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.

Diagnosis of Vocal Cord Paralysis in Anaesthesia

Vocal cord paralysis can occur as a complication o surgery or anaesthesia,if permanent is a significant clinica problem.Early detection is important to optimize the chance o repair,and avoid complications associated with an impaired swallow.An algorithm to detect altered vocal cord function was presented based on wavelet packet analysis(WPA) and suppor vector machines(SVM),and compared with the Hoarseness Diagram method(HDm),which was reported as an objective voice quality evaluation approach and could be used for pathological voice discrimination.Experiments using voice signals recorded from subjects before and after the procedure show high classification accuracy with the new algorithm,whereas HDm fails in the detection of a hoarse voice.This finding would help to develop a screening tool to detect the vocal structure damage during surgery.

Formation of granulation tissue on bilateral vocal cords after doublelumen endotracheal intubation:A case report

BACKGROUND Most case reports on laryngeal granuloma formation have described patients after tracheotomy and single-lumen endotracheal intubation.Few studies have investigated vocal cord granuloma formation after double-lumen endotracheal(DLT)intubation.CASE SUMMARY We report granulation tissue formation on the bilateral vocal cords after DLT intubation in a 45-year-old,153-cm-tall female patient.Previous imaging reports showed no formation of vocal cord granuloma before DLT intubation.Therefore,we inferred that DLT intubation may have been the main reason for the postoperative granulation tissue formation on her bilateral vocal cords,based on the patient’s history of DLT intubation,persistent hoarseness after thoracic surgery,and fibrolaryngoscopic and pathological reports during 12 mo follow-up.CONCLUSION Thirty-two Fr DLT tubes should be utilized for thoracic surgery on female patients who are shorter than 153 cm in height.

Vocal Cord Paralysis Secondary to Carotid Artery Dissection: A Case Report

Background and Objective: Vocal cord paralysis results in impairment of breathing and/or speech. One of the causes of vocal cord paralysis is the disruption of vagus nerve innervation to the vocal cords by the mass effect of a neighbouring structure. We report a rare case of vocal cord paralysis secondary to internal carotid artery dissection. Method: The diagnosis was based on clinical history, physical examination and imaging studies. Literature review was done. Case Report: This was a 53-year-old female with a history of unremitting, progressive hoarseness and mild dysphagia to liquid, who was clinically found to have impaired left vocal cord mobility, a left-sided pulsatile neck mass and left carotid artery dissection based on imaging studies. Symptoms abated after conservative treatment with Aspirin and she has remained symptom free since two years of follow-up. Conclusion: Vocal cord paralysis can be a consequence of carotid artery dissection causing mass effect on the vagus nerve. Thus, carotid artery dissection should not be forgotten as a possible cause of vocal cord paralysis in some cases of vocal cord paralysis of uncertain etiology. Treatment with anti-platelet drug can bring about resolution of symptoms and return of vocal cord mobility.

Glottographic study and clinical application of sustained vibration of vocal cords

This paper deals about a quantitative and qualitative study of the sustained vibration pat-terns of vocal cords with a mulfifunctional glottograph developed by the authors.The glottogramsand their parameters for the modal,falsetto,breathy and pressed voices are presented.This paper al-so sets out to explore the influence of the changes in the properties of the vocal tract andfundamental frequency,on vocal cord vibration.Typical clinical results show that the glottographicmethod may be used in the diagnosis and treatment of laryngeal diseases,phonation physiology andevaluation of artistic voice.

Hoarseness Due to Right Vocal Cord Paralysis Associated with Aortic Diverticulum from Right Aortic Arch—A Rare and Unusual Vascular Etiology of Right Vocal Cord Paralysis

Right vocal cord paralysis in our present case was diagnosed on clinical and radiological examination which is precipitated by an anomalous right aortic arch with diverticulum. This is a very uncommon vascular etiology of hoarseness and is extremely rare. Because of this rarity, the practicing otolaryngologist may miss this finding while evaluating a case of idiopathic right vocal cord paralysis. Thus, the authors feel that idiopathic or unexplained right vocal cord paralysis should be routinely investigated with a CT or MRI of neck and chest with or without contrast to avoid such shortcomings. There is only one such case of right vocal cord paralysis by right aortic which has been reported earlier in literature.

LASER SCANNING CYTOMETRIC DNA ANALYSES AND EXPRE- SSION OF P53 PROTEIN,KI67 AND BCL-X IN EARLY AND ADVANCED CARCINOMAS OF THE VOCAL CORD

Objective To study DNA ploidy and genetic changes in the different stages of neoplastic growth in the vocal cord, as well as their biological behavior, for further recognition of the lesions of carcinoma in situ and early carcinoma. Methods 18 tumor lesions of the vocal cord were DNA analyzed by laser scanning cytometry and followed up, and 62 lesions were immunohistochemically investigated for p53, Ki67 and Bcl-X, and with main observation on carcinomas in situ (CISs) and early microinvasive carcinomas (EMICs) which were compared with invasive carcinomas and polyps. Results DNA analysis showed that almost all the CISs and EMICs were diploidy, while 90% invasive carcinomas were aneuploidy. Follow-up data displayed that no one died of the tumor in CIS and EMIC, as well as in the patients with diploidy tumor, and all the patients died of the tumors were with anueploidy tumor. Immunohistochemically, 86% of CIS and EMIC and 91% of invasive carcinoma expressed p53 protein, and the positivities for Ki67 in them were respectively 29% and 27%, which were very significantly different from those of polyps of the vocal cord(P<0.001). In contrast, expression of Bcl-X were decreasing from benign to malignant lesions, and it was lowest in the invasive carcinomas, significantly different from that of polyp(P=0.002). Conclusion The present study showed that there were differences of DNA ploidy and genetic expressions among benign lesions, CISs and EMICs, and invasive carcinomas of the vocal cord, indicating that they might be different in biological entities. CIS of the vocal cord could be considered as a borderline lesion, and is better to receive conservative treatment. Moreover, p53 protein determination combined with Ki67 would be helpful in diagnosis of the carcinomas of the vocal cord.

Clinical classification and treatment of leukokeratosis of the vocal cords

Background Leukokeratosis of the vocal cords is a clinical descriptive diagnosis, which includes a group of squamous intraepithelial lesions of the vocal cord mucosa. We investigated the clinical classification and treatment efficacy of leukokeratosis of the vocal cords. Methods We conducted a retrospective analysis of the medical history, laryngoscopic examinations, morphological features under a surgical microscope, and pathology results of 360 cases of leukokeratosis of the vocal cords to examine correlations among treatment modalities, therapeutic effects, and clinical features. Results All cases were divided into four types based on symptoms, examination results, and treatment efficacies as follows： 21 patients had type I inflammatory leukoplakia and their vocal cord morphology and voice quality recovered after conservative therapies; 76 patients had type II frictional polyps and received CO2 laser submucosal cordectomy; 68 patients had type III sulcus vocalis and received mucosal slicing with dredging; and 195 cases had type IV simple leukokeratosis and received partial subligamental cordectomy with CO2 lasers or transmuscular cordectomy. Our treatment achieved a surgical cure rate of 90.9% （308/339）, with a recurrence rate of 9.1% （31/339） and malignant transformation rate of 6.5% （22/339）. All cancerous transformations occurred in type IV patients. Conclusion Choosing conservative or C02 laser surgery based on the morphological characteristics of squamous epithelial lesions of keratinized vocal cord mucosa can maximally protect voice quality, reduce complications, and improve the cure rate.

Vocal cord mucosal flap for the treatment of acquired anterior laryngeal web

Background Anterior glottic web is one type of laryngeal stenosis.Previous surgical methods had some drawbacks,such as large surgical trauma,long postoperative recovery time,and multiple-stage surgery.This study aimed to explore better treatment to repair anterior glottis web.Methods We performed vocal cord mucosal flap procedure on 32 patients with anterior laryngeal webs.All subjects received vocal cord scar releasing and vocal cord mucosal flap repair and suture under general anesthesia with selfretaining laryngoscope.Results All 32 patients completed surgery in one stage,without postoperative laryngeal edema,difficulty in breathing,or other complications.After the surgery,the anterior commissure of vocal cords recovered to a decent triangle shape in 28 patients; however,in four patients there were 2 to 3 mm adhesion residuals on the anterior ends of the vocal cords,accompanied by scar appearance of bilateral vocal cords.The GRB score,voice handicap index scores,and maximum phonation time score significantly improved in all patients after the surgery.There was no evidence of recurrent laryngeal webbing in the 6-rnonth follow-up.Conclusion Vocal cords mucosal flap repair surgery has the advantages of less trauma,quick recovery,and significant improvement of the voice in the treatment of laryngeal webs.

Giant cell angiofibroma in the vocal cord

Giant cell angiofibroma （GCA） was first described in 1995, and it is a rare tumor in soft tissues,1 Since the initial report of the disease in orbital tissue, GCA has been reported in a variety of other soft tissues.2,3 The morphological hallmark is richly vascularized, patternless spindle cell proliferation in the presence of pseudovascular spaces and multinucleated giant cells. The pathological diagnosis of GCA is mainly based on positive staining of CD34. GCA is usually considered to be a benign tumor. In clinic, GCA needs to be distinguished from other tumors in soft tissues. Herein,we report two rare cases of GCA in the vocal cord and describe its histological features.

Nursing of patients with vocal cord movement disorder after aortic dissection surgery

Background Vocal cord movement disorder （VCMD） is a laryngeal disorder characterized by paradoxical adduction of the vocal cords during in inspiration, expiration or both. The nursing experience of patients with VCMD after aortic dissection surgery is limited. Methods We retrospectively analyzed the clinical data and nursing records of 269 patients after aortic dissection surgery in Guangdong General Hospital between May 2010 and May 2012. We observed the patients＇ pronunciation, and judged if there was dysphagia undergoing water drinking test two hours after extubation, to confirm whether patients had VCMD. Results Seventeen patients had VCMD after aortic dissection surgery, of whom 2 suffered hoarseness, 3 had dysphasia and 12 had both hoarseness and dysphasia. After timely treatment and carefully nursing, all the patients recovered well. Conclusions With the enhanced care of patients with aortic dissection, observing hoarseness appearance and drinking experiment immediately after extubation can detect VCMD as soon as possible. Further rehabilita- tion training and psychology care can prevent bucking and aspiration effectively, and promoting recovery and improving patient＇s life quality.

Research on hoarse speech based on vocal cord model and glottal waveform

Considering the fact that hoarse speech is usually caused by pathological changes of vocal cords, and its motion state is reflected by glottal waveform, we present a new method of research on hoarse speech based on dissymmetric four-mass model of vocal cords and glottal wave analysis-synthesis ill this paper. By linking hoarse speech waveform with glottal wave and the vocal cord model, the characteristic parameters of normal speech and hoarse speech before and after laryngeal operation are studied. The parameters of glottal wave periodicity and vocal cord symmetry of hoarse speech are compared with those of normal speech. It is applied to analyzing the relations between model parameters and hoarse mechanism in pathology and physiology. Experimental results show that this new method can unveil the relations between acoustic features and pathological causes of hoarse speech, providing theoretical and experimental bases both for diagnosing laryngeal diseases non-contactly and for improving the tone quality of hoarse speech.

儿童声带颗粒细胞瘤2例临床特征分析

目的:分析儿童声带颗粒细胞瘤(GCT)的临床特征。方法:回顾性分析2013年1月至2023年12月西安交通大学第二附属医院收治的2例儿童声带GCT患者的临床资料。结果:病例1,女,6岁,因“发声无力3月余”入院,喉镜提示声门下弥漫性膨隆,颈部增强CT提示前联合下方低密度结节并渐进性强化;患儿在全麻下行支撑喉镜CO_(2)激光切除术,术后病理确诊GCT;术后1个月至术后2年复查,肿物无复发,术区局部瘢痕形成,但无明显黏连,声门闭合可。病例2,女,11岁,因“声嘶半年余”入院,喉镜提示前联合光滑肿物,颈部增强CT及喉部增强MRI提示前联合强化结节;患儿在全麻下行支撑喉镜CO_(2)激光切除术,术后病理确诊GCT,术后2周至术后1年复查,肿物无复发,声门下瘢痕形成,声门闭合良好。结论:儿童声带GCT常表现为发音异常,需依靠病理确诊;手术切除为其主要治疗方法,术后应密切随访。

经颈超声检查评估咽喉部手术患者声带运动异常的价值

目的探讨经颈超声检查评估咽喉部手术患者声带运动异常的应用价值。方法选取2021年1月至2023年12月在海南省人民医院行甲状腺或咽喉部手术的49例患者纳入研究,所有患者术前及甲状腺患者术后均行喉镜及颈部超声检查声带运动情况,以喉镜评估声带运动为金标准,比较经颈超声与喉镜检查在评估声带运动方面有无差异。结果49例患者中行甲状腺肿瘤手术34例,术前超声检查显示声带区28例,超声与喉镜检查声带运动均正常。术后喉镜及超声检查均发现2例患者一侧声带固定,另喉镜提示1例患者一侧声带运动减弱,超声检查无阳性发现。喉部手术患者15例,均为喉癌;超声显示声带区结构的12例患者术前喉镜提示9例一侧声带固定,超声均正确诊断;另超声提示2例气道狭窄,声带运动减弱,因气道狭窄喉镜检查无法窥探至声带平面。将40例超声及喉镜均可显示声带区患者的声带运动情况进行比较,两者具有高度的一致性(Kappa值=0.826,P<0.001)。结论经颈超声检查作为一种非侵入式检查手段对部分患者声带运动情况的评估结果与喉镜检查结果具有高度的一致性,且简便易行,患者无需特殊准备,检查过程无痛苦,具有临床应用价值。

Multifaceted superoxide dismutase 1 expression in amyotrophic lateral sclerosis patients:a rare occurrence?

Amyotrophic lateral sclerosis(ALS)is a neuromuscular condition resulting from the progressive degeneration of motor neurons in the cortex,brainstem,and spinal cord.While the typical clinical phenotype of ALS involves both upper and lower motor neurons,human and animal studies over the years have highlighted the potential spread to other motor and non-motor regions,expanding the phenotype of ALS.Although superoxide dismutase 1(SOD1)mutations represent a minority of ALS cases,the SOD1 gene remains a milestone in ALS research as it represents the first genetic target for personalized therapies.Despite numerous single case reports or case series exhibiting extramotor symptoms in patients with ALS mutations in SOD1(SOD1-ALS),no studies have comprehensively explored the full spectrum of extramotor neurological manifestations in this subpopulation.In this narrative review,we analyze and discuss the available literature on extrapyramidal and non-motor features during SOD1-ALS.The multifaceted expression of SOD1 could deepen our understanding of the pathogenic mechanisms,pointing towards a multidisciplinary approach for affected patients in light of new therapeutic strategies for SOD1-ALS.

Pitfalls in internal jugular vein cannulation

Central venous catheter insertion in the internal jugular vein(IJV)is frequently performed in acute care settings,facilitated by its easy availability and increased use of ultrasound in healthcare settings.Despite the increased safety profile and insertion convenience,it has complications.Herein,we aim to inform readers about the existing literature on the plethora of complications with potentially disastrous consequences for patients undergoing IJV cannulation.

鼻内镜、显微镜配合支撑喉镜在声带息肉手术中的应用对比

目的:对比鼻内镜、显微镜配合支撑喉镜在声带息肉手术中的应用效果。方法:选取79例声带前息肉患者,根据术式不同分为A组和B组,对比2组手术相关指标差异。结果:A组手术时间长于B组(P<0.05),术中声带息肉完全暴露率高于B组(P<0.05);术后6个月,A组总有效率高于B组;B组手术无效者均为声带息肉显露困难者;2组总并发症发生率差异无统计学意义(P>0.05)。结论:采取鼻内镜配合支撑喉镜治疗声带息肉的手术时间较长,但在声带息肉暴露困难患者的效果较好。除此之外,两种术式可灵活选择。

Atypical presentation of a posterior fossa tumour:A case report

BACKGROUND We described a case of a patient with a meningioma in the posterior fossa presenting atypically with an isolated unilateral vocal cord palsy causing severe respiratory distress.This is of interest as the patient had no other symptomatology,especially given the size of the mass,which would typically cause a pressure effect leading to neurological and auditory symptoms.CASE SUMMARY This case report described a 48-year-old male who was married with two children and employed as a car guard.He had a medical history of asthma for the past 10 years controlled with an as-needed beta 2 agonist metered dose inhaler.He initially presented to our facility with severe respiratory distress.He reported a 1-wk history of shortness of breath and wheezing that was not relieved by his bronchodilator.He had no constitutional symptoms or impairment of hearing.On clinical examination,the patient’s chest was“silent.”Our initial assessment was status asthmaticus with type 2 respiratory failure,based on the history of asthma,a“silent chest,”and the arterial blood gas results.CONCLUSION A posterior fossa meningioma of such a large size and with extensive infiltration rarely presents with an isolated unilateral vocal cord palsy.The patient’s chief presenting feature was severe respiratory distress,which combined with his background medical history of asthma,was misleading.Clinicians should thus consider meningioma as a differential diagnosis for a unilateral vocal cord palsy even without audiology involvement.

Nasogastric tube syndrome:A Meta-summary of case reports

BACKGROUND Since its description in 1790 by Hunter,the nasogastric tube(NGT)is commonly used in any healthcare setting for alleviating gastrointestinal symptoms or enteral feeding.However,the risks associated with its placement are often underes-timated.Upper airway obstruction with a NGT is an uncommon but potentially life-threatening complication.NGT syndrome is characterized by the presence of an NGT,throat pain and vocal cord(VC)paralysis,usually bilateral.It is poten-tially life–threatening,and early diagnosis is the key to the prevention of fatal upper airway obstruction.However,fewer cases may have been reported than might have occurred,primarily due to the clinicians'unawareness.The lack of specific signs and symptoms and the inability to prove temporal relation with NGT insertion has made diagnosing the syndrome quite challenging.AIM To review and collate the data from the published case reports and case series to understand the possible risk factors,early warning signs and symptoms for timely detection to prevent the manifestation of the complete syndrome with life-threatening airway obstruction.METHODS We conducted a systematic search for this meta-summary from the database of PubMed,EMBASE,Reference Citation Analysis(https://www.referencecitation-analysis.com/)and Google scholar,from all the past studies till August 2023.The search terms included major MESH terms"Nasogastric tube","Intubation,Gastrointestinal","Vocal Cord Paralysis",and“Syndrome”.All the case reports and case series were evaluated,and the data were extracted for patient demographics,clinical symptomatology,diagnostic and therapeutic interventions,clinical course and outcomes.A datasheet for evaluation was further prepared.RESULTS Twenty-seven cases,from five case series and 13 case reports,of NGT syndrome were retrieved from our search.There was male predominance(17,62.96%),and age at presentation ranged from 28 to 86 years.Ten patients had diabetes mellitus(37.04%),and nine were hypertensive(33.33%).Only three(11.11%)patients were reported to be immunocompromised.The median time for developing symptoms after NGT insertion was 14.5 d(interquartile range 6.25-33.75 d).The most commonly reported reason for NGT insertion was acute stroke(10,37.01%)and the most commonly reported symptoms were stridor or wheezing 17(62.96%).In 77.78%of cases,bilateral VC were affected.The only treatment instituted in most patients(77.78%)was removing the NG tube.Most patients(62.96%)required tracheostomy for airway protection.But 8 of the 23 survivors recovered within five weeks and could be decannulated.Three patients were reported to have died.CONCLUSION NGT syndrome is an uncommon clinical complication of a very common clinical procedure.However,an under-reporting is possible because of misdiagnosis or lack of awareness among clinicians.Patients in early stages and with mild symptoms may be missed.Further,high variability in the presentation timing after NGT insertion makes diagnosis challenging.Early diagnosis and prompt removal of NGT may suffice in most patients,but a significant proportion of patients presenting with respiratory compromise may require tracheostomy for airway protection.

支撑喉镜联合鼻内镜切除术治疗声带息肉的效果分析

目的:探讨支撑喉镜联合鼻内镜切除术治疗声带息肉的效果。方法:选取2021年8月—2022年9月北华大学附属医院耳鼻喉科收治的80例声带息肉患者作为研究对象,以随机数字表法分为试验组与对照组,各40例。对照组采用全身麻醉支撑喉镜下声带息肉切除术治疗,试验组应用支撑喉镜联合鼻内镜切除术治疗。比较两组治疗效果、嗓音功能、并发症发生情况。结果:试验组治疗总有效率高于对照组,差异有统计学意义(P=0.025)。术前,两组标准化噪声能量(NNE)、振幅微扰(Shimmer)、基频微扰(Jitter)水平比较,差异无统计学意义(P>0.05);术后14 d,两组NNE、Shimmer、Jitter水平低于术前,且试验组低于对照组,差异有统计学意义(P<0.05)。试验组并发症总发生率低于对照组,差异有统计学意义(P=0.023)。结论:支撑喉镜联合鼻内镜切除术治疗声带息肉的效果显著,能够改善患者嗓音功能,减少术后并发症。