RESUMEN
Anti-galactocerebroside (Gal-C) antibodies are present in patients with conditions such as Guillain-Barré syndrome and mycoplasma pneumonia. We report a rare case of left vocal cord paralysis in a patient with anti-Gal-C IgG antibodies that improved after administeration of antivirals and steroids.
Asunto(s)
Galactosilceramidas , Parálisis de los Pliegues Vocales , Humanos , Galactosilceramidas/inmunología , Parálisis de los Pliegues Vocales/etiología , Antivirales/uso terapéutico , Inmunoglobulina G/sangre , Masculino , Autoanticuerpos/sangre , Resultado del Tratamiento , Femenino , Persona de Mediana EdadRESUMEN
OBJECTIVES: Injection laryngoplasty (IL) has been widely used as an initial treatment option for unilateral vocal fold paralysis (UVFP). An additional (second) IL is considered a salvage treatment for unsatisfactory outcomes of initial IL resulting from inadequate injection or early resorption of the injection material. This study aims to evaluate the efficacy of additional IL, distinguishing between "salvage" (within 4 months) and "repeated" injections (beyond 4 months), and to analyze prognostic factors for successful outcomes. METHODS: This retrospective study involved patients who received IL at Asan Medical Center from January 2014 to December 2020. Voice parameters were collected after each procedure, and those who conducted the statistical analysis were blinded to the study subjects. Among the 65 patients who underwent additional IL, 51 patients were enrolled in this study. Postinjection grade, roughness, breathiness, asthenia, strain (GRBAS) scales were used to determine satisfactory treatment outcomes. Success of the additional IL was defined as a postinjection grade of dysphonia score of 0 or 1, with a reduction in grade compared with the preinjection grade. RESULTS: The mean age of the patients was 61.6 years. Out of a total of 51 patients, 37 were men participating in the study. The odds ratio represents the likelihood of success in the second IL. Improved voice outcome after the additional IL was maintained in 23 (45%) patients. Compared with the failure group, the success group had a longer injection time interval between the initial and additional injection (9.1 vs. 7.4â months, respectively, p = 0.010). The success group had a higher proportion of patients with injection intervals >6â months (73.9% vs. 42.9%, p = 0.026). Logistic regression analysis revealed an injection interval >6â months had an odds ratio of 0.265 (confidence interval: 0.080-0.874, p = 0.029). CONCLUSIONS: Additional injections would benefit the patients whose voice outcomes are maintained for a longer period (>6â months) after the first injection.
Asunto(s)
Laringoplastia , Terapia Recuperativa , Parálisis de los Pliegues Vocales , Humanos , Parálisis de los Pliegues Vocales/cirugía , Parálisis de los Pliegues Vocales/fisiopatología , Parálisis de los Pliegues Vocales/terapia , Masculino , Laringoplastia/métodos , Persona de Mediana Edad , Femenino , Estudios Retrospectivos , Terapia Recuperativa/métodos , Resultado del Tratamiento , Anciano , Inyecciones , Adulto , Calidad de la VozRESUMEN
BACKGROUND: The aim of this study is to describe the management and associated follow-up strategies adopted by thyroid surgeons with different surgical volumes when loss of signal (LOS) occurred on the first side of planned bilateral thyroid surgery, and to further define the consensus on intraoperative neuromonitoring (IONM) applications. METHODS: The International Neural Monitoring Study Group (INMSG) web-based survey was sent to 950 thyroid surgeons worldwide. The survey included information on the participants, IONM team/equipment/procedure, intraoperative/postoperative management of LOS, and management of LOS on the first side of thyroidectomy for benign and malignant disease. RESULTS: Out of 950, 318 (33.5%) respondents completed the survey. Subgroup analyses were performed based on thyroid surgery volume: <50 cases/year (n = 108, 34%); 50 to 100 cases/year (n = 69, 22%); and >100 cases/year (n = 141, 44.3%). High-volume surgeons were significantly (P < .05) more likely to perform the standard procedures (L1-V1-R1-S1-S2-R2-V2-L2), to differentiate true/false LOS, and to verify the LOS lesion/injury type. When LOS occurs, most surgeons arrange otolaryngologists or speech consultation. When first-side LOS occurs, not all respondents decided to perform stage contralateral surgery, especially for malignant patients with severe disease (eg, extrathyroid invasion and poorly differentiated thyroid cancer). CONCLUSIONS: Respondents felt that IONM was optimized when conducted under a collaborative team-based approach, and completed IONM standard procedures and management algorithm for LOS, especially those with high volume. In cases of first-site LOS, surgeons can determine the optimal management of disease-related, patient-related, and surgical factors. Surgeons need additional education on LOS management standards and guidelines to master their decision-making process involving the application of IONM.
Asunto(s)
Tiroidectomía , Humanos , Tiroidectomía/métodos , Encuestas y Cuestionarios , Monitorización Neurofisiológica Intraoperatoria , Enfermedades de la Tiroides/cirugía , Pautas de la Práctica en Medicina/estadística & datos numéricos , Traumatismos del Nervio Laríngeo Recurrente/prevención & control , Traumatismos del Nervio Laríngeo Recurrente/etiología , Parálisis de los Pliegues Vocales/etiología , Femenino , MasculinoRESUMEN
OBJECTIVES: Percutaneous Vocal Fold Lateralization (PVFL) consists of external fixation with non-absorbable percutaneous suture of the vocal fold in a lateral position, under direct glottic visualization. The objective of this study is to determine the effectiveness of PVFL in a university pediatric hospital, as well as to describe the potential risks and complications of the surgery. METHODS: Retrospective cohort study, with data collected from electronic medical records. The study was approved by the Research Ethics Committee of the institution. Surgeries were performed with the modified Lichentenberg technique and data, and outcomes were analyzed. RESULTS: Six patients with Bilateral Vocal Fold Paralysis who underwent Percutaneous Vocal Fold Lateralization were evaluated. Three patients were male. The age at diagnosis ranged from 2 to 132 days (mean 10.5 days). The reason for investigating the upper airway was the presence of increased work of breathing and stridor. Five patients had a favorable clinical evolution, with spontaneous ventilation in room air and absence of stridor or ventilatory effort, without the need for tracheostomy. Surgical results in this series corroborate the findings of other similar cohorts, which showed Percutaneous Vocal Fold Lateralization as a safe and effective procedure in avoiding tracheostomy or allowing decannulation in children with Bilateral Vocal Fold Paralysis. CONCLUSIONS: PVFL seems to be a safe and effective procedure, but it has morbidity, due to immediate, and probably late, non-serious complications. Studies with a larger number of patients, with longer follow-up and using a controlled and randomized clinical design are needed to establish the role of PVFL in the treatment of BVFP in newborns and infants. LEVELS OF EVIDENCE: Level 4 (step 4).
Asunto(s)
Parálisis de los Pliegues Vocales , Pliegues Vocales , Humanos , Parálisis de los Pliegues Vocales/cirugía , Masculino , Estudios Retrospectivos , Femenino , Lactante , Recién Nacido , Pliegues Vocales/cirugía , Pliegues Vocales/fisiopatología , Resultado del Tratamiento , Centros de Atención Terciaria , Hospitales Pediátricos , Técnicas de Sutura , Brasil , Estudios de CohortesRESUMEN
BACKGROUND: Charcot-Marie-Tooth disease (CMT) is one of the most common inherited neuropathies. The disease is generally characterized by sensory loss most prominent in distal extremities, muscle weakness, and muscle wasting. There is still no effective therapy for Charcot-Marie-Tooth disease. CASE PRESENTATION: The patient is a 6-year-old Iranian girl, of Fars ethnicity, who was admitted with a chief complaint of hoarseness and an impression of Charcot-Marie-Tooth disease type 4B. She was initially treated with noninvasive ventilation and, after a year, electively underwent cordotomy as a novel therapeutic approach. CONCLUSIONS: Charcot-Marie-Tooth disease type 4B is a less common but important cause of stridor. Noninvasive ventilation treatment and unilateral posterior cordotomy can be utilized for hereditary neuropathies.
Asunto(s)
Enfermedad de Charcot-Marie-Tooth , Ventilación no Invasiva , Parálisis de los Pliegues Vocales , Humanos , Enfermedad de Charcot-Marie-Tooth/complicaciones , Enfermedad de Charcot-Marie-Tooth/cirugía , Femenino , Parálisis de los Pliegues Vocales/cirugía , Niño , Ventilación no Invasiva/métodos , Cordotomía/métodos , Terapia por Láser/métodos , Resultado del TratamientoRESUMEN
Many voice disorders are linked to imbalanced muscle activity and known to exhibit asymmetric vocal fold vibration. However, the relation between imbalanced muscle activation and asymmetric vocal fold vibration is not well understood. This study introduces an asymmetric triangular body-cover model of the vocal folds, controlled by the activation of bilateral intrinsic laryngeal muscles, to investigate the effects of muscle imbalance on vocal fold oscillation. Various scenarios were considered, encompassing imbalance in individual muscles and muscle pairs, as well as accounting for asymmetry in lumped element parameters. Measurements of amplitude and phase asymmetries were employed to match the oscillatory behavior of two pathological cases: unilateral paralysis and muscle tension dysphonia. The resulting simulations exhibit muscle imbalance consistent with expectations in the composition of these voice disorders, yielding asymmetries exceeding 30% for paralysis and below 5% for dysphonia. This underscores the relevance of muscle imbalance in representing phonatory scenarios and its potential for characterizing asymmetry in vocal fold vibration.
Asunto(s)
Músculos Laríngeos , Fonación , Vibración , Pliegues Vocales , Pliegues Vocales/fisiología , Pliegues Vocales/fisiopatología , Humanos , Músculos Laríngeos/fisiología , Músculos Laríngeos/fisiopatología , Simulación por Computador , Disfonía/fisiopatología , Parálisis de los Pliegues Vocales/fisiopatología , Modelos Biológicos , Fenómenos BiomecánicosRESUMEN
BACKGROUND Ortner syndrome, or cardiovocal syndrome, is a left recurrent laryngeal nerve palsy secondary to cardiovascular causes. Aortic pseudoaneurysm is a rare life-threatening condition resulting from weakening of the aortic wall. Clinical presentation of aortic pseudoaneurysm is highly variable. Hoarseness is often caused by benign conditions; however, it can be the first symptom of an underlying serious condition requiring immediate diagnosis and management. CASE REPORT We report a series of 2 patients with sudden hoarseness as the first symptom of an aortic arch pseudoaneurysm. Two men, with ages of 76 and 60 years, had sudden hoarseness a few weeks before. Laryngoscopy showed a left vocal cord palsy in both cases. A computed tomography (CT) scan showed a thoracic aortic pseudoaneurysm located at the aortic arch compressing the left recurrent laryngeal nerve. Both patients were treated with endovascular aortic repair. The first patient underwent a carotid-subclavian artery bypass, and the left subclavian artery was closed with a vascular plug device. He was discharged a week later, with persistent hoarseness. In the second case, subclavian artery occlusion and pseudoaneurysm embolization with coils were performed. Control CT scan confirmed the procedure's success. However, after an initial favorable evolution, the patient had severe non-vascular complications and finally died. CONCLUSIONS Considering these 2 cases and those reported in the literature, aortic origin should be considered in the differential diagnosis of hoarseness, particularly when it appears suddenly. Thoracic endovascular aortic repair is a feasible option for those patients with penetrating aortic ulcer or pseudoaneurysm located in the aortic arch.
Asunto(s)
Aneurisma Falso , Ronquera , Parálisis de los Pliegues Vocales , Humanos , Masculino , Ronquera/etiología , Aneurisma Falso/terapia , Aneurisma Falso/complicaciones , Aneurisma Falso/diagnóstico por imagen , Parálisis de los Pliegues Vocales/etiología , Parálisis de los Pliegues Vocales/diagnóstico , Anciano , Persona de Mediana Edad , Aneurisma de la Aorta Torácica/complicaciones , Aneurisma de la Aorta Torácica/diagnóstico , Tomografía Computarizada por Rayos X , Aorta Torácica/diagnóstico por imagenRESUMEN
A young female patient was referred by her general practitioner to the ear, nose and throat outpatient clinic with a 5-year history of progressive hoarseness and loss of voice. A chest radiograph was reported as showing marked dilatation of the left pulmonary artery without any other features to suggest underlying pulmonary arterial hypertension. A provisional diagnosis of left recurrent laryngeal nerve palsy secondary to its compression between the left pulmonary artery and the undersurface of the aortic arch-Ortner's or cardiovocal syndrome-was suggested and confirmed on further investigation including CT, microlaryngoscopy and echocardiography.
Asunto(s)
Aneurisma , Arteria Pulmonar , Parálisis de los Pliegues Vocales , Femenino , Humanos , Aneurisma/diagnóstico , Aneurisma/etiología , Dilatación Patológica , Ecocardiografía , Enfermedades de las Válvulas Cardíacas/complicaciones , Enfermedades de las Válvulas Cardíacas/diagnóstico , Ronquera/diagnóstico , Ronquera/etiología , Arteria Pulmonar/diagnóstico por imagen , Arteria Pulmonar/patología , Válvula Pulmonar/diagnóstico por imagen , Síndrome , Tomografía Computarizada por Rayos X , Parálisis de los Pliegues Vocales/diagnóstico , Parálisis de los Pliegues Vocales/etiologíaRESUMEN
OBJECTIVE: Postoperative recurrent laryngeal nerve paralysis is one of the complications of thyroid surgery, and the prevention and management of paralysis is an important issue for surgeons. In this study, in order to gain further understanding of recurrent laryngeal nerve paralysis after thyroid surgery, we analyzed and examined the usefulness of nerve stimulators for recurrent laryngeal nerve paralysis and the factors that may cause recurrent laryngeal nerve paralysis. Furthermore, in cases where transient recurrent laryngeal nerve paralysis occurred, we analyzed and examined the timing of improvement in vocal cord movement for each intraoperative finding and intraoperative operation that caused the paralysis. METHODS: At the Department of Otorhinolaryngology Head and Neck Surgery, Sapporo Medical University Hospital, between January 2012 and December 2021, the subjects were 543 thyroid surgery cases (692 nerves) without preoperative paralysis or cancer nerve invasion performed. The relationship between postoperative transient and permanent paralysis of the recurrent laryngeal nerve was evaluated using univariate and multivariate analysis. The factors evaluated were gender, age, BMI, total thyroidectomy, benignity, malignancy, Graves' disease, using IIONM (intermittent intraoperative nerve monitoring), using CIONM (continuous intraoperative nerve monitoring), malignant tumor T3b or higher, with lateral neck dissection, and years of experience of the surgeon. Furthermore, by targeting 87 nerves with transient paralysis, surgical operations were divided into three groups: minor injury, major injury, and adhesion, and their relationship with the timing of postoperative vocal fold movement improvement was evaluated. RESULTS: Permanent paralysis of the recurrent laryngeal nerve occurred in 12 nerves (1.7 %), and transient paralysis occurred in 100 nerves (14.5 %). Univariate analysis showed no association with each factor, but multivariate analysis showed that transient paralysis was significantly lower in men and in patients using IIONM. The improvement time for vocal cord paralysis was 2.8 months in the minor injury group, 4.5 months in the major injury group, and 3.2 months in the adhesion group, indicating a statistically significant difference between the minor injury group and the major injury group. CONCLUSION: This study suggests that the use of IIONM and gentle manipulation of women may prevent recurrent laryngeal nerve paralysis during thyroid surgery. In addition, understanding the period of nerve recovery for each operation for postoperative transient recurrent laryngeal nerve paralysis may contribute to patient explanations and determining the timing of therapeutic intervention for speech improvement surgery.
Asunto(s)
Complicaciones Posoperatorias , Tiroidectomía , Parálisis de los Pliegues Vocales , Humanos , Parálisis de los Pliegues Vocales/etiología , Parálisis de los Pliegues Vocales/prevención & control , Masculino , Tiroidectomía/efectos adversos , Femenino , Persona de Mediana Edad , Complicaciones Posoperatorias/epidemiología , Complicaciones Posoperatorias/prevención & control , Adulto , Anciano , Traumatismos del Nervio Laríngeo Recurrente/prevención & control , Neoplasias de la Tiroides/cirugía , Disección del Cuello/efectos adversos , Adulto Joven , Enfermedad de Graves/cirugía , Recuperación de la Función , Factores Sexuales , Factores de Riesgo , Pliegues Vocales/inervación , Pliegues Vocales/cirugía , Anciano de 80 o más Años , Nervio Laríngeo Recurrente , Adolescente , Análisis MultivarianteRESUMEN
Introduction: Recurrent laryngeal nerve palsy is a rare but important complication after endarterectomy (CEA). The impact on voice quality after this procedure is also important. The aim of the study was to assess voice quality and vocal cord function after CEA. Material and Methods: 200 patients were enrolled in the study. Inclusion criteria were indications for CEA and patient consent to the procedure. Endoscopic examination of the larynx was performed before the procedure, immediately after the procedure, on the 2nd day after the procedure, then 3 month and 6 months after the procedure. Voice was assessed by maximum phonation time (MPT), GRBAS scale, Voice Handicap Index (VHI) and the Voice-Related Quality of Life (V-RQOL) questionnaire. Results: In the study group, the results on the GRBAS scale were significantly worse and the average MPT was shorter compared to the control group. In the V-RQOL assessment, patients rated their voice as fair or good, significantly more often noticed that they had difficulty speaking loudly and being heard, and that they felt short of air when speaking. In VHI-30, the total score was significantly higher in the study group compared to the control group. Voice disorders after the procedure were reported by 68 patients, while a disorder of the recurrent laryngeal nerve was observed immediately after the procedure in 32 patients. Most vocal cord disorders were transient. Ultimately, 3% of patients were diagnosed with vocal cord paralysis. Conclusion: Cranial nerves paralysis, including the recurrent laryngeal nerve, are a common complication after CEA. Majority the paralysis is transient, but requires appropriate diagnostic and therapeutic procedures. Vocal cord evaluation is a non-invasive and widely available examination and should be performed pre- and postoperatively after all neck surgeries. The incidence of voice disorders after CEA significantly affects the quality of life of patients and requires voice rehabilitation and patient care with psychological support.
Asunto(s)
Endarterectomía Carotidea , Calidad de Vida , Parálisis de los Pliegues Vocales , Calidad de la Voz , Humanos , Parálisis de los Pliegues Vocales/etiología , Parálisis de los Pliegues Vocales/diagnóstico , Parálisis de los Pliegues Vocales/fisiopatología , Masculino , Femenino , Anciano , Persona de Mediana Edad , Resultado del Tratamiento , Factores de Tiempo , Endarterectomía Carotidea/efectos adversos , Encuestas y Cuestionarios , Evaluación de la Discapacidad , Fonación , Recuperación de la Función , Pliegues Vocales/fisiopatología , Pliegues Vocales/inervación , Laringoscopía , Anciano de 80 o más Años , Traumatismos del Nervio Laríngeo Recurrente/etiología , Traumatismos del Nervio Laríngeo Recurrente/diagnóstico , Traumatismos del Nervio Laríngeo Recurrente/fisiopatología , Estudios de Casos y Controles , Nervio Laríngeo Recurrente/fisiopatología , Estudios Prospectivos , Factores de RiesgoRESUMEN
PURPOSE: Assessing vocal cord mobility is crucial for patients undergoing thyroid surgery. We aimed to evaluate the feasibility and efficacy of surgeon-performed transcutaneous laryngeal ultrasound (TLUS) compared to flexible nasolaryngoscopy. METHOD: From February 2022 to December 2022, we conducted a prospective observational study on patients scheduled for total thyroidectomy at our Institution. All patients underwent TLUS followed by flexible nasolaryngoscopy by a blinded otolaryngologist. Findings were classified as normal or vocal cord movement impairment and then compared. Patients evaluable on TLUS were included in Group A, while those not evaluable were included in Group B, and their features were compared. RESULTS: Group A included 180 patients, while Group B included 21 patients. Male sex (p < 0.001), age (p = 0.034), BMI (p < 0.001), thyroid volume (p = 0.038), and neck circumference (p < 0.001) were associated with Group B. TLUS showed a sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of 100%, 99.4%, 94.4%, 100%, and 99.4%, respectively. Cohen's K value was 0.984. CONCLUSION: TLUS is a valid, easy-to-perform, non-invasive, and painless alternative for evaluating vocal cords in selected patients. It can be used either as a first level exam and as screening tool for selecting cases for flexible nasolaryngoscopy. TLUS should be integrated into routine thyroid ultrasound examination.
Asunto(s)
Laringoscopía , Tiroidectomía , Ultrasonografía , Humanos , Masculino , Femenino , Estudios Prospectivos , Persona de Mediana Edad , Adulto , Pliegues Vocales/diagnóstico por imagen , Anciano , Estudios de Factibilidad , Sensibilidad y Especificidad , Complicaciones Posoperatorias/diagnóstico por imagen , Parálisis de los Pliegues Vocales/diagnóstico por imagenRESUMEN
BACKGROUND: This study was conducted to evaluate the feasibility and surgical outcomes of minimally invasive video-assisted thyroidectomy (MIVAT) and three remote-access approaches, namely the robotic bilateral axillo-breast approach (BABA-R), endoscopic breast-chest approach (BCA-E), and robotic gasless transaxillary approach (GTAA-R) in lateral neck dissection for papillary thyroid carcinoma, compared with conventional transcervical approach (CTA). METHODS: The literature search was conducted in the PubMed, EMBASE, and Cochrane Library databases, covering the period January 2000 to February 2024. A systematic review and network meta-analysis were performed to compare surgical feasibility, safety, and oncologic outcomes between approaches. RESULTS: Fourteen articles on lateral neck dissection in patients with papillary thyroid carcinoma were included after systematic screening. The number of removed and metastatic lateral lymph nodes, the extent of lateral neck dissection, the rate of transient recurrent laryngeal nerve palsy and hypoparathyroidism, serum-stimulated thyroglobulin levels, and recurrence were not significantly different between the MIVAT and three remote-access approaches. Additionally, these were comparable to those of the CTA. However, the MIVAT and remote-access approaches took a longer operative time but provided superior cosmetic outcomes compared to the CTA. CONCLUSION: Lateral neck dissection using the MIVAT and three remote-access approaches was feasible and comparable to CTA in the number of lymph nodes removed, complications, stimulated thyroglobulin level, and recurrence. The MIVAT and remote-access approaches lasted longer but provided significantly superior cosmetic outcomes compared to the CTA.
Asunto(s)
Estudios de Factibilidad , Disección del Cuello , Cáncer Papilar Tiroideo , Neoplasias de la Tiroides , Tiroidectomía , Cirugía Asistida por Video , Humanos , Disección del Cuello/métodos , Cáncer Papilar Tiroideo/cirugía , Cáncer Papilar Tiroideo/patología , Neoplasias de la Tiroides/cirugía , Neoplasias de la Tiroides/patología , Cirugía Asistida por Video/métodos , Tiroidectomía/métodos , Procedimientos Quirúrgicos Robotizados/métodos , Metaanálisis en Red , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Parálisis de los Pliegues Vocales/etiología , Tempo Operativo , Hipoparatiroidismo/etiología , Metástasis Linfática , Recurrencia Local de NeoplasiaRESUMEN
BACKGROUND: This study aimed to observe the occurrence of recurrent laryngeal nerve injury after McKeown esophagectomy for esophageal squamous cell carcinoma, as well as its recovery and influencing factors within 7 months after surgery. METHODS: From July 2020 to July 2021, among all patients who underwent minimally invasive McKeown esophagectomy, 90 patients who developed vocal cord paralysis after surgery were included in the study. These patients underwent endoscopic vocal cord function assessment every 1 to 2 months and continued until 7 months postoperatively. RESULTS: Among all 388 patients undergoing esophagectomy, 23.2% (90/388) of patients suffered postoperative vocal cord paralysis. Left, right, and bilateral injuries were confirmed in 73 (81.1%), 12 (13.3%), and 5 patients (5.6%), respectively. With a median recovery time being 183 days, the cumulative overall recovery rate was 65.4% at 7 months, 68.6% for the left side, 55.6% for the right, and 20.0% for bilateral injuries. In multivariable analysis, cervical paraoesophageal lymph node dissection and conventional thoracoscopic-assisted esophagectomy were demonstrated to be independent risk factors associated with non-recovery of vocal cord paralysis. CONCLUSIONS: After intensive endoscopic follow-up, a cumulative vocal cord paralysis recovery rate of 65.4% within 7 months was observed in patients after minimally invasive McKeown esophagectomy. Cervical paraoesophageal lymph node dissection and conventional thoracoscopic-assisted esophagectomy were demonstrated to be risk factors hindering vocal cord paralysis recovery.
Asunto(s)
Neoplasias Esofágicas , Esofagectomía , Complicaciones Posoperatorias , Recuperación de la Función , Traumatismos del Nervio Laríngeo Recurrente , Parálisis de los Pliegues Vocales , Humanos , Esofagectomía/efectos adversos , Esofagectomía/métodos , Parálisis de los Pliegues Vocales/etiología , Parálisis de los Pliegues Vocales/epidemiología , Masculino , Femenino , Persona de Mediana Edad , Neoplasias Esofágicas/cirugía , Factores de Riesgo , Anciano , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/epidemiología , Traumatismos del Nervio Laríngeo Recurrente/etiología , Traumatismos del Nervio Laríngeo Recurrente/prevención & control , Traumatismos del Nervio Laríngeo Recurrente/epidemiología , Carcinoma de Células Escamosas de Esófago/cirugía , Estudios Retrospectivos , Procedimientos Quirúrgicos Mínimamente Invasivos/efectos adversos , Procedimientos Quirúrgicos Mínimamente Invasivos/métodos , Adulto , Resultado del Tratamiento , Escisión del Ganglio Linfático/efectos adversosRESUMEN
Unilateral vocal cord paralysis is frequently observed in patients who undergo thyroid surgery. This study explored the correlation between acoustic voice analysis (objective measure) and Voice Handicap Index (VHI, a self-assessment tool). One hundred and forty patients who had thyroid surgery with or without postoperative unilateral vocal cord paralysis (PVCP and NPVCP) were included. The patients were evaluated by the VHI and Dysphonia Severity Index (DSI) tools. VHI scores were significantly higher in PVCP patients than in NPVCP patients. Jitter (%) and shimmer (%) were significantly increased, whereas DSI was significantly decreased in PVCP patients. Receiver operating characteristics curve revealed that VHI scores were associated with the diagnosis of PVCP, of which VHI total score yielded an area under the curve (AUC) of 0.81. Among acoustic parameters, DSI was highly associated to PVCP (AUC=0.82, 95%CI=0.75 to 0.89). Moreover, we found a correlation between VHI scores and voice acoustic parameters. Among them, DSI had a moderate correlation with functional and VHI scores, as suggested by an R value of 0.41 and 0.49, respectively. VHI scores and acoustic parameters were associated with the diagnosis of PVCP.
Asunto(s)
Índice de Severidad de la Enfermedad , Tiroidectomía , Parálisis de los Pliegues Vocales , Calidad de la Voz , Humanos , Parálisis de los Pliegues Vocales/etiología , Parálisis de los Pliegues Vocales/fisiopatología , Parálisis de los Pliegues Vocales/diagnóstico , Masculino , Femenino , Persona de Mediana Edad , Adulto , Tiroidectomía/efectos adversos , Complicaciones Posoperatorias/diagnóstico , Acústica del Lenguaje , Anciano , Curva ROC , Evaluación de la Discapacidad , Disfonía/etiología , Disfonía/diagnóstico , Disfonía/fisiopatologíaRESUMEN
PURPOSE: The anatomical variations of the recurrent laryngeal nerve (RLN) are common during thyroidectomy. We aimed to evaluate the risk of RLN paralysis in case of its anatomical variations, retrospectively. METHODS: The patients with primary thyroidectomy between January 2016 and December 2019 were enrolled. The effect of age, gender, surgical intervention, neuromonitorisation type, central neck dissection, postoperative diagnosis, neck side, extralaryngeal branching, non-RLN, relation of RLN to inferior thyroid artery (ITA), grade of Zuckerkandl tubercle on vocal cord paralysis (VCP) were investigated. RESULTS: This study enrolled 1070 neck sides. The extralaryngeal branching rate was 35.5%. 45.9% of RLNs were anterior and 44.5% were posterior to the ITA, and 9.6% were crossing between the branches of the ITA. The rate of total VCP was 4.8% (transient:4.5%, permanent: 0.3%). The rates of total and transient VCP were significantly higher in extralaryngeal branching nerves compared to nonbranching nerves (6.8% vs. 3.6%, p = 0.018; 6.8% vs. 3.2%, p = 0.006, respectively). Total VCP rates were 7.2%, 2.5%, and 2.9% in case of the RLN crossing anterior, posterior and between the branches of ITA, respectively (p = 0.003). The difference was also significant regarding the transient VCP rates (p = 0.004). Anterior crossing pattern increased the total and transient VCP rates 2.8 and 2.9 times, respectively. CONCLUSION: RLN crossing ITA anteriorly and RLN branching are frequent anatomical variations increasing the risk of VCP in thyroidectomy that cannot be predicted preoperatively. This study is the first one reporting that the relationship between RLN and ITA increased the risk of VCP.
Asunto(s)
Nervio Laríngeo Recurrente , Glándula Tiroides , Tiroidectomía , Parálisis de los Pliegues Vocales , Humanos , Tiroidectomía/efectos adversos , Femenino , Masculino , Parálisis de los Pliegues Vocales/etiología , Parálisis de los Pliegues Vocales/epidemiología , Persona de Mediana Edad , Estudios Retrospectivos , Adulto , Glándula Tiroides/irrigación sanguínea , Glándula Tiroides/cirugía , Glándula Tiroides/inervación , Anciano , Traumatismos del Nervio Laríngeo Recurrente/etiología , Factores de Riesgo , Adulto Joven , Complicaciones Posoperatorias/etiología , Complicaciones Posoperatorias/epidemiología , AdolescenteRESUMEN
A wide variety of treatments have been developed to improve respiratory function and quality of life in patients with bilateral vocal fold paresis (BVFP). One experimental method is the electrical activation of the posterior cricoarytenoid (PCA) muscle with a laryngeal pacemaker (LP) to open the vocal folds. We used an ovine (sheep) model of unilateral VFP to study the long-term effects of functional electrical stimulation on the PCA muscles. The left recurrent laryngeal nerve was cryo-damaged in all animals and an LP was implanted except for the controls. After a reinnervation phase of six months, animals were pooled into groups that received either no treatment, implantation of an LP only, or implantation of an LP and six months of stimulation with different duty cycles. Automated image analysis of fluorescently stained PCA cross-sections was performed to assess relevant muscle characteristics. We observed a fast-to-slow fibre type shift in response to nerve damage and stimulation, but no complete conversion to a slow-twitch-muscle. Fibre size, proportion of hybrid fibres, and intramuscular collagen content were not substantially altered by the stimulation. These results demonstrate that 30 Hz burst stimulation with duty cycles of 40% and 70% did not induce PCA atrophy or fibrosis. Thus, long-term stimulation with an LP is a promising approach for treating BVFP in humans without compromising muscle conditions.
Asunto(s)
Modelos Animales de Enfermedad , Terapia por Estimulación Eléctrica , Músculos Laríngeos , Parálisis de los Pliegues Vocales , Animales , Ovinos , Parálisis de los Pliegues Vocales/terapia , Parálisis de los Pliegues Vocales/fisiopatología , Terapia por Estimulación Eléctrica/métodos , Músculos Laríngeos/fisiopatología , Humanos , Marcapaso Artificial/efectos adversos , Pliegues Vocales/fisiopatología , Pliegues Vocales/patología , FemeninoRESUMEN
Endoscopic posterior cricoid split and costal rib graft placement (EPCSCG) is an important tool in enlarging the glottic and subglottic airway, both of which can be disproportionally affected in the small airways of neonates and early infants. We present a series of 8 patients under the age of one who successfully underwent EPCSCG, with 7/8 patients avoiding tracheostomy entirely. Of these patients, the indication for EPCSCG was isolated bilateral vocal fold immobility (6/8), bilateral vocal fold immobility with subglottic stenosis (1/8), and isolated subglottic stenosis (1/8). EPCSCG can be safely applied to select patients less than one year of age.
Asunto(s)
Cartílago Costal , Cartílago Cricoides , Laringoestenosis , Humanos , Cartílago Cricoides/cirugía , Masculino , Lactante , Cartílago Costal/trasplante , Femenino , Laringoestenosis/cirugía , Recién Nacido , Parálisis de los Pliegues Vocales/cirugía , Resultado del Tratamiento , Endoscopía/métodos , Laringoscopía/métodos , Estudios Retrospectivos , Costillas/trasplante , Costillas/cirugíaRESUMEN
OBJECTIVE: To perform laryngeal framework surgery for unilateral vocal fold paralysis and obtain favorable voice improvement, it is necessary to accurately determine the vocal fold and arytenoid cartilage positions. Thus, the position and angle of the paralyzed vocal folds and arytenoid cartilage projected onto the affected thyroid plate were measured using computed tomography (CT) before and after surgery. METHODS: Forty-six male patients with thyroid cartilage ossification observed on preoperative CT and vocal fold paralysis were included. Using Adobe Illustrator®, the thyroid plate on the affected side was reconstructed from the continuous images of the sagittal section of the CT examination during participant's quiet breathing (reconstructed affected thyroid plate [RATP]). RESULTS: The anterior commissure mean position was slightly cranial to the midpoint of the thyroid cartilage midline. The paralyzed vocal fold angle was not parallel to the baseline. The average unaffected vocal fold angle during vocalization projected onto the affected thyroid plate was 13.83°, which differed significantly from the average paralyzed vocal fold angle before surgery (19.05°). However, no significant difference was observed in comparison with the average angle of the paralyzed vocal fold after arytenoid adduction. The average distance from the inferior notch of the affected side thyroid cartilage to the affected arytenoid cartilage was 16.7 mm. CONCLUSION: By understanding the positional relationship between the thyroid cartilage plate and internal structure from preoperative CT images, more effective surgery can be performed according to individual differences. LEVEL OF EVIDENCE: IV Laryngoscope, 134:4088-4094, 2024.
Asunto(s)
Cartílago Tiroides , Tomografía Computarizada por Rayos X , Parálisis de los Pliegues Vocales , Pliegues Vocales , Humanos , Masculino , Cartílago Tiroides/diagnóstico por imagen , Cartílago Tiroides/cirugía , Parálisis de los Pliegues Vocales/cirugía , Parálisis de los Pliegues Vocales/diagnóstico por imagen , Parálisis de los Pliegues Vocales/fisiopatología , Pliegues Vocales/diagnóstico por imagen , Pliegues Vocales/cirugía , Pliegues Vocales/fisiopatología , Persona de Mediana Edad , Adulto , Anciano , Cartílago Aritenoides/cirugía , Cartílago Aritenoides/diagnóstico por imagenRESUMEN
OBJECTIVE: Laryngeal framework surgery is a widely accepted treatment for unilateral vocal fold paralysis with good functional outcomes. Recently, with the aging of the population, opportunities to perform this procedure in elderly patients have increased; however, the safety and efficacy of this procedure in elderly patients has not been established. Therefore, this study aimed to investigate the safety and functional outcomes of laryngeal framework surgery in elderly patients. METHODS: Between January 2008 and December 2017, 97 patients with unilateral vocal fold paralysis underwent laryngeal framework surgery, and 71 among them completed pre- and post-operative voice function evaluations. The clinical course of these 71 patients were retrospectively reviewed. RESULTS: Out of 71 patients, 35 were assigned to the younger group (< 65 years) and 36 to the elderly group (≥ 65 years). Complications included post-operative edema and submucosal hematoma that were safely managed in all cases, and no differences were identified between the groups. Significant improvements were observed in maximum phonation time (MPT), mean flow rate, alternating current/direct current ratio, pitch perturbation quotient, amplitude perturbation quotient, and noise-to-harmonic ratio in both groups, and multivariate analysis of variance revealed greater improvement in the younger group in MPT. CONCLUSION: Laryngeal framework surgeries for unilateral vocal fold paralysis are safe and effective, regardless of age. Better improvement was observed in the younger group in the MPT suggesting that the effects of laryngeal framework surgeries is more likely to be present in the younger group than in the elderly.