1/30. Clinical course of acute laryngeal trauma and associated effects on phonation.We report the clinical course of blunt laryngeal trauma in three young patients. All three patients underwent several phoniatric examinations as well as indirect microlaryngoscopy and microstroboscopy. The follow-up period ranged from three to eight months. In the first case, there was isolated haemorrhage of the left vocal fold; in the second, dislocation of the arytenoid cartilage with formation of an adhesion in the area of the anterior commissure; and, in the third, non-dislocated fracture of the thyroid cartilage with development of haematoma in the right hemilarynx and transient vocal fold paralysis. One patient required surgical treatment; however, repositioning of the arytenoid cartilage, attempted seven weeks following the injury, proved unsuccessful. In conclusion, all three patients showed significant limitation of vocal fold vibration many months after trauma which was unrelated to the extent of resulting tissue damage. In all three cases, patients developed secondary posttraumatic functional dysphonia requiring treatment.- - - - - - - - - - ranking = 1keywords = larynx (Clic here for more details about this article) |
2/30. Laryngeal scleroma.Respiratory scleroma is a chronic, progressive granulomatous disease of the respiratory tract. The causal organism is the klebsiella rhinoscleromatis. The disease has three stages: the initial catarrhal stage, granulomatous stage, and sclerotic stage. The object of this report was to determine the clinical behaviour of the laryngeal scleroma. The study included 17 patients with this manifestation characterized by airway obstruction and dysphonia. The report revealed that respiratory scleroma affected the larynx in 40%, and the principal findings were glottic/subglottic stenosis.- - - - - - - - - - ranking = 1keywords = larynx (Clic here for more details about this article) |
3/30. Late complication of type 1 thyroplasty: a case report.We present a previously unreported late complication of medialization laryngoplasty (ML), also described as a thyroplasty, type 1. Five years following ML with Silastic, a 64-year-old female presented with dysphonia and a mass in the laryngeal ventricle on the ipsilateral side of the ML. A computed tomography scan of the larynx revealed migration of the thyroid cartilage window into the ventricle without migration of the Silastic implant. These findings were confirmed on surgical exploration. Following removal of the Silastic implant and the thyroid cartilage window fragment, the patient was successfully remedialized with autologous lipoinjection. Migration of the thyroid cartilage window appears to be a late complication of ML when the thyroid cartilage window is left intact and not removed. Complications of ML are discussed; specifically, difficulties resulting from retention of the thyroid cartilage window at the time of the ML are addressed.- - - - - - - - - - ranking = 1keywords = larynx (Clic here for more details about this article) |
4/30. Giant cell tumor of the larynx.giant cell tumors are benign tumors generally found in the long bones. Very rarely, they can occur in the larynx and may present with dysphonia, dysphagia, or dyspnea. A case of giant cell tumor of the larynx was recently identified and successfully treated by a partial laryngectomy. A literature review has revealed 18 case reports of giant cell tumor of the larynx. All cases occurred in men. These 19 cases are reviewed, and follow-up data presented where available. There have been no reports of recurrence regardless of treatment, and an excellent prognosis can be expected when one encounters this unusual laryngeal neoplasm.- - - - - - - - - - ranking = 7keywords = larynx (Clic here for more details about this article) |
5/30. Tracheo-tracheal puncture for voice rehabilitation after laryngotracheal separation.For patients with intractable aspiration, laryngotracheal separation (LTS) may be the only means of protecting the airway. The LTS prevents pulmonary compromise caused by aspiration; however, airway separation from the larynx also prevents laryngeal phonation. This case report suggests a supplemental procedure to the LTS, which maintains airway protection yet allows for laryngeal communication.- - - - - - - - - - ranking = 1keywords = larynx (Clic here for more details about this article) |
6/30. Failed medialization laryngoplasty: management by revision surgery.OBJECTIVE: The purpose of this study was to evaluate the cause of immediate and late medialization laryngoplasty failures and to describe their management. methods: A retrospective analysis was performed in 20 patients who underwent revision surgery after failed medialization laryngoplasty. Analysis was based on preoperative spiral CT scan, preoperative and postoperative videostrobolaryngoscopy, and phonatory function measures. RESULTS: Three major types of failures were identified. The most common problem was arytenoid rotation with a persistent posterior glottic gap (11 of 20). Malposition or wrong size of the implants resulted in a lateralized vocal fold or false vocal fold medialization (6 of 20). Three patients had implants that were extruding. Late atrophy and bowing resulted in a glottal gap (2 of 20). One patient had fibrosis around the implant requiring removal. Spiral CT scan of the larynx located the implant precisely and showed the degree of arytenoid rotation. patients with arytenoid rotation and posterior gap had revision medialization combined with arytenoid adduction. Revision medialization was performed in 11 patients, arytenoid adduction in 12 patients, lipoinjection in 2 patients, and 4 implants were removed. The voice was improved in 15 patients. Improved voice was correlated with improved phonation time and reduced phonatory airflow rates. CONCLUSION: Immediate and late failures of medialization laryngoplasty are due to several possible causes. Revision surgery is feasible and highly successful. To select between the surgical alternatives work up should include preoperative analysis of vocal function, videostrobolaryngoscopic analysis, and spiral CT of the larynx.- - - - - - - - - - ranking = 2keywords = larynx (Clic here for more details about this article) |
7/30. Effects of testosterone replacement on a male professional singer.testosterone has been known to play an important role in the development of the postpubertal male voice for many centuries. In fact, the prevention of pubertal development of the voice by castrating young male singers was a well-known practice, especially in italy beginning in the sixteenth century. The "castrati" were well known for their clear, high-pitched voices. Because of the resulting small larynx and vocal folds, castrati apparently produced a distinctive resonance as well as the high pitch, which cannot be matched even by the counter tenors of today. Busy voice labs occasionally see males with sex hormone deficiencies secondary to chromosomal or gonadal problems. This is a presentation of an unusual patient who was a trained tenor singer and was found to have hypogonadism on a premarital health examination. Administration of replacement testosterone resulted in significant vocal register and voice quality changes.- - - - - - - - - - ranking = 1keywords = larynx (Clic here for more details about this article) |
8/30. Laryngopharyngeal dysfunction from the implant vagal nerve stimulator.OBJECTIVES/HYPOTHESIS: The objective of the study was to examine the side-effect profile of the vagal nerve stimulator. Vagal nerve stimulators have been used to treat intractable seizures in all age groups. They provide relief to the patient with a seizure disorder by decreasing the overall number and severity of seizure activities. Although significant complications are rare, many patients have some complaint, usually of their voice. STUDY DESIGN: A retrospective evaluation of four patients with intractable epilepsy. methods: Evaluation of charts and medical records and endoscopic examination of the larynx. RESULTS: In this small series, all four patients had implantation-related paresis. Three of the four appear to have side effects from device activation. CONCLUSIONS: patients in whom a vagal nerve stimulator is placed can have adverse side effects. These can be related to the surgical manipulation of the vagus nerve, resulting in a temporary paresis of the vocal folds. A second set of side effects is related to the actual electrical stimulation of the device, and these side effects can directly affect the laryngeal musculature.- - - - - - - - - - ranking = 1keywords = larynx (Clic here for more details about this article) |
9/30. Rosai-Dorfman disease revealed in the upper airway: a case report and review of the literature.Rosai-Dorfman disease (RDD) is a systemic disease and its etiology is not well understood. It is a very rare but established disease. We report a case of RDD diagnosed in the upper airway that became a life-threatening condition because of the stricture of the subglottic space. A 49-year-old female complained of nasal obstruction, hoarseness and lacrimation. After evaluation following by fiberscopic examination and CT scanning of the head and neck, sinusitis and laryngeal masses were detected. Endoscopic sinus surgery and endolaryngeal microsurgery were performed simultaneously. The masses in the nasal cavity and larynx showed the same histological findings. Proliferative large histiocytes with voluminous clear cytoplasm and rounded nuclei, and lymphophagocytosis known as emperipolesis are the characteristic features of RDD. In this case, extranodal manifestations in the subglottic space gradually emerged postoperatively. tracheotomy was performed to ensure an airway and prevent suffocation. An extensive treatment is not required in most patients with RDD, however, some patients who have extranodal manifestations involving the airway may detoriorate into a life-threatening condition.- - - - - - - - - - ranking = 1keywords = larynx (Clic here for more details about this article) |
10/30. Cricoid chondrosarcoma presenting as arytenoid hypertelorism.BACKGROUND: Arytenoid hypertelorism (arytenoid cartilages spaced too widely apart) appears to be the most common initial recognizable physical finding of cricoid chondrosarcoma. Nine cases from the Center for voice disorders are presented. With arytenoid hypertelorism caused by cricoid chondrosarcoma, usually the posterior larynx is open. In fact, patients with arytenoid hypertelorism caused by cricoid chondrosarcoma may be aphonic even though the anterior membranous vocal folds make contact during attempted phonation. methods: Between 1991 and 2002, nine patients were diagnosed with cricoid chondrosarcoma. patients' charts and video examinations were retrospectively evaluated for symptoms and the presence of arytenoid hypertelorism on endoscopic evaluation. Two were women, and seven were men, with a mean age of 70 (range 53-72) years at diagnosis. RESULTS: Eight (88%) patients had aphonia or dysphonia caused by arytenoid hypertelorism as their presenting symptom. Six were diagnosed after failed medialization laryngoplasty or other laryngeal rehabilitation surgery. All nine patients had a low-grade tumor. The initial treatment in eight patients was hemicricoidectomy, and one patient had a total laryngectomy. In four cases, a second procedure was needed 1 to 6 years later because of recurrence. Seven patients are alive without clinically significant disease; one is alive with moderate disease, and one has died from an unrelated cause. CONCLUSIONS: Severely dysphonic, elderly patients presenting with arytenoid hypertelorism of unknown cause should be evaluated by fiberoptic laryngoscopy and by computed tomography scan to rule out cricoid chondrosarcoma. Because these tumors behave so benignly, the authors recommend conservative surgery (unilateral hemicricoidectomy) as the diagnostic/treatment modality of choice.- - - - - - - - - - ranking = 1keywords = larynx (Clic here for more details about this article) |
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