A comparative study on the efficacy of different treatment methods for preventing vocal cord adhesion after laser treatment for glottic cancer

A Surgical Technique of Inner Capsule Vaporization With CO2 Laser for Vocal Fold Cysts.

BackgroundTransoral laser microsurgery is widely used for treating T1/T2 glottic cancers. Hyaluronic acid (HA) is commonly used in vocal cord augmentation. We investigated the impact of intra-operative injection laryngoplasty on voice outcomes in early glottic cancer.MethodsTwenty patients were randomized to the treatment group receiving HA injection to the vocal cord contralateral to the lesion; or the control group, receiving no injection. Patients had a Voice Handicap Index-10 (VHI-10) questionnaire and a Maximum Phonation Time (MPT) measurement preoperatively and at 3, 12 and 24 months post-operatively. Mean change in VHI-10 and MPT, compared to baseline and between time points, were compared. Survival estimates were calculated.ResultsMean VHI-10 scores improved over time amongst all patients. There were no changes in mean VHI-10 from pre-operative values to 3, 12 or 24 months post-operatively. There were no significant differences when comparing various timepoints between groups. There were no significant changes in MPT amongst the groups, or the time-points compared. Two-year overall survival was 91.7%; disease free survival was 80.9%; no difference in recurrence free survival was seen between the groups.ConclusionSubjective voice scores improved over time in both groups; there were no improvements in VHI-10 or MPT scores in the injection group, over control, at any time points. We saw no significant impact for intra-operative HA injection laryngoplasty on subjective or objective voice outcomes following surgery for early glottic cancers.Graphical abstract

Outcomes of Arytenoid Adduction under Laryngeal Mask Mechanical Ventilation for Unilateral Vocal Fold Paralysis

As phonomicrosurgical techniques have evolved, endoscopic cordectomy (EC) has been used more commonly for early-stage glottic cancer. Patients undergoing more extensive surgery often experience significant postoperative dysphonia for which there is no standard treatment. Surgical options include injection laryngoplasty and thyroplasty. We reviewed the literature to evaluate the efficacy of thyroplasty after EC. A comprehensive literature search was conducted to identify studies of adults undergoing thyroplasty for dysphonia after EC for glottic cancer. Primary outcomes included voice, as measured subjectively by the voice handicap index (VHI) and objectively by aerodynamics-specifically maximum phonation time (MPT). Secondary outcomes included additional acoustic and aerodynamic measurements, variations in the technical aspects of thyroplasty, and a description of adverse events. Seven articles met inclusion criteria. Each study allowed 6 to 12 months after EC before performing thyroplasty. General anesthesia frequently was used rather than monitored anesthesia care . Implants varied between centers and were chosen based on surgeon preference. Of the three studies including statistical analysis, one reported improvement in VHI and grade. The second reported improvement in VHI; grade, roughness, breathiness, asthenia, strain; jitter; shimmer; noise-to-harmonic ratio (NHR); and MPT. The third reported improvements in jitter, shimmer, NHR, fundamental frequency, MPT, and sound pressure level. The most frequent adverse events were hematoma, infection, and implant extrusion. Optimizing voice after EC remains a clinical challenge. Our review suggests that thyroplasty is one potentially beneficial option in appropriately selected patients. More controlled studies are needed to assess efficacy of thyroplasty in this context. Laryngoscope, 128:690-696, 2018.

Objective: To explore the feasibility of one-stage repair and reconstruction of glottic area wounds with the ventricular mucosal flap to prevent postoperative vocal cord adhesion in patients with T1b glottic laryngeal cancer. Methods: This case series study involved the research and analysis of clinical data of 12 patients with T1b glottic laryngeal cancer treated in the Department of Otorhinolaryngology, the Second Affiliated Hospital of Zhejiang University School of Medicine from January 2021 to June 2023. All patients were male, aged 50-85 years (median age 64.5 years), and underwent CO2 laser vocal cord resection under oral support laryngoscopy, followed by one-stage reconstruction of the glottic wound using a ventricular mucosal flap transfer. Postoperative observation indicators included oncological efficacy, surgical complications, degree of vocal cord adhesion, and vocal function, with routine follow-up conducted. The preoperative and postoperative Voice Handicap Index (VHI) scores were compared using a paired-sample Wilcoxon signed-rank test. Results: All 12 patients were followed up for more than 1 year, with follow-up periods ranging from 12 to 37 months and a median follow-up period of 19.5 months. During the follow-up period, no tumor recurrence was observed in any of the patients. One patient experienced suture detachment and displacement of the ventricular mucosal flap postoperatively, and no patient reported respiratory distress symptoms after surgery. 6 patients had no postoperative vocal cord adhesion, and the vocal cord length ratio in 12 patients was (0.80±0.23). The maximum glottic opening angle after surgery was (46.5±7.7) degrees. Voice function was evaluated before surgery and in six months postoperatively, when the laryngeal mucosa was on the stable phase. The median VHI-10 score for the 12 patients was 20 preoperatively and 10 postoperatively, the difference was statistically significant (Z=-2.827,P<0.05). Conclusions: The application of ventricular mucosal flap repair and reconstruction for glottic wound following laser resection of T1b laryngeal cancer effectively prevents postoperative vocal cord adhesion. The postoperative recovery of vocal function in these patients is favorable.

Background Postoperative pneumonia in patients with esophageal cancer occurs due to swallowing dysfunction and aspiration. Recently, intervention by speech-language pathologists (STs) has reported to be important for the prevention of postoperative pneumonia. In this study, we report on the perioperative swallowing rehabilitation led by STs at our hospital. In addition, we focused maximum phonation time (MPT) assessment and repetitive saliva swallowing test (RSST) as swallowing function assessment methods that can identify patients as high risk for pneumonia. We aimed to evaluate the clinical utility of MPT assessment and RSST in patients undergoing oncological esophagectomy. Methods ST intervention was started at the induction of preoperative chemotherapy, and pre-surgical swallowing rehabilitation including oral care, incentive spirometry, abdominal breathing, and breath-hold swallowing was started and continued after surgery. MPT is the longest speech duration after maximal inspiration, and RSST is the number of empty swallowing that can be repeated in 30 seconds. In total, 47 consecutive patients who underwent esophagectomy for esophageal cancer between 2020 and 2023 were eligible. The perioperative changes in MPTs and RSST scores were examined. In addition, univariate and multivariate analyses were performed to identify the predictive factors of postoperative pneumonia. Results The median MPTs before surgery and on postoperative days (PODs) 3, 6, and 10 were 18.4, 7.2, 10.6, and 12.4 s, respectively; postoperative MPTs were significantly lower than preoperative MPT. Meanwhile, there were no significant changes in perioperative RSST scores. A short MPT on POD 6 was one of the independent predictive factors for the incidence of postoperative pneumonia (OR: 12.6, 95%CI: 1.29–123, P = 0.03) in the multivariate analysis. Regarding the onset of postoperative pneumonia, the MPT on POD6 was significantly associated with late-onset pneumonia, but not with early pneumonia (P = 0.02 and P = 0.25, respectively). Conclusion The MPT significantly decreased after esophagectomy. However, the RSST score did not. The MPT on POD6 can be a predictor of postoperative pneumonia. Early resumption of oral intake after esophagectomy might be a risk factor of aspiration pneumonia since expectoration function is not restored, especially in patients with a low MPT on POD 6.

Laryngoscope, 2010

Postoperative pneumonia in patients with esophageal cancer occurs due to swallowing dysfunction and aspiration. Recently, maximum phonation time (MPT) assessment and repetitive saliva swallowing test (RSST) have been focused on as swallowing function assessment methods that can identify patients as high risk for pneumonia. We aimed to evaluate the clinical utility of MPT assessment and RSST in patients undergoing oncological esophagectomy. In total, 47 consecutive patients who underwent esophagectomy for esophageal cancer between August 2020 and July 2023 were eligible. The perioperative changes in MPTs and RSST scores were examined. In addition, univariate and multivariate analyses were performed to identify the predictive factors of postoperative pneumonia. The median MPTs before surgery and on postoperative days (PODs) 3, 6, and 10 were 18.4, 7.2, 10.6, and 12.4s, respectively; postoperative MPTs were significantly lower than preoperative MPT. In addition, the MPT of POD 6 was significantly longer than that of POD 3 (P < 0.05). Meanwhile, there were no significant changes in perioperative RSST scores. Overall, 8 of 47 patients (17.0%) developed pneumonia postoperatively. A short MPT on POD 6 was one of the independent predictive factors for the incidence of postoperative pneumonia (odds ratio: 12.6, 95% confidence interval: 1.29-123, P = 0.03) in the multivariate analysis. The MPT significantly decreased after esophagectomy. However, the RSST score did not. The MPT on POD6 can be a predictor of postoperative pneumonia.

Objective: To systematically evaluate the effects of visual glottal closure training guided by swallowing electronic laryngoscopy and conventional voice training on the Voice Handicap Index (VHI) scores and Maximum Phonation Time (MPT) in patients with post-stroke dysphonia (PSD), providing evidence-based support for precise rehabilitation in such patients. Methods: A randomized controlled trial design was employed, selecting patients with post-stroke dysphonia who met the inclusion criteria as the study subjects. Patients were randomly divided into an experimental group (receiving visual glottal closure training) and a control group (receiving conventional voice training), with 32 cases in each group. Both groups underwent training for 8 weeks, twice a week, with each session lasting 30 minutes. The VHI scale was used to assess the subjective degree of voice impairment, and MPT was measured to evaluate vocal efficiency at four time points: baseline (T0), mid-treatment (T1, 4 weeks), end of treatment (T2, 8 weeks), and follow-up 3 months after treatment (T3). Statistical analysis was performed on the data. Results: A total of 64 patients were included, with 58 completing the study (29 in the experimental group and 29 in the control group), resulting in a dropout rate of 9.38%. There were no statistically significant differences in VHI scores and MPT between the two groups at baseline (T0) (P &gt; 0.05). During the mid-treatment phase (T1), at the end of treatment (T2), and during the follow-up period (T3), the Voice Handicap Index (VHI) scores of patients in both groups significantly decreased compared to the baseline period (P &lt; 0.05), and the Maximum Phonation Time (MPT) significantly increased compared to the baseline period (P &lt; 0.05). Moreover, the VHI scores of the experimental group at each time point (T1: 42.35 points vs. 56.82 points, T2: 28.16 points vs. 45.73 points, T3: 25.48 points vs. 41.95 points) were significantly lower than those of the control group (P &lt; 0.05), and the MPT (T1: 12.68s vs. 9.35s, T2: 16.82s vs. 11.57s, T3: 15.96s vs. 10.83s) was significantly longer than that of the control group (P &lt; 0.05). Conclusion: Both visual glottal closure training guided by swallowing electronic laryngoscopy and conventional voice training can improve the subjective voice impairment and vocal efficiency of patients with post-stroke dysphonia. However, visual glottal closure training demonstrates superior efficacy and sustained therapeutic effects, making it a preferred rehabilitation option for patients with post-stroke dysphonia.

Objective: To evaluate the effectiveness of poly (lactic-co-glycolic acid) (PLGA) nanofiber membrane on prevention of postoperative abdominal adhesion. Methods: PLGA nanofiber membrane was prepared by high-voltage electrospinning technique. The effectiveness of the membrane in prevention of postoperative abdominal adhesions was characterized with rat abdominal adhesion models. Results: PLGA nanofiber membrane was prepared successfully by electrospinning technique. Scanning electron microscopy (SEM) observation showed that the average diameter of PLGA fibers was approximately 800 nm, and the membrane had microporous structures. Mechanical tests showed that the tensile strength of PLGA nanofiber membrane was 6.36 ± 0.39 MPa, which was significantly higher than the tensile strength of DIKANG absorbable medical film. The results of in vivo experiments showed that PLGA nanofiber membrane and DIKANG absorbable medical film could both reduce the degree of abdominal adhesions. The histological results showed that there was only a small extent of inflammatory cell infiltration in the PLGA group and the control group. The proliferation of connective tissue was reduced, and so was the degree of adhesion. Conclusion: PLGA nanofiber membrane can significantly reduce the incidence and severity of postoperative adhesions, and bodes well for future clinical applications.

Correlation between the Voice Handicap Index and voice measurements in four groups of patients with dysphonia

Factors Influencing Voice Outcomes After Intracordal Trafermin Injection in Age-Related Vocal Fold Atrophy.

Shape of Thyroid Cartilage Influences Outcome of Montgomery Medialization Thyroplasty: A Gender Issue

Injection Laryngoplasty of Unilateral Vocal Fold Paralysis Evaluated With Pause and Speech Measurements

Introduction:Mucous retention cysts are a subtype of intracordal vocal cysts that may occur spontaneously or may be associated with poor vocal hygiene, and which require optimal treatment. The objective of this study was to present a new laser-assisted microsurgery technique for treating intracordal mucous retention cysts and to describe the final outcomes. Materials and Methods:In this prospective study, we assessed the pre-operative and post-operative acoustic analysis, maximum phonation time (MPT), and voice handicap index (VHI) of four patients with a diagnosis of mucous retention cyst. The island flap technique was applied to all patients without any complications. In this procedure, we favored the super-pulse mode using a 2-W power CO2 laser to remove the medial wall of the cyst, before clearing away the lateral wall margins of the cyst using repeat-pulse mode and a 2-W power CO2 laser. Indeed, we maintained the underlying epithelium and lamina propria, including the island flap attached to the vocal ligament. Results:There was a statistically significant improvement in the MPT (pre-op,11.05 s; post-op,15.85 s; P=0.002) and the VHI (pre-operative, 72/120; post-operative,27/120; P=0.001) in all patients. Moreover, jitter and shimmer were refined after surgery, but there was no statistically significant relationship between pre-operative and post-operative data (P=0.071) (P=0.622). In the follow-up period (median, 150 days), there was no report of recurrence or mucosal stiffness. Conclusion: The island flap procedure in association with CO2 laser microsurgery appears to be a safe and effective treatment option for intracordal mucous retention cysts, but needs further investigation to allow comparison with other methods.