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1.
Medicine (Baltimore) ; 100(14): e25455, 2021 Apr 09.
Artigo em Inglês | MEDLINE | ID: mdl-33832154

RESUMO

RATIONALE: An impacted foreign body (FB) in the larynx of an adult is a rare but potentially life-threatening occurrence. Patients with Down's syndrome (DS) are vulnerable to airway FB. However, the anesthesia for FB removal can be challenging. This report describes a case in which a FB was impacted between the vestibular folds in an adult with DS, congenital heart disease, and a difficult airway. PATIENT CONCERNS: A 41-year-old woman swallowed a piece of sharp-tipped wooden skewer presented with a sudden onset of aphonia, dysphagia, and an acute sore throat without respiratory difficulty. The patient had DS, congenital heart disease, pulmonary arterial hypertension, and severe obstructive sleep apnea-hypopnea syndrome. The airway evaluation indicated that ventilation and intubation would be difficult due to retrognathia, macroglossia, adenotonsillar hypertrophy, and Mallampati's classification III. DIAGNOSIS: The clinical symptoms and laboratory examination confirmed FB penetrated between the vestibular folds. INTERVENTIONS: After careful multidisciplinary preoperative assessment and preparation, the FB was removed successfully by direct laryngoscopy under moderate sedation and spontaneous ventilation, with the application of 1% lidocaine as topical anesthesia. OUTCOMES: The laryngeal FB was removed successfully without any complications. And the patient was discharged home the next day. LESSONS: This case report shows the importance of anesthetic depth for laryngeal FB removal. The use of moderate sedation (allowing spontaneous ventilation) and adequate analgesia combined with local anesthesia enabled the patient to withstand the stress of direct laryngoscopy. Appropriate assessment, careful preparation, and multidisciplinary collaboration yielded the smooth removal of a laryngeal FB in an adult with DS.


Assuntos
Síndrome de Down/complicações , Corpos Estranhos/diagnóstico por imagem , Corpos Estranhos/terapia , Cardiopatias Congênitas/complicações , Laringoscopia/métodos , Laringe/diagnóstico por imagem , Adulto , Feminino , Humanos
2.
Artigo em Chinês | MEDLINE | ID: mdl-33794613

RESUMO

Objective:To improve the diagnosis and treatment of laryngeal schwannoma. Methods: The clinical data of 15 patients with laryngeal schwannoma were retrospectively analyzed, including 5 male patients and 10 female patients. The tumors were located in aryepiglottic fold in 4 cases, arytenoid region in 4 cases, interarytenoid in 2 cases, false vocal cord in 2 cases, epiglottis in 1 case, vocal cord in 1 case, and subglottic region in 1 case. All patients underwent laryngeal mass resection under general anesthesia, including 4 cases of tumor resection by external approach and 11 cases of tumor resection by oral approach. Results:Following up for 13-80 months, 1 patient had low voice after operation. The hoarseness of 5 patients improved after operation, but not completely recovered. One patient died of esophageal cancer at 49 months of follow-up, and no recurrence was found during the follow-up period. The remaining 8 cases had no obvious abnormalities. Conclusion:The clinical symptoms of laryngeal schwannoma vary, and the prognosis is generally good. The choice of surgical path is closely related to the location and size of the laryngeal schwannoma. If the laryngeal schwannoma is well exposed under endoscopy, the tumor can be removed by transoral radiofrequency coblation. Schwannomas on both sides of the subglottic region can be resected by two surgeries, and the tracheotomy can be performed first if necessary.


Assuntos
Neoplasias Laríngeas , Laringe , Neurilemoma , Feminino , Humanos , Neoplasias Laríngeas/cirurgia , Masculino , Recidiva Local de Neoplasia , Neurilemoma/cirurgia , Estudos Retrospectivos
3.
Vestn Otorinolaringol ; 86(2): 33-37, 2021.
Artigo em Russo | MEDLINE | ID: mdl-33929149

RESUMO

The article deals with optimization of treatment policy for singers with chronic catarrhal laryngitis. The survey sample is 51 singers with chronic catarrhal laryngitis of the age from 29 to 54 and the length of time worked from 8 to 22 years. The following methods are used: anamnesis, microbiological investigation, voice evaluation according to Visual Analog Scale (VAS), microlaryngoscopy, videolaryngostroboscopy, voice acoustic analysis (MDVP Kay Pentax system), statistical processing of results. It is shown that the cause of chronic catarrhal laryngitis in professional singers is non-bacterial irritants that provoke the appearance of an inflammatory process in the larynx, as well as uncontrolled use of drugs that irritate and dry out the mucous membrane and imperfect vocal technique. Pathogenic flora as an etiologic factor in the occurrence of laryngitis does not play an important role. A comprehensive treatment scheme for chronic catarrhal laryngitis using inhalation therapy and drugs that improve trophic processes in the laryngeal mucosa, which allows to increase the effectiveness of treatment and achieve stable remission of the disease, is suggested.


Assuntos
Laringite , Laringe , Canto , Distúrbios da Voz , Adolescente , Adulto , Criança , Doença Crônica , Humanos , Laringite/diagnóstico , Laringite/tratamento farmacológico , Laringite/etiologia , Laringoscopia , Adulto Jovem
4.
Vestn Otorinolaringol ; 86(2): 93-98, 2021.
Artigo em Russo | MEDLINE | ID: mdl-33929160

RESUMO

Scleroma is a chronic infectious disease characterized by developing inflammation nye granulomas, mainly of the upper respiratory tract, with subsequent scarring. The reasons for the development of scleroma remain unclear, but it is generally accepted that the gram-negative coccal bacterium Klebsiella rhinoscleromatis (pas-Volkovich's loch - Frisch) is the causative agent of this disease. Endemic in the spread of scleroma is considered There are tropical and temperate zones such as Africa, Asia, Eastern Europe, South America and Central America. Features of development scleroma in the present case and the complexity of the diagnosis caused by atypical, the rapid development of the disease, the greater prevalence of the process (including the orbit), with the transition to the soft tissues of the cheek bone and upper jaw, which is not typical for scleroma. The process was primarily localized in the left maxillary sinus and mimicked sinusitis. The presence of radicular cysts and darkening of the left maxillary sinus on radiographs, taking into account the clinical picture of the disease, were interpreted incorrectly, which led to the establishment of an incorrect diagnosis and subsequent surgical interventions. More targeted and consistent examination of histo-the logical material obtained after three surgical interventions made it possible to identify the characteristic signs scleroma, establish the correct diagnosis and prescribe effective treatment. In our case, we applied Ciprofloxacin course for 3 months at a maximum daily dose of 2000 mg in combination with probiotics. During treatment, it was noted a significant improvement in the patient's well-being, facial pains became less intense, a decrease in the volume of ma tissues of the left cheek and improved nasal breathing.


Assuntos
Laringe , Rinoscleroma , Humanos , Klebsiella pneumoniae , Nariz , Rinoscleroma/complicações , Rinoscleroma/diagnóstico , Rinoscleroma/terapia
5.
BMC Cancer ; 21(1): 446, 2021 Apr 22.
Artigo em Inglês | MEDLINE | ID: mdl-33888069

RESUMO

BACKGROUND: Radiotherapy, along with laser surgery, is considered a standard treatment option for patients with early glottic squamous cell cancer (SCC). Historically, patients have received complete larynx radiotherapy (CL-RT) due to fear of swallowing and respiratory laryngeal motion and this remains the standard approach in many academic institutions. Local control (LC) rates with CL-RT have been excellent, however this treatment can carry significant toxicities include adverse voice and swallowing outcomes, along with increased long-term risk of cerebrovascular morbidity. A recent retrospective study reported improved voice quality and similar local control outcomes with focused vocal cord radiotherapy (VC-RT) compared to CL-RT. There is currently no prospective evidence on the safety of VC-RT. The primary objective of this Bayesian Phase II trial is to compare the LC of VC-RT to that of CL-RT in patients with T1N0 glottic SCC. METHODS: One hundred and fifty-five patients with T1a-b N0 SCC of the true vocal cords that are n ot candidate or declined laser surgery, will be randomized in a 1:3 ratio the control arm (CL-RT) and the experimental arm (VC-RT). Randomisation will be stratified by tumor stage (T1a/T1b) and by site (each site will be allowed to select one preferred radiation dose regimen, to be used in both arms). CL-RT volumes will correspond to the conventional RT volumes, with the planning target volume extending from the top of thyroid cartilage lamina superiorly to the bottom of the cricoid inferiorly. VC-RT volumes will include the involved vocal cord(s) and a margin accounting for respiration and set-up uncertainty. The primary endpoint will be LC at 2-years, while secondary endpoints will include patient-reported outcomes (voice impairment, dysphagia and symptom burden), acute and late toxicity radiation-induced toxicity, overall survival, progression free survival, as well as an optional component of acoustic and objective measures of voice analysis using the Consensus Auditory-Perceptual Evaluation of Voice. DISCUSSION: This study would constitute the first prospective evidence on the efficacy and safety of VC-RT in early glottic cancer. If positive, this study would result in the adoption of VC-RT as standard approach in early glottic cancer. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT03759431 Registration date: November 30, 2018.


Assuntos
Carcinoma de Células Escamosas/patologia , Carcinoma de Células Escamosas/radioterapia , Glote/patologia , Laringe/efeitos da radiação , Prega Vocal/patologia , Prega Vocal/efeitos da radiação , Teorema de Bayes , Carcinoma de Células Escamosas/diagnóstico por imagem , Feminino , Glote/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética , Masculino , Estadiamento de Neoplasias , Radioterapia/efeitos adversos , Radioterapia/métodos , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Carga Tumoral
6.
Sensors (Basel) ; 21(9)2021 Apr 21.
Artigo em Inglês | MEDLINE | ID: mdl-33919359

RESUMO

The voice producing process is a complex interplay between glottal pressure, vocal folds, their elasticity and tension. The material properties of vocal folds are still insufficiently studied, because the determination of material properties in soft tissues is often difficult and connected to extensive experimental setups. To shed light on this less researched area, in this work, a dynamic pipette aspiration technique is utilized to measure the elasticity in a frequency range of 100-1000 Hz. The complex elasticity could be assessed with the phase shift between exciting pressure and tissue movement. The dynamic pipette aspiration setup has been miniaturized with regard to a future in-vivo application. The techniques were applied on 3 different porcine larynges 4 h and 1 d postmortem, in order to investigate the deterioration of the tissue over time and analyze correlation in elasticity values between vocal fold pairs. It was found that vocal fold pairs do have different absolute elasticity values but similar trends. This leads to the assumption that those trends are more important for phonation than having same absolute values.


Assuntos
Laringe , Prega Vocal , Animais , Fenômenos Biomecânicos , Elasticidade , Fonação , Suínos
7.
Artigo em Chinês | MEDLINE | ID: mdl-33730809

RESUMO

Objective: To investigate the clinical characteristics, diagnosis, endoscopic surgical procedures, and therapeutic effect of blunt laryngeal trauma with arytenoid injury. Methods: We retrospectively reviewed 12 patients who suffered blunt laryngeal trauma with laryngeal mucosa avulsion and arytenoid region injury at the Department of Otorhinolaryngology Head and Neck Surgery, Beijing Tongren Hospital from April 2007 to December 2018. Among the 12 patients, 10 were males, 2 were females, aged from 7 to 48 years old, with a median age of 21 years old. All patients were performed with transoral endoscopic laryngeal microsurgery under general anesthesia. Clinical characteristics, laryngoscopic signs, laryngeal CT, endoscopic surgical findings and procedures, and therapeutic effect were analyzed. The subjective and objective parameters of the voice quality of patients before and after surgery were compared using SPSS 22.0 statistical software by paired T test. Results: All patients had a history of obvious dysphonia immediately after trauma, accompanied by throat pain and hemoptysis without obvious dyspnea and dysphagia. Slight subcutaneous emphysema was found in 3 patients by physical examination. Laryngoscope revealed that 14 sides of vocal folds immobilized, arytenoid and/or ventricular region and posterior glottis mucosa were avulsed in 4 patients within 48 h of injury, and arytenoid cartilage was exposed in 4 sides. The arytenoid and ventricular regions were covered with thick pseudo-membrane or granulation, with abnormal structure in 8 patients with damage of more than 48 h. Intraoperative exploration revealed that there were 17 sides of arytenoid region (bilateral 5 cases, unilateral 7 cases) with varying degrees of injury. There was only limited laceration on three sides of the vocal folds. The lateral ventricular and vocal fold mucosae were avulsed vertically from the arytenoid region and arytenoid cartilage was exposed in 14 sides, among which 6 sides had abnormal arytenoid cartilage morphology and 8 sides had fracture displacement. Laryngeal CT showed irregular thickening of lateral glottis and/or supratroglottic structures in patients with vocal folds immobility, among which asymmetry of arytenoid cartilage structure on both sides in 3 cases and displacement in 2 cases were found. Restoration and microsuture of the fractured arytenoid, perichondrium and avulsion laryngeal mucosa under the direct laryngoscope were performed. The degree of dysphonia was significantly improved immediately after laryngeal microsurgery, the voice significantly improved in G, R, B, A, jitter, shimmer, NHR, and MPT three months after surgery(t=12.792, 12.792, 10.340, 3.276, 2.865, 3.781, 3.173, 3.090, respectively, P<0.05). Except for 1 patient with scar on vocal fold, all the other patients had normal laryngeal morphology and normal vocal fold movement. No laryngeal stenosis was found during the follow-up period. Conclusions: For patients with blunt laryngeal trauma, the injury of arytenoid region and arytenoid cartilage should be evaluated if there is obvious hoarseness, vocal fold immobility, avulsion of ventricular/vocal folds mucosa, or structural abnormality of arytenoid region under laryngoscopic examination. For highly suspected cases, microrphonosurgery under the direct laryngoscope should be performed as soon as possible, which can effectively reduce the occurrence of vocal fold movement disorders and laryngeal scar/stenosis, reconstruct the normal laryngeal structure, and restore the vocal function.


Assuntos
Doenças da Laringe , Laringe , Adolescente , Adulto , Idoso , Cartilagem Aritenoide/cirurgia , Criança , Endoscopia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Adulto Jovem
8.
Medicine (Baltimore) ; 100(12): e25165, 2021 Mar 26.
Artigo em Inglês | MEDLINE | ID: mdl-33761691

RESUMO

RATIONALE: Rosai-Dorfman disease (RDD) is a rare and self-limiting condition caused by the non-neoplastic proliferation of histiocytes/phagocytes in the sinusoids of lymph nodes and in extranodal tissues. Of the extranodal involvement, laryngeal involvement is extremely rare. Because of its rarity and nonspecific clinicoradiologic features, RDD is often difficult to differentiate from other benign or malignant lymphoproliferative diseases. We present a case of RDD with infiltration of IgG4-bearing plasma cells manifesting laryngeal and nasal masses with cervical lymphadenopathy. PATIENT CONCERNS: A 45-year-old male patient presented with recurrent epistaxis and airway disturbance. DIAGNOSES: On endoscopy, there were submucosal masses in both nasal cavities and both sides of subglottic larynx. On neck CT, there were well-defined, enhancing soft tissue masses in both nasal cavities and both sides of subglottic larynx, resulting in mild airway narrowing. In addition, multiple enlarged lymph nodes showing homogeneous enhancement were noted in both parotid glands and both internal jugular chains. All lesions demonstrated marked FDG-uptake on PET/CT. Therefore, the initial radiologic differential diagnoses included lymphoma and IgG4-related disease. Biopsy was performed on the nasal and laryngeal lesions, and they revealed RDD with infiltration of IgG4-bearing plasma cells. INTERVENTION: The patient underwent surgical resection of the masses in the nasal cavity and larynx to relieve airway narrowing. OUTCOMES: After surgery, airway obstruction was much improved and the patient was asymptomatic. On outpatient follow-up, he exhibited a stable condition and had no dyspnea on exercise. LESSONS: Clinical awareness and suspicion are important for the accurate diagnosis and management of patients with homogeneous masses in the larynx or nasal cavity, even if there is no combined cervical lymphadenopathy.


Assuntos
Histiocitose Sinusal/imunologia , Histiocitose Sinusal/patologia , Imunoglobulina G/imunologia , Laringe/patologia , Linfadenopatia/patologia , Cavidade Nasal/patologia , Plasmócitos/imunologia , Obstrução das Vias Respiratórias/etiologia , Obstrução das Vias Respiratórias/cirurgia , Biópsia , Diagnóstico Diferencial , Endoscopia , Epistaxe/etiologia , Radioisótopos de Flúor , Histiocitose Sinusal/complicações , Histiocitose Sinusal/cirurgia , Humanos , Laringe/cirurgia , Linfadenopatia/etiologia , Linfadenopatia/cirurgia , Masculino , Pessoa de Meia-Idade , Cavidade Nasal/cirurgia , Pescoço , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons , Recidiva
9.
Pol Merkur Lekarski ; 49(289): 64-66, 2021 Feb 24.
Artigo em Inglês | MEDLINE | ID: mdl-33713097

RESUMO

In a traditional epiglottis biopsy surgery, the operator performs the direct laryngoscopy to visualise an operating field. However, in patients with tumour-altered epiglottis, this procedure can be unsuccessful, because of difficult laryngeal exposure (DLE). This term refers to an insufficient visualisation of larynx, according to anatomical and pathological lesions. A CASE REPORT: The aim of paper was to present a video laryngoscopy performed for surgical purpose in patient with tumour-altered epiglottis. Woman 52 year old was admitted to hospital for planned surgical epiglottis biopsy under general anesthesia. We utilised McGrath video laryngoscope to provide a successful larynx visualisation during an epiglottic tumour biopsy procedure, when a rigid diagnostic laryngoscope failed. McGrath appeared to provide an excellent view of the larynx, which enable the operator to perform the biopsy of the tumour. The operation proceeded without any complications. CONCLUSIONS: In case of shared airway procedure, such as epiglottis biopsy examination, video laryngoscopy appeared to be an effective method to expose the entrance to larynx and enable the surgical manipulation at the same time.


Assuntos
Laringoscópios , Laringe , Insuficiência Renal Crônica , Feminino , Humanos , Intubação Intratraqueal , Laringoscopia , Pessoa de Meia-Idade
10.
Vestn Otorinolaringol ; 86(1): 96-102, 2021.
Artigo em Russo | MEDLINE | ID: mdl-33720660

RESUMO

Neoplasms of the upper respiratory tract and ear are tumors of visual localization; however, patients often go to specialized medical institutions in the presence of a widespread tumor process. This paper presents a brief overview of the most common benign and malignant tumors with localization in the oropharynx, nasopharynx, larynx and ear. The clinical picture, diagnosis and various treatment options are presented. Attention is paid to early diagnosis and the need for timely consultation with an oncologist and doctors of related specialties.


Assuntos
Laringe , Neoplasias , Detecção Precoce de Câncer , Humanos , Nasofaringe , Traqueia
11.
J Equine Vet Sci ; 99: 103374, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33781434

RESUMO

The dynamic upper airway functional (URT) problems of Colombian paso horses (CPH) have not been investigated in literature up to date. These horses perform special walking gaits with high poll flexion of the neck. Our goal is to evaluate the upper airway mechanics in CPH, showing abnormal respiratory sounds and poor performance during exercise. Resting and overground endoscopy was performed in 40 CPHs. Statistical analyses were performed using the sciPy package. One-tailed Fisher exact tests were used to check for positive contingency between each pair of upper respiratory tract disorder (P < .05). Arytenoid cartilage collapse was observed in 35 of 40 cases during exercise. Among these, dynamic laryngeal collapse (DLC) was the most significant finding, but ventromedial luxation of the apex of the corniculate process of the arytenoid and recurrent laryngeal neuropathy was also observed. Dorsal displacement of the soft palate was only detected in 4 of 40 cases. DLC was significantly associated with vocal cord collapse, nasopharyngeal collapse, and medial collapse of the margins of the epiglottis, and medial collapse of the margins of the epiglottis was associated with nasopharyngeal collapse. DLC is only a typical feature in some special breeds worldwide. We suggest that the extensive poll flexion and the relatively small laryngeal lumen and high intensitivity workload are the most important predisposing factors of DLC. Ventromedial luxation of the apex of the corniculate process of the arytenoid was over-represented in our caseload, compared with other studies. Whereas, despite the intensive workload, dorsal displacement of the soft palate was relatively uncommon. We presume that this could also be tailored to the high poll flexion performed during the special gaits.


Assuntos
Doenças dos Cavalos , Laringe , Animais , Cartilagem Aritenoide , Colômbia , Endoscopia/veterinária , Cavalos
12.
J Laryngol Otol ; 135(3): 264-268, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33632350

RESUMO

OBJECTIVES: This study aimed to report the pre- and post-operative laryngeal endoscopic findings in patients referred by non-otolaryngologists who are undergoing thyroid and/or parathyroid surgery, and to determine the number and nature of referrals before and after the release of the clinical practice guideline for improving voice outcomes after thyroid surgery. METHODS: This retrospective cohort study, conducted at a tertiary care academic hospital, comprised adult patients referred by the endocrine surgery service for laryngoscopy from 2007 to 2018 (n = 166). Data regarding patient demographics, reason for referral and endoscopic findings were recorded. RESULTS: The number of referrals increased significantly after the release of the practice guideline. The most common indication for referral pre- and post-operatively was voice change. The most common finding during laryngoscopy was normal examination findings (pre-operatively) and unilateral vocal fold immobility (post-operatively). CONCLUSION: Peri-operative thyroid and/or parathyroid patients have laryngoscopic findings other than vocal fold immobility. Laryngoscopy to detect structural and functional pathology is warranted.


Assuntos
Laringoscopia/estatística & dados numéricos , Otolaringologia/estatística & dados numéricos , Glândulas Paratireoides/cirurgia , Encaminhamento e Consulta/estatística & dados numéricos , Glândula Tireoide/cirurgia , Adulto , Feminino , Humanos , Laringoscopia/normas , Laringe/patologia , Laringe/cirurgia , Masculino , Pessoa de Meia-Idade , Otolaringologia/normas , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/etiologia , Período Pós-Operatório , Guias de Prática Clínica como Assunto , Período Pré-Operatório , Encaminhamento e Consulta/normas , Estudos Retrospectivos , Paralisia das Pregas Vocais/diagnóstico , Paralisia das Pregas Vocais/etiologia , Prega Vocal/patologia , Prega Vocal/cirurgia , Voz , Distúrbios da Voz/diagnóstico , Distúrbios da Voz/etiologia
13.
Artigo em Chinês | MEDLINE | ID: mdl-33540998

RESUMO

Objective:The aim of this study is to explore the glottic proportion(GP) and gender difference in Chinese subjects with normal larynx. Methods:Two hundred patients with normal larynx in Sixth Medical Center of PLA General Hospital from January 2017 to December 2019 were selected as the experimental group. Group 1 included 100 females and group 2 included 100 males. Sixty patients with normal larynx in the Pontes article were selected as the control group, including 30 females as group 3 and 30 males as group 4. Results:The GP range in group 1 was 0.78-1.76, with a mean of 1.24; 0.82-2.20 in group 2, with a mean of 1.37; 0.91-1.20 in group 3, with a mean of 1.04; 1.07-1.44 in group 4, with a mean of 1.21. Statistical analysis showed that the data of the four groups were normal distribution, the standard deviation was 0.16 in group 1, 0.26 in group 2, 0.08 in group 3, 0.10 in group 4, and the test of homogeneity of variance was P<0.05. Games-Howell test was used for multi-group analysis, including group 1 and group 2, group 3 and group 4, group 1 and group 3, group 2 and group 4. The statistical results of the four groups all showed P<0.05, indicating that there were statistical differences. Conclusion:On the whole, the average GP of male group was higher than that of female, but not all males have a greater GP value than females. In the range of high GP value, males accounted for a large proportion, while in the range of low GP value, females accounted for a large proportion. In the past, most articles regard men and women as two groups to study the glottic proportion, and it was suggested that more attention should be paid to individual differences when discussing glottic proportion and related laryngeal diseases.


Assuntos
Doenças da Laringe , Neoplasias Laríngeas , Laringe , Feminino , Glote , Humanos , Masculino , Prega Vocal
14.
Artigo em Chinês | MEDLINE | ID: mdl-33540970

RESUMO

Objective:The aim of this study was to analyze and compare the clinical pattern, diagnosis and treatment in primary and secondary laryngeal and pharyngeal TB. Methods:A retrospective analysis was carried out on 103 patients diagnosed laryngeal tuberculosis in our department. Characteristics of demography, life-style, clinical features, diagnosis and treatment were obtained from medical case records. Clinical analysis of 103 patients with pathologically confirmed laryngeal TB was carried out retrospectively in the second affiliated hospital of Nanchang university in Jiangxi province. Results:Among 103 patients, 64 cases were diagnosed as primary laryngeal TB and 39 cases were diagnosed as secondary laryngeal TB. The most common complaints were hoarseness and odynophagia. The true and the false vocal cords were most commonly involved. Most patients with primary tuberculosis of the larynx present a single, hyperplastic lesion.Secondary laryngeal TB of larynx was characterized by ulcers, edema effusive, multiple sites lesions. The anti-TB treatment was given systemically to all patients. The surgery should be considered if the patient has a laryngeal obstruction. Conclusion:The clinical manifestations and signs of primary and secondary tuberculosis of the larynx are different. Laryngeal tuberculosis is easy to be misdiagnosed as laryngitis and laryngeal tumors. Pathological examination should be performed to confirm the diagnosis.


Assuntos
Laringe , Tuberculose Laríngea , Tuberculose Pulmonar , Rouquidão , Humanos , Estudos Retrospectivos , Tuberculose Laríngea/diagnóstico
15.
Artigo em Chinês | MEDLINE | ID: mdl-33540973

RESUMO

Objective:To explore the value of endoscopic-assisted modified cricothyroid membrane approach laryngeal surgery in patients with difficult airways and evaluate its safety. Methods:All patients with laryngeal surgery who were hospitalized were evaluated. For the patients with difficult airways those could not be exposed through routine surgical approach, after full communication, we carried out the endoscope-assisted modified loop thyroscopic approach to the thyroid membrane. Results:All the 12 patients completed the operation successfully, and the visual field exposure was satisfactory during the operation. None of the patients had bleeding and glottic and subglottic stenosis after the operation, and the sound recovered satisfactorily. Conclusion:The cricothyroid membrane approach is not a routine choice for laryngeal surgery, but it is significantly better than other surgical methods for patients with difficult airways who are difficult to expose by conventional approaches, and it is a good choice for patients who cannot be exposed by conventional surgical approaches. The choice is worthy of clinical promotion.


Assuntos
Laringe , Endoscopia , Glote , Humanos , Laringe/cirurgia
16.
JAMA Otolaryngol Head Neck Surg ; 147(3): 232-237, 2021 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-33507221

RESUMO

Importance: Patients with laryngeal injury after endotracheal intubation often present long after initial injury with mature fibrosis compromising cricoarytenoid joint mobility and glottic function. Objective: To compare functional outcomes between early and late intervention for intubation-related laryngeal injury. Design, Setting, and Participants: This retrospective cohort study involved 29 patients with laryngeal injury resulting from endotracheal intubation who were evaluated at a tertiary care center between May 1, 2014, and June 1, 2018. Ten patients with intubation injury to the posterior glottis who received early treatment were compared with 19 patients presenting with posterior glottic stenosis who received late treatment. Statistical analysis was performed from May 1 to July 1, 2019. Exposures: Early intervention, defined as a procedure performed 45 days or less after intubation, and late treatment, defined as an intervention performed greater than 45 days after intubation. Main Outcomes and Measures: Patient-specific and intervention-specific covariates were compared between the 2 groups, absolute differences with 95% CIs were calculated, and time to tracheostomy decannulation was compared using log-rank testing. Results: The 2 groups had similar demographic characteristics and a similar burden of comorbid disease. Ten patients who received early intervention (7 women [70%]; median age, 59.7 years [range, 31-72 years]; median, 34.7 days to presentation [IQR, 1.5-44.8 days]) were compared with 19 patients who received late intervention (11 women [58%]; median age, 53.8 years [range, 34-73 years]; median, 341.9 days to presentation [IQR, 132.7-376.3 days]). Nine of 10 patients (90%) who received early intervention and 11 of 19 patients (58%) who received late interventions were decannulated at last follow-up (absolute difference, 32%; 95% CI, -3% to 68%). Patients who received early treatment required fewer total interventions than patients with mature lesions (mean, 2.2 vs 11.5; absolute difference, 9.3; 95% CI, 6.4-12.1). In addition, none of the patients who received early treatment required an open procedure, whereas 17 patients (90%) with mature lesions required open procedures to pursue decannulation. Conclusions and Relevance: This study suggests that early intervention for patients with postintubation laryngeal injury was associated with a decreased duration of tracheostomy dependence, a higher rate of decannulation, and fewer surgical procedures compared with late intervention. Patients who underwent early intervention also avoided open reconstruction. These findings may bear relevance to the management of patients requiring extended durations of endotracheal intubation during recovery for critical illness related to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.


Assuntos
/terapia , Intubação Intratraqueal/efeitos adversos , Doenças da Laringe/etiologia , Doenças da Laringe/terapia , Laringe/lesões , Pneumonia Viral/terapia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/virologia , Estudos Retrospectivos , Fatores de Tempo , Traqueostomia
17.
J Surg Oncol ; 123(4): 872-880, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33497489

RESUMO

INTRODUCTION: Hypopharyngeal cancer (HPC) is well characterized by the early submucosal spread of cancer cells into adjacent subsites of the hypopharynx and deep tissues, advocating a wide extent of treatment. However, the microscopic extensions (ME) from gross tumors, according to the primary tumor dimensions, has not been reported in detail. METHODS: We included patients who underwent upfront curative surgery, and retrospectively reviewed pathology specimens from 45 HPC cases. The distance of the MEs, defined as tumor infiltration beyond the gross tumor border on the submucosal and deep sides, was measured. We analyzed potential correlations between MEs and various physical tumor factors. RESULTS: A rough linear correlation between the submucosal ME and the maximal diameter of tumors was found (p < .001, r2 = 0.225). Deep MEs did not correlate with tumor physical factors. However, the MEs differed significantly by the T status (p = .033 and .015 in submucosal and deep sides). In T1-2 tumors, the submucosal MEs were less than 0.5 cm, whereas those of T3-4 tumors were 1.5-2.0 cm. CONCLUSION: In HPC, local MEs beyond the gross tumor border correlated with primary tumor T status. Our findings support that the surgical safety margin for HPC can be adjusted according to tumor dimension.


Assuntos
Neoplasias Hipofaríngeas/patologia , Neoplasias Hipofaríngeas/cirurgia , Laringe/cirurgia , Tratamentos com Preservação do Órgão/métodos , Idoso , Feminino , Seguimentos , Humanos , Masculino , Margens de Excisão , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos
20.
BMJ Case Rep ; 14(1)2021 Jan 28.
Artigo em Inglês | MEDLINE | ID: mdl-33509858

RESUMO

Bardet-Biedl syndrome (BBS) is a rare autosomal recessive ciliopathy characterised by rod-cone dystrophy, obesity, postaxial polydactyly, cognitive impairment, hypogonadism, renal abnormalities, and rarely, laryngeal webs or bifid epiglottis. Most patients present with obesity. Multiple genes are involved in causation of BBS and there is also evidence of triallelic inheritance. We herein report an Asian boy who had weak cry and stridor since birth, and on evaluation was found to have both laryngeal web and bifid epiglottis. Mutation analysis revealed a homozygous variant in BBS10 gene.


Assuntos
Síndrome de Bardet-Biedl/diagnóstico , Epiglote/anormalidades , Hipotireoidismo/diagnóstico , Laringe/anormalidades , Síndrome de Bardet-Biedl/complicações , Síndrome de Bardet-Biedl/genética , Síndrome de Bardet-Biedl/fisiopatologia , Broncoscopia , Chaperoninas/genética , Dedos/anormalidades , Dedos/fisiopatologia , Mutação da Fase de Leitura , Humanos , Hipotireoidismo/complicações , Hipotireoidismo/tratamento farmacológico , Lactente , Laringe/cirurgia , Masculino , Obesidade Pediátrica/fisiopatologia , Polidactilia/fisiopatologia , Tiroxina/uso terapêutico , Dedos do Pé/anormalidades , Dedos do Pé/fisiopatologia
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