after the LTFP. These three horses were otherwise clinically normal when exercised in free head carriage. CONCLUSION: Dynamic laryngeal collapse associated with poll flexion can occur as a complication after the LTFP in harness racehorses and should be considered as a differential in horses with persistence of airway problems after surgery. CLINICAL SIGNIFICANCE: Postoperative DLC may be underdiagnosed in harness racehorses because this complication is obvious only when horses are driven with bit and reins during high speed treadmill or overground videoendoscopy.


Assuntos
Doenças dos Cavalos/cirurgia , Doenças da Laringe/veterinária , Laringe/cirurgia , Animais , Feminino , Cavalos , Doenças da Laringe/cirurgia , Laringe/patologia , Masculino , Prega Vocal/patologia
14.
Vet Surg ; 49(1): 131-137, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31633204

RESUMO

OBJECTIVE: To describe the use of a silicone-covered laser guide and diode laser for surgical correction of epiglottic entrapment and report postoperative outcomes in horses with epiglottic entrapment. STUDY DESIGN: Retrospective case series. ANIMALS: Thoroughbred and standardbred racehorses (n = 29) with epiglottic entrapment. METHODS: A silicone-covered laser guide was placed endoscopically to direct the diode laser cutting action during transection of the entrapping subepiglottic membrane and to act as a physical barrier between the membrane and the epiglottic cartilage. Postoperative complications and trainer satisfaction were recorded via use of a follow-up questionnaire. Race records were reviewed to determine return to racing and detect differences in the number of starts, wins, or earnings before and after surgery. RESULTS: The entrapping membrane was successfully released in all horses. Mild postoperative complications such as swelling of the surgical site (12 horses) and coughing or mild nasal discharge (5 horses) were recorded during the first few days after surgery. Ninety-six percent of trainers were satisfied with the outcome of the procedure; 93% of horses returned to racing. CONCLUSION: Laser guide-assisted transection of the subepiglottic membrane corrected epiglottic entrapment in standing horses. CLINICAL SIGNIFICANCE: Ease of surgical technique, mild postoperative complications, and a good prognosis to return to racing make this a suitable alternative to the traditional laser procedure.


Assuntos
Epiglote/cirurgia , Doenças dos Cavalos/cirurgia , Doenças da Laringe/veterinária , Lasers Semicondutores/uso terapêutico , Complicações Pós-Operatórias/veterinária , Animais , Endoscopia/veterinária , Feminino , Cavalos , Doenças da Laringe/cirurgia , Masculino , Estudos Retrospectivos
15.
Eur Arch Otorhinolaryngol ; 277(1): 207-215, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31654182

RESUMO

PURPOSE: To evaluate the individual and combined ability of videostroboscopy (VS), high-speed digital imaging (HSDI), enhanced endoscopy (EE) and saline infusion (SI) to predict neoplasia, defined as glottic precursor lesion (GPL) or T1a glottic cancer, in patients suspected for glottic neoplasia. METHODS: A nationwide prospective cohort study of patients treated by cordectomy for suspected GPL or T1a glottic cancer from August 1st 2016 to October 31st 2018 was conducted in the five Danish University Departments of Head and Neck surgery. Sensitivity, specificity, negative and positive predictive values, and area under Receiver Operating Curves (AUC-ROC) were calculated with 95% confidence intervals with respect to the histological diagnosis. Logistic regression with an imputation model for missing data was applied. RESULTS: 261 patients aged 34-91 years participated; 79 (30.3%) with non-neoplasia (i.e., inflammation, papilloma, hyperkeratosis) and 182 (69.7%) neoplasia, hereof 95 (36.4%) with GPL and 87 (33.3%) with T1a glottic cancer. Data from 188 VS, 60 HSDI, 100 preoperative EE, 209 intraoperative EE, and 234 SI were analyzed. In the complete case analysis the AUC-ROC of each diagnostic test was low, but increased when the tests were combined and especially if the combination included EE. However, multinomial logistic regression with imputation showed significant association (p < 0.05) only between age, male gender, and perpendicular vasculature in intraoperative EE, and the endpoint neoplasia. CONCLUSIONS: Intraoperative EE was the most accurate diagnostic method in detecting neoplasia. The prediction ability of methods applied preoperatively was more limited, but improved when test modalities were combined.


Assuntos
Glote/patologia , Glote/cirurgia , Neoplasias Laríngeas/diagnóstico , Laringoscopia/métodos , Lesões Pré-Cancerosas/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Área Sob a Curva , Feminino , Glote/irrigação sanguínea , Humanos , Cuidados Intraoperatórios , Doenças da Laringe/diagnóstico , Doenças da Laringe/patologia , Doenças da Laringe/cirurgia , Neoplasias Laríngeas/irrigação sanguínea , Neoplasias Laríngeas/patologia , Neoplasias Laríngeas/cirurgia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Lesões Pré-Cancerosas/patologia , Lesões Pré-Cancerosas/cirurgia , Cuidados Pré-Operatórios , Estudos Prospectivos , Sistema de Registros , Mucosa Respiratória/irrigação sanguínea , Mucosa Respiratória/patologia , Mucosa Respiratória/cirurgia , Sensibilidade e Especificidade , Prega Vocal/irrigação sanguínea , Prega Vocal/patologia , Prega Vocal/cirurgia
16.
Laryngoscope ; 130(8): 1989-1995, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-31693179

RESUMO

OBJECTIVES: To determine recurrence rates for benign phonotraumatic vocal fold lesions after microlaryngoscopic surgery. STUDY DESIGN: Retrospective review. METHODS: Records of adults who underwent microlaryngoscopy between 2006 and 2017 for vocal fold cysts, midfold masses, polyps, pseudocysts, sulcus vocalis (Ford type 3), and varices were reviewed for demographics, medical history, treatment, and lesion recurrence. Patients operated for nonphonotraumatic lesions (e.g., granuloma, keratosis/leukoplakia, papilloma) were excluded. Stroboscopic examinations were re-reviewed to confirm diagnosis and outcome. RESULTS: Five hundred ten adults (223 male:287 female; mean age 40.3 ± 14.9 years) were included. Overall, 62 of 510 (12.2%) recurred (median time to recurrence: 70.0 months). Of these, 44 (71.0%) recurred to the same lesion type and 49 (79.0%) to the same side. Recurrence rates by initial lesion type were as follows: cysts, two of 92 (2.2%); midfold masses, four of 18 (22.2%); polyps, 25 of 235 (10.6%); pseudocysts, 30 of 145 (20.7%); sulcus vocalis, one of 18 (5.6%); and varices, zero of two (0%) (χ 2 = 28.7, degrees of freedom [df] = 5, P < 0.001). No significant difference in recurrence existed between males (21 of 223, 9.4%) and females (41 of 287, 14.3%). However, young adults (17 of 86, 19.8%) had significantly higher recurrence rates compared to middle-aged (12 of 155, 7.7%) and older adults (3/60, 5.0%) (χ 2 = 9.5, df = 3, P = 0.023). Of 62 recurrences, 18 were re-operated and four re-recurred. CONCLUSION: Benign phonotraumatic vocal fold lesions recur at variable rates. This variation suggests pathophysiologic differences between categories that may not be entirely explained by behavioral factors. LEVEL OF EVIDENCE: 4 Laryngoscope, 130: 1989-1995, 2020.


Assuntos
Doenças da Laringe/cirurgia , Laringoscopia , Prega Vocal/cirurgia , Adolescente , Adulto , Feminino , Humanos , Laringoscopia/métodos , Masculino , Pessoa de Meia-Idade , Recidiva , Estudos Retrospectivos , Adulto Jovem
17.
Laryngoscope ; 130(6): 1503-1507, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-31498454

RESUMO

OBJECTIVE: Patients with laryngeal pathology are often treated with CO2 laser surgery, usually in the operating room under general anesthesia. Although office-based laser surgery using several other laser types has been investigated, prospective studies on office-based CO2 laser surgery are scarce. Our goal was to investigate the feasibility of office-based CO2 laser surgery for benign and premalignant laryngeal pathology by analyzing completion rate, safety, effect on voice quality, and success rate (i.e., no residual or recurrent disease). METHODS: A prospective cohort study was performed of 30 consecutive procedures. Inclusion started in June 2016 and was completed in August 2018. Adult patients with clinically benign or premalignant laryngeal lesions who could not undergo transoral laser microsurgery in the operating room under general anesthesia were included. Reasons were either contraindications for general anesthesia, previously failed therapeutic laryngoscopy under general anesthesia, and preference of a procedure under topical anesthesia by the patient. The mean follow-up was 9 months. RESULTS: Thirty procedures were performed in 27 patients (24 males) with an average age of 62 years. Twenty-nine (97%) procedures were fully completed without complications. The mean preoperative Voice Handicap Index (VHI) score (VHI 44) significantly decreased 2 months (VHI 28, P = 0.032) and 6 months (VHI 14, P < 0.001) after the procedure. Almost two-thirds of patients showed no residual or recurrent disease at their follow-up visits. CONCLUSION: Office-based CO2 laser surgery is a feasible and safe procedure that results in significant voice-quality improvement. Almost two-thirds of patients did not require further treatment. LEVEL OF EVIDENCE: 2 Laryngoscope, 130:1503-1507, 2020.


Assuntos
Procedimentos Cirúrgicos Ambulatórios , Doenças da Laringe/cirurgia , Lasers de Gás/uso terapêutico , Lesões Pré-Cancerosas/cirurgia , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos
18.
Laryngoscope ; 130(7): 1750-1755, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-31498467

RESUMO

OBJECTIVES/HYPOTHESIS: Voice rest is often prescribed following phonosurgery by most surgeons despite limited empiric evidence to support its practice. This study assessed the effect of postphonosurgery voice rest on vocal outcomes. STUDY DESIGN: Prospective, randomized controlled trial. METHODS: Patients with unilateral vocal fold lesions undergoing CO2 laser excision were recruited in a prospective manner and randomized into one of two groups: 1) an experimental arm consisting of 7 days of absolute voice rest, or 2) a control arm consisting of no voice rest. The primary outcome measure was the Voice Handicap Index-10 (VHI-10) questionnaire. Secondary outcomes included aerodynamic measurements (maximum phonation time), acoustic measures (fundamental frequency, jitter, shimmer, and harmonic-to-noise ratio), and auditory-perceptual measures. Primary and secondary outcomes were assessed preoperatively and reassessed postoperatively at the 1- and 3-month follow-up. Patient compliance to voice rest instructions were controlled for using subjective and objective parameters. RESULTS: Thirty patients were enrolled with 15 randomized to each arm of the study. Statistical analysis for the entire cohort showed a significant improvement in the mean preoperative VHI-10 compared to postoperative assessments at 1-month (19.0 vs. 7.3, P < .05) and 3-month (19.0 vs. 6.2, P < .05) follow-up. However, between-group comparisons showed no significant difference in postoperative VHI-10 at either time point. Similarly, secondary outcome measures yielded no significant difference in between-group comparisons. CONCLUSIONS: Our study shows no significant benefit to voice rest on postoperative voice outcomes as determined by patient self-perception, acoustic variables, and auditory-perceptual analysis. LEVEL OF EVIDENCE: 1b CLINICAL TRIAL NUMBER: NCT02788435 (clinicaltrials.gov) Laryngoscope, 130:1750-1755, 2020.


Assuntos
Doenças da Laringe/cirurgia , Terapia a Laser/métodos , Lasers de Gás/uso terapêutico , Prega Vocal/cirurgia , Qualidade da Voz/fisiologia , Treinamento da Voz , Avaliação da Deficiência , Feminino , Seguimentos , Humanos , Doenças da Laringe/fisiopatologia , Doenças da Laringe/reabilitação , Masculino , Pessoa de Meia-Idade , Fonação/fisiologia , Estudos Prospectivos , Inquéritos e Questionários , Resultado do Tratamento , Prega Vocal/fisiopatologia
19.
J Voice ; 34(1): 140-144, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30337120

RESUMO

PURPOSE: To report the voice outcome measures of thulium laser therapy as an office procedure in patients with vocal fold polyps. METHOD: This is a retrospective chart review of all patients with vocal fold polyps who underwent office-based thulium laser treatment between November 2016 and December 2017. Demographic data were collected. Objective voice outcome measures included extent of resolution, type of closure, and mucosal wave characteristics. Also, subjective outcome measures were reported, namely, Voice Handicap Index-10. RESULTS: A total of 20 patients were enrolled with a mean age of 50.95 ± 14.70 years. All patients had unilateral vocal fold polyps except for one who had bilateral polyps. Out of the 20 patients, 16 had complete regression of disease and 4 had partial regression. The number of patients with incomplete glottal closure decreased from 12 pretreatment to only 1 patient posttreatment, and the number of patients with impaired mucosal waves decreased from 13 to 5. There was also a significant decrease in the mean VHI-10 score before and after treatment (15.61 vs. 4.61 P value < 0.001). CONCLUSION: Thulium laser can be used as an office procedure for the treatment of vocal fold polyps.


Assuntos
Procedimentos Cirúrgicos Ambulatórios/instrumentação , Doenças da Laringe/cirurgia , Terapia a Laser/instrumentação , Lasers Semicondutores/uso terapêutico , Pólipos/cirurgia , Túlio , Prega Vocal/cirurgia , Distúrbios da Voz/cirurgia , Adulto , Idoso , Procedimentos Cirúrgicos Ambulatórios/efeitos adversos , Feminino , Humanos , Doenças da Laringe/diagnóstico , Doenças da Laringe/fisiopatologia , Terapia a Laser/efeitos adversos , Lasers Semicondutores/efeitos adversos , Masculino , Pessoa de Meia-Idade , Pólipos/diagnóstico , Pólipos/fisiopatologia , Recuperação de Função Fisiológica , Estudos Retrospectivos , Túlio/efeitos adversos , Fatores de Tempo , Resultado do Tratamento , Prega Vocal/fisiopatologia , Distúrbios da Voz/diagnóstico , Distúrbios da Voz/fisiopatologia , Qualidade da Voz
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