Cases reported "Granuloma, Laryngeal"

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1/7. Lateral thyrotomy with strap muscle transposition for Teflon granuloma.

    Lateral thyrotomy and strap muscle transposition have been used independently before. However, the published literature does not record the coordinated use of both procedures in the treatment of Teflon granuloma. In this paper, we present a case of vocal fold paralysis that had been treated successfully by Teflon injection in 1999. Two years later, however, the patient developed a host of symptoms that included a husky voice, shortness of breath and suffocation, which indicated Teflon granuloma. He underwent surgery to excise the Teflon granuloma via a lateral thyrotomy. The affected paraglottic space was then reconstructed using strap muscle transposition. One year postoperatively, the glottis had closed completely on phonation, and the voice retained a moderate roughness due to a scarring change from the earlier Teflon reaction. The patient had no problems with aspiration or shortness of breath during speaking. Our experience indicates that a physician can remove the entire granuloma and create a smooth, straight vibratory surface with complete glottic closure during phonation by using a combination of lateral thyrotomy and strap muscle transposition.
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2/7. How I do it: miniplate reconstruction of the lateral thyroid lamina: one-stage restoration of voice after teflon granuloma resection.

    This case report describes a one-stage technique for long-term voice restoration and laryngeal reconstruction in the treatment of Teflon (Dupont, Wilmington, delaware) granuloma. A patient who presented with severe dysphonia underwent resection of a Teflon granuloma via a lateral laryngotomy. A pedicled strap muscle flap was used to reconstruct the paraglottic space. The muscle flap was positioned through the lateral laryngotomy with direct endoscopic visualization of the endolarynx to ensure correct vertical positioning and medialization of the vocal fold. The muscle flap was secured in this position with suture fixation. The trapdoor piece of cartilage that was elevated to create the window in the lateral thyroid lamina was repositioned over the pedicled muscle flap and reinforced with a titanium miniplate, which was secured to the remaining thyroid cartilage. The patient had excellent voice results and has not required revision or augmentation. Reinforcement of the lateral thyroid lamina using titanium miniplate fixation helps to stabilize the muscle pedicle flap and the position of the vocal fold, in this case resulting in good long-term voice results after a single-stage reconstruction.
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3/7. Laryngeal granuloma: a complication of prolonged endotracheal intubation.

    Laryngeal granuloma is an uncommon complication arising from irritation of the laryngeal structures. We present a case where bilateral laryngeal granulomas became clinically evident 3 mo after orthognathic surgery. The patient, a 19-yr-old female, developed acute dyspnea after experiencing gradual voice loss. Excision of the lesions under endotracheal general anesthesia led to an uneventful outcome. The causes, predisposing factors, diagnostic features, and treatment of laryngeal granuloma are reviewed.
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4/7. Submucosal cordectomy for laryngeal stenosis.

    Submucosal cordectomy, an old procedure first described for the treatment of bilateral abductor vocal cord paralysis, was used to relieve glottic or minimal subglottic stenosis in four patients. Three attained adequate airways with no further procedures; one required subsequent dilations for granulation tissue after which decannulation was successfully effected. Although airway restoration has been successful, the resultant voice has been poor, poorer than that usually achieved with arytenoidectomy. When cricoarytenoid scarring precludes arytenoidectomy and lateral vocal cord fixation, an adequate laryngeal lumen can be restored with submucosal cordectomy if sufficient laryngeal cartilage support remains.
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5/7. Treatment of vocal fold granuloma using botulinum toxin type A.

    Contact granuloma of the vocal folds has been associated with abnormal use of the voice, and acid reflux may exacerbate the inflammatory process. Treatments have included voice therapy and antireflux measures. Surgical excision is considered in patients who do not respond to medical management. Localized injections of botulinum toxin type A (BOTOX) have been effective in patients with disorders of muscular control in the head and neck. In this study, granulomas resolved in six patients who underwent injection of the affected vocal folds. Botulinum toxin type A is probably successful because it prevents forceful closure of the arytenoids during phonation and coughing. Localized injection of this neurotoxin is promising both as an initial treatment and as an alternative treatment in patients who do not respond to standard therapy or who are poor surgical candidates.
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6/7. Nonspecific laryngeal granuloma: a case study of a professional singer.

    A professional singer with laryngeal granuloma underwent surgery following failed response to conservative treatments. Two primary findings emerged. First, although a sizable lesion was present initially, presurgical voice measures were largely normal or superior. The exception was elevated phonatory effort during singing. Second, postsurgical voice functions were entirely normal or superior (including phonatory effort), despite demanding singing performances a few weeks following surgery. The results add to the limited corpus of quantitative, normative-referenced data on voice in patients with granulomas and are inconsistent with previous reports of voice abnormalities in such patients and poor functional response to surgery.
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7/7. Excision and low-dose radiotherapy for refractory laryngeal granuloma.

    Laryngeal granulomas are uncommon lesions of an inflammatory origin. They are conventionally managed by simple excision with the occasional use of adjuvant treatment depending on the aetiological factors. Unfortunately, recurrences can occur, requiring repeated excision. Some lesions are refractory to this approach and alternative management approaches include excision and immediate adjuvant radiotherapy. The use of radiotherapy in the management of benign disease can be limited by the risk of induction of late malignancy and informed consent of a patient must include an assessment of this risk. We describe a case of refractory laryngeal granuloma successfully treated by excision and immediate radiotherapy in a patient occupationally dependent upon his voice.
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