American Laryngological Association Research Articles

Laryngoplasty: Indications and Pitfalls

At the 109th annual meeting of the American Laryngological Association, Palm Beach, Fla, Michael D. Maves, MD, and Brian McCabe, MD, Iowa City, reported their studies of laryngoplasty techniques as an alternative method for managing patients with unilaterally paralyzed vocal cords. Dr Maves described the technique, a modification of the procedure pioneered by Isshiki, as an improvement over conventional therapy for the treatment of paralyzed vocal cords, such as Teflon injection. The technique, developed at the University of Iowa, utilizes a combination of local anesthesia along with fiberoptic laryngoscopic video monitoring of the patient's larynx during the procedure. This very innovative concept allows continuous monitoring of both the patient's voice and laryngoscopic evaluation of the patient's vocal cord to assess both the quality and the anatomic appearance of the patient's larynx. Their procedure involves a midthyroid incision with resection of a small window of cartilage. A Silastic implant fashioned in

Laser Epiglottectomy: Endoscopic Technique and Indications

At the American Laryngological Association annual meeting, Steven Zeitels, MD, C. W. Vaughn, MD, and G. T. Simpson, MD, of Boston University, reported their experience in managing various supraglottic pathologies in 49 patients by laser epiglottectomy. Utilizing general endotracheal anesthesia, the majority of patients (23) were treated for supraglottic airway obstruction caused by benign or malignant tumors, inflammatory processes, and postradiation edema. Other indications for laser epiglottectomy included diagnosis and staging of supraglottic carcinoma (18 patients), debulking advanced tumors (14 patients), and treatment of localized carcinomas and improvement of glottic visualization due to epiglottic obstruction following trauma or radiation (four patients). This unique series is enhanced by the investigators' concise elaboration of the actual surgical technique. Such a report provides useful information to both the novice and experienced laryngeal surgeon. The lack of significant postoperative problems with alimentation, airway, or voice, attest to the skill of these investigators and the

Glomus Vagal Tumors

Drs Hugh F. Biller and William Lawson, Mount Sinai Medical Center, New York, reported their experience with 18 cases of glomus vagal tumors at the April 1988 meeting of the American Laryngological Association in Palm Beach, Fla. Their report showed the female-to-male ratio to be 2:1. The patients (40%) had multiple paragangliomas. Computed tomographic and magnetic resonance imaging scans were the most helpful tests for diagnosis, with arteriography used to help identify the multicentric cases as well as carotid artery encroachment. Adequate surgical exposure was necessary to avoid carotid artery injury. The authors found vagal nerve paralysis in 100% of the cases postoperatively, which resulted in dysphagia and aspiration in some of the cases. These cases were managed with cricopharyngeal myotomy and polytef (Teflon) injection. Additionally, some of the patients had weakness or paralysis of the hypoglossal and spinal accessory nerve. There were four patients who had clinical evidence of

Tumor Growth and Extension in the Larynx

At the April 1988 meeting of the American Laryngological Association in Palm Beach, Fla, Dr Louis W. Welsh, Jenkintown, Pa, recently reported a study of the internal structure of the larynx and the anatomic factors that impacted on the pattern of tumor spread and expansion. This study was based on the administration of a dye in the subepithelial tissues. Photographs of the animal larynx with the dye injected were made, and the larynx was then sent for histologic examination. This report confirmed the work of Pressman and other investigators who found that the larynx was divided into submucosal compartments bounded by the ligaments, perichondrium, cartilaginous framework, and the muscular fibrillar network. There was spread to the other side of the supraglottis, but not across the ventricle. Dye would spread around the anterior commissure but not to the other vocal cord at the level of the glottis. The subglottic spread allowed

Choanal Atresia: Treatment Trends in 47 Patients Over a 33-Year Period

At the American Laryngological Association Meeting in Palm Beach, Fla, Jonathan Ferguson, MD, and H. Bryan Neel III, MD, Rochester, Minn, presented an update on the management of choanal atresia. Treatment and outcome were compared in 11 patients treated from 1977 to 1985, compared with 36 patients treated from 1951 to 1977. The authors believe that the advent of computed tomographic scanning has aided them in diagnosis as well as evaluation of the type of surgery required. They emphasize two different deformities, ie, an hour-glass deformity, reflecting lateral narrowing, and a delta deformity, reflecting widening of the vomer. All five patients who were managed with transnasal perforation and placement of a stent required second operations, while only eight of 18 similarly treated patients from 1951 to 1977 required second procedures. All three patients managed by transpalatal repair succeeded, compared with 50% of those treated similarly from 1951 to 1977. Transseptal

Implantation of a Recurrent Nerve Stimulator for the Treatment of Spastic Dysphonia

At the American Laryngological Association meeting in Palm Beach, Fla, Dr Michael Friedman and colleagues, Chicago, reported a new treatment for spastic dysphonia. The technique consists of implanting a small electrical stimulating device subcutaneously. In the single patient described, the result was good, and voice improvement was optimized through electrical stimulation of the recurrent laryngeal nerve at 2 mA and 25 Hz. The preoperative patient selection process includes percutaneous stimulation of the recurrent nerve to determine efficacy. The authors stressed the experimental nature of the procedure. Evidence from a canine model, as well as the case report, indicated no adverse cardiorespiratory effects secondary to electrical stimulation of the recurrent nerve.

Surgical Correction of Dysphonia due to Bowing of the Vocal Cords

Dr James Koufman, Winston Salem, NC, at the Annual Meeting of the American Laryngological Association in Palm Beach, Fla, reported his experience with laryngoplastic surgical correction of dysphonia associated with bowing of the vocal cords. Dr Koufman reviewed the four major laryngoplasty techniques that have been used for the treatment of bowing of the vocal cords by lengthening and, thus, tightening the vocal ligaments. Koufman's technique is based on the anatomy of Broyle's ligament, which relates to the attachment of the vocal cords at the anterior commissure. Koufman's innovative modification provides for advancement of Broyle's ligament by using a superiorly based flap. This causes less mechanical disruption of Broyle's ligament. The vocal cords are then extended toward the medial aspect by the placement of Silastic implants to augment the lateral aspects of the larynx and vocal cords. These spaces occupying Silastic grafts allow the vocal cords to remain in the

Laryngeal Framework Surgery in the Management of Spastic Dysphonia

At the annual meeting of the American Laryngological Association in Palm Beach, Fla, Dr Harvey Tucker, Cleveland, reported a new surgical procedure for the management of spastic dysphonia. The procedure, performed under local anesthesia, consists of relaxing the vocal folds using parasagittal incisions bilaterally in the anterior thyroid cartilage. The medial segment, with the attached anterior commissure tendon, is retrodisplaced, and then the lateral cut ends of the thyroid cartilage are approximated. Sixteen patients have undergone the procedure, ten (63%) of whom were reported to be free of spasm six months later. Side effects of the procedure are lowering of the fundamental frequency of speech and loss of vocal volume (ie, loudness). No surgical complications were encountered in the cases reported.

Model of a New Generation of Tracheostomy and Endotracheal Tubes

J. R. Avasarala and collaborators, Nagoya, Japan, at the April 1988 meeting of the American Laryngological Association in Palm Beach, Fla, reported the creation of new types of tracheostomy and endotracheal tubes with sensors built into them that can activate an alarm if they are becoming obstructed. They revealed that their research found that electrodes within the lumen of the tube would activate a signal as the resistance across the electrodes changed. Mucous secretion, blood, and tissue within the lumen or at the end of the tube would cause a change in the resistance and, therefore, would set off an alarm. This type of tube would be especially useful in the intensive care unit and may eliminate the possibility of cannula obstruction deaths postoperatively.

American Laryngological Association

American Laryngological Association

American Laryngological Association

American Laryngological Association

American Laryngological Association

American Laryngological Association

American laryngological association. Preliminary program. Subject to change and council approval

American laryngological association. Preliminary program. Subject to change and council approval

American Laryngological Association

American Laryngological Association

The Memorable Life of Hosmer A. Johnson, Early Midwestern Laryngologist

Hosmer A. Johnson, one of the early laryngologists in the Midwest, graduated in 1852 from Rush Medical College, and was the first intern in Chicago. With four other faculty members he left Rush in 1859 to establish what subsequently became the Northwestern University Medical School. He taught many subjects and was extremely active in local and national societies. An interest in diseases of the chest led him into laryngology and he became a charter member of the American Laryngological Association, where he reported on congenital tumors of the larynx, laryngeal paralysis, and cancer of the larynx. Dr. Johnson was a master of six or seven foreign languages, a versatile civic leader, a talented orator, and was greatly admired for his medical skills. The breadth of his accomplishments and character made for a truly memorable life.

American Laryngological Association

American Laryngological Association

Laryngeal papillomas yield to 'fine tool' laser

ABSTRACT Destruction of laryngeal papillomas with the CO2 laser has yielded dramatically improved remission rates in a group of patients previously treated by the more traditional cup forceps removal technique.According to a report presented at the annual meeting of the American Laryngological Association in Palm Beach, Fla, 45 (41%) of 109 patients in a University of California, San Francisco (UCSF) laser therapy program were free of disease at follow-up examinations conducted two months to five years after treatment. Their average remission period has now exceeded eight months. Of 12 who arrived with tracheotomy tubes in place, six have had the tubes removed in the course of laser therapy.All of the 109 had previously undergone multiple cup forceps removals of their papillomas. In fact, before entering the laser program they had undergone a total of 1,050 such removals, an average of ten each, without eradication of their disease.Two

Laryngeal papillomas yield to 'fine tool' laser

Destruction of laryngeal papillomas with the CO₂laser has yielded dramatically improved remission rates in a group of patients previously treated by the more traditional cup forceps removal technique. According to a report presented at the annual meeting of the American Laryngological Association in Palm Beach, Fla, 45 (41%) of 109 patients in a University of California, San Francisco (UCSF) laser therapy program were free of disease at follow-up examinations conducted two months to five years after treatment. Their average remission period has now exceeded eight months. Of 12 who arrived with tracheotomy tubes in place, six have had the tubes removed in the course of laser therapy. All of the 109 had previously undergone multiple cup forceps removals of their papillomas. In fact, before entering the laser program they had undergone a total of 1,050 such removals, an average of ten each, without eradication of their disease. Two

American Laryngological Association

American Laryngological Association

American Laryngological Association, Inc.

American Laryngological Association, Inc.