DOCSLIB.ORG

New Aspects of Clinical Application of Endoscopic Arytenoid Abduction Lateropexy

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
New Aspects of Clinical Application of Endoscopic Arytenoid Abduction Lateropexy NEW ASPECTS OF CLINICAL APPLICATION OF ENDOSCOPIC ARYTENOID ABDUCTION LATEROPEXY PhD Thesis Ádám Bach M.D. Department of Oto-Rhino-Laryngology, Head and Neck Surgery University of Szeged University of Szeged, Clinical Medical Sciences Doctoral School PhD Program: Clinical and Experimental Research for Reconstructive and Organ-sparing Surgery Program director: Prof. Lajos Kemény M.D. Supervisor: Prof. László Rovó M.D. Szeged 2018 i PUBLICATIONS RELATED TO THE PhD THESIS I. Bach Á, Sztanó B, Kiss JG, Volk GF, Müller A, Pototschnig C, Rovó L. The role of laryngeal electromyography in the diagnosis of vocal cord movement disorders. [A laryngealis electromyographia szerepe a hangszalag- mozgászavarok diagnosztikájában és az alkalmazott kezelés kiválasztásában] Orv Hetil. 2018;159:303–311. Impact factor: 0,349 II. Bach Á, Sztanó B, Matievics V, Bere Z, Volk GF, Müller A, Förster G, Castellanos PF, Rovó L. Isolated Recovery of Adductor Muscle Function Following Bilateral Recurrent Laryngeal Nerve Injuries. Accepted for publication in The Laryngoscope on 05 November, 2018, DOI: 10.1002/lary.27718 Impact factor: 2,442 III. Rovó L, Bach Á, Sztanó B, Matievics V, Szegesdi I, Castellanos PF. Rotational thyrotracheopexy after cricoidectomy for low-grade laryngeal chrondrosarcoma. Laryngoscope. 2017;127:1109-1115. Impact factor: 2,442 ii CITABLE ABSTRACTS I. Rovó L, Bach Á, Matievics V, Szegesdi I, Castellanos PF, Sztanó B. Reconstruction of the subglottic region in cases of benign and malignant lesions. 4th Congress of European ORL-HNS, October 7-11, 2017, Barcelona, Spain II. Bach Á, Sztanó B, Matievics V, Szegesdi I, Castellanos PF. Adductor reinnervation after recurrent laryngeal nerve injuries – Its clinical importance in bilateral vocal cord paresis. 11th Congress of the European Laryngological Society, 3rd Joint Meeting of ELS- ABEA & ALA, 2nd Meeting of Società Italiana di Laringologia, June 8-11, 2016, Genoa, Italy III. Bach Á, Sztanó B, Nagy A, Matievics V, Szegesdi I, Rovó L. 90° Rotated thyreo-tracheopexy after total and subtotal cricoidectomy - a new surgical method. 3rd Congress of European ORL-HNS, June 7-11, 2015, Prague, Czech Republic IV. Bach Á, Sztanó B, Szakács L, Rovó L. Function preserving solution of a chondrosarcoma of the cricoid cartilage. (PP80) 10th Congress of the European Laryngological Society, April 9-12, 2014, Antalya, Turkey V. Bach Á, Sztanó B, Matievics V, Szakács L, Rovó L. Life quality before and after a reversible glottis enlarging procedure. (PP82) 10th Congress of the European Laryngological Society, April 9-12, 2014, Antalya, Turkey iii VI. Sztanó B, Szakács L, Madani S, Bach Á, Bere Z, Rovó L. Endoscopic arytenoid abduction lateropexy for the treatment of bilateral vocal cord immobility – pediatric application 2nd Congress of CE-ORL-HNS, April 27-30, 2013, Nice, France iv PUBLICATIONS NOT DIRECTLY REALTED TO THE PhD THESIS: I. Matievics V, Sztanó B, Bach Á, Rovó L. Phoniatric outcomes of endoscopic arytenoid abduction lateropexy in patients with transient bilateral vocal cord paralysis. [Endoszkópos arytenoid abdukciós lateropexia foniátriai eredményei átmeneti kétoldali gégebénulás esetén] Orv Hetil. 2018;159:1188-1192. II. Matievics V, Bach Á, Sztanó B, Rovó L. Az endoszkópos arytenoid abdukciós lateropexia foniátriai eredményei nehézlégzéssel járó féloldali gégebénulás esetén. Otorhinolaringologia Hungarica. 2018;64:74-77. III. Matievics V, Bach Á, Sztanó B, Bere Z, Tóbiás Z, Castellanos PF, Müller A, Rovó L. Functional outcomes of endoscopic arytenoid abduction lateropexy for unilateral vocal cord paralysis with dyspnea. Eur Arch Otorhinolaryngol. 2017;274:3703-3710. IV. Madani S, Bach Á, Matievics V, Erdélyi E, Sztanó B, Szegesdi I, Castellanos PF, Rovó L. A new solution for neonatal bilateral vocal cord paralysis: Endoscopic arytenoid abduction lateropexy. Laryngoscope. 2017;127:1608-1614. V. Szakács L, Sztanó B, Matievics V, Bere Z, Bach Á, Castellanos PF, Rovó L. A comparison between transoral glottis-widening techniques for bilateral vocal fold immobility. Laryngoscope. 2015;125:2522-2529. v ABBREVIATIONS BVFI Bilateral Vocal Fold Immobility BVFP Bilateral Vocal Fold Paralysis CRD Complex Repetitive Discharge EAAL Endoscopic Arytenoid Abduction Lateropexy EMG Electromyography ETGI Endolaryngeal Thread Guide Instrument F0 Fundamental frequency HNR Harmonics to Noise Ratio LEMG Laryngeal Electromyography MUAP Motor Unit Action Potential PCA Posterior Cricoarytenoid Muscle PIF Peak Inspiratory Flow PSA Pathological Spontaneous Activity QOL Quality of Life SWAL-QOL Swallowing Quality of Life TA Thyroarytenoid Muscle UDP Ultra Dream Pulse vi CONTENT 1. INTRODUCTION .................................................................................................................. 1 2. ENDOSCOPIC ARYTENOID ABDUCTION LATEROPEXY – BACKGROUND AND SURGICAL TECHNIQUE ........................................................................................................ 3 3. AIMS OF THE THESIS ........................................................................................................ 6 4. INTRODUCTION OF LARYNGEAL ELECTROMYOGRAPHY INTO CLINICAL PRACTICE ................................................................................................................................. 7 4.1. Introduction ..................................................................................................................... 7 4.2. Method ............................................................................................................................. 8 4.2.1. Indications, contraindications ................................................................................... 8 4.2.2. Equipment ................................................................................................................. 9 4.2.3. EMG monitoring ..................................................................................................... 10 4.2.4. Interpretation of LEMG .......................................................................................... 14 5. ISOLATED RECOVERY OF ADDUCTOR MUSCLE FUNCTION FOLLOWING BILATERAL RECURRENT LARYNGEAL NERVE INJURIES ......................................... 17 5.1. Introduction ................................................................................................................... 17 5.2. Materials and methods ................................................................................................... 18 5.2.1. Patients .................................................................................................................... 18 5.2.2. Voice assessment .................................................................................................... 20 5.2.3. Respiratory assessment ........................................................................................... 22 5.2.4. Assessment of vocal fold movement ...................................................................... 22 5.3. Results ........................................................................................................................... 24 5.3.1. Endoscopic results .................................................................................................. 24 5.3.2. Laryngeal electromyography results ....................................................................... 25 5.3.3. Respiratory results .................................................................................................. 26 5.3.4. Voice results ............................................................................................................ 28 6. ENDOSCOPIC ARYTENOID ABDUCTION LATEROPEXY FOR THE COMPLEX RECONSTRUCTION OF THE AIRWAY AFTER TOTAL CRICOIDECTOMY................ 30 6.1. Introduction ................................................................................................................... 30 6.2. Materials and methods ................................................................................................... 31 6.2.1. Patients .................................................................................................................... 31 6.2.2. Surgical technique ................................................................................................... 32 6.2.3. Functional evaluation and follow-up care ............................................................... 37 6.3. Results ........................................................................................................................... 39 vii 7. DISCUSSION ...................................................................................................................... 40 7.1. Introduction of laryngeal electromyography into clinical practice ............................... 40 7.2. Selective recovery of adductor muscle function following recurrent laryngeal nerve injuries .................................................................................................................................. 42 7.3. Endoscopic arytenoid abduction lateropexy for the complex reconstruction of the airway after total cricoidectomy ........................................................................................... 46 8. CONCLUSIONS AND NEW RESULTS ............................................................................ 47 8.1. Introduction of laryngeal electromyography into clinical practice ............................... 47 8.2. Isolated recovery of adductor muscle function following bilateral recurrent laryngeal nerve
Load more

Recommended publications
  • Identification of Two Novel LAMP2 Gene Mutations in Danon Disease
    The Laryngoscope © 2016 the American Laryngological, Rhinological and Otological Society, Inc. Rotational Thyrotracheopexy After Cricoidectomy for Low-Grade Laryngeal Chrondrosarcoma László Rovó, MD, PhD; Ádám Bach, MD; Balázs Sztanó, MD, PhD; Vera Matievics, MD; Ilona Szegesdi, MD; Paul F. Castellanos, MD, FCCP Objectives:The complex laryngeal functions are fundamentally defined by the cricoid cartilage. Thus, lesions requiring subtotal or total resection of the cricoid cartilage commonly warrant total laryngectomy. However, from an oncological per­ spective, the resection of the cricoid cartilage would be an optimal solution in these cases. The poor functional results of the few reported cases of total and subtotal cricoidectomy with different reconstruction techniques confirm the need for new approaches to reconstruct the infrastructure of the larynx post cricoidectomy. Study Design:Retrospective case series review. Methods:Four consecutive patients with low-grade chondrosarcoma were treated by cricoidectomy with rotational thy­ rotracheopexy reconstruction to enable the functional creation of a complete cartilaginous ring that can substitute the func­ tions of the cricoid cartilage. The glottic structures were stabilized with endoscopic arytenoid abduction lateropexy. Patients were evaluated with objective and subjective function tests. Results: Tumor-free margins were proven; patients were successfully decannulated within 3 weeks. Voice outcomes were adequate for social conversation in all cases. Oral feeding was possible in three patients. Conclusion:Total and subtotal cricoidectomy can be a surgical option to avoid total laryngectomy in cases of large chondrosarcomas destroying the cricoid cartilage. The thyrotracheopexy rotational advancement technique enables the effec­ tive reconstruction of the structural deficit of the resected cricoid cartilage in cases of total and subtotal cricoidectomy.
    [Show full text]
  • Surgical Management of Laryngotracheal Stenosis in Adults
    View metadata, citation and similar papers at core.ac.uk brought to you by CORE provided by Serveur académique lausannois Eur Arch Otorhinolaryngol (2005) 262: 609–615 DOI 10.1007/s00405-004-0887-9 LARYNGOLOGY Mercy George Æ Florian Lang Æ Philippe Pasche Philippe Monnier Surgical management of laryngotracheal stenosis in adults Received: 22 July 2004 / Accepted: 18 October 2004 / Published online: 25 January 2005 Ó Springer-Verlag 2005 Abstract The purpose was to evaluate the outcome fol- the efficacy and reliability of this approach towards the lowing the surgical management of a consecutive series management of laryngotracheal stenosis of varied eti- of 26 adult patients with laryngotracheal stenosis of ologies. Similar to data in the literature, post-intubation varied etiologies in a tertiary care center. Of the 83 pa- injury was the leading cause of stenosis in our series. A tients who underwent surgery for laryngotracheal ste- resection length of up to 6 cm with laryngeal release nosis in the Department of Otorhinolaryngology and procedures (when necessary) was found to be technically Head and Neck Surgery, University Hospital of Lau- feasible. sanne, Switzerland, between 1995 and 2003, 26 patients were adults (‡16 years) and formed the group that was Keywords Laryngotracheal stenosis Æ Laryngotracheal the focus of this study. The stenosis involved the trachea resection Æ Anastomosis (20), subglottis (1), subglottis and trachea (2), glottis and subglottis (1) and glottis, subglottis and trachea (2). The etiology of the stenosis was post-intubation injury (n =20), infiltration of the trachea by thyroid tumor (n Introduction =3), seeding from a laryngeal tumor at the site of the tracheostoma (n =1), idiopathic progressive subglottic In the majority of patients, acquired stenosis of the sub- stenosis (n =1) and external laryngeal trauma (n =1).
    [Show full text]
  • ICD-9-CM Procedures (FY10)
    2 PREFACE This sixth edition of the International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) is being published by the United States Government in recognition of its responsibility to promulgate this classification throughout the United States for morbidity coding. The International Classification of Diseases, 9th Revision, published by the World Health Organization (WHO) is the foundation of the ICD-9-CM and continues to be the classification employed in cause-of-death coding in the United States. The ICD-9-CM is completely comparable with the ICD-9. The WHO Collaborating Center for Classification of Diseases in North America serves as liaison between the international obligations for comparable classifications and the national health data needs of the United States. The ICD-9-CM is recommended for use in all clinical settings but is required for reporting diagnoses and diseases to all U.S. Public Health Service and the Centers for Medicare & Medicaid Services (formerly the Health Care Financing Administration) programs. Guidance in the use of this classification can be found in the section "Guidance in the Use of ICD-9-CM." ICD-9-CM extensions, interpretations, modifications, addenda, or errata other than those approved by the U.S. Public Health Service and the Centers for Medicare & Medicaid Services are not to be considered official and should not be utilized. Continuous maintenance of the ICD-9- CM is the responsibility of the Federal Government. However, because the ICD-9-CM represents the best in contemporary thinking of clinicians, nosologists, epidemiologists, and statisticians from both public and private sectors, no future modifications will be considered without extensive advice from the appropriate representatives of all major users.
    [Show full text]
  • Transoral Approach to Laser Thyroarytenoid Myoneurectomy for Treatment of Adductor Spasmodic Dysphonia: Short-Term Results
    Annals of Oioliigy, Rhinohgy & Laryngology 116(1); 11-1 ©2007 Annals Publishing Company, All righis reserved. Transoral Approach to Laser Thyroarytenoid Myoneurectomy for Treatment of Adductor Spasmodic Dysphonia: Short-Term Results Chih-Ying Su. MD: Hui-Ching Chuang. MD; Shang-Shyue Tsai. PhD: Jeng-FenChiu,PhD Objectives: The surgical technique for the resection of the recurrent larvngeal nerve for adductor spasmodic dysphonia (ASD) ha.s high late failure rates. During the pa.st decade, botulinum toxin has emerged as the treatment of choice for ASD. Although effective, it also has significant disadvantages, including a temporary effect and an unpredictable dose- response relationship. In this study we investigated the effectiveness of a new transoral approach to laser thyroarytenoid mynneurectomy for treatment of ASD. Methods: Fourteen patients with ASD underwent transoral laser myoneurectomy of bilateral thyroarytenoid muscles. Under general anesthesia, an operating miLTOscope and a carbon dioxide laser were used to pertorm myectomy of the mid-posterior belly of bilateral thyroarytenoid muscles together with neurectomy ofthe terminal nerve fibers among the deep muscle bundles. Care was taken not to damage ihe vocal is ligaments, arytenoid cartilages, and lateral cricoarytenoid muscles. Preoperative and postoperative videolaryngostroboscopy and vocal assessments were studied, Results: The 13 patients who completed more than 6 months follow-up were enrolled in this study. Moderate and marked vocal improvement was achieved in 92^;? of the patient.s (12 of 13) after laser surgery during an average tbllow-up period of !7 months (range. 6 to 31 months). No vocaifoldatrophy or paralysis was observed in any patient. None of the patients had a recurrence during the foilow-up period.
    [Show full text]
  • Canadian Surgery Forum 2014
    Vol. 57 (4 Suppl 1) August/août 2014 canjsurg.ca DOI: 10.1503/cjs.009414 Canadian Surgery Forum canadien de Forum chirurgie Abstracts of presentations to the Résumés des communications Annual Meetings of the présentées aux congrès annuels de Canadian Association l’Association canadienne of Bariatric Physicians des médecins et chirurgiens and Surgeons bariatriques Canadian Association Association canadienne of General Surgeons des chirurgiens généraux Canadian Association l’Association canadienne of Thoracic Surgeons des chirurgiens thoraciques Canadian Hepato-Pancreato- Canadian Hepato-Pancreato- Biliary Association Biliary Association Canadian Society of la Société canadienne Surgical Oncology d’oncologie chirurgicale Canadian Society la Société canadienne des of Colon and chirurgiens du côlon Rectal Surgeons et du rectum Vancouver, BC Vancouver (C-B) Sept. 17–21, 2013 du 17 au 21 sept., 2013 Abstracts • Résumés FORUM CANADIEN DE CHIRURGIE 2014 Canadian Association of Bariatric Physicians and Surgeons Association canadienne des médecins et chirurgiens bariatriques 1 This retrospective study evaluated the short-term outcomes of (CJS Editors' Choice Award) Weight loss and obesity- our first 162 laparoscopic sleeve gastrectomies. related outcomes of gastric bypass, sleeve gastrectomy Between August 2010 and February 2013, 212 patients under- and gastric banding in patients enrolled in a population- went LSG as a sole bariatric operation. A retrospective review of based bariatric program: prospective cohort study. a prospectively collected database was performed. Postoperative R.S. Gill, S. Apte, S. Majumdar, C. Agborsangaya, complications and weight loss at 12 months were examined. C. Rueda-Clausen, D. Birch, S. Karmali, S. Klarenbach, Quality of life (using IWQOL-lite and EQ-5D) and diabetes reso- A.
    [Show full text]
  • Tracheal and Bronchial Surgery
    Tracheal and Bronchial Surgery 1A031 Honorary Editors: Douglas E. Wood, Douglas J. Mathisen, Erino Angelo Rendina Editors: Xiaofei Li, Federico Venuta, David C. van der Zee Associate Editors: Dirk Van Raemdonck, Federico Rea, Jinbo Zhao Xiaofei Li, Federico Venuta, David C. van der Zee Xiaofei Li, Federico Venuta, Editors: Tracheal and Bronchial Surgery Honorary Editors: Douglas E. Wood, Douglas J. Mathisen, Erino Angelo Rendina Editors: Xiaofei Li, Federico Venuta, David C. van der Zee Associate Editors: Dirk Van Raemdonck, Federico Rea, Jinbo Zhao AME Publishing Company Room C 16F, Kings Wing Plaza 1, NO. 3 on Kwan Street, Shatin, NT, Hong Kong Information on this title: www.amegroups.com For more information, contact [email protected] Copyright © AME Publishing Company. All rights reserved. This publication is in copyright. Subject to statutory exception and to the provisions of relevant collective licensing agreements, no reproduction of any part may take place without the written permission of AME Publishing Company. First published 2017 Printed in China by AME Publishing Company Editors: Xiaofei Li, Federico Venuta, David C. van der Zee Cover Image Illustrator: Zhijing Xu, Shanghai, China Tracheal and Bronchial Surgery Hardcover ISBN: 978-988-77841-8-0 AME Publishing Company, Hong Kong AME Publishing Company has no responsibility for the persistence or accuracy of URLs for external or third-party internet websites referred to in this publication, and does not guarantee that any content on such websites is, or will remain, accurate or appropriate. The advice and opinions expressed in this book are solely those of the author and do not necessarily represent the views or practices of AME Publishing Company.
    [Show full text]
  • Paolo Macchiarini, M.D., Ph.D., Karolinska Institute Job Application
    Paolo Macchiarini Professor in Regenerative Medicine Ref nr: 2-1097/2014-3 The application has been submitted: 2014-08-06 19:22:04 Day of birth 1958-08-22 Address B53 Division of ENT, CLINTEC 14186 Huddinge Sweden Email [email protected] Mobile phone Phone 0760503213 Personal letter To Whom It May Concern, I appreciate the opportunity to apply for this position. I completed my surgical training in general & thoracic surgery, vascular surgery, and heart-lung transplantation. My PhD research was on tissue and organ transplantation at Paris-Sud University, Paris, France. I have also been previously appointed at Hannover Medical School, Hannover, Germany, and University of Barcelona, Barcelona, Spain as a Director for post-graduate program for Residents and Fellows in General Thoracic Surgery and organ and tissues transplantation Since 2010, I am a Visiting Professor at Karolinska Institute, and a Director at the Advanced Center for Translational Regenerative Medicine (ACTREM) and the European Airway Institute. Currently, I am also a Professor of Regenerative Medicine at the Kuban Medical State University in Krasnodar, Russia. I have established in Sweden and Russia a multi-disciplinary research team that consists of biologist, engineers, clinicians and mathematician who can combine their expertise in the field of tissue engineering and cell therapy to investigate bench-to-beside translational research. My primary clinical interests include the investigation of different organs and tissues in the thorax and the potential to recover and/ or reconstitute their function. In particular, adult and pediatric surgery for complex tracheal, lung, esophageal and mediastinal diseases, as well as intrathoracic, non-cardiac transplantation (lung, heart-lung and airways) and intrathoracic regenerative surgery.
    [Show full text]
  • Laryngeal Chondrosarcoma Arising from Cricoid Cartilage: a Case Report
    CASE REPORT Laryngeal Chondrosarcoma Arising From Cricoid Cartilage: A Case Report Mansour Moghimi1, Mahmood Kazeminasab2, Mohammad Reza Vahidi3, Mojtaba Meybodian3, Mojtaba Babaei Zarch4, Mostafa Babai5 1 Department of Pathology, School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran 2 Student Research Committee, Shahid Sadoughi Univerity of Medical Scineces, Yazd, Iran 3 Department of Otolaryngology-Head and Neck Surgery, Otorhinolaryngology Research Center, Shahid Sadoughi University of Medical Sciences, Yazd, Iran 4 School of Medicine, Shahid Sadoughi University of Medical Sciences, Yazd, Iran 5 Resident of Radiology, School of Medicine, Ahvaz Jundishapour Univerity of Medical Scineces, Ahvaz, Iran Received: 03 Nov. 2016; Accepted: 16 May 2017 Abstract- Laryngeal chondrosarcoma is a rare tumor that involves head and neck region such as larynx in rare cases. This malignant tumor usually grows quite slowly. The patient may experience symptoms for several years before a diagnosis is made. The diagnosis is achieved by clinical, radiological and pathological features. Management is basically surgical. Prognosis is generally good, depending basically on histologic grade. Herein, we report a case of laryngeal chondrosarcoma presented with hoarseness. Spiral CT scan demonstrated an expansile mass with calcification originating from cricoid cartilage. The patient underwent surgery for open excisional biopsy, and postoperative histopathologic evaluations confirmed "laryngeal chondrosarcoma" as definite diagnosis. The patient denied total laryngectomy for complete removal of the tumor. Six months follow up showed no more growth. © 2018 Tehran University of Medical Sciences. All rights reserved. Acta Med Iran 2018;56(6):405-409. Keywords: Larynx; Chondrosarcoma; Cricoid cartilage; Conservative surgery Introduction hospital because of hoarseness. The patient had a 10- year history of the neck mass; however, hoarseness Laryngeal chondrosarcomas (LCSs) are rare tumors started 3 months ago.
    [Show full text]
  • Otolaryngology-Head and Neck Surgery Clinical
    OTOLARYNGOLOGY HEAD &NECK SURGERY CLINICAL REFERENCE GUIDE Fifth Edition OTOLARYNGOLOGY HEAD &NECK SURGERY CLINICAL REFERENCE GUIDE Fifth Edition Raza Pasha, MD Justin S. Golub, MD, MS 5521 Ruffin Road San Diego, CA 92123 e-mail: [email protected] Website: www.pluralpublishing.com Copyright © 2018 by Plural Publishing, Inc. Typeset in 9/11 Adobe Garamond Pro by Flanagan’s Publishing Services, Inc. Printed in the United States of America by McNaughton & Gunn All rights, including that of translation, reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, recording, or otherwise, including photocopying, recording, taping, Web distribution, or information storage and retrieval systems without the prior written consent of the publisher. For permission to use material from this text, contact us by Telephone: (866) 758-7251 Fax: (888) 758-7255 e-mail: [email protected] Every attempt has been made to contact the copyright holders for material originally printed in another source. If any have been inadvertently overlooked, the publishers will gladly make the necessary arrangements at the first opportunity. NOTICE TO THE READER Care has been taken to confirm the accuracy of the indications, procedures, drug dosages, and diagnosis and remediation protocols presented in this book and to ensure that they conform to the practices of the general medical and health services communities. However, the authors, editors, and publisher are not responsible for errors or omissions or for any consequences from application of the information in this book and make no warranty, expressed or implied, with respect to the currency, completeness, or accuracy of the contents of the publication.
    [Show full text]
  • 1 Chapter 111: Chronic Aspiration David W. Eisele the Three Major Functions of the Larynx
    Chapter 111: Chronic Aspiration David W. Eisele The three major functions of the larynx - respiration, phonation, and airway production - are all intimately related. Impaired laryngeal protective function can result in aspiration. Aspiration is defined as the laryngeal penetration of secretions, such as saliva, ingested liquids or solids, or reflux of gastric contents, below the level of the true vocal cords. A certain amount of aspiration is known to occur normally. Evaluation of normal humans during sleep by scintigraphy reveals aspiration in nearly one half of those evaluated (Huxley et al, 1978). A certain amount of aspiration may be tolerated without complications provided clearance is normal and defense mechanisms are intact. The contamination of the respiratory tract associated with aspiration can result in a spectrum of bronchopulmonary complications. The severity of complications depends on the volume and the character, such as the pH, of the aspirated material. Respiratory complications of aspiration include bronchospasm, airway obstruction, tracheitis, bronchitis, pneumonia, pulmonary abscess, sepsis, and death (Awe et al, 1966; Bartlett and Gorbach, 1975; Cameron and Zuidema, 1972). Significant aspiration results in a high rate of mortality (Cameron et al, 1973a). Aspiration may be an isolated event related to temporary impairment of normal swallowing mechanisms and airway protection, which may secondary to temporary neurologic dysfunction such as with a depressed state of consciousness related to drugs, alcohol, or metabolic derangement. In addition, seizure, injury, or infection may cause isolated aspiration. Elderly patients are more likely to experience aspiration, presumably related to physiologic and neurologic changes associated with age (Blitzer, 1990). Patients with dentures experience impairment of the oral phase of swallowing with decreased oral sensation and oral control, which may contribute to aspiration.
    [Show full text]
  • Laryngotracheal Resection for Benign Stenosis
    Review Article Page 1 of 10 Laryngotracheal resection for benign stenosis Camilla Vanni1, Domenico Massullo2, Anna Maria Ciccone1, Antonio D’Andrilli1, Giulio Maurizi1, Mohsen Ibrahim1, Claudio Andreetti1, Camilla Poggi1, Federico Venuta3,4, Erino A. Rendina1,4 1Department of Thoracic Surgery, 2Department of Anesthesiology, Sant’Andrea Hospital, Sapienza University, Rome, Italy; 3Department of Thoracic Surgery, Policlinico Umberto I, Sapienza University, Rome, Italy; 4Lorillard Spencer Cenci Foundation, Rome, Italy Contributions: (I) Conception and design: C Vanni, G Maurizi, A D’Andrilli, EA Rendina; (II) Administrative support: M Ibrahim, C Andreetti, C Poggi; (III) Provision of study materials or patients: D Massullo, EA Rendina, F Venuta, AM Ciccone, A D’Andrilli; (IV) Collection and assembly of data: C Vanni, G Maurizi, A D’Andrilli; (V) Data analysis and interpretation: C Vanni, G Maurizi; (VI) Manuscript writing: All authors; (VII) Final approval of manuscript: All authors. Correspondence to: Camilla Vanni. Department of Thoracic Surgery, Sant’Andrea Hospital, Via di Grottarossa 1035-1039, 00189 Rome, Italy. Email: [email protected]. Abstract: Surgical treatment of benign subglottic stenosis encases a current therapeutic trouble. The need to achieve a complete resection with respect to recurrent nerves and proximity of the anastomosis to the vocal cords are the main technical issues. Interventional endoscopic treatments play a limited role in this setting due to the high rate of recurrences requiring repeated procedures. Surgical resection and reconstruction with primary anastomosis represent the curative treatment of choice for most subglottic strictures, allowing definitive and stable high success rate on long-term. Technical aspects and surgical results are discussed in the present review.
    [Show full text]
  • Function of the Posterior Cricoarytenoid Muscle in Phonation: in Vivo Laryngeal Model
    Function of the posterior cricoarytenoid muscle in phonation: In vivo laryngeal model HONG-SHIK CHOI, MD, GERALD S. BERKE, MD, MING YE, MD, and JODY KREIMAN, PhD, Los Angeles, California The function of the posterior cricoarytenoid (PCA) muscle In phonation has not been well documented. To date, several electromyographlc studies have suggested that the PCA muscle Is not simply an abductor of the vocal folds, but also functions In phonation. This study used an In vivo canine laryngeal model to study the function of the PCA muscle. SUbglottic pressure and electroglottographlc, photoglottographlc, and acoustic waveforms were gathered from fiVe adult mongrel dogs under varying conditions of nerve stimulation. Subglottic pressure. fundamental frequency, sound Intensity, and vocal efficiency decreased with Increasing stimulation of the posterior branch of the recurrent laryngeal nerve. These results suggest that the PCA muscle not only acts to brace the larynx against the anterior pull of the adductor and cricothyroid muscles, but also functions Inhlbltorlly In phonation by controlling the phonatory glottal width. (OTOLARYNGOL HEAD NECK SURG 1993;109: 1043-51.) The important physiologicfunctions of the larynx­ during phonation in some clinical cases. Kotby and protection of the lower airway, phonation, and res­ Haugen? also observed increased activity in the 1 piration - are all mediated by the laryngeal mus­ PCA muscle during phonation and postulated that cles. Intrinsic laryngeal muscles are classified into the muscle is not simply an abductor of the vocal three groups: the tensors, which regulate the length cord. and tension of the vocal folds; the adductors, which Gay et al." observed increased activity in the PCA close the glottis; and the abductor, which opens the muscle during phonation in chest voice at high glottis.
    [Show full text]