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1.
BMJ Case Rep ; 14(10)2021 Oct 27.
Artigo em Inglês | MEDLINE | ID: mdl-34706913

RESUMO

A 33-year-old woman was diagnosed with right recurrent laryngeal nerve (RLN) schwannoma. She presented with a long history of hoarseness, and only recently developed dysphagia. On physical examination, a mass was observed over the right cervical level IV. Endoscopic examination of the larynx showed that she had right unilateral vocal cord palsy. She successfully underwent transcervical resection of the tumour followed by injection laryngoplasty. This study discusses the presentation of the tumour, radiological findings, our working diagnosis and treatment options of RLN schwannoma.


Assuntos
Laringoplastia , Neurilemoma , Traumatismos do Nervo Laríngeo Recorrente , Paralisia das Pregas Vocais , Adulto , Feminino , Humanos , Neurilemoma/diagnóstico por imagem , Neurilemoma/cirurgia , Nervo Laríngeo Recorrente , Paralisia das Pregas Vocais/etiologia , Paralisia das Pregas Vocais/cirurgia
2.
Laryngoscope ; 131(12): 2817-2822, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34228358

RESUMO

OBJECTIVES/HYPOTHESIS: Determine the incidence of short- and long-term dysphagia in pediatric patients with and without syndromes/neurodevelopmental delay following supraglottoplasty (SGP) at our institution. STUDY DESIGN: Retrospective cohort study. METHODS: A retrospective cohort study of children ≤18 years old who underwent SGP from 2014 to 2019 was undertaken. Age at surgery, sex, race, insurance, underlying syndromes/neurodevelopmental delay, concurrent surgical procedures, and clinical swallowing assessments were reviewed. Logistic regression was performed to identify factors associated with postoperative feeding difficulties. Time-to-event analysis was performed to assess time to resolution of dysphagia. RESULTS: A total of 231 patients were identified. Average age at time of SGP was 13.7 months. Of 231 patients, 88 (38.1%) had a syndrome/neurodevelopmental delay. Of these 231 patients, 112 had a preoperative videofluoroscopic swallow study or fiberoptic endoscopic evaluation of swallowing, of whom 53/112 (47.3%) had dysphagia. After SGP, 138/231 (59.7%) underwent clinical/instrumental swallowing assessments, of whom 95/138 (68.8%) had immediate postsurgical dysphagia. At last follow-up (1 month to 45 months), 15/95 (15.8%) had persistent dysphagia on instrumental assessment, 14/15 of whom had syndromes/neurodevelopmental delay. Time-to-event analysis revealed that for the nonsyndromic cohort, 25% had resolution of dysphagia by 4 months, 50% by 10 months, and 75% by 14 months. Cox proportional hazards regression revealed that the presence of underlying syndromes/neurodevelopmental delay was the only factor predictive of long-term postoperative dysphagia (hazard ratio of resolution 0.21 [95% confidence interval 0.096-0.48]). CONCLUSIONS: While short-term feeding difficulties following SGP in pediatric patients are not uncommon, long-term dysphagia is rare in patients without syndromes/neurodevelopmental delay. These data can be used when counseling caregivers about the risks and benefits of SGP. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:2817-2822, 2021.


Assuntos
Transtornos de Deglutição/epidemiologia , Glote/cirurgia , Laringomalácia/cirurgia , Laringoplastia/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Adolescente , Criança , Pré-Escolar , Transtornos de Deglutição/etiologia , Feminino , Glote/anormalidades , Humanos , Incidência , Lactente , Recém-Nascido , Laringoplastia/métodos , Masculino , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Resultado do Tratamento
3.
Vet Surg ; 50(7): 1409-1417, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34309058

RESUMO

OBJECTIVE: To evaluate the airway mechanics of modified toggle LP constructs in an airflow chamber model and compare these to the airway mechanics of standard LP constructs. STUDY DESIGN: Ex-vivo experimental study. SAMPLE POPULATION: Fifty-one equine cadaveric larynges. METHODS: Bilateral LP constructs were performed using a modified toggle (n = 23) or a standard (n = 21) LP technique. Constructs were tested in an airflow model before and after cyclic loading which was designed to mimic postoperative swallowing. The cross-sectional area (CSA), peak translaryngeal airflow (L/s), and impedance (cmH2 0/L/s) were determined and compared between LP constructs before and after cycling. RESULTS: The mean CSA of the rima glottidis of the modified toggle LP constructs was 15.2 ± 2.6 cm2 before and 14.7 ± 2.6 cm2 after cyclic loading, and the mean CSA of the rima glottidis of the standard LP constructs was 16.4 ± 2.9 cm2 before and 15.7 ± 2.8 cm2 after cyclic loading. The modified toggle LP constructs had similar peak translaryngeal impedance before and after cyclic loading (p = .13); however, the standard LP constructs had higher peak translaryngeal impedance after cyclic loading (p = .02). CONCLUSION: The modified toggle and standard LP constructs had comparable airway mechanics in an ex-vivo model. CLINICAL SIGNIFICANCE: Further investigation is warranted to determine the extent to which the modified toggle LP technique restores normal airway function in horses with RLN.


Assuntos
Laringoplastia , Laringe , Animais , Glote , Cavalos , Laringoplastia/veterinária , Vácuo
4.
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
5.
Eur Arch Otorhinolaryngol ; 278(10): 3883-3890, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34109479

RESUMO

PURPOSE: The objective was to investigate whether a patient's preoperative test results can predict the need for future reoperation in unilateral vocal fold paralysis (UVFP). METHODS: A single-centre retrospective study was performed. The study group consisted of 18 patients with UVFP who had been treated with injection laryngoplasty but who required further treatment and were augmentated again within 36 months. The control group consisted of 33 injected patients who had not required reintervention up to 36 months later. RESULTS: Only glottal gap was associated with a relative risk for reinjection. Glottal gap was found to be severe in 77.8% of the patients from the study group compared to 42.4% of the controls, and the difference was statistically significant. The kind of injected material (calcium hydroxylapatite or hyaluronic acid), age, and voice assessment (perceptual, objective, or subjective) did not seem to affect the likelihood of reoperation being needed. There were no between-group statistically significant differences in individual aspects of the GRBAS scale. The global score was slightly higher in the study group, but it did not reach statistical significance (U = 198.5; p = 0.09). A comparison of VHI scores did not yield statistically significant differences between the study and control groups. No significant differences in objective acoustic voice parameters were observed between the groups. CONCLUSION: Only glottal gap occurred to be associated with a relative risk for reinjection. A kind of injected material (CaHA or HA), age, perceptual, objective and subjective voice assessment do not seem to impact the likelihood of reoperation in patients with UVFP.


Assuntos
Laringoplastia , Paralisia das Pregas Vocais , Humanos , Estudos Retrospectivos , Resultado do Tratamento , Paralisia das Pregas Vocais/cirurgia , Prega Vocal , Qualidade da Voz
6.
Laryngoscope ; 131(11): 2567-2571, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-33973649

RESUMO

OBJECTIVES/HYPOTHESIS: An artificial intelligence (AI) tool was developed using audio clips of cis-male and cis-female voices based on spectral analysis to assess %probability of a voice being perceived as female (%Prob♀). This program was validated with 92% accuracy in cisgender speakers. The aim of the study was to assess the relationship of fo on %Prob♀ by a validated AI tool in a cohort of trans females who underwent intervention to feminize their voice with behavioral modification and/or surgery. STUDY DESIGN: Cohort study. METHODS: Fundamental frequency (fo ) from prolonged vowel sounds (fo /a/) and fo from spontaneous speech (fo -sp) were measured using the Kay Pentax Computerized Speech Lab (Montvale, NJ) in trans females postintervention. The same voice samples were analyzed by the AI tool for %Prob♀. Chi-square analysis and regression models were performed accepting >50% Prob♀ as female voice. RESULTS: Forty-two patients were available for analysis after intervention. fo -sp post-treatment was positively correlated with %Prob♀ (R = 0.645 [P < .001]). Chi-square analysis showed a significant association between AI %Prob♀ >50% for the speech samples and fo -sp >160 Hz (P < .01). Sixteen of 42 patients reached an fo -sp >160 Hz. Of these, the AI program only perceived nine patients as female (>50 %Prob♀). CONCLUSION: Patients with fo -sp >160 Hz after feminization treatments are not necessarily perceived as having a high probability of being female by a validated AI tool. AI may represent a useful outcome measurement tool for patients undergoing gender affirming voice care. LEVEL OF EVIDENCE: 3 Laryngoscope, 131:2567-2571, 2021.


Assuntos
Inteligência Artificial , Laringoplastia , Medida da Produção da Fala/métodos , Percepção do Timbre/fisiologia , Pessoas Transgênero , Feminino , Humanos , Masculino , Estudos Retrospectivos , Fatores Sexuais , Acústica da Fala , Resultado do Tratamento , Voz/fisiologia
8.
HNO ; 69(9): 726-733, 2021 Sep.
Artigo em Alemão | MEDLINE | ID: mdl-33978776

RESUMO

Laryngeal framework surgery is an umbrella term for all phonosurgical procedures by which the cartilaginous structure of the larynx and thereby the position and tension of the vocal folds are changed. The aim is to improve the voice. By far the best known and most frequently performed operation is thyroplasty type 1 according to Isshiki, also known as medialization thyroplasty, which is indicated for treatment of glottic insufficiency. Although the first medialization thyroplasty was successfully performed by Payr in Germany in 1915, more than 100 years later, it is still not widely used in Germany.


Assuntos
Laringoplastia , Laringe , Paralisia das Pregas Vocais , Glote , Humanos , Resultado do Tratamento , Paralisia das Pregas Vocais/cirurgia , Prega Vocal/cirurgia
9.
Laryngoscope ; 131(12): 2798-2804, 2021 12.
Artigo em Inglês | MEDLINE | ID: mdl-34032289

RESUMO

OBJECTIVES/HYPOTHESIS: Evaluate swallowing and airway outcomes following laryngotracheoplasty with posterior grafting (LTP PCCG). METHODS: Retrospective review of pediatric patients undergoing LTP PCCG from 2016 to 2019 at a tertiary care pediatric hospital. We included demographics, indications, approach, and revision status. We evaluated preoperative and postoperative instrumental and functional swallow evaluations, and we also gathered information on airway outcomes. RESULTS: Thirty-one patients were included in the study. Median (interquartile range [IQR]) age was 4.0 (2.0, 7.0) years old. Primary indication for surgery was bilateral vocal cord immobility (BVCI) in 11 (35.5%) and posterior glottic stenosis (PGS) in 20 (64.5%). Mean (standard deviation) length of follow-up was 11.0 (8.3) months. Twelve patients had gastrostomy tubes (GT) before surgery, and no patients required placement of GT after surgery. Of the remaining 19 patients, 6 required nasogastric feeding for >4 weeks (average length 1.8 months, longest 3.5 months). At last follow-up, 25 (80.6%) patients were primarily orally fed. Eighteen patients had tracheotomies prior to surgery. No patients without a tracheostomy required placement of tracheostomy before or after surgery and only 1 patient had a tracheostomy at last follow-up. Average time to decannulation was 3.7 months, with surgery-specific success of 87.1% and overall success of 96.8%. Four (12.9%) patients required a major intervention to achieve decannulation. CONCLUSION: LTP PCCG is an effective surgical technique to address PGS and BVCI with high decannulation rates. It may cause temporary swallowing dysfunction, but in this series a majority of children were orally fed at last follow-up. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:2798-2804, 2021.


Assuntos
Transtornos de Deglutição/cirurgia , Laringoplastia/efeitos adversos , Laringoestenose/cirurgia , Traqueia/cirurgia , Paralisia das Pregas Vocais/cirurgia , Criança , Pré-Escolar , Transtornos de Deglutição/etiologia , Feminino , Seguimentos , Gastrostomia/estatística & dados numéricos , Humanos , Lactente , Laringoplastia/métodos , Laringoestenose/complicações , Masculino , Estudos Retrospectivos , Resultado do Tratamento , Paralisia das Pregas Vocais/complicações
10.
Kyobu Geka ; 74(2): 116-119, 2021 Feb.
Artigo em Japonês | MEDLINE | ID: mdl-33976016

RESUMO

A 83-year-old man underwent thyroplasty with arytenoid adduction for right recurrent laryngeal nerve palsy 1 year ago. He had been suffering from hemosputum and cough for last 2 months, and was referred to our hospital for medical examination. Laryngoscopy and neck computed tomography showed subglottic nodule. No evidence of malignancy was noted by a transbronchial biopsy of subglottic nodule. Since subglottic nodule grew rapidly during 2 months observation period, subglottic nodule resection was performed by bronchoscope. Histopathologic examination revealed that the tumor was suture granuloma with no evidence of malignancy. Cervical abscess as a complication of subglottic suture granuloma resection was occurred, because of suture material for arytenoid adduction and the injury of mucous membrane for removing the granuloma with the fenestration of thyroid cartilage for thyroplasty.


Assuntos
Laringoplastia , Abscesso/diagnóstico por imagem , Abscesso/etiologia , Abscesso/cirurgia , Idoso de 80 Anos ou mais , Cartilagem Aritenoide/diagnóstico por imagem , Cartilagem Aritenoide/cirurgia , Granuloma , Humanos , Masculino , Suturas
11.
Laryngoscope ; 131(11): 2550-2557, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-33956345

RESUMO

OBJECTIVES/HYPOTHESIS: We report a posterior laryngeal rating system and measures of voice disability in pediatric patients undergoing phonosurgery for vocal fold paralysis. Posterior glottic deficiency may account for persistent voice disability. STUDY DESIGN: Retrospective Study. METHODS: Retrospective analyses of 66 subjects with primary unilateral vocal fold paralysis were reviewed for the status of posterior glottis and voice disability (Pediatric Voice Handicap Index [pVHI]). Gestation age (GA), weight, and medical/surgical history were reviewed. The width, length, and depth of the larynx were analyzed to create a reproducible rating scale. RESULTS: Mean GA was 29 weeks, with an intubation history for all subjects, with 90% having a left vocal fold immobility. Cardiac surgery was performed in 92% of subjects. A progressive rating (type 0-3) Benjamin Defect Severity Scale (BDSS) was developed to rate the absence or presence of a posterior abnormality. BDSS-2 and BDSS-3 subjects were more likely to have low birth weight. Extremely preterm GA was more likely to be associated with BDSS-1 (mild) or BDSS-2. History of multiple and prolonged intubations were seen more frequently in BDSS-2 or BDSS-3. Post-op pVHI reduced an average of 15 points for BDSS-0 to BDSS-2, but only 3 points for BDSS-3. Post-op pVHI matched normal values for preintervention dysphonic children. CONCLUSIONS: The presence of a persistent breathy voice after intervention for unilateral vocal fold immobility is potentially associated with posterior glottic defects. Low birth weight with multiple/prolonged intubation is more likely to be present with higher-grade BDs, whereas low GA is more likely to be associated with BDSS-1 to BDSS-2. LEVEL OF EVIDENCE: 4 Laryngoscope, 131:2550-2557, 2021.


Assuntos
Disfonia/diagnóstico , Recém-Nascido Prematuro , Intubação Intratraqueal/efeitos adversos , Laringoscopia/efeitos adversos , Paralisia das Pregas Vocais/diagnóstico , Adolescente , Fatores Etários , Criança , Pré-Escolar , Disfonia/etiologia , Disfonia/cirurgia , Feminino , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Escala de Gravidade do Ferimento , Laringoplastia , Estudos Longitudinais , Masculino , Estudos Retrospectivos , Resultado do Tratamento , Paralisia das Pregas Vocais/etiologia , Paralisia das Pregas Vocais/cirurgia , Prega Vocal/lesões , Prega Vocal/cirurgia
12.
Eur Ann Otorhinolaryngol Head Neck Dis ; 138(6): 471-473, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33867249

RESUMO

INTRODUCTION: Adductor spasmodic dysphonia (Ad-SD) is usually treated by botulinum toxin injection into the thyroarytenoid muscles. In older patients, atrophy of these muscles is responsible for glottic leak, causing presbyphonia and is managed by vocal fold medialization using autologous fat or hydroxyapatite (HA). We report the first case of uncontrollable laryngeal spasm requiring tracheostomy after hydroxyapatite injection laryngoplasty in a patient with spasmodic dysphonia and presbyphonia. CASE REPORT: An 83-year-old man had been treated for Ad-SD by botulinum toxin injections every six months for 14 years. Due to severely disabling glottic leak, autologous fat injection laryngoplasty was then successfully performed. Six months later, following recurrence of severe hypophonia, hydroxyapatite injection was performed, subsequently complicated by immediate acute respiratory distress secondary to adductor laryngeal spasm requiring reintubation and tracheostomy. The postoperative course was marked by gradual recovery of vocal fold mobility with decannulation on day 12. DISCUSSION: This case allows a discussion of the possible pathophysiological mechanisms responsible for adductor laryngeal spasm. Vocal fold medialization procedures should be performed with caution in patients with Ad-SD.


Assuntos
Laringismo , Laringoplastia , Idoso , Idoso de 80 Anos ou mais , Durapatita , Humanos , Masculino , Recidiva Local de Neoplasia , Espasmo/cirurgia , Traqueostomia
13.
Laryngoscope ; 131(8): E2452-E2460, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-33847388

RESUMO

OBJECTIVES/HYPOTHESIS: Test a new jellyfish collagen biomaterial aimed to increase duration of injection medialization laryngoplasty (IL) against two products in clinical practice. STUDY DESIGN: Animal model. METHODS: Left recurrent laryngeal nerve sectioning and IL were performed in New Zealand White rabbits (N = 6/group). Group 1 received micronized cross-linked jellyfish collagen (MX-JC) and adipose derived stem cells (ADSCs), Group 2, MX-JC alone, Group 3, cross-linked hyaluronic acid (X-HA), and Group 4, micronized acellular dermis (MACD). Animals were sacrificed at 4 and 12 weeks. Major outcomes were MRI tissue volumes and histopathology. RESULTS: After 100 µL IL MRI volumes (means ± STD) at 4 and 12 weeks were: Group 1: 27.2 ± 15.6 and 13.1 ± 5.2 µL, Group 2: 60.8 ± 18 and 27.8 ± 2.47 µL, Group 3: 27.4 ± 12 and 10.6 ± 8 µL, and Group 4: 37.5 ± 11 and 9.85 ± 1 µL. Group 2 volumes were largest and Group 3 were smallest in all comparisons (P < .05). Histologically, low grade inflammatory responses were observed in Group 1, mild histiocytic infiltration in Group 2, widespread muscle fiber loss in Group 3, and plasmocytic infiltration in Group 4. CONCLUSIONS: MX-JC showed the least resorption at 4 and 12 weeks among all groups. T cell inflammatory responses were observed with MX-JC but were reduced by 12 weeks while B cell immune responses, indicative of antibody priming, were predominantly noted with MACD. MX-JC + ADSC showed low grade immunity while the XHA showed greater myocyte loss compared to the other groups. LEVEL OF EVIDENCE: NA Laryngoscope, 131:E2452-E2460, 2021.


Assuntos
Colágeno/farmacologia , Ácido Hialurônico/análogos & derivados , Laringoplastia/métodos , Imageamento por Ressonância Magnética/métodos , Paralisia das Pregas Vocais/terapia , Derme Acelular/efeitos adversos , Animais , Linfócitos B/imunologia , Materiais Biocompatíveis/administração & dosagem , Materiais Biocompatíveis/farmacologia , Cadáver , Colágeno/administração & dosagem , Modelos Animais de Doenças , Feminino , Ácido Hialurônico/administração & dosagem , Ácido Hialurônico/farmacologia , Imunidade/imunologia , Inflamação/patologia , Imageamento por Ressonância Magnética/estatística & dados numéricos , Células-Tronco Mesenquimais/patologia , Plasmócitos/imunologia , Padrões de Prática Médica , Coelhos , Traumatismos do Nervo Laríngeo Recorrente/complicações , Traumatismos do Nervo Laríngeo Recorrente/patologia , Linfócitos T/patologia , Paralisia das Pregas Vocais/diagnóstico , Paralisia das Pregas Vocais/etiologia
14.
Laryngoscope ; 131(11): 2540-2544, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-33864644

RESUMO

OBJECTIVES: The purpose of this study was to better understand the effects of stitch placement on arytenoid medialization by measuring normative cricoarytenoid joint anatomy and changes in arytenoid position when varying arytenopexy stitch configuration. METHODS: This adult human larynx study was done in two parts. First, measurements of the cricoid and arytenoid cartilage anatomy relevant to cricoarytenoid joint function were made in 45 preserved larynges (26 male (M), 19 female (F)) using digital calipers. Second, the arytenoids of six fresh larynges ( three M, three F) were sutured to the cricoid using various arytenopexy-stitch placements ranging from inferior-lateral to superior-medial, and the resulting arytenoid positions were compared by measuring medial displacement of the arytenoid body and change in glottal configuration from macro still images using Image J. Paired t-tests were used to compare the results. RESULTS: Cartilage and joint facet dimensions showed differences between males (M) and females (F). Cricoid facet lengths averaged 9.3 mm (M) and 7.1 mm (F), and widths averaged 4.9 mm (M) and 4.0 mm (F). The arytenoid facet widths averaged 10.5 mm (M) and 9.7 mm (F). Average distances between cricoid facets were 11.8 mm for both males and females. Securing the arytenoid superior-medially on the cricoid facet produced more medialization (2.2 mm vs 1.0 mm, P < .001) and better glottic aperture configuration (9.5° vs 2.7°, P < .001) than securing the arytenoid inferior-laterally on the facet. CONCLUSIONS: Anatomic consistency in cricoarytenoid anatomy provides reliable surgical landmarks for ideal placement of an arytenopexy suture to optimally reposition the arytenoid cartilage. Optimal arytenoid medialization can be accurately reproduced with an arytenopexy-suture that is placed superior-medially on the cricoid facet. LEVEL OF EVIDENCE: NA Laryngoscope, 131:2540-2544, 2021.


Assuntos
Cartilagem Aritenoide/anatomia & histologia , Cartilagem Cricoide/anatomia & histologia , Laringoplastia/métodos , Paralisia das Pregas Vocais/cirurgia , Idoso de 80 Anos ou mais , Pontos de Referência Anatômicos , Cartilagem Aritenoide/cirurgia , Cadáver , Cartilagem Cricoide/cirurgia , Feminino , Humanos , Masculino , Técnicas de Sutura
15.
Eur Arch Otorhinolaryngol ; 278(6): 2143-2146, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-33738568

RESUMO

BACKGROUND: Cervical ultrasound allows real-time visualization of the laryngeal structures. We describe its application for injection laryngoplasty in the voice clinic. METHODS: Hyaluronic acid infiltration of the vocal fold under ultrasonographic control. CONCLUSIONS: With this technique, the position of the needle in the depth of the vocal fold and its spatial relations with nearby structures can be assessed. This allows for an accurate infiltration of the material in contrast to other techniques and avoids discomfort related to the gag reflex with nasofibrolaryngoscopy. No specific complications have been observed so far, however, this technique may be difficult in cases with calcified cartilages or uncooperative patients.


Assuntos
Laringoplastia , Paralisia das Pregas Vocais , Voz , Humanos , Injeções , Resultado do Tratamento , Paralisia das Pregas Vocais/diagnóstico por imagem , Paralisia das Pregas Vocais/cirurgia , Prega Vocal/diagnóstico por imagem , Prega Vocal/cirurgia
16.
Otolaryngol Head Neck Surg ; 165(4): 556-562, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-33588618

RESUMO

OBJECTIVES: (1) Demonstrate true vocal fold (TVF) tracking software (AGATI [Automated Glottic Action Tracking by artificial Intelligence]) as a quantitative assessment of unilateral vocal fold paralysis (UVFP) in a large patient cohort. (2) Correlate patient-reported metrics with AGATI measurements of TVF anterior glottic angles, before and after procedural intervention. STUDY DESIGN: Retrospective cohort study. SETTING: Academic medical center. METHODS: AGATI was used to analyze videolaryngoscopy from healthy adults (n = 72) and patients with UVFP (n = 70). Minimum, 3rd percentile, 97th percentile, and maximum anterior glottic angles (AGAs) were computed for each patient. In patients with UVFP, patient-reported outcomes (Voice Handicap Index 10, Dyspnea Index, and Eating Assessment Tool 10) were assessed, before and after procedural intervention (injection or medialization laryngoplasty). A receiver operating characteristic curve for the logistic fit of paralysis vs control group was used to determine AGA cutoff values for defining UVFP. RESULTS: Mean (SD) 3rd percentile AGA (in degrees) was 2.67 (3.21) in control and 5.64 (5.42) in patients with UVFP (P < .001); mean (SD) 97th percentile AGA was 57.08 (11.14) in control and 42.59 (12.37) in patients with UVFP (P < .001). For patients with UVFP who underwent procedural intervention, the mean 97th percentile AGA decreased by 5 degrees from pre- to postprocedure (P = .026). The difference between the 97th and 3rd percentile AGA predicted UVFP with 77% sensitivity and 92% specificity (P < .0001). There was no correlation between AGA measurements and patient-reported outcome scores. CONCLUSIONS: AGATI demonstrated a difference in AGA measurements between paralysis and control patients. AGATI can predict UVFP with 77% sensitivity and 92% specificity.


Assuntos
Inteligência Artificial , Glote/fisiopatologia , Laringoscopia , Gravação em Vídeo , Paralisia das Pregas Vocais/fisiopatologia , Feminino , Humanos , Injeções , Laringoplastia , Masculino , Pessoa de Meia-Idade , Medidas de Resultados Relatados pelo Paciente , Software , Paralisia das Pregas Vocais/terapia
17.
J Speech Lang Hear Res ; 64(2): 481-490, 2021 02 17.
Artigo em Inglês | MEDLINE | ID: mdl-33524276

RESUMO

Purpose The purpose of this study is to familiarize speech-language-pathologists with the current state of the science regarding medialization laryngoplasty in the treatment of voice disorders, with emphasis on current evidence-based practice, voice outcomes, and future directions for research. Method A literature review was performed in PubMed and Embase using the keywords vocal fold/cord and laryngoplasty, thyroplasty, augmentation, or laryngeal framework. Articles published between 2010 and 2020 were reviewed for data about clinical applications, technical approach, voice-related outcomes, and basic science or clinical innovations with the potential to improve patient care. A synthesis of data was performed from articles meeting the outlined search criteria. Conclusions As key members in the multidisciplinary care of voice disorders, speech-language pathologists need to be informed of current research in medialization laryngoplasty, a procedure commonly used for patients with glottic insufficiency. Advances in anesthetic technique, office-based procedures, and the development of materials with increased bio-tolerability over the past decade have led to innovations in treatment and improved patient outcomes. Recent applications of computational and bioengineering approaches have the potential to provide new directions in the refinement of currently available techniques and the improvement of patient-based treatment outcomes.


Assuntos
Laringoplastia , Paralisia das Pregas Vocais , Humanos , Patologistas , Estudos Retrospectivos , Fala , Resultado do Tratamento , Prega Vocal
18.
J Laryngol Otol ; 135(2): 159-167, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33593469

RESUMO

OBJECTIVE: The aim of this study was to establish arytenoid asymmetry as a pre-operative predictive parameter for arytenoid adduction surgery in unilateral vocal fold paralysis and thereafter identify the most predictive parameter for arytenoid adduction among the established parameters. METHODS: A retrospective comparative study was undertaken. The 'arytenoid asymmetry angle' formed between skewed 'glottic' and 'interarytenoid' axes (traced along the plane of closure of the membranous and cartilaginous glottis, respectively) was quantified in pre-operative laryngoscopic images of 85 adults with unilateral vocal fold paralysis who underwent either type 1 thyroplasty (group 1) or type 1 thyroplasty with arytenoid adduction (group 2). The need for arytenoid adduction was determined intra-operatively based on subjective voice improvement and laryngoscopic results. RESULTS: Arytenoid asymmetry (p < 0.0001), posterior phonatory gap (p = 0.001) and vertical level difference (p = 0.004) were significantly greater in group 2 (descending order of parameters). Arytenoid asymmetry angle showed a significant positive correlation with the latter two parameters. CONCLUSION: Arytenoid asymmetry is the most predictive parameter for arytenoid adduction. An arytenoid asymmetry angle of more than or equal to 33.9° is an indication for arytenoid adduction. This aids in pre-operative planning of arytenoid adduction.


Assuntos
Cartilagem Aritenoide/cirurgia , Laringoplastia/métodos , Paralisia das Pregas Vocais/fisiopatologia , Paralisia das Pregas Vocais/cirurgia , Adulto , Cartilagem Aritenoide/anormalidades , Feminino , Glote/cirurgia , Humanos , Laringoscopia/métodos , Masculino , Pessoa de Meia-Idade , Fonação/fisiologia , Valor Preditivo dos Testes , Período Pré-Operatório , Estudos Retrospectivos , Resultado do Tratamento , Paralisia das Pregas Vocais/diagnóstico por imagem , Qualidade da Voz/fisiologia
19.
Acta Otolaryngol ; 141(1): 85-88, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33393421

RESUMO

BACKGROUND: Laryngomalacia is the commonest laryngeal anomaly and cause of stridor in children. Although most cases are self-limiting, failure to thrive, hypoxaemia or significant apnoeic episodes may warrant surgical intervention in the form of aryepiglottoplasty. Opinion is divided as to the pathophysiological mechanisms involved in the disease process. AIMS AND OBJECTIVES: This study explores the aetiology of laryngomalacia by reviewing the histology of aryepiglottoplasty resection specimens. MATERIAL AND METHODS: The histology reports of 61 aryepiglottoplasty specimens resected between 1 October 2014 and 31 October 2018 were reviewed. RESULTS: Age of patients ranged from 3 weeks to 36 months. 36 patients were male and 25 female. 43 of 61 (70.5%) cases had inflammation, most of which were mild. 3 (4.9%) cases had histological specimens with detectable eosinophils. None of the specimens had signs of granulomatous change, ulceration or calcification. Cartilage was present in the resected specimen in 47 (77%) cases. Over half of these (59.6%) were immature cartilage. CONCLUSION AND SIGNIFICANCE: The results suggest a mild concurrent laryngitis/supraglottitis in most cases. Eosinophilia is rare and does not support eosinophilic oesophageal reflux as part of the aetiology. The high proportion of immature cartilage in the specimens supports the theory of chondropathic aetiology.


Assuntos
Laringomalácia/patologia , Laringe/patologia , Pré-Escolar , Eosinófilos/patologia , Feminino , Humanos , Lactente , Recém-Nascido , Laringomalácia/cirurgia , Laringoplastia/métodos , Masculino , Estudos Retrospectivos
20.
Surg Radiol Anat ; 43(8): 1225-1233, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-33388863

RESUMO

PURPOSE: This study aims to determine laryngeal dimension in relation to all three transcutaneous injection laryngoplasty (TIL) approaches (thyrohyoid, transthyroid and cricothyroid) using three-dimensionally reconstructed Computed Tomography (CT) scan and compare the measurements between sex, age group and ethnicity. METHODS: CT scans of the neck of two hundred patients were analysed by two groups of raters. For thyrohyoid approach, mean distance from the superior border of the thyroid cartilage to the laryngeal cavity (THd) and mean angle from the superior border of the thyroid cartilage to mid-true cords (THa) were measured. For transthyroid approach, mean distance from mid-thyroid cartilage to mid-true cords (TTd) and Hounsfield unit (HU) at mid-thyroid cartilage (TTc) were measured. For cricothyroid approach, mean distance from the inferior border of the thyroid cartilage to the laryngeal cavity (CTd) and mean angle from the inferior border of the thyroid cartilage to mid-true cords (CTa) were measured. RESULTS: There were statistically significant differences between males and females for all measurements except for CTa (p < 0.0001). No significant difference across age groups and ethnicities were found for all three approaches (p > 0.05). There was a significant fair positive correlation between age and TTc (p = 0.0002). For all measurements obtained, there were moderate to excellent inter-group consistency and intra-rater reliability. CONCLUSION: This study demonstrated a significant sex dimorphism that may influence the three TIL approaches except for needle angulation in the cricothyroid approach. The knowledge of laryngeal dimension is important to increase success in TIL procedure.


Assuntos
Cartilagem Cricoide/anatomia & histologia , Laringoplastia/métodos , Cartilagem Tireóidea/anatomia & histologia , Paralisia das Pregas Vocais/cirurgia , Prega Vocal/cirurgia , Adolescente , Adulto , Idoso , Cartilagem Cricoide/diagnóstico por imagem , Cartilagem Cricoide/cirurgia , Estudos Transversais , Feminino , Humanos , Imageamento Tridimensional , Injeções/instrumentação , Injeções/métodos , Masculino , Pessoa de Meia-Idade , Agulhas , Fatores Sexuais , Cartilagem Tireóidea/diagnóstico por imagem , Cartilagem Tireóidea/cirurgia , Tomografia Computadorizada por Raios X , Adulto Jovem
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