RESUMEN
OBJECTIVE: To assess if laryngeal electromyography could provide additional information in the prognosis of congenital bilateral idiopathic abductor vocal cord paralysis (abCBILP). METHODS: We performed a retrospective review over a 23-year period (1995-2018) of all children younger than 13 years old in the Medical University of Innsbruck. RESULTS: We identified five infants with abCBILP. Fiberoptic laryngeal endoscopy revealed bilateral vocal cord immobility in adduction without accompanying laryngeal findings. Tracheostomy rate was 100%. Tracheostomy was performed after minimum 3 weeks of non-improvement with continuous positive airway pressure treatment or intubation. In all patients, repeated laryngeal electromyography revealed volitional activity. All patients showed excellent full late recovery in the second quinquennium of life. CONCLUSION: Presence of volitional activity in laryngeal electromyography could identify patients with excellent prognosis. Prospective laryngeal electromyography studies are required in more patients with abCBILP in order to document laryngeal electromyography findings also by patients with poor late recovery. Patients with poor prognosis could be selected for early laryngeal intervention to avoid tracheostomy-dependent issues. LEVEL OF EVIDENCE: 4 Laryngoscope, 130:E252-E257, 2020.
Asunto(s)
Parálisis de los Pliegues Vocales/congénito , Parálisis de los Pliegues Vocales/fisiopatología , Adolescente , Austria , Broncoscopía , Niño , Preescolar , Electromiografía , Humanos , Lactante , Recién Nacido , Laringoscopía , Pronóstico , Estudios Retrospectivos , Traqueostomía , Parálisis de los Pliegues Vocales/terapiaRESUMEN
Ear canal infections may not always be clinically distinguished between a bacterial otitis externa, an otomycosis or a mixed infection. In addition, tympanic membrane perforations are often not immediately apparent. The use of a broad-spectrum antiseptic agent without an inner ear toxic effect would therefore be beneficial. We report the case of a female patient suffering from intractable otitis externa with tympanic membrane perforation, who was successfully treated locally with a mixture of 1% NCT and 0.1% dexamethasone.
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Dexametasona/administración & dosificación , Otitis Externa/complicaciones , Otitis Externa/tratamiento farmacológico , Taurina/análogos & derivados , Perforación de la Membrana Timpánica/complicaciones , Perforación de la Membrana Timpánica/tratamiento farmacológico , Antiinflamatorios/administración & dosificación , Combinación de Medicamentos , Femenino , Humanos , Persona de Mediana Edad , Taurina/administración & dosificación , Insuficiencia del Tratamiento , Resultado del TratamientoRESUMEN
Single-stage microvascular reconstruction of neck defects with jejunum or other free flaps are well established methods. However, these flaps usually are buried subcutaneously and viability surveillance is difficult. Alternatively to technical monitoring devices, we present a simple method using a "sentinel" part of the free jejunum flap transposed outside to the skin surface or sutured into the skin when using fasciocutaneous or myocutaneous flaps. Although this method is not new, it is rarely used. Compared to pure technical monitoring devices, it is easily performed and monitoring of buried free flaps especially in the neck region is reliable.
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Neoplasias Esofágicas/cirugía , Supervivencia de Injerto/fisiología , Neoplasias Hipofaríngeas/cirugía , Microcirugia , Colgajos Quirúrgicos/irrigación sanguínea , Humanos , Microcirculación/fisiopatología , Reoperación , Técnicas de SuturaRESUMEN
This retrospective analysis presents a minimally invasive method for a transnasal approach to treat bilateral and unilateral choanal atresia and stenosis in infants and children. We describe an advanced surgical technique that applies the use of a KTP laser and give recommendations for preoperative diagnosis and postoperative assessment. We report 13 cases of bilateral and unilateral choanal atresia or stenosis treated over a 3 1/2-year period. We used a transnasal approach and endoscopic control. For bilateral choanal atresia, the operation was performed within the first few days of birth. For unilateral choanal atresia or stenosis, surgery was performed several weeks after birth. In all cases, an intranasal stent was inserted. Our findings demonstrate that this transnasal approach provides significant benefits. A primary advantage is the diminished risk of intraoperative or postoperative complications. Additional benefits include lower rates of re-obstruction and a decreased incidence of subsequent disease, including chronic secretory otitis media.
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Atresia de las Coanas/cirugía , Terapia por Láser , Terapia por Láser/métodos , Preescolar , Atresia de las Coanas/diagnóstico , Diseño de Equipo , Humanos , Lactante , Recién Nacido , Terapia por Láser/instrumentación , Nariz , Stents , Tomografía Computarizada por Rayos XRESUMEN
For the treatment of unilateral laryngeal paralysis with glottic insufficiency injection laryngoplasty is a popular modality of treatment. This procedure augments the volume of the paralyzed vocal fold by endoscopic injection. However, the ideal substance has not yet been found for that purpose. We report for the first time the systematic application and long-term results of vulcanized polydimethylsiloxane (PDMS) particles in the treatment of glottic insufficiency in the human larynx. Of 10 patients treated with PDMS in the early 1990s, 7 patients could be retrieved for reevaluation. Laryngeal function was assessed by videostroboscopy, expert rating, and further characterized by the objective parameters of voice profile and maximum phonation time. In a standardized questionnaire, all patients were asked for their personal impression of the results. Mean follow-up time was 88.4 months (range 69-102 months). Glottic closure was complete in 5 of 7 patients. There were no signs of granuloma formation or other pathologic changes of the injected vocal folds. In 4 cases, voices were rated normal or near-normal; 2 voices were rated as fair; 1 usable. All the patients reported significant and lasting voice improvement. None of the patients reported any problems related to PDMS. PDMS particles provide permanent augmentation of human vocal fold volume without complications. Their use is a valuable and safe alternative when a definitive one-step procedure seems advantageous. However, further studies are needed to assess voice improvement in comparison to other materials.
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Materiales Biocompatibles Revestidos , Dimetilpolisiloxanos , Laringe/fisiología , Siliconas , Anciano , Anciano de 80 o más Años , Materiales Biocompatibles Revestidos/efectos adversos , Dimetilpolisiloxanos/efectos adversos , Elastómeros , Femenino , Estudios de Seguimiento , Humanos , Hidrogel de Polietilenoglicol-Dimetacrilato , Laringoscopía , Laringe/anatomía & histología , Laringe/cirugía , Masculino , Ensayo de Materiales , Persona de Mediana Edad , Siliconas/efectos adversosRESUMEN
Lipomata of the larynx and the hypopharynx are very rare benign lesions; as they look macroscopically like retention cysts, their diagnosis is usually made after surgery. Sometimes, lipomata of the hypopharynx become very large and life-threatening. Plain fluoroscopy and fluoroscopy aided with barium often fail to depict the lesion if it is localized subepiglottically; standard barium swallow examination and computed tomography allow an accurate diagnosis to be made in many cases, although magnetic resonance imaging is still more accurate and allows not only a more specific diagnosis of the lesion, but also a better depiction of the origin of the frequently pedunculated tumor and its extension into the parapharyngeal space. This paper adds 6 cases of hypopharyngeal and 1 case of laryngeal lipoma to the literature and discusses modern diagnostic and therapeutic strategies.
Asunto(s)
Neoplasias Hipofaríngeas/patología , Neoplasias Laríngeas/diagnóstico , Lipoma/diagnóstico , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Neoplasias Hipofaríngeas/cirugía , Neoplasias Laríngeas/cirugía , Laringoscopía , Terapia por Láser , Lipoma/cirugía , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Tomografía Computarizada por Rayos XRESUMEN
BACKGROUND: The increasing application of sophisticated methods of laryngeal framework surgery requires a profound knowledge of the size and proportions of the human larynx and its cartilaginous components. Only inadequate data regarding this subject have so far been accessible. The aim of this study was to collect exact and reliable morphometric data of the human laryngeal framework. Materials and Methods Larynges from 98 corpses (52 male, 46 female) were removed during autopsy 4-64 hours postmortem and processed without delay or fixation. Following a standard routine for preparation, 28 parameters were measured on thyroid cartilage, cricoid cartilage, arytenoid cartilage, epiglottis, and the larynx as a whole organ. None of the patients had histories or visible signs of laryngeal disease. Anatomical preparations were performed with customary surgical tools and morphometric measurements then carried out with a pair of compasses and a caliper rule. RESULTS: A total of 5,100 measurements was performed on 98 larynges. These included, aside from evaluation of the whole organ, identification of the internal and external diameters of the cricoid cartilage, height and length of the thyroid alae in different planes, angle of thyroid alae, height of arytenoid cartilage, width and length of epiglottic cartilage, and position of the anterior commissure related to the thyroid cartilage. The results provide a full scale of data determining the size and extent not only of the cartilaginous components, but of the laryngeal framework as a whole. Mean values, standard deviations, and sample sizes are given for every parameter separately for both sexes. CONCLUSION: This study provides a comprehensive and detailed description of the dimensions of the adult human larynx.
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Laringe/anatomía & histología , Adulto , Anciano , Anciano de 80 o más Años , Antropometría , Femenino , Humanos , Cartílagos Laríngeos/anatomía & histología , Laringe/cirugía , Masculino , Persona de Mediana Edad , Valores de ReferenciaRESUMEN
The morphologic development of the human larynx during the first years of life is poorly understood to date. This study used plastinated whole organ serial sections to determine the growth and structure of the infant larynx. The larynges of 43 children 1 to 60 months old were plastinated. Whole organ serial sections were obtained by cutting the resulting specimen with a diamond band saw. The slices were then submitted to computer-assisted morphometric investigation. We found that the subglottic airway rapidly increases in size during the first 2 years of life. Further growth follows a linear mode. The relative proportion of the mucosal lining decreases likewise. In contrast to that in adults, and comparable to that in most mammals, the cartilaginous glottis accounts for 60% to 75% of the vocal folds' length at <2 years. No sexual dimorphism of the larynx exists during childhood. This study supplies detailed morphometric data on the growth and structure of the human larynx during the first years of life. It is the first to use plastinated whole organ serial sections for morphology of the pediatric larynx. Therefore, this study provides quantitative anatomic data of clinical interest that have not been available to date.
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Laringe/anatomía & histología , Preescolar , Femenino , Humanos , Lactante , Laringe/crecimiento & desarrollo , MasculinoRESUMEN
BACKGROUND: We conducted a prospective study to investigate voice quality after transoral endolaryngeal laser surgery in terms of ability to communicate effectively. Eighty patients with T1 or T2 glottic carcinoma were enrolled in the study. The main objective was to identify the influence of type and extent of surgery on postoperative voice parameters after endoscopic laser surgery. MATERIAL AND METHODS: The postoperative mechanism of phonation was assessed by videostroboscopy six months after surgery at the earliest. A phonetogram was produced and its area calculated (relative phonetogram, RP) in relation to a gender-specific normal phonetogram. A speech therapist (ST) and a trained otolaryngologist (TO) rated each voice independently for communication ability in a grade from 1 (poor) to 6 (near normal). RESULTS: After simple cordectomy the mean values were as follows: RP = 24.8%, TO = 3.26, ST = 3.33. When the anterior commissure was completely preserved mean results were better (RP = 34%, TO = 3.92, ST = 3.83). Results were worse following extended cordectomy (RP = 14.7%, TO = 2.82, ST = 3.00) and transglottic resection (RP = 13.7%, TO = 2.30, ST = 2.86), but similar within these two groups. The parameters RP, TO, and ST do not differ significantly between the group who had speech therapy after surgery (N = 33) and the group who did not (N = 47). Voice production at glottic level yields better results for every parameter than supraglottic substitute phonation. The amount of tissue removed was less significant. CONCLUSION: We conclude that postoperative phonatory results correlate with the postoperative mechanism of phonation. There is no linear correlation with the amount of tissue removed. Comparing similar types of resection preservation of the anterior commissure plays a key role. From the data in this study there is no evidence of a significant benefit from speech therapy. The parameter RP is an effective and relatively simple parameter to complete auditive voice assessment.
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Endoscopía , Neoplasias Laríngeas/cirugía , Laringectomía , Laringoscopía , Terapia por Láser , Trastornos de la Voz/etiología , Calidad de la Voz/fisiología , Femenino , Estudios de Seguimiento , Humanos , Neoplasias Laríngeas/patología , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Fonación/fisiología , Inteligibilidad del Habla , Resultado del Tratamiento , Pliegues Vocales/patología , Pliegues Vocales/cirugíaRESUMEN
PURPOSE: The purpose of this work was to test a newly developed, post-processing software for virtual CT endoscopic methods. Virtual endoscopic images were generated from helical CT data sets in the region of the shoulder joint (n = 2), the tracheobronchial system (n = 3), the nasal sinuses (n = 2), the colon (n = 2), and the common carotid artery n = 1). Software developed specifically for virtual endoscopy ("Navigator") was used which, after a previous threshold value selection, makes the reconstruction of internal body surfaces possible by an automatic segmentation process. We have evaluated the usage of the software, the reconstruction time for individual images and sequences of images as well as the quality of the reconstruction. All pathological findings of the virtual endoscopy were confirmed by surgery. RESULTS: The post-processing program is easy to use and provides virtual endoscopic images within 50 seconds. Depending of the extent of the data set, virtual tracheobronchoscopy as a cine loop sequence required about 15 minutes. Through use of the threshold value-dependent surface reconstruction the demands on the computer configuration are limited; however, this also created quality problems in image calculation as a consequence of the accompanying loss of data. CONCLUSIONS: The Navigator software enables the calculation of virtual endoscopic models with only moderate demands on the hardware.
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Endoscopios , Procesamiento de Imagen Asistido por Computador/instrumentación , Tomografía Computarizada por Rayos X/instrumentación , Artefactos , Broncografía , Arteria Carótida Común/diagnóstico por imagen , Colon/diagnóstico por imagen , Humanos , Senos Paranasales/diagnóstico por imagen , Sensibilidad y Especificidad , Articulación del Hombro/diagnóstico por imagen , Programas Informáticos , Tráquea/diagnóstico por imagenRESUMEN
In order to perform its basic functions, those of coordination of breathing, swallowing and speech, the larynx requires an intact neural apparatus to permit the perfect, well-coordinated action of the neuromuscular structures of extra- and intralaryngeal muscles. Electrophysiological measurements including electromyography, reflexmyography, electric and magnetic stimulated myography of the central motor nerve functions are the methods of classification of dysfunctions into neurapraxia, axonotmesis, neurotmesis, regeneration or myopathy. Different types of electrodes, depending on the methods of application, show a variety of neurophysiological findings which allow the investigator to decide about the type of lesion. An overview on neurophysiological techniques in vocal cord disorders is presented.
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Electromiografía , Parálisis de los Pliegues Vocales/fisiopatología , Pliegues Vocales/fisiopatología , Axones/patología , Deglución/fisiología , Estimulación Eléctrica , Electrodos , Electromiografía/instrumentación , Electromiografía/métodos , Humanos , Enfermedades de la Laringe/diagnóstico , Enfermedades de la Laringe/fisiopatología , Músculos Laríngeos/inervación , Músculos Laríngeos/fisiopatología , Traumatismos del Nervio Laríngeo , Nervios Laríngeos/fisiopatología , Laringe/fisiopatología , Magnetismo , Enfermedades Musculares/diagnóstico , Enfermedades Musculares/fisiopatología , Miografía/métodos , Degeneración Nerviosa , Regeneración Nerviosa , Conducción Nerviosa , Unión Neuromuscular/fisiopatología , Reflejo/fisiología , Respiración/fisiología , Habla/fisiología , Parálisis de los Pliegues Vocales/diagnósticoRESUMEN
Botulinum toxin A was used preoperatively to temporarily paralyze the intrinsic laryngeal muscles to hinder movements during the healing period after operation. In addition, toxin was injected into the cricopharyngeal muscle to allow a better passive drainage of the saliva into the esophagus. We treated six patients. Three suffered from chronic aspiration problems after multiple lower cranial nerve lesions, and three patients were apallic (after stroke and major brain injury). Two weeks before scheduled operation, we injected the toxin into the posterior cricoarytenoid muscles, the aryepiglottic muscles, and the vocalis muscle on both sides, as well as the cricopharyngeal muscle. The amount of injected toxin varied between 1.0 and 1.4 mL, equal to 200 to 280 units of botulinum toxin A (Dysport). After a complete palsy of these muscles (controlled by direct electromyography), a closure of the larynx was performed. After laminotomy and exposure of the intralaryngeal structures, the false vocal cords were mobilized and adapted with sutures. Because involuntary movements of the intralaryngeal musculature were absent, primary healing without complications occurred in all cases. Aspiration and related complications disappeared in all patients. In addition, the intensity of patient care could be considerably reduced. Preoperative use of botulinum toxin A allows sufficient laryngeal closure. This procedure is especially useful in the treatment of children and young adults, preserving the ability of later speech rehabilitation because of the return of voluntary movements of the intrinsic laryngeal muscles 6 months after the injection. Furthermore, this technique, as minimal surgical intervention, can be performed in high-risk patients.
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Toxinas Botulínicas/farmacología , Toxinas Botulínicas/uso terapéutico , Laringe/efectos de los fármacos , Laringe/cirugía , Neumonía por Aspiración/tratamiento farmacológico , Adolescente , Adulto , Toxinas Botulínicas/administración & dosificación , Niño , Trastornos de Deglución/complicaciones , Femenino , Humanos , Inyecciones Intramusculares , Masculino , Persona de Mediana Edad , Neumonía por Aspiración/etiología , Neumonía por Aspiración/cirugía , Índice de Severidad de la Enfermedad , Traqueostomía , Resultado del TratamientoRESUMEN
Endonasal nasal and sinus surgery using an endoscope for visual control has minimized the risks of surgery. A new technique is presented in which a suction-irrigation endoscope is used for visual control during surgery. The instrument is combined with a suction-rotation microdebrider with different tips and a power generator. The handling of this instrument is easy and atraumatic and it achieves a relatively bloodless field to reduce further the risk of inadvertent penetration of the skull base and lamina papyracea during endoscopic surgery.
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Desbridamiento/instrumentación , Suministros de Energía Eléctrica , Endoscopios , Microcirugia/instrumentación , Enfermedades de los Senos Paranasales/cirugía , Succión/instrumentación , Diseño de Equipo , Humanos , Complicaciones Intraoperatorias/prevención & controlRESUMEN
Many surgical procedures in the field of ENT take place in close proximity to vital structures like the orbit, the skull base, the internal carotid artery etc. In our clinic we have decided to study two different computer-assisted navigation systems to reduce the risk of trauma to these structures during endonasal endoscopic procedures. Such systems should be able to correlate the position of the surgical instrument, ideally in the submillimeter range, to CT- or MR-images. The ARTMA Virtual Patient finds the position of the instrument by permanently measuring magnetic fields. The ISG-system uses a mechanical arm to localize the probe in the patient. Using Computer-Assisted-Surgery (CAS) does not significantly extend the time needed for surgery. We found that it prevents the surgeon from inadvertently injuring structures. Other groups have shown (1) that CAS-systems minimize the risk of complications of surgical procedures in the frontobasis arising from mishaps in the usage of the endoscope or the surgical tool. If properly used, CAS-systems can be a very helpful tool in the hand of an experienced surgeon but will never replace his expertise and knowledge.
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Senos Etmoidales/cirugía , Pólipos Nasales/cirugía , Neoplasias de los Senos Paranasales/cirugía , Seno Esfenoidal/cirugía , Terapia Asistida por Computador/métodos , Humanos , Imagen por Resonancia Magnética , Procedimientos Quirúrgicos Operativos/métodos , Tomografía Computarizada por Rayos XRESUMEN
Transoral laser resection of oral cavity and oropharynx squamous cell carcinoma (OOSCC) is a widely accepted approach in the absence of cervical lymph node metastases. This study investigated the results of transoral laser surgery and discontinuous neck dissection (ND) for OOSCC with clinically obvious or suspected cervical node metastases. One hundred seventeen patients with infiltrating oral carcinoma were treated for cure with transoral resection of the primary and staged ND. Twenty-nine primaries were classified as T1, 50 as T2, 35 as T3, and 3 as T4. Lymph node metastases were identified in the ND specimen of 36 patients. All patients were followed for a minimum of 3 years unless they died. Estimated tumor-related survival after 5 years is 81% for stage I and II disease of the oral cavity, 86% for stage I and II disease of the oropharynx, 73% for stage III disease of the oral cavity, 65% for stage III disease of the oropharynx, and 21% for stage IV disease of the oral cavity and the oropharynx. Local and regional control of cancer was achieved in 72 (62%) of the 117 patients. Forty-five local and regional recurrences were diagnosed during the follow-up period. Two patients died of distant metastases with no evidence of local or regional recurrence. The combination of transoral laser resection and staged ND for the treatment of OOSCC seems to offer satisfactory cure rates for a selected group of patients. These two minor surgical interventions cause less morbidity than commando-type surgery and lead to low perioperative mortality and morbidity.