1/33. Pediatric vocal fold medialization with silastic implant: intraoperative airway management.Vocal fold immobility accounts for 10% of all congenital laryngeal abnormalities, second only to laryngomalacia. Acquired unilateral vocal fold immobility (UVFI) is generally due to surgical trauma. The problems associated with this condition include a breathy dysphonia, weak cough, and aspiration. Treatment involves observation, voice and swallowing therapy, and various surgical options. Medialization laryngoplasty with silastic implant (ML-s) is a very successful procedure with consistent results in the adult population. It is usually done under local anesthesia with sedation to allow the voice to be monitored during the procedure. The surgeon can then fashion a custom implant or use a specific prefabricated implant. Additionally, use of the flexible fiberoptic nasopharyngolaryngoscope (FFNPL) allows the surgeon to see the endolarynx during the procedure, thus avoiding overmedialization and airway obstruction. Children, however, do not tolerate such invasive procedures under local anesthesia and sedation, have much smaller airways and, therefore, present several problems when addressing this problem surgically. Management of the pediatric airway during ML-s can be achieved using a laryngeal mask airway (LMA) and the FFNPL. While this does not allow the voice to be assessed intraoperatively, appropriate medialization of the vocal fold can be judged via the FFNPL, and airway obstruction avoided. ML-s using the LMA and FFNPL was performed in two children aged 8 and 4 years old. Both had excellent voice results and no complications. The details of these cases are reported. The literature on treatment of UVFI in children is reviewed, and practical and theoretical issues discussed.- - - - - - - - - - ranking = 1keywords = voice (Clic here for more details about this article) |
2/33. Concurrent glottic and tracheal stenoses: restoration of airway continuity in end-stage malignant disease.Six patients known to have inoperable esophageal carcinoma presented with stridor due to both malignant tracheal stenosis (with additional respiratory-digestive tract fistula in 2 patients) and bilateral vocal cord paralysis. Patency was restored by endotracheal stenting plus unilateral cordotomy. Four patients had immediate relief. Two patients required enlargement of the vocal cord incision. One of them declined reoperation and underwent tracheostomy. The stent function was uneventful, with no dislodgment or mucus impaction. The fistula seal was complete, with no aspiration through the newly shaped glottic orifice. The peak expiratory flow increased from 24.4% /- 9.7% of predicted normal before the procedure to 40.5% /- 13.7% after the procedure. Restoration of airway continuity in serial laryngotracheal stenoses by a combined approach is a feasible technique in end-stage cancer patients. It effectively relieves respiratory distress and ensures voice preservation. In addition, it may avoid the risks of tracheotomy.- - - - - - - - - - ranking = 0.25keywords = voice (Clic here for more details about this article) |
3/33. Intratracheal thyroid.Ectopic thyroid tissue within the trachea (intratracheal or endotracheal tissue) is a rare cause of upper airway obstruction. The symptoms may be classical or, as in most cases in which the voice is not affected, the first sign may be a wheeze. This may result in the symptoms being mistaken for asthma. The presence of a submucosal upper tracheal mass is quite unusual. If one is familiar with the fact that thyroid tissue may occur in this location, then this diagnosis should be considered in patients with such symptoms, and the appropriate diagnostic studies and surgical management should be instituted. The present case report entailed a 56-year-old female who was admitted to the hospital after having been treated for a year in an outlying area. She had increasing shortness of breath and wheezing and had been treated several times for asthma. Indirect laryngoscopy revealed an upper tracheal submucosal mass which was confirmed by direct laryngoscopy and by tomography. Biopsies were taken confirming nodular ectopic thyroid tissue. The patient was operated on through a cervical incision and a tracheal flap was elevated in order to carry out a submucosal dissection of this mass. The patient has done well for more than a year following surgery, and histologically this lesion was benign in the thyroid tissue.- - - - - - - - - - ranking = 0.25keywords = voice (Clic here for more details about this article) |
4/33. A huge epiglottic cyst causing airway obstruction in an adult.An epiglottic cyst causing airway obstruction is rare in an adult. Early definitive diagnosis and management obviate an unnecessary tracheostomy. We report a case of a 64-year-old woman who arrived at our hospital with progressive stridor and foreign body sensation when swallowing for 6 weeks. A hot potato voice and biphasic stridor were remarkable upon physical examination. Indirect mirror and fibroscopic examination revealed a huge epiglottic cyst. The neck lateral X-ray and computed tomography scan demonstrated a huge cystic mass over the epiglottis. A 2.5 x 3.0 cm cystic mass was removed with endoscopic CO2 laser after needle decompression. The patient was discharged on the third day after surgery without complications. An epiglottic cyst in an adult seldom causes upper airway obstruction and is easily ignored by clinicians. We emphasize that complete airway evaluation including routine check-up of the larynx is mandatory for patients with intractable obstructive airway disease. Endoscopic laser surgery is effective in the surgical removal of an epiglottic cyst.- - - - - - - - - - ranking = 0.25keywords = voice (Clic here for more details about this article) |
5/33. Cricoarytenoid arthritis: a cause of acute upper airway obstruction in rheumatoid arthritis.PURPOSE: To report acute upper airway obstruction due to cricoarytenoid arthritis, a well known but uncommon complication of rheumatoid arthritis. CLINICAL FEATURES: We report the case of a 70-yr-old female scheduled for a colostomy who had been suffering from rheumatoid arthritis for 17 years. Preoperative history and physical examination revealed no cardiopulmonary compromise. anesthesia was induced while an assistant immobilized the cervical spine and an atraumatic intubation was performed. Surgery was uneventful. Muscle paralysis was reversed, demonstrated by normalization of the train-of-four response, and the patient was extubated awake. Shortly postextubation, the patient developed inspiratory stridor, which disappeared after a second dose of neostigmine. The patient was transported to the postanesthesia care unit. Just prior to arrival the patient once again developed inspiratory stridor, became distressed, and oxygen saturation decreased. Direct laryngoscopy followed by a nasal fibreoptic examination of the larynx was performed. Cricoarytenoid arthritis secondary to rheumatoid arthritis with airway compromise was diagnosed. An uneventful awake tracheostomy was performed. The patient was discharged on day ten with a colostomy and a tracheostomy in place. One month postdischarge the patient's trachea was decannulated. On follow-up, a normal voice and mobile cords were observed. CONCLUSION: Cricoarytenoid arthritis is an infrequent complication of rheumatoid arthritis. A thorough history and physical examination are necessary to recognize signs and symptoms of cricoarytenoid arthritis. Prompt recognition of airway obstruction due to cricoarytenoid arthritis is essential for appropriate management.- - - - - - - - - - ranking = 0.25keywords = voice (Clic here for more details about this article) |
6/33. The successful management of congenital laryngeal web with endoscopic lysis and topical mitomycin-C.Laryngeal web is a rare congenital anomaly. The primary goals of management for congenital laryngeal web are to provide a patent airway and to achieve a good voice quality. However, vocal cords have a tendency for fibrosis and granulation tissue formation after surgical interventions. Traditionally, the treatment of choice for laryngeal web is laryngofissure and placement of a stent or keel. This report presents the successful management of a congenital laryngeal web in a 10-month-old boy with endoscopic lysis and topical mitomycin-C application.- - - - - - - - - - ranking = 0.25keywords = voice (Clic here for more details about this article) |
7/33. Report of an obstructive goiter and its surgical treatment during delivery.We report a case of a morbidly obese young woman in her third trimester of pregnancy presenting with a history of goiter and respiratory disease. The recent history of this patient was significant for worsening respiratory symptoms over a period of 2 weeks, and, on presentation at 36 weeks gestation, she was stridorous, dyspneic at rest, and had a hoarse voice. Evaluation revealed a morbidly obese individual with a large goiter. She was biochemically euthyroid. Fiberoptic laryngoscopy revealed a left true vocal cord paresis, and ultrasound evaluation was significant for diffuse multinodular enlargement, with each lobe measuring greater than 10 cm and the isthmus measuring 5. Pulmonary function testing revealed a significant degree of upper airway obstruction without significant lower airway disease. Given the patient's clinical signs and symptoms, her tenuous airway, poor candidacy for urgent tracheotomy, and her proximity to delivery, it was agreed that the patient should undergo elective cesarean section and at its completion undergo subtotal thyroidectomy for the obstructive goiter.- - - - - - - - - - ranking = 0.25keywords = voice (Clic here for more details about this article) |
8/33. Laryngeal abscess after injection laryngoplasty with micronized AlloDerm.OBJECTIVE: patients with unilateral vocal cord paralysis usually present with dysphonia and occasionally with swallowing problems. Operative management includes thyroplasty type I, injection laryngoplasty, arytenoid adduction, and reinnervation. Recent publications have documented the safety of micronized AlloDerm (Cymetra, LifeCell Corporation, Branchburg, NJ) for injection laryngoplasty, but we report the first documented case of a laryngeal abscess after injection laryngoplasty with Cymetra. STUDY DESIGN: Single case report of a laryngeal abscess after injection laryngoplasty with Cymetra. methods: The patient's clinical course is presented and discussed, and the pertinent literature is reviewed. RESULTS: Prompt hospital admission with intravenous antibiotics and steroids resolved this airway emergency. Follow-up visits showed a significantly improved postoperative voice with an intact airway. CONCLUSION: A review of the literature reveals that this case of a laryngeal abscess after injection laryngoplasty with Cymetra is the first of its kind. Studies have shown that the use of AlloDerm in the head and neck region is safe, but otolaryngologists need to be cognizant of potential complications when working with this material.- - - - - - - - - - ranking = 0.25keywords = voice (Clic here for more details about this article) |
9/33. A Christmas tree in the larynx.A 2 year-old boy presented with acute upper airway obstruction following a 15-month history of noisy breathing and hoarseness. An urgent laryngotracheal bronchoscopy was performed following inhalational induction of anesthesia. Using a fiberoptic bronchoscope, visualization of the larynx through a laryngeal mask airway revealed a flat plastic Christmas tree embedded within granulomatous cords causing almost complete obstruction and requiring tracheostomy prior to extraction. Twelve days later, the tracheostomy was successfully decannulated with the child's voice beginning to normalize. The family remembered the decoration from Christmas celebrations 2 years prior and recalled a coughing episode that predated the onset of hoarseness.- - - - - - - - - - ranking = 0.25keywords = voice (Clic here for more details about this article) |
10/33. Choking, sore throat with referred otalgia and dysphagia in a patient with diffuse idiopathic skeletal hyperostosis (DISH).A patient with a progressively increasing immobilisation of the cervical spine, severe impaired swallowing (choking), sore throat with referred right-sided otalgia, mild voice disorder and dysphagia due to extrinsic bone compression of the posterior hypopharyngeal wall and oesophagus is presented. Radiographic investigation demonstrated the underlying condition to be a diffuse idiopathic skeletal hyperostosis with prominent and bumpy alteration of the anterior longitudinal ligament impinging the hypopharynx. Via an anterolateral approach towards the cervical spine the anterior irregular part of the ossification was removed and the surface of the spine flattened. The postoperative evolution was uneventful.- - - - - - - - - - ranking = 0.25keywords = voice (Clic here for more details about this article) |
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