Place of Partial Arytenoidectomy in the Management of Bilateral Vocal Cord Immobilitis

Surgical management of laryngeal paralysis varies depending on whether the vocal cords are in abduction, adduction or paramedian position. Various surgical techniques have been described including partial arytenoidectomy which is reported to give good surgical results that are stable over time. The objective of the study was to analyze the surgical therapeutic elements of bilateral paralysis, especially to assess partial arytenoidectomy, one of the most performed techniques. This was a descriptive retrospective study of cases of bilateral immobility admitted between January 1st 2008 and March 31st 2018 and treated surgically. Socio-demographic and therapeutic data were collected. The survey involved 46 patients, with an equal number of male and female (23) with 50% of male patients and 23 patients were female, or a sex ratio of 1. The average age of the patients was 56 ± 17 years ranging between 14 and 89 years. Posterior partial arytenoidectomy was the most widely performed surgical technique (26 patients or 56.5%), followed by cordopexia or lateral-fixing of a vocal cord (19.6%) and posterior cordectomy (17.4%). Patients who received a partial arytenoidectomy and cordopexia had their vocal cords either in adduction or in the paramedian position. Those who received a posterior cordectomy had their vocal cords in adduction. 18 patients (39.13%) were taken to the operating theatre in less than 6 hours, 28 (60.9%) had no post-operative complications, and 9 patients received a surgical enlargement resumption. In post-operative follow-up, 11 patients suffered pulmonary aspiration corrected after speech therapy;26 patients (56.5%) did not. Partial arytenoidectomy remains the most performed surgical procedure in the management of closed bilateral laryngeal paralysis at the Mont-Godinne University Hospital. It allows a reliable and durable breathing function over time with less impact on the voice.

Psychosocial Experience in Goiter Patients

Introduction: Goiter often poses aesthetic disgrace problem. The psychosocial impacts of goiter, in particular in woman may be significant. Objective: studying the psychological and social impacts of the disease in goiter patients within the African context and their consequences on the treatment. Methods: It was a transversal study that took place from May 1to July 31, 2011 in the Collines and Donga departments situated in the center and the north of Benin. The study consisted of a survey conducted through an individual discussion based on questionnaire submitted to goiter patients who accepted to provide their answers. Results: This survey involved 86 patients of which 83 women and 3 men. Their average age was 43.7 ± 13.41. Goiter was noticeable in the totality of the patients. 68.6% of patients declared that they experienced on daily basis the shame caused by the disease. 66% thought that it was a natural disease;however, 27.9% believed that it was caused by bewitchment or sorcery. 46.5% and 37.2% resorted to modern and indigenous medicine respectively;16.3% made no therapeutic move. Despite the psychosocial impacts of the disease, 50% of the patients rejected surgical intervention possibility. The core motives they raised were lack of financial means (34.8%), disease recurrence fright (23.3%), anesthesia fright (16.3%), and surgical fright (14%). Conclusion: Despite the psychological impacts of the disease, strong resistance exists probably more on cultural aspect than the motives mentioned by thyroidectomy patients.