DOCSLIB.ORG

Combined Arytenoid Adduction and Laryngeal Reinnervation in the Treatment of Vocal Fold Paralysis

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Combined Arytenoid Adduction and Laryngeal Reinnervation in the Treatment of Vocal Fold Paralysis The Latyngoscope Lippincott Williams & Wilkins, Inc., Philadelphia Q 1999 The American Laryngolog.lca1, Rhinological and Otological Society, Inc. Combined Arytenoid Adduction and Laryngeal Reinnervation in the Treatment of Vocal Fold Paralysis - Dinesh K. Chhetri, MD; Bruce R. Gerratt, PhD; Jody Kreiman, PhD; Gerald S. Berke, MD ObjectivelHypothesis: Glottal closure and sym- Words: Vocal cord paralysis, arytenoid adduction, la- metrical thyroarytenoid stiffness are two important ryngeal reinnervation, ansa cervicalis nerve, percep- functional characteristics of normal phonatory pos- tual analysis. ture. In the treatment of unilateral vocal cord paral- Laryngoscope, 1091928-1936,1999 ysis, vocal fold medialization improves closure, facil- itating entrainment of both vocal folds for improved INTRODUCTION phonation, and reinnervation is purported to main- tain vocal fold bulk and stiffness. A combination of Medialization procedures such as Teflon injection, medialization and reinnervation would be expected thyroplasty, and arytenoid adduction are currently popu- to further improve vocal quality over medialization lar in the treatment of unilateral vocal cord paralysis.'-" alone. Study Design: A retrospective review of preop- The optimal medialization procedure continues to be de- erative and postoperative voice analysis on all pa- bated. Injection techniques and thyroplasty are suitable tients who underwent arytenoid adduction alone (ad- for relieving anterior vocal fold insufficiency, whereas ar- duction group) or combined arytenoid adduction and ytenoid adduction corrects posterior glottic chink^.^,^ Re- ansa cervicalis to recurrent laryngeal nerve anasto- cent reports have proposed laryngeal reinnervation using mosis (combined group) between 1989 and 1995 for the ansa cervicalis nerve anastomosis to recurrent laryn- the treatment of unilateral vocal cord paralysis. Pa- geal nerve in the treatment of unilateral vocal cord paral- tients without postoperative voice analysis were in- vited back for its completion. A perceptual analysis ysis.6 The ansa cervicalis nerve is an ideal candidate €or was designed and completed. Methods: Videostrobo- laryngeal reinnervation because it is located in close prox- scopic measures of glottal closure, mucosal wave, and imity to the larynx, and sacrificing this nerve results in no symmetry were rated. Aerodynamic parameters of la- serious functional or cosmetic sequelae.7 However, satis- ryngeal airflow and subglottic pressure were mea- factory physiological motion of paralyzed vocal folds dur- sured. A 2-second segment of sustained vowel was ing phonation and respiration has not been achieved with used for perceptual analysis by means of a panel of this technique. With this nonspecific method of reinner- voice professionals and a rating system. Statistical vation the vocal process remains immobile, glottic closure calculations were performed at a significance level of may remain incomplete,6 and functional return of laryn- P = .06. Results: There were 9 patients in the adduc- tion group and 10 patients in the combined group. geal movement is hampered by synkinesis, which is the Closure and mucosal wave improved significantly in result of random regrowth of axons into the abductor and both groups. Airflow decreased in both groups, but adductor branches.8 the decrease reached statistical significance only in In laryngeal paralysis the stiffness of the denervated the adduction group. Subglottic pressure remained vocal fold is decreased.9 This leads to a deviant vibratory unchanged in both groups. Both groups had signifi- pattern of an inferior quality involving two unequal vocal cant perceptual improvement of voice quality. In all fold masses. During follow-up studies of thyroplasty type tested parameters the extent of improvement was I patients, it was noted that sometimes there was slight similar in both groups. Conclusion: The role of laryn- decrement of voice over a period of 2 to 3 months after the geal reinnervation in the treatment of unilateral vo- operation. The main factor responsible for increased dys- cal cord paralysis remains to be established. Key phonia was reported to be atrophy of the vocal cord.'"," Vocal cord atrophy from denervation injury can be coun- From the Division of Head and Neck Surgery, University of Califor- tered by reinnervation. Histological evidence of reinner- nia Los Angeles School of Medicine, Los Angeles, California. vation after ansa cervicalis to recurrent laryngeal nerve Editor's Note: This Manuscript was accepted for publication August anastomosis has been demonstrated previously.l"l3 Pos- 4, 1999. terior commissure closure and symmetric thyroarytenoid Send Reprint Requests to Gerald S. Berke, MD, Division of Head and Neck Surgery, 62-132 CHS, UCLA School of Medicine, Los Angeles, CA stiffness are two important functional characteristics of 90095. U.S.A. normal phonatory posture.14 We hypothesized that a Laryngoscope 109: December 1999 Chhetri et al.: Vocal Fold Paralysis 1928 combination of medialization and laryngeal reinnervation adducting the true vocal fold. Proper medialization was verified would lead to better vocal quality over medialization alone by flexible nasolaryngoscopy. in the treatment of unilateral vocal cord paralysis. In a The ansa cervicalis to recurrent laryngeal nerve anastomo- combined procedure, medialization would facilitate clo- sis was as described by Crumley8 and Crumley et al.16 In a sure and reinnervation would preserve vocalis muscle combined operation, localization and preparation of nerves were mass and tension. performed first, followed by arytenoid adduction and, finally, nerve anastomosis. The ansa cervicalis nerve was first exposed We describe our initial experience with arytenoid overlying the great vessels or within the carotid sheath. A branch adduction combined with laryngeal reinnervation using of the ansa cervicalis (to the omohyoid or to the sternothyroid) ansa cervicalis nerve to recurrent laryngeal nerve anasto- was then identified, followed, and divided at its insertion into its mosis in the treatment of unilateral vocal cord paralysis. muscle, then transposed over in the region of the trachcoesoph- With a combined surgical approach, we expect an imme- ageal groove. The recurrent laryngeal nerve was identified by diate postoperative improvement in phonation, which we retracting the superior thyroid neurovascular bundle laterally assume can be attributed to the medialization procedure, and inferiorly and dissecting posteriorly and inferiorly until the followed several months later by further improvement in nerve was identified as it came up to enter the larynx at the voice as the functional effects of laryngeal reinnervation inferior horn of the thyroid cartilage. The nerve was dissected out distally in the tracheoesophageal groove and divided at a suitable are noted. The results of the combination surgery are distance that allowed for an unencumbered anastomosis (usually compared with arytenoid adduction as a single therapeu- 7-10 mm). Nerve anastomosis was accomplished with microsur- tic modality. gical neurorrhaphy (epineurial repair) using 8-0 to 10-0 suture under magnification. MATERIALS AND METHODS To perform videolaryngostroboscopy, a 90” telescopic laryn- During the years 1989 and 1995, 18 patients underwent goscope attached to a miniature endoscopic videocamera (Storz arytenoid adduction (adduction group) and 13 patients under- Tricam, Karl Storz GmbH & Co., Tuttlingen, Germany) and a went combined arytenoid adduction and laryngeal reinnervation stroboscopic unit (Bruel& Kjaer Rhino-Larynx Stroboscope, type (combined group) at the University of California Los Angeles 4914, Bruel & Kjaer, Norcross, GA) was inserted into the oro- (UCLA) Medical Center by the senior author (G.s.B.) Retrospec- pharynx until the vocal folds could be visualized. The patient was tive chart review was performed for all these patients. No set instructed to sustain the vowel lil at a comfortable pitch and protocol was used to randomly assign patients into the treatment loudness. The video images were recorded on a %-inch video tape arms. During the initial years of the study period, patients were recorder (Sony U-matic VO-5800, Sony Electronics, Tokyo, Ja- randomly assigned into the adduction or combined groups. Later pan) for later analysis. Glottal closure, mucosal wave on both in the study period, and as the experience with reinnervation was vocal folds, and symmetry were analyzed. Glottal closure was garnered, patients tended to undergo the combined procedure rated on a five-point scale ranging from complete to absent (Fig. more frequently. All patients received an objective preoperative 1).Mucosal wave was rated on a five-point scale ranging from and postoperative voice analysis, which included videolaryn- unrestricted to absent (Fig. 2). Symmetry was rated as symmet- gostroboscopy, aerodynamic analysis, and voice recording. Pa- rical or asymmetrical (Fig. 3). tients without postoperative voice analysis were invited back for Laryngeal airflow and subglottic pressure measurements its completion. Patients were excluded from the study when pre- were performed as described by Smitheran and Hixon.17 Flow operative voice analysis was of inadequate quality (five patients was monitored with a pneumotachographic mask, which was in adduction group and one patient in combined group) or when placed over the patient’s face, connected to a differential pressure the distance of their current residence precluded their return to transducer
Load more

Recommended publications
  • 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]
  • 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]
  • Complications of Airway Management
    Complications of Airway Management Paulette C Pacheco-Lopez MD, Lauren C Berkow MD, Alexander T Hillel MD, and Lee M Akst MD Introduction Methods Results Risk Factors Injury by Anatomic Site Late Complications of Intubation Special Considerations Conclusion Although endotracheal intubation is commonly performed in the hospital setting, it is not without risk. In this article, we review the impact of endotracheal intubation on airway injury by describing the acute and long-term sequelae of each of the most commonly injured anatomic sites along the respiratory tract, including the nasal cavity, oral cavity, oropharynx, larynx, and trachea. Injuries covered include nasoseptal injury, tongue injury, dental injury, mucosal lacerations, vocal cord immobility, and laryngotracheal stenosis, as well as tracheomalacia, tracheoinnominate, and tra- cheoesophageal fistulas. We discuss the proposed mechanisms of tissue damage that relate to each and present their most common clinical manifestations, along with their respective diagnostic and management options. This article also includes a review of complications of airway management pertaining to video laryngoscopy and supraglottic airway devices. Finally, potential strategies to prevent intubation-associated injuries are outlined. Key words: intubation; airway complications; subglottic stenosis; vocal cord injury [Respir Care 2014;59(6):1006–1021. © 2014 Daedalus Enterprises] Introduction health care professionals throughout the world and is a relatively safe maneuver. However, endotracheal intuba- The establishment of an adequate airway is integral to tion is not risk-free, and its complications are well de- managing patients both in the elective operating room set- scribed in the literature. These can range from minor soft ting and in the emergent nonoperating room setting.
    [Show full text]
  • Readingsample
    Operative Techniques in Laryngology Bearbeitet von Clark A. Rosen, Hans Leden, Robert H. Ossoff, BLAKE SIMPSON 1. Auflage 2008. Buch. xxvi, 312 S. Hardcover ISBN 978 3 540 25806 3 Format (B x L): 21 x 27,9 cm Gewicht: 1089 g Weitere Fachgebiete > Medizin > Chirurgie Zu Inhaltsverzeichnis schnell und portofrei erhältlich bei Die Online-Fachbuchhandlung beck-shop.de ist spezialisiert auf Fachbücher, insbesondere Recht, Steuern und Wirtschaft. Im Sortiment finden Sie alle Medien (Bücher, Zeitschriften, CDs, eBooks, etc.) aller Verlage. Ergänzt wird das Programm durch Services wie Neuerscheinungsdienst oder Zusammenstellungen von Büchern zu Sonderpreisen. Der Shop führt mehr als 8 Millionen Produkte. Chapter 1 Anatomy and Physiology of the Larynx 1 1.1 Anatomy the anterior surface of the thyroid laminae at the oblique line. The inferior pharyngeal constrictor muscles insert on the pos- 1.1.1 Laryngeal Cartilages terior edge of each thyroid lamina. The relationship of the internal laryngeal structures to the 1.1.1.1 Thyroid surface anatomy of the thyroid cartilage is important in sur- gical planning, particularly in planning the placement of the window for thyroplasty. The level of the vocal fold lies closer to The laryngeal skeleton consists of several cartilaginous struc- the lower border of the thyroid cartilage lamina than to the up- tures (Fig. 1.1), the largest of which is the thyroid cartilage. The per, and not at its midpoint, as is frequently (and erroneously) thyroid cartilage is composed of two rectangular laminae that stated. Correct placement of the window is necessary to avoid are fused anteriorly in the midline.
    [Show full text]
  • Reviewing and Refining Surgical Interventions for Glottic Insufficiency
    Reviewing and Refining Surgical Interventions for Glottic Insufficiency By Matthew R. Hoffman A dissertation submitted in partial fulfillment of the requirements for the degree of Doctor of Philosophy (Communication Sciences and Disorders) at the UNIVERSITY OF WISCONSIN-MADISON 2013 Date of final oral examination: 4/25/13 The dissertation is approved by the following members of the Final Oral Committee: Jack J. Jiang, Professor, Surgery Timothy M. McCulloch, Associate Professor, Surgery Gary Weismer, Professor, Communication Sciences and Disorders Michelle R. Ciucci, Assistant Professor, Communication Sciences and Disorders Michael H. McDonald, Surgery Charles N. Ford, Professor Emeritus, Surgery i ACKNOWLEDGEMENTS Thank you to my committee members, Drs. Jack Jiang, Timothy McCulloch, Gary Weismer, Michelle Ciucci, Michael McDonald, and Charles Ford. They gave me their time and an opportunity when I was a young undergraduate student and had nothing to offer and challenged me to pursue new directions once I did. I am particularly grateful to: Dr. Jiang, for teaching me how to conduct research and think scientifically over the last eight years; Dr. McCulloch, for allowing me to help him pursue a new research interest and then helping me on any and all of mine; Dr. Weismer, for guiding me through the doctoral program; Dr. Ciucci, for the time she dedicated to helping me write this dissertation; Dr. McDonald, for revealing the wonders of the Eustachian tube and serving as my first clinical otolaryngology mentor; and Dr. Ford, for his constant willingness to work with and teach me, from our aerodynamic assessment of spasmodic dysphonia to our device for identifying the thyroplasty window position, and for allowing me to scrub in on an operation for the first time, a medialization thyroplasty.
    [Show full text]
  • The 13Th International Conference on Advances in Quantitative Laryngology, Voice and Speech Research (June 2–4, 2019, Montreal, Quebec, Canada)
    applied sciences Meeting Report The 13th International Conference on Advances in Quantitative Laryngology, Voice and Speech Research (June 2–4, 2019, Montreal, Quebec, Canada) Luc Mongeau Department of Mechanical Engineering, McGill University, Montreal, QC H3A 0G4, Canada; [email protected] Received: 28 May 2019; Accepted: 29 May 2019; Published: 30 June 2019 Abstract: The 13th International Conference on Advances in Quantitative Laryngology, Voice and Speech Research (AQL 2019) will be held in Montreal, Canada, 3–4 June 2019. Pre-conference workshops will be held on 2 June 2019. The conference and workshops provide a unique opportunity for partnership and collaboration in the advancement of quantitative methods for the measurement and modelling of voice and speech. The AQL accomplishes this mandate by facilitating an interprofessional scientific conference and training intended for an international community of otolaryngologists, speech–language pathologists and voice scientists. With a continued drive toward advancements in translational and clinical voice science, the AQL has rapidly expanded over the past 20 years, from a forum of 15 European member laboratories to a globally recognized symposium, connecting over 100 delegates from across the world. Contents 1 Pre-Conference 4 1.1 Hybrid Aeroacoustic Approach for the Efficient Numerical Simulation of Human Phonation.............................................4 1.2 simVoice—Numerical Computation of the Human Voice Source..............6 1.3 Aeroacoustic and Vibroacoustic Mechanisms during Phonation..............7 1.4 A Machine-Learning Based Reduced-Order Modeling of Glottal Flow..........8 1.5 Updated Rules for Constructing a Triangular Body-Cover Model of the Vocal Folds from Intrinsic Laryngeal Muscle Activation.............................9 1.6 Synthetic Vocal Fold Model Closed Quotient Optimization................
    [Show full text]
  • Vocal Fold Medialization by Surgical Augmentation Versus Arytenoid Adduction in the in Vivo Canine Model
    Ann Otol Rhinol Laryngol100:1991 VOCAL FOLD MEDIALIZATION BY SURGICAL AUGMENTATION VERSUS ARYTENOID ADDUCTION IN THE IN VIVO CANINE MODEL DAVID C. GREEN, MD GERALD S. BERKE, MD PAUL H. WARD, MD Los ANGELES, CALIFORNIA There are a variety of methods for treating unilateral vocal cord paralysis, but to date there have been few studies that compare these phonosurgical techniques by using objective measures of voice improvement. Vocal efficiency is an objective voice measure that is defined as the ratio of the acoustic power produced by the larynx to the subglottic air power. Vocal efficiency has been found to decrease with glot­ tic disorders such as vocal cord paralysis and carcinoma. This study compared the effects of vocal fold medialization by surgical augmenta­ tion to those of arytenoid adduction on the vocal efficiency, videostroboscopy, and acoustics (jitter, shimmer, and signal-to-noise ratio) of a simulated unilateral vocal cord paralysis in an in vivo canine model. Arytenoid adduction was superior to surgical augmentation in vocal efficiency, traveling wave motion, and acoustics. KEYWORDS - flaccid laryngeal paralysis, laryngoplasty, phonosurgery, recurrent laryngeal nerve, stroboscopy, vocal efficiency. INTRODUCTION noid muscle contraction plays a greater role in in­ There are a variety of methods for treating uni­ tensity control during normal phonation than later­ lateral vocal cord paralysis. These include Teflon al cricoarytenoid contraction by changing cord stiffness and shape, while lateral cricoarytenoid injection;' thyroplasty, 2 arytenoid adduction," and contraction plays a greater role in pathologic cases nerve" and nerve-muscle pedicle transfer. 5 Most of these methods have been reported to improve the with incomplete glottic closure by enhancing cordal voice.
    [Show full text]
  • Nerve-Muscle Pedicle Flap Implantation Combined with Arytenoid Adduction
    ORIGINAL ARTICLE Nerve-Muscle Pedicle Flap Implantation Combined With Arytenoid Adduction Eiji Yumoto, MD; Tetsuji Sanuki, MD; Yutaka Toya, MD; Narihiro Kodama; Yoshihiko Kumai, MD Objectives: To describe a new technique of nerve- Main Outcome Measures: The maximum phonation muscle pedicle (NMP) flap implantation combined with time, mean airflow rate, pitch range, and acoustic para- arytenoid adduction (AA) to treat dysphonia due to uni- meters (jitter, shimmer, and harmonics to noise ratio) were lateral vocal fold paralysis and to examine postoperative evaluated before surgery and twice after surgery. vocal function. Results: All parameters improved significantly after sur- Study Design: Retrospective review of clinical gery (PϽ.01). The measurements for maximum phonation records. time, mean airflow rate, and harmonics to noise ratio were within normal ranges after surgery. Furthermore, the maxi- Setting: Tertiary academic center. mum phonation time and jitter were significantly improved after long-term follow-up compared with early postopera- Patients: Twenty-two consecutive patients underwent tive measurements (PϽ.01 and PϽ.05, respectively). NMP flap implantation with AA and were followed up short term over a period of 1 to 6 months (mean, 2.9 Conclusions: Precise harvest of an NMP flap and its place- months) and long term over a period of 7 to 36 months ment directly onto the thyroarytenoid muscle combined (mean, 21.4 months). with AA provided excellent vocal function. The NMP Interventions: An NMP flap was made using an ansa cer- method may have played a certain role in the improve- vicalis branch and a piece of the sternohyoid muscle. A win- ment of postoperative vocal function, although further study dow was opened in the thyroid ala at the level of the vocal with electromyographic examination is required to clarify fold.
    [Show full text]
  • Chapter 15 Vocal Fold Medialization, Arytenoid Adduction, And
    Chapter 15 Vocal Fold Medialization, Arytenoid Adduction, and Reinnervation Andrew Blitzer, Steven M. Zeitels, James L. Netterville, Tanya K. Meyer, and Marshall E. Smith Restoration of vocal function with laryngeal framework sur- Thyroplasty Type I gery (laryngoplastic phonosurgery) was introduced at the Thyroplasty type I (Fig. 15.1) is the most widely used of beginning of the 20th century. Today, these procedures have Isshiki’s original thyroplasty techniques. It involves creating emerged as the dominant surgical management approach for a rectangular cartilaginous window at the level of the true the treatment of the aerodynamic incompetence and acoustic vocal fold and using cartilage, Silastic, Gore-Tex, or other deterioration associated with vocal fold paralysis/paresis. implant material to medialize the true vocal fold. This pro- Other indications include cancer defects, vocal fold scar, sul- cedure achieves closure of the musculomembranous vocal cus vocalis, bowing associated with vocal fold atrophy, laryn- fold only; arytenoid position is not appreciably altered by geal trauma, and neuromuscular disorders including abductor the implant. Thyroplasty type I is a relatively simple and spasmodic dysphonia and parkinsonism. Laryngeal frame- reversible procedure that is ideally performed with local work surgery has also been employed to alter pitch for gender anesthesia to facilitate fine-tuning of the voice with precise reassignment; however, this topic is not discussed here. placement of the implant material. There have been a large Although medialization of the musculomembranous number of manuscripts describing a multitude of variations vocal fold by means of rearranging the laryngeal cartilage of the original procedure, primarily introducing different framework was described by Payr1 in 1915, and others in implant materials and their placement.
    [Show 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.
    [Show full text]