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1.
Neuroimaging Clin N Am ; 32(1): 37-53, 2022 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-34809843

RESUMO

Cancers of the pharynx and larynx are treated using a combination of chemotherapeutic, radiation, and surgical techniques, depending on the cancer type, biology, location, and stage, as well as patient and other factors. When imaging in the postsurgical setting, the knowledge of the type of tumor, preoperative appearance, and type of surgery performed is essential for accurate interpretation. Surgical anatomic changes, surgical implants/devices, and potential postsurgical complications must be differentiated from suspected recurrent tumors.


Assuntos
Neoplasias Laríngeas , Laringe , Humanos , Neoplasias Laríngeas/diagnóstico por imagem , Neoplasias Laríngeas/cirurgia , Laringectomia , Laringe/diagnóstico por imagem , Laringe/cirurgia , Faringectomia , Faringe/diagnóstico por imagem , Faringe/cirurgia , Complicações Pós-Operatórias/diagnóstico por imagem
3.
Artigo em Chinês | MEDLINE | ID: mdl-34666447

RESUMO

Objective: To investigate the clinical diagnosis and treatment of congenital laryngotracheoesophageal cleft (LTEC) in children. Methods: The clinical data of 8 children (including 7 males and 1 female)with congenital laryngotracheoesophageal cleft from January 2016 to June 2020 were retrospectively analyzed. The median diagnosing age was 3.75 months (5 days to 12 months). According to the modified Benjamin Inglis classification proposed by Sandu in 2006,there were 3 cases of type Ⅱ, 3 cases of type Ⅲa, 1 case of type Ⅲb and 1 case of type Ⅳa. All children were followed up regularly. Results: Six patients were treated for recurrent bronchopneumonia and aspiration during feeding. The patients were first treated in the pneumology departmentt or intensive care unit. Six patients combined with other malformations. Endoscopic repair operations were performed in 6 cases (3 cases of type Ⅱ, 3 cases of type Ⅲ a), 1 case of LTEC was operated through cervical approach, and 1 case of type IVa LTEC associated with VACTERL was repaired under thoracoscope combined with suspension laryngoscope. Seven patients underwent tracheotomy before or during the repair operations. Gastrostomy was performed in 2 children. The operations were successfully performed in all cases. Three children with type Ⅱ LTEC recovered well and decannulated. One case of type Ⅲa was followed up for 5 months with occasionally choking while feeding. Two cases of type Ⅲa, 1 case of type Ⅲb and 1 case of type Ⅳa died due to severe reflux, tracheomalacia or respiratory failure. Conclusions: Congenital LTEC is a rare congenital malformation which is difficult to diagnose for the poor specificity of clinical manifestations. LTEC needs to be classified by endoscopy examination under general anesthesia. Severe cases of LTEC have poorer outcomes than the mild cases, and the perioperative managements need multi-disciplinary cooperation to reduce the mortality.


Assuntos
Laringe , Traqueia , Criança , Feminino , Humanos , Lactente , Laringe/cirurgia , Masculino , Estudos Retrospectivos , Traqueostomia , Traqueotomia
4.
Vestn Otorinolaringol ; 86(4): 36-40, 2021.
Artigo em Russo | MEDLINE | ID: mdl-34499445

RESUMO

The relevance of the study is due to the need to improve the methods of managing patients after reconstructive surgery on the larynx and trachea. OBJECTIVES: To optimize the management of wounds after tracheostomy and/or reconstuctive operations on larynx and trachea on the basis of use of modern dressings in the inpatient and outpatient settings. MATERIAL AND METHODS: The patients were divided into two: group I tracheostomy after reconstructive operations on the larynx and trachea. The postoperative area was ligated with drugs based on sodium alginate. Tracheostomy of group II patients was carried out according to the standard technique. RESULTS: In the first group of patients, postoperative wounds healed by primary intention on the 5-6th day after the operation in patients with bilateral paralysis of the larynx and on the 8-10th day in patients with chronic cicatricial stenosis of the larynx and trachea. In group II, postoperative wounds in the tracheostomy foramen area healed on day 7 in patients with bilateral paralysis of the larynx and on days 10-14 in patients with chronic cicatricial stenosis of the larynx and trachea. CONCLUSIONS: The Proposed algorithm for the management of patients after reconstructive operations on the larynx and trachea, of tracheostomy have improved clinical outcomes after surgery and to reduce the economic costs for this group of patients.


Assuntos
Laringe , Procedimentos Cirúrgicos Reconstrutivos , Estenose Traqueal , Humanos , Laringe/cirurgia , Traqueia/cirurgia , Estenose Traqueal/diagnóstico , Estenose Traqueal/etiologia , Estenose Traqueal/cirurgia , Traqueostomia/efeitos adversos
5.
Curr Opin Otolaryngol Head Neck Surg ; 29(6): 473-478, 2021 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-34535008

RESUMO

PURPOSE OF REVIEW: To review the recent literature on indications for and functional outcomes following laryngectomy for severe laryngeal dysfunction. RECENT FINDINGS: The use of functional laryngectomy as a definitive treatment for severe laryngeal dysfunction is increasing as more patients with head and neck cancer are treated with definitive chemoradiotherapy. Data are emerging on the efficacy of this technique as measured by aspiration, recurrent pneumonias, enteral tube feeding dependence, and surgical complication rates. Though most patients have marked improvement in aspiration and oral intake, difficulties in swallowing and voicing functions may persist. SUMMARY: Functional laryngectomy is an effective treatment for end-stage laryngeal dysfunction. There is a clear benefit with regard to prevention of aspiration and alleviation of nothing by mouth status. However, qualitative speech and swallowing outcomes are less well studied, though available data suggest that many patients still suffer some degree of continued chronic impairment. More research is needed on these outcomes in order to appropriately counsel patients regarding long-term functional outcomes.


Assuntos
Neoplasias de Cabeça e Pescoço , Neoplasias Laríngeas , Laringe , Quimiorradioterapia/efeitos adversos , Humanos , Neoplasias Laríngeas/cirurgia , Laringectomia , Laringe/cirurgia , Estudos Retrospectivos , Resultado do Tratamento
6.
Laryngoscope ; 131(12): 2773-2781, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34338303

RESUMO

OBJECTIVES/HYPOTHESIS: The objective of this study was to compare ventilation techniques utilized in microlaryngeal surgery. STUDY DESIGN: Retrospective cohort study. METHODS: Two-hundred surgeries performed from May 1, 2018 to March 1, 2020 and stratified as intubated, intermittently intubated (AAIV) or apneic. Patient demographics, comorbidities, anesthetic agents, intraoperative parameters/events, and complications were studied and compared across the three groups using inferential analyses. RESULTS: Median body mass index in the AAIV group was significantly higher (33 vs. 29; P = .0117). Median oxygen nadirs were lower in AAIV cases (81% vs. 91-92%) while CO2 peak measurements were lower (33 mmHg vs. 48 mmHg) in the fully apneic cohort which were significantly shorter cases (P < .0001). CO2 peak measurements were comparable between AAIV and intubated cohorts (median 48.5 mmHg vs. 48.0 mmHg). Median apnea times were significantly prolonged by 2-5.5 minutes using nasal cannula and THRIVE/Optiflow in fully apneic cases when compared to no supplementary oxygenation (P = .0013). Systolic blood pressures following insertion of laryngoscope were higher (159.5 vs. 145 mmHg) and postoperative diastolic pressures were lower (68.5 vs. 76.5 mmHg) in fully apneic cases than intubated cases. No differences existed between frequencies of complications. CONCLUSIONS: This study compares intubated, intermittently apneic, and fully apneic surgeries. No statistically significant differences were noted in comorbid conditions. While intraoperative hemodynamic fluctuations were more pronounced in the fully apneic cohort, and oxygenation distributions were lower in the AAIV cohort, no significant differences existed between events and complications. Apneic techniques are as safe and effective as traditional intubation. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:2773-2781, 2021.


Assuntos
Cânula/efeitos adversos , Complicações Intraoperatórias/epidemiologia , Laringe/cirurgia , Microcirurgia/efeitos adversos , Respiração Artificial/efeitos adversos , Adulto , Idoso , Estudos de Viabilidade , Feminino , Hemodinâmica , Humanos , Complicações Intraoperatórias/etiologia , Masculino , Pessoa de Meia-Idade , Respiração Artificial/instrumentação , Respiração Artificial/métodos , Respiração Artificial/estatística & dados numéricos , Estudos Retrospectivos
7.
Medicine (Baltimore) ; 100(34): e27045, 2021 Aug 27.
Artigo em Inglês | MEDLINE | ID: mdl-34449490

RESUMO

BACKGROUND: Laryngeal microsurgery (LMS) causes hemodynamic instability and postoperative agitation, cough, pain, nausea, and vomiting. Moreover, because of a short operation time, it is associated with challenging anesthetic management. The aim of this study was to compare the usefulness of continuous administration of dexmedetomidine and remifentanil in inducing general anesthesia in patients undergoing LMS. METHODS: This is a prospective randomized control design. Continuous intravenous infusion of dexmedetomidine (group D) or remifentanil (group R) was administered from 10 minutes before the induction of anesthesia to the end of surgery. In both groups, 1.5 mg/kg propofol and 0.5 mg/kg rocuronium were administered for the induction of anesthesia, and desflurane were titrated during the measurement of the bispectral index. We recorded hemodynamic data, recovery time, grade of cough, pain score, and analgesic requirements during the perioperative period. RESULTS: 61 patients were finally analyzed (30 for group D, 31 for group R). The incidence of moderate to severe postoperative sore throat was higher in group R than in group D (42% vs 10%, P = .008), and the quantity of rescue fentanyl used in post-anesthesia care unit was significantly higher in group R than in group D (23.2 ±â€Š24.7 mg vs 3.3 ±â€Š8.6 mg; P < .001); however, the time required for eye opening was significantly longer in group D than in group R (599.4 ±â€Š177.9 seconds vs 493.5 ±â€Š103.6 seconds; P = .006). The proportion of patients with no cough or single cough during extubation was comparable between the 2 groups (group D vs group R: 73% vs 70%) as was the incidence of hemodynamic instability. CONCLUSION: Although there was a transient delay in emergence time, dexmedetomidine reduced postoperative opioid use and the incidence of sore throat. Dexmedetomidine may be used as an alternative agent to opioids in patients undergoing LMS.


Assuntos
Dexmedetomidina/uso terapêutico , Hemodinâmica/efeitos dos fármacos , Hipnóticos e Sedativos/uso terapêutico , Laringe/cirurgia , Remifentanil/uso terapêutico , Adulto , Idoso , Analgésicos Opioides/administração & dosagem , Período de Recuperação da Anestesia , Tosse/etiologia , Feminino , Humanos , Masculino , Microcirurgia , Pessoa de Meia-Idade , Dor Pós-Operatória/tratamento farmacológico , Dor Pós-Operatória/epidemiologia , Dor Pós-Operatória/prevenção & controle , Período Perioperatório , Estudos Prospectivos , Índice de Gravidade de Doença , Adulto Jovem
8.
Int J Pediatr Otorhinolaryngol ; 150: 110874, 2021 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-34392101

RESUMO

INTRODUCTION: The best strategy to manage an interarytenoid defect [Type 1 laryngeal cleft (LC-1) or deep interarytenoid groove (DIG)] in pediatric aerodigestive patients with dysphagia remains uncertain. This study compared benefit of interarytenoid augmentation (IAA) to suture repair or clinical observation alone in pediatric patients. METHODS: A 3-year retrospective, single-center analysis of children with dysphagia undergoing endoscopic airway evaluation was performed. Physician preference guided treatment plan: suture repair with CO2 laser, IAA (carboxy methylcellulose or calcium hydroxyapatite), or observation. Primary outcome was improved post-operative diet. Significance was assumed at p < 0.05. RESULTS: 449 patients underwent diagnostic endoscopy. Mean age (±SD) at procedure was 21 ± 13 months, with nearly one fourth (28 %) of children ≤ 12 months. Eighty (18 %) had either an LC-1 (n = 55) or DIG (n = 25). Of these, 35 (42 %) underwent suture repair, 22 (28 %) IAA, and 23 (30 %) observation only. Aspiration improved overall in the interventional groups compared to observational controls (58 % vs. 9 %, p < 0.05), with no change in benefit observed by age of intervention. IAA was as effective as suture repair (59 % vs 55 %, p = 0.46). In patients with only a DIG, IAA intervention alone significantly improved swallow function (66.6 % vs. 0 %, p < 0.05). CONCLUSION: In pediatric aerodigestive patients with dysphagia, 18 % of children have an addressable lesion. IAA or suture repair similarly improves dietary advancement. IAA improves swallow function in patients with DIG. These findings support a novel protocol to intervene in dysphagia patients with LC-1 or DIG via IAA at the initial operative evaluation.


Assuntos
Transtornos de Deglutição , Laringe , Pré-Escolar , Transtornos de Deglutição/etiologia , Transtornos de Deglutição/cirurgia , Durapatita , Endoscopia , Humanos , Lactente , Laringe/cirurgia , Estudos Retrospectivos
9.
HNO ; 69(9): 719-725, 2021 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-34195859

RESUMO

Significant and new impulses regarding the treatment concept for outpatient phonosurgery on unsedated patients are currently coming from various Anglo-American authors. These "office-based procedures" have been propagated as an alternative to many conventional surgical interventions under anesthesia. The main reason for this remarkable development is the use of new endoscopic techniques in combination with photoangiolytic laser (KTP and blue laser), which allow safe and efficient phonosurgical procedures. Patient acceptance is high since outpatient procedures are considered to have a lower surgical risk. Despite the widespread euphoria, there is a lack of studies evaluating the medical decision criteria and safety management of office-based laryngeal surgery.


Assuntos
Doenças da Laringe , Laringoplastia , Laringe , Terapia a Laser , Procedimentos Cirúrgicos Ambulatórios , Humanos , Doenças da Laringe/cirurgia , Laringoscopia , Laringe/cirurgia
10.
Vestn Otorinolaringol ; 86(3): 52-55, 2021.
Artigo em Russo | MEDLINE | ID: mdl-34269024

RESUMO

Purpose is to study the long-term results of patients with cicatricial stenosis of the larynx treated with use lyophilized xenodermoimplants for postoperative wound plasty. MATERIAL AND METHODS: The results of treatment of 34 patients (age from 32 to 56 years) with cicatricial stenosis of the larynx were analyzed. A fundamentally new method of surgical treatment of such patients has been developed and introduced into practice, in which lyophilized xenodermoimplants were used for plasty of the wound surface. RESULTS: The proposed technique made it possible in the immediate postoperative period to obtain a good result in 28 (82.4%) patients, satisfactory - in 6 (17.6%). The length of hospital stay was reduced by 8-10 days. In the long-term period (after 6-11 years), 27 patients were examined. Of these, 21 (77.8%) obtained a good result, and 6 (22.2%) - satisfactory. CONCLUSION: The proposed method of surgical rehabilitation of the respiratory function of the larynx with its cicatricial stenosis using lyophilized xenodermoimplants is quite effective and can be proposed for use in clinical practice.


Assuntos
Laringoestenose , Laringe , Adulto , Constrição Patológica , Humanos , Laringoestenose/diagnóstico , Laringoestenose/etiologia , Laringoestenose/cirurgia , Laringe/cirurgia , Pessoa de Meia-Idade , Período Pós-Operatório , Respiração
11.
Vestn Otorinolaringol ; 86(3): 134-136, 2021.
Artigo em Russo | MEDLINE | ID: mdl-34269037

RESUMO

Adenocystic carcinoma accounts for 3-5% of all malignant neoplasms of the head and neck organs. Due to the rarity of detecting this cancer in the larynx, treatment options are still controversial: surgery with postoperative radiation therapy or surgery alone. Patient A., 64 years old, turned to the City Clinical Oncological Hospital No. 1 in October 2019 with complaints of moderate pain when swallowing, sensation of a foreign body. Fibrolaryngoscopy revealed an exophytic form of growth bright red color formation with a small tuberous surface up to 12 mm in size in the area of the free left edge of the epiglottis. There was a thickening of the pharyngeal-epiglottis fold. Histological examination revealed adenocystic cancer. Diagnosed with Laryngeal cancer with cT1N0M0. On December 23, 2019, endolaryngeal resection of the larynx was performed using an operating microscope in the volume R0. This observation is of interest both in morphological terms (extremely rarely detected cancer of the larynx) and in terms of treatment (an organ-preserving operation was performed - endolaryngeal resection of the larynx).


Assuntos
Carcinoma Adenoide Cístico , Neoplasias Laríngeas , Laringe , Humanos , Neoplasias Laríngeas/diagnóstico , Neoplasias Laríngeas/cirurgia , Laringe/cirurgia , Pessoa de Meia-Idade , Faringe
12.
Sci Rep ; 11(1): 13760, 2021 07 02.
Artigo em Inglês | MEDLINE | ID: mdl-34215788

RESUMO

High-speed videoendoscopy is an important tool to study laryngeal dynamics, to quantify vocal fold oscillations, to diagnose voice impairments at laryngeal level and to monitor treatment progress. However, there is a significant lack of an open source, expandable research tool that features latest hardware and data analysis. In this work, we propose an open research platform termed OpenHSV that is based on state-of-the-art, commercially available equipment and features a fully automatic data analysis pipeline. A publicly available, user-friendly graphical user interface implemented in Python is used to interface the hardware. Video and audio data are recorded in synchrony and are subsequently fully automatically analyzed. Video segmentation of the glottal area is performed using efficient deep neural networks to derive glottal area waveform and glottal midline. Established quantitative, clinically relevant video and audio parameters were implemented and computed. In a preliminary clinical study, we recorded video and audio data from 28 healthy subjects. Analyzing these data in terms of image quality and derived quantitative parameters, we show the applicability, performance and usefulness of OpenHSV. Therefore, OpenHSV provides a valid, standardized access to high-speed videoendoscopy data acquisition and analysis for voice scientists, highlighting its use as a valuable research tool in understanding voice physiology. We envision that OpenHSV serves as basis for the next generation of clinical HSV systems.


Assuntos
Glote/cirurgia , Doenças da Laringe/cirurgia , Laringoscopia/métodos , Laringe/cirurgia , Adolescente , Adulto , Feminino , Glote/diagnóstico por imagem , Glote/fisiopatologia , Humanos , Doenças da Laringe/diagnóstico por imagem , Doenças da Laringe/patologia , Laringoscopia/instrumentação , Laringe/diagnóstico por imagem , Laringe/patologia , Masculino , Pessoa de Meia-Idade , Redes Neurais de Computação , Gravação em Vídeo , Prega Vocal/diagnóstico por imagem , Prega Vocal/fisiopatologia , Prega Vocal/cirurgia , Voz/fisiologia , Distúrbios da Voz/diagnóstico por imagem , Distúrbios da Voz/fisiopatologia , Distúrbios da Voz/cirurgia , Qualidade da Voz/fisiologia , Adulto Jovem
13.
Laryngoscope ; 131(12): 2805-2810, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34184769

RESUMO

OBJECTIVES/HYPOTHESIS: Endoscopic repair is the preferred surgical treatment for type 1 laryngeal clefts (T1LCs) and deep interarytenoid notches (DINs). No studies exist showing differences in repair rates using laser and cold steel. Our objective is to assess overall success and revision rate for endoscopic cleft repair and determine whether there is any difference in surgical outcomes between cold steel and laser techniques. STUDY DESIGN: Retrospective chart review, cohort study. METHODS: Retrospective review at a quaternary care pediatric hospital. Included all patients who underwent endoscopic repair for T1LCs and DINs between January 2010 and December 2019. Demographics, comorbidities, surgical data, outcomes, and revision status were collected and analyzed. We excluded patients who did not have a follow-up at our institution. RESULTS: A total of 194 patients were identified, 14 were excluded for lack of follow-up data so 180 were analyzed. Of these, 127 had cold steel repair and 53 had laser repair. There is no significant difference in demographics or comorbidities. In the cold steel group, 4 of 127 (3.1%) had breakdown and in the laser group, 10 of 53 (18.9%) had breakdown. Patients who failed after a cold steel repair tended to break down later (median 12.7 months) when compared to laser repairs (median 2.1 months). Nine of the 10 patients with breakdown after laser repair were noted on initial postoperative evaluation. CONCLUSIONS: Endoscopic cleft repair is a well-described and effective method for repair of T1LCs and DINs. Both cold steel and laser have high success rates; however, higher failure rates were noted in the laser repair group. Failure after laser repair may occur earlier than failure after cold steel repair. But this did not reach significance. LEVEL OF EVIDENCE: 3 Laryngoscope, 131:2805-2810, 2021.


Assuntos
Anormalidades Congênitas/cirurgia , Laringoscopia/efeitos adversos , Laringe/anormalidades , Lasers/efeitos adversos , Procedimentos Cirúrgicos Reconstrutivos/efeitos adversos , Criança , Pré-Escolar , Feminino , Hospitais Pediátricos/estatística & dados numéricos , Humanos , Lactente , Laringoscopia/instrumentação , Laringe/cirurgia , Masculino , Procedimentos Cirúrgicos Reconstrutivos/instrumentação , Sistema de Registros/estatística & dados numéricos , Estudos Retrospectivos , Fatores de Tempo , Falha de Tratamento
14.
Semin Pediatr Surg ; 30(3): 151056, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34172214

RESUMO

Laryngeal webs and laryngotracheoesophageal clefts (LTECs) are rare malformations of the larynx. Both can have a wide range of symptoms. While webs typically affect voice and airway and LTECs typically affect swallowing and airway, this is not always the case. A high index of suspicion is required for timely and accurate diagnosis. A discussion of management and treatment options will be presented. Both endoscopic and open surgical techniques exist for both pathologies and will be reviewed.


Assuntos
Doenças da Laringe , Laringe , Endoscopia , Humanos , Laringe/cirurgia
15.
J Trauma Acute Care Surg ; 90(6): e132-e137, 2021 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-34016931

RESUMO

Laryngotracheal separation injuries are a rare but serious condition, as survival from such injuries relies on proper airway management. As a result, recommendations for management have been based on small case reports and expert opinion. We reviewed our last 10 years of experience with managing laryngotracheal separation injuries and identified 6 cases for chart review. Awake tracheostomy or videolaryngobronchoscopy was used in each case to initially obtain the airway. Surgical repair was then performed immediately using nonabsorbable monofilament suture or a miniplate, and a low fenestrated tracheostomy was placed. All of our patients who followed up were decannulated, eating regular diets, and had satisfactory voice quality at 3 months postoperatively. Review of the literature revealed that, while management strategies have changed over time, treatment still varies widely depending on surgeon preference and the details of each injury. Outcomes from our series suggest that our described techniques and management strategies can be used with good outcomes. We believe that this is due to securing a safe airway, early surgical intervention with no unnecessary tissue dissection, effective reconstruction of the airway, and the fenestrated tracheostomy technique.


Assuntos
Manuseio das Vias Aéreas/métodos , Laringe/lesões , Lesões do Pescoço/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/métodos , Traqueia/lesões , Adolescente , Adulto , Manuseio das Vias Aéreas/estatística & dados numéricos , Broncoscopia/métodos , Broncoscopia/estatística & dados numéricos , Feminino , Seguimentos , Humanos , Laringoscopia/métodos , Laringoscopia/estatística & dados numéricos , Laringe/diagnóstico por imagem , Laringe/cirurgia , Masculino , Pessoa de Meia-Idade , Lesões do Pescoço/diagnóstico , Procedimentos Cirúrgicos Reconstrutivos/estatística & dados numéricos , Estudos Retrospectivos , Tomografia Computadorizada por Raios X , Traqueia/diagnóstico por imagem , Traqueia/cirurgia , Traqueostomia/métodos , Traqueostomia/estatística & dados numéricos , Resultado do Tratamento , Adulto Jovem
16.
Nuklearmedizin ; 60(4): 272-277, 2021 Aug.
Artigo em Alemão | MEDLINE | ID: mdl-34034355

RESUMO

AIM: Local recurrence of thyroid carcinomas can result in tumor infiltration in the lower region of the larynx. Since these tumors typically no longer store iodine, treatment options are greatly limited. The present study describes our experience with laryngo-tracheal resection of such cases of local recurrence. MATERIALS AND METHODS: From July 2019 to November 2020, we treated five patients with malignant infiltration of the trachea and larynx due to local recurrence of a thyroid carcinoma. We performed laryngo-tracheal resection with end-to-end anastomosis in four patients and frontolateral partial laryngectomy in one patient. RESULTS: The median length of hospital stay was 6 days (5-14). An R0 resection was performed in two patients. Problems with the anastomosis or bilateral recurrent laryngeal nerve paralysis was not seen in any of the patients. One patient had to be reintubated on the second postoperative day due to lung failure. He was able to be extubated after five days. CONCLUSION: High tracheal resection with partial resection of the larynx was able to be performed with minimal risk. Although radical resections are rare, they expand oncological treatment options in the case of local recurrence of thyroid carcinomas that are iodine-refractory. High tracheal resection could be part of the oncological treatment spectrum in the case of local recurrence of thyroid carcinomas that no longer store iodine.


Assuntos
Iodo , Laringe , Neoplasias da Glândula Tireoide , Humanos , Laringe/diagnóstico por imagem , Laringe/cirurgia , Masculino , Invasividade Neoplásica , Recidiva Local de Neoplasia/cirurgia , Neoplasias da Glândula Tireoide/cirurgia , Traqueia/diagnóstico por imagem , Traqueia/cirurgia
17.
J Speech Lang Hear Res ; 64(5): 1447-1456, 2021 05 11.
Artigo em Inglês | MEDLINE | ID: mdl-33887153

RESUMO

Purpose The excised canine larynx provides an advantageous experimental framework in the study of voice physiology. In recent years, signal processing methods have been applied to analyze phonations in excised canine larynx experiments. However, phonations have a highly complex and nonstationary nature corresponding to different proportions of regular and chaotic signal elements. Current nonlinear dynamic methods that are used to assess the degree of irregularity in the voice fail to recognize the distribution of voice type components (VTCs). Method Based on measures of intrinsic dimension, this article presents a method to analyze the VTC distribution of phonations in excised canine larynx experiments. Thirty-nine phonation samples from 13 excised canine larynges at three different subglottal pressures were analyzed. Results Phonation produced with subglottal pressures above phonation instability pressure (PIP) and below phonation threshold pressure (PTP) resulted in high proportions of Voice Types 3 and 4, characterized by chaotic and noisy signals. Phonation produced with pressure between PTP and PIP contained mostly Type 1 voice, characterized by a regular and nearly periodic signal. Mean proportions of all VTCs varied significantly in comparisons of phonations produced with Sub-PTP and PTP as well as in comparisons of phonations produced with PTP and PIP. Conclusions Across all VTCs, the VTC profiles of normal and abnormal phonation differ significantly. Normal phonation is strongly associated with VTC1 (Voice Type Component 1), whereas abnormal phonation exhibits increased VTC4 (Voice Type Component 4). The study further demonstrates the ability of intrinsic dimension to successfully detect multiple voice types in an acoustic signal and highlights the need for expanded use of intrinsic dimension in human voice. Supplemental Material https://doi.org/10.23641/asha.14417585.


Assuntos
Laringe , Fonação , Acústica , Animais , Cães , Humanos , Laringe/cirurgia , Dinâmica não Linear , Processamento de Sinais Assistido por Computador
18.
Eur Arch Otorhinolaryngol ; 278(8): 2927-2935, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33885971

RESUMO

PURPOSE: It is not always possible to create linear access to the larynx using a rigid operating laryngoscope for microlaryngoscopy. In this study, we evaluate the usability of a novel curved surgical prototype with flexible instruments for the larynx (sMAC) in a simulation dummy and human body donor. METHODS: In a user study (n = 6), head and neck surgeons as well as medical students tested the system for visualization quality and accessibility of laryngeal landmarks on an intubation dummy and human cadaver. A biopsy of the epiglottis was taken from the body donor. Photographic and time documentation was carried out. RESULTS: The sMAC system demonstrated general feasibility for laryngeal surgery. Unlike conventional microlaryngoscopy, all landmarks could be visualized and manipulated in both setups. Biopsy removal was possible. Visibility of the surgical field remained largely unobstructed even with an endotracheal tube in place. Overall handling of the sMAC prototype was satisfactorily feasible at all times. CONCLUSION: The sMAC system could offer an alternative for patients, where microlaryngoscopy is not applicable. A clinical trial has to clarify if the system benefits in clinical routine.


Assuntos
Laringoscópios , Laringe , Epiglote , Humanos , Intubação Intratraqueal , Laringoscopia , Laringe/cirurgia
20.
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 por Emissão de Pósitrons combinada à Tomografia Computadorizada , Recidiva
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