Bilateral Laryngeal Paralysis Research Articles

Assessment of survey radiography as a method of diagnosing bilateral laryngeal paralysis in dogs.

The gold standard for diagnosis of laryngeal paralysis is laryngoscopy under light anesthesia. This prospective analytical cross-sectional study aimed to determine whether a radiographic assessment of the larynx could be used as a non-invasive screening tool for diagnosing laryngeal paralysis in non-sedated animals, as the laryngeal ventricles may appear wider in affected animals. The laryngeal ventricles of 18 dogs with bilateral laryngeal paralysis composing the affected group and 25 non-sedated dogs presenting no respiratory abnormality composing the control group were evaluated using right lateral radiography of the larynx. Three observers measured the ratios of the maximal ventricular length and surface to the body length of the third cervical vertebra (MVL/LC3 and VS/LC3, respectively). They also subjectively assessed the ventricular shape as either normal or rounded. The most accurate criterion was found to be MVL/LC3, as the respective areas under the ROC curves were 0.96 (95% confidence interval [CI]: 0.95-0.97), 0.89 (95% CI: 0.87-0.91), 0.80 (95% CI: 0.65-0.95) for MVL/LC3, VS/LC3, and ventricular shape evaluation, respectively. Based on ROC curve analysis, two thresholds of clinical interest were set for the MVL/LC3; bilateral laryngeal paralysis was very unlikely for values<0.3 and very likely for values>0.5. The findings of this study support the use of lateral laryngeal radiography as a screening tool for diagnosing bilateral laryngeal paralysis. However, further diagnostic tests remain required if MVL/LC3 lies between these threshold values or if clinically indicated. Further studies are warranted to explore the use of laryngeal radiography in unilateral paralysis and other laryngeal or oropharyngeal diseases.

Surgical treatment of unilateral laryngeal paralysis by selective reinnervation in thyroid surgery

State of the problem: One of the complications in thyroid surgery is a lesion of RLN which can be bilateral with a violation of respiratory function of the larynx and unilateral, in which the first priority is a violation of vocal function of the larynx. The most effective treatment for paralysis of the larynx is the method of laryngeal reinnervation, which can be non-selective, which is usually used in unilateral laryngeal paralysis and promotes reinnervation of both abductors and laryngeal adductors. Selective reinnervation is selectively focuses on the reinnervation of individual target muscles, so it is more often used in bilateral laryngeal paralysis. But despite this, it was used in unilateral laryngeal paralysis during surgery on the thyroid gland during intentional resection of the anterior branch of RLN with partial invasion of its tumour process. Aim: evaluation of the results of surgical treatment unilateral laryngeal paralysis by the method selective reinnervation in thyroidectomy. Materials and Methods: clinical case results of patient A. 15 years old with papillary thyroid cancer and metastases to regional lymph nodes of the neck (T4aN1M0) with absence disorders of laryngeal motility before surgery were analyzed. Examination of the larynx and voice examination were performed before surgery, 2-3 days and 6,12 months after surgery. Changes of laryngoscopic images and evaluation of the Indicators: maximum pho- nation time, fundamental frequency, noise to harmonic ratio, Jitter (loc), Shimmer (loc), Voice Handicap Index-30 (VHI-30), completed version of Jacobcon B. Results: Considering extralaryngeal bifurcation of the recurrent laryngeal nerve (RLN) and invasion of the tumor into the adductive branch of RLN on the left, its dissection was performed and end-to-end neuroanastomosis was formed, completed is selective laryngeal reinnervation. In the immediate postoperative period, patients complained of voice disorders. Study of voice parameters corresponded to severe voice disorders. Partial resumption of the mobility of the larynx and voice function was after 6 months. The signs of the laryngoscopic picture and the spectral analysis of the voice corresponded to the indicators before the operation after 12 months Сonclusions 1. Primary selective reinnervation of the larynx can be used to treat unilateral laryngeal paralysis under the following conditions: extralaryngeal branching of the recurrent laryngeal nerve (bifurcation), lesion of only one of its branches, which will provide sufficient coaxiality to perform anastomosis "end-to-end" and preservation electrical integrity of another branch. 2. This method allows you to restore the motility of the denervated vocal folds and the main indicators of the voice. 3. Given only one clinical case of treatment of unilateral laryngeal paralysis by selective reinnervation, this technique needs further study and refinement.

Xq27.1 palindrome mediated interchromosomal insertion likely causes familial congenital bilateral laryngeal abductor paralysis (Plott syndrome)

Bilateral laryngeal abductor paralysis is a rare entity and the second most common cause of stridor in newborns. So far, no conclusive genetic or chromosomal aberration has been reported for X-linked isolated bilateral vocal cord paralysis, also referred to as Plott syndrome. Via whole genome sequencing (WGS), we identified a complex interchromosomal insertion in a large family with seven affected males. The 404 kb inserted fragment originates from chromosome 10q21.3, contains no genes and is inserted inversionally into the intergenic chromosomal region Xq27.1, 82 kb centromeric to the nearest gene SOX3. The patterns found at the breakpoint junctions resemble typical characteristics that arise in replication-based mechanisms with long-distance template switching. Non protein-coding insertions into the same genomic region have been described to result in different phenotypes, indicating that the phenotypic outcome likely depends on the introduction of regulatory elements. In conclusion, our data adds Plott syndrome as another entity, likely caused by the insertion of non-coding DNA into the intergenic chromosomal region Xq27.1. In this regard, we demonstrate the importance of WGS as a powerful diagnostic test in unsolved genetic diseases, as this genomic rearrangement has not been detected by current first-line diagnostic tests, i.e., exome sequencing and chromosomal microarray analysis.

Связанное со здоровьем качество жизни при терапевтической коррекции двустороннего паралича гортани

The task of treating any disease is to improve the quality of human life. However, there is no widespread practice in clinical studies to assess the health-related quality of life before and after medical intervention. The aim of the study was to evaluate the health-related quality of life in patients with bilateral laryngeal paralysis and the impact on the quality of life of methods of therapeutic rehabilitation of respiratory function using the international standardized questionnaire SF-36 (Russian version developed and recommended by the Multinational Center for Quality of Life Research (MCQLR)). A survey of 44 patients with bilateral laryngeal paralysis after a strumectomy lasting more than 1 year was conducted twice. The first questionnaire was conducted before the rehabilitation of respiratory function, the second questionnaire was conducted 4–6 months after rehabilitation. The patients underwent rehabilitation as part of two groups: in group 1, respiratory function rehabilitation was carried out by the method of prolonged injectable relaxation of the cricoid muscle with botulinum toxin type A. In group 2, respiratory function rehabilitation was carried out with phonopedic correction by the development of respiratory techniques and drug sedation with benzodiazepine. According to the results obtained, prolonged relaxation of the cricoid muscle by a single injection of botulinum toxin type A into the thickness of the cricoid muscle improves the physical component of the quality of life associated with health by 36%, the mental component, by 50%. Phonopedic correction will improve the physical component of the quality of life by 6%, and the mental component, by 4%. The obtained result can be used in communication between the patient and the doctor at the stage of explaining the effectiveness of available methods of conservative treatment for laryngeal paralysis.

Laryngeal silicone stent as a treatment option for laryngeal paralysis in dogs: a preliminary study of 6 cases.

BackgroundLaryngeal paralysis is a common idiopathic degenerative neurological disease in older medium-to-large breed dogs, with surgical correction of the obstruction being the treatment of choice.ObjectivesThis study evaluated the use of laryngeal silicone stents to treat canine laryngeal paralysis in dogs where classic surgical treatment was not accepted by the owners.MethodsDogs diagnosed with laryngeal paralysis, for which the owners refused arytenoid lateralization surgery as a first-line treatment, were treated with laryngeal silicone stents.ResultsSix dogs with bilateral laryngeal paralysis were included in the study. All dogs showed improvement in clinical signs immediately after the procedure. No clinical signs or radiographic changes were noted in four out of six dogs in the follow-up visit performed 1 wk later. One dog was suspected of aspirating water while drinking, but the signs disappeared after repositioning the stent. Another dog had a relapse of stridor due to caudal migration of the stent. This dog underwent arytenoid lateralization surgery because larger stents are not commercially available. At the time of writing, between seven and 13 mon after stent placement, no significant incidents have occurred in four dogs, and all owners report a satisfactory quality of life.ConclusionsLaryngeal silicone stenting is an interesting alternative for treating dogs with acquired laryngeal paralysis when the owners refuse classic arytenoid lateralization surgery. Furthermore, stent placement can be a temporary solution to stabilize these dogs until a permanent surgical treatment can be performed.

A comparative analysis of outcomes after surgical reconstruction of stenoses in the upper respiratory tract in children

Introduction. Definition " upper respiratory tract stenosis " (URTS) includes a large number of nosologies. The most common are cicatricial stenoses, in particular, post-intubation ones as well as bilateral paralysis of the larynx. An important issue for nowadays is choosing the curative modality for such patients.Purpose. To compare outcomes after treating children with URTS.Material and methods. The authors have assessed results of treatment of 110 patients who had reconstructive surgery in 2010-2019. Patients were divided into two groups depending on the nosology: stenosis of the upper respiratory tract (n = 71) and bilateral paralysis of the larynx (n-39). In each group, four types of surgeries were performed: costal cartilage plasty, plasty with T-tube (TT), a modified version of plasty with TT, plasty with a stent. The choice of treatment technique was determined mostly by the tendency to make this or that type of surgery in authors' departments, as well as by the nosology, severity of the disease and patient's age. Decannulation terms, surgical time, early and late postoperative complications as well as relapse-free period were assessed.Results. 66% patients were decannulated in Group 1; in Group 2 - 69%. Group 1 a statistically reliable comparison was possible between the following techniques: costal cartilage plasty and laryngeal stent plasty (p 0.005) as well as plasty with TT implantation and the proposed modified technique (p 0.005). While using Mann-Whitney test and Log Rank, the authors found out that in Group 1 there were no significant difference in surgical time, relapse-free period and stenosis degree (p 0.005). However, decannulation terms after plastic surgery of the larynx with costal cartilage implantation are longer than after plastic surgery with stent implantation (p 0.005). In Group 2, the authors compared three abovementioned curative modalities, excluding laryngeal plasty with TT implantation. Thus, surgical time for costal cartilage plasty is longer, if to compare to other two techniques (p 0.005). There is also no significant difference in decannulation terms and relapse-free periods between all three techniques (p 0.005).Conclusion. The results obtained have demonstrated the effectiveness of long-term stenting with TT placement in children, mainly with cicatricial stenoses, and in older children. The trial also revealed that laryngoplasty with costal cartilage in children with bilateral laryngeal paralysis is an effectiveness choice too.

Laryngeal paralysis secondary to cervical bite injuries in five dogs

Case histories : Medical records of a veterinary hospital in Belgium were reviewed for dogs (n=5) that presented between 2016 and 2019 with laryngeal paralysis secondary to bite wounds to the cervical region received while fighting with other dogs . The time elapsed between the trauma and presentation was from a few hours up to 5 days. Clinical findings and treatment Bilateral laryngeal paralysis was identified in three dogs and unilateral laryngeal paralysis in two dogs via endoscopic assessment of laryngeal function. The primary concomitant lesions included tracheal injury in 3/5 dogs and oesophageal injury in 1/5 dogs. One dog with bilateral laryngeal paralysis was treated medically as no signs of dyspnoea were present. Surgical management was elected in 4/5 dogs based on evaluation of their clinical status and lesions revealed by endoscopic examination of upper gastrointestinal and respiratory tracts. Dogs underwent surgical procedures as were determined to be appropriate for treatment of the lesions identified on clinical examination, diagnostic imaging, and endoscopy. The cervical region was explored through a ventral midline approach in 2/4 cases to close tracheal perforations. Temporary tracheostomy was performed in 2/4 cases. Procedures to correct brachycephalic airway obstructive syndrome were performed in 2/4 cases. Cricoarytenoid lateralisation was performed in 2/4 dogs. Dogs were hospitalised for 2–10 days and received antimicrobial therapy before surgery and for 2–3 weeks after surgery. Physical examination and respiratory function were normal in 3/5 dogs 4–6 months after discharge. Information regarding outcomes for two cases was obtained from the owners by telephone assessment 1–6 months after surgery. The owner of each dog reported the respiratory function to be excellent. Diagnosis: Uni- or bilateral, transient or permanent laryngeal paralysis with concomitant oesophageal, tracheal, or laryngeal lesions following cervical dog bite injuries diagnosed by endoscopic examination of upper gastrointestinal and respiratory tracts. Clinical relevance: This case series describes the diagnosis and management of dogs with laryngeal paralysis secondary to cervical dog bite injuries. To the authors’ knowledge, this is the first published report documenting bilateral laryngeal paralysis secondary to cervical dog bite injuries. Clinicians should be aware of this pathology and the importance of investigating laryngeal function in dogs presenting with cervical bites, particularly those with inspiratory dyspnoea. Upper airway and digestive endoscopy are recommended for complete assessment of cervical traumatic injuries.

Intraoperative Neuromonitoring in Thyroid and Parathyroid Surgery.

Background: It has been reported that the incidence of recurrent laryngeal nerve (RLN) injury is higher in an operational procedure in the thyroid and parathyroid region. Elevating voice pitch is achieved by the cricothyroid contraction, which in turn is innervated by the external branch of the superior laryngeal nerve (EBSLN). Due to the subtle nature and clinical variability of EBSLN damage, diagnosis may be difficult. The use of intraoperative neuromonitoring (IONM) as a supplement to enhance surgical identification in thyroid and parathyroid operation appeared to have collected momentum with operators. Methods: IONM clinical usage rationale, efficiency, and safety profile are discussed in this overview in thyroid and parathyroid surgery. Results: IONM usage incurred numerous skepticisms in decreasing the frequency of EBSLN or RLN injury. However, a recent article has shown the efficacy and benefits of using IONM in thyroid and parathyroid procedures. IONM facilitates the recognition of RLN and EBSLN, verifies its functional integrity, localizes the site of a nerve injury, and gives postsurgical function feedback. This technique has been successful in reducing rates of bilateral laryngeal paralysis, with the elevated safety profile for surgical patients. Conclusions: It is recommended using IONM in all thyroidectomies and in high-risk parathyroidectomies.

Bilateral laryngeal paralysis following a ventral slot surgery in a dog

An English springer spaniel developed laryngeal paralysis immediately after a ventral slot decompression surgery to treat an intervertebral disc extrusion that was causing a C1–T2 myelopathy with cervical hyperaesthesia. Postsurgical stabilisation in the intensive care unit is described. This included mechanical ventilation, tracheostomy tube placement and care, and laryngeal tie-back surgery aftercare. Common complications after ventral slot decompression include pain, severe haemorrhage and deterioration in the neurological status. Laryngeal paralysis has not yet been reported in dogs after a ventral slot.

Recurrent aspiration pneumonia due to bilateral associated laryngeal paralysis after tooth extraction under general anesthesia: a case report

BackgroundAssociated laryngeal paralysis is a clinical condition merged with other cranial nerve disorders associated with vocal cord paralysis. It is a rare complication in patients after general anesthesia. Here, we report our experience with a patient who developed associated laryngeal paralysis after oral surgery.Case presentationA healthy 31-year-old man underwent extraction of horizontally impacted wisdom teeth in the bilateral mandible under general anesthesia. During the surgery, no significant changes in respiratory and cardiovascular parameters or neurosurgical abnormalities occurred. After the surgery, the patient was diagnosed with aspiration pneumonia. Furthermore, the results of otorhinolaryngological and neurological examinations led to a diagnosis of a combination of bilateral glossopharyngeal and vagus nerve paralysis, right recurrent nerve paralysis, and right hypoglossal nerve paralysis. In this case, seriously associated peripheral laryngeal paralysis with repeated episodes of aspiration pneumonia improved in approximately 6 months with rehabilitation and vitamin B12 administration, and no complications remained.ConclusionsWe suggest that the anesthesiologist should take care of each procedure minutely. It is important to diagnose cases of nerve palsy as soon as possible to reduce the damage. Having had experience with this case, we believe sharing our experience with anesthesiologists is important.

Current aspects of treatment of patients with bilateral laryngeal paralysis

Objectives - to improve the effectiveness of treatment of patients with bilateral laryngeal paralysis by developing a treatment algorithm, justifying the surgical methods and the criteria for the effectiveness evaluation. Material and methods. 52 patients (including 49 women and 3 men) with bilateral larynx paralysis were examined and operated in 2017-2019. The age of the patients ranged from 27 to 71 years. 20 patients underwent the laryngoplasty, including the right-side myoaritenoidchordectomy with laterofixing of the opposite vocal fold with external access. 32 patients received the laryngoplasty with microsurgical technique under the direct support laryngoscopy. Results. The differentiated approach to the surgical treatment of patients with bilateral larynx paralysis allowed to decannulate 97% of patients in early postoperative period with restoration of the respiratory function and preservation of the voice function. In 2 patients it was impossible to form a physiological glottic chink due to a rough scar-dystrophic process in the surgery area. Conclusion. The preliminary use of tracheostomy tube is a factor that impairs the effectiveness of reconstructive surgical interventions in patients with bilateral laryngeal paralysis, if compared to patients with single-step tracheostomy and laryngoplasty. The long course of the bilateral laryngeal paralysis (more than 1 year) leads to persistent and irreversible pathological changes in the arytenoid cartilage and vocal folds. Minimally invasive techniques for the bilateral laryngeal paralysis treatment under the direct support laryngoscopy are the "gold standard" of global laryngology, if the indications for surgery are strictly observed. In all other cases, the patients are subject to a one-step reconstructive surgery with an open approach to the paralyzed voice fold.

PRZEBIEG POWROTU FUNKCJI KRTANI U PACJENTA PO REKONSTRUKCJI NERWÓW KRTANIOWYCH WSTECZNYCH

BackgroundAccording to the literature, the rate of laryngeal paralysis after thyroid surgery is as high as several percent. For oncolog-ical operations the rate can reach 20%. The return of laryngeal function depends on the degree of nerve damage. Surgical procedures are required to increase the likelihood of nerve function recovery. Three methods of phonosurgery are currently used. The first is based on injecting auto or alloplastic materials into the vocal fold. The second interferes with the skeleton of the laryngeal cartilages; according to the Isshiki clas-sification, it includes type I thyreoplasty (medialisation thyreoplasty), optionally with complementary arytenoid adduction. The third method reconstructs the laryngeal nerves. Combinations of the three methods are increasingly used. Conservative treatment including phoniatric voice rehabilitation should be started as early as possible.Case reportThe paper presents a case report of a patient after thyroid surgery due to papillary carcinoma, complicated by bilateral laryn-geal paralysis and aphonia.ConclusionsFunctional Voice Therapy started just after healing of the postoperative wound in the neck eliminated abnormal compensatory mechanisms of phonation. Reconstruction of the laryngeal nerves is an opportunity to quickly return laryngeal function and prevents unwanted secondary functional mechanisms within the vocal organ.

Unusual pathophysiological mechanisms of ptyalism in two horses

SummaryThis report outlines two cases of ptyalism that were not associated with oral conditions or primary dysphagia. The first, a 9‐year‐old Thoroughbred gelding, was associated with left‐sided peripheral vestibular disease and bone modelling around the left tympanic bulla. The second, a 7‐year‐old Dutch Warmblood mare, was associated with progressive bilateral laryngeal paralysis and a mediastinal T‐cell lymphoma. In Case 1, a neurological pathophysiology was proposed involving altered autonomic innervation of the salivary glands; whilst in Case 2, the mechanism remains unclear but may have involved mechanical compression of the intrathoracic oesophagus or stimulation of afferents within the vagus nerve. This case series highlights rare causes of ptyalism that have not been previously reported in the literature.

REINNERVATION AS A METHOD OF TREATMENT OF ONE-SIDED ABDUCTION LARYNX PARALYSIS IN OPERATIONS ON THYROID GLAND

Introduction. The use of selective larynx reinnervation creates the prerequisites for the resumption of synchronous mobility of the vocal folds and is used to correct breathing problems in the case of bilateral laryngeal paralysis, but it can be used to correct unilateral abduction paralysis during an operation on the thyroid gland. Objective: To assess the possibility of performing selective larynxreinnervation during abduction unilateral paralysis in thyroid surgery. Materials and methods: All patients underwent examination of the larynx (fibrolaryngoscopy with data archiving) before and after operation, as well as 4, 6,12,18 months after operation, voice spectral analysis, voice quality assessment (VHI-30), EAT-10 survey (determining the degree of dysphagia). Results. Selective reinnervation was carried out in 2 groups of patients with non-peel-shaped branching of RLN. Group 1 (1 patient) with pre-existing postoperative unilateral laryngeal abduction paralysis, severe dysphonic and moderate aspiration disorders, delayed selective larynx reinnervation was performed (autoplasty of the RLN adduction branch using n. transversus colli fragment). Group 2 (1 patient) performed primary selective larynx reinnervation in connection with resection of the adduction branch of the RLN (tumor invasion into it). An anastomosis of the end-to-end RLN branch of the RLN was performed with three epiperineural sutures. In a patient of group 1, a change in the tone and tension of the free edge of the «paralyzed» vocal fold was recorded 15 months after reinnervation, and the first signs of coordinated movement — after 18 months — fully recovered in almost 2 years. In a patient of group 2, the restoration of the tone of the «paralyzed» vocal fold and the restoration of its mobility were recorded 4 months after larynx reinnervation. In both patients, there was a recovery of the main indicators of the spectral analysis of the voice to normal values, as well as a decrease in the indices (points) of dysphagia on the EAT-10 scale and the index of voice disorders on the VHI-30 scale to normal. Conclusions: Selective larynx reinnervation is applicable not only to eliminate respiratory failure with bilateral laryngeal paralysis, but also to restore voice function, to eliminate the symptoms of aspiration in unilateral laryngeal paralysis. Taking into account the statistical unreliability of the groups of this research and the complexity of this methodology in practical application, it requires further study and a multidisciplinary approach.

Congenital bilateral laryngeal paralysis in a 10-month-old English springer spaniel

This report describes a 10-month-old female, English springer spaniel that was referred to the surgical department for investigation of progressive exercise intolerance and stridor. After performing a complete blood test,...

Cranial versus caudal thoracic epidural anesthesia using three volumes of lidocaine in conscious Beagle dogs

ObjectiveTo compare the effects of epidural injection of three volumes of lidocaine injected at the third (T3) or eleventh thoracic vertebra (T11) in conscious dogs to induce thoracic epidural anesthesia (TEA) and to measure the epidural dispersion of iohexol under similar conditions. Study designProspective crossover experiment. AnimalsA group of five Beagle dogs weighing 10.4 ± 0.5 kg (mean ± standard deviation). MethodsEach dog was anesthetized twice, separated by 1 week, for inserting an epidural catheter at the lumbosacral space and advancing the tip to T3 (treatment TEAT3) or T11 (treatment TEAT11). For each treatment, three volumes of 2% lidocaine (0.05, 0.10 and 0.20 mL kg–1) were administered at 24 hour intervals, and sensory blockade (SB) of dermatomes was estimated by pinching the skin with mosquito forceps. Under identical conditions of injection volume and site, iohexol was administered 3 hours after lidocaine injection to identify epidural distribution (ED) using computed tomography. The effects of injection site and volume on SB of thoracic dermatomes and ED were analyzed using a linear mixed model (p < 0.05). ResultsThoracic SB and ED significantly increased as the volume increased (p < 0.001 and p < 0.001, respectively), and significantly decreased in TEAT3 than in TEAT11 (p = 0.011 and p = 0.002, respectively). Cervical SB was obtained in three of five dogs in TEAT3 and two of five dogs in TEAT11 injected with 0.20 mL kg–1. One dog showed temporary inspiratory stridor probably caused by bilateral laryngeal paralysis, but no hypoxia. Conclusions and clinical relevanceTEA induced at T3 produced less thoracic SB than did TEA at T11 with the same volumes of lidocaine. The cervical SB obtained with the highest volume of lidocaine may increase the risk of laryngeal paralysis and pulmonary aspiration.

Acquired Laryngeal Paralysis in a Dog with Hypothyroidism: A Case Report

Laryngeal paralysis related to hypothyroidism is a rare disorder reported in dogs. A 12 year old, neutered female, Golden Retriever breed dog referred to Ankara University Animal Hospital with a history of dyspnea and gagging after feeding. Routine blood work was not revealed any abnormalities. Decreased levels of total T4 &amp;lt;0.5 µg/dL and Free T4 &amp;lt;0.35µg/dL were remarkable. The exact diagnosis of bilateral laryngeal paralysis confirmed endoscopically. Although laryngeal surgery was planned, the dog unfortunately died due to aspiration of the gastric contents. The current case here reflects a rare case of acquired laryngeal paralysis related to hypothyroidism in a dog.

Splenic hemangioma stable for several months with kalium bromatum and micro-immunotherapy

A female dog, 13 years old, of Tervueren-breed came to consultation due to breathlessness and wheezing laryngeal problems. After echo diagnosis of bilateral laryngeal paralysis and splenic hemangioma, the dog was treated with micro-immunotherapy and kali bromatum. Her state was stabilized and enhanced. The quality of life meliorated, she was more playful and active.

Evidencia y recomendación. ¿La neuromonitorización intermitente es útil para la reducción de parálisis de nervio laríngeo recurrente en cirugía de tiroides?

Introduction and objective: Clinical Question. In a patient with thyroid disease [patient], submitted to thyroidectomy [intervention], the use of neuromonitoring against the single visual identification of recurrent laryngeal nerve (RLN) [comparison], offers advantages? [result]. Material and Methods: Literature review in PubMed, Scopus and Cochrane Library data descriptors and search strategy: (((((((laryngeal) OR larynx)) AND nerve) AND monitoring) AND thyroidectomy)) AND meta-analysis. 10 items in English or Spanish of which 7 were selected for the qualitative study were obtained. Results: Level of evidence. Evidence for the lower incidence of transient unilateral paralysis in patients with neuromonitoring is moderate-high. Evidence on the lower incidence of permanent unilateral paralysis of RLN with NM is low. Evidence on the lower incidence of bilateral paralysis of RLN with neuromonitoring is low. Conclusions: Recommendation. Concerning the reduction of transient paralysis of the RLN the recommendation of the use of neuromonitoring in thyroid surgery is strongly in favor. Regarding permanent paralysis recommendation is weak in favor (no recommendation against). Regarding prevention of bilateral laryngeal paralysis recommendation for weak. The decision to use NM cannot be based on the incidence of RLN paralysis.

The use of botulinum toxin a for improvement of bronchial tree functions in the patients with bilateral laryngeal paralysis

The article provides the assessment of the use of Botulinum toxin A in the treatment of patients with bilateral laryngeal paralysis (BLP), based on the study of changes of spirometry parameters FVC, FEV1, FEV / FVC, PEF, MEF75, MEF50, MEF25 and the measurement of distance between the vocal folds before and after the treatment. A clinical examination covered 19 patients with BLP, which, depending on the treatment method, were divided into 2 groups: the Ist group included 7 BLP patients, who did phonopedic exercises and respiratory gymnastics. The second group included 12 BLP patients with Botulinum toxin A injections into the larynx muscles. In the 1st group patients treatment dynamics, no significant changes have been revealed in spirometry and endoscopic control of the width of the fissure of glottis associated with phonopedic exercises and respiratory gymnastics, in the second group patients of spirometry parameters before and after the treatment were as follows: FVC – up to 3.30 after 3.55; FEV1 – up to 1.72 after 2.80; FEV / FVC – up to 52 after 78; PEF- up to 1.97 after 3.36; MEF75 – up to 1.73 after 3.03; MEF50 – up to 1.41 after 2.76; MEF25 – up to 1.25 after 1.63, the distance between the vocal folds before the preparation injection was on the average 2 mm, in 14 days after the Botulinum toxin treatment the width of the fissure of glottis averaged 5 mm. The results of the study revealed the improvement in spirometry parameters: FVC – 41%; FEV1 – 42%; FEV/ FVC – 34%, PEF – 35%; MEF75 – 35%; MEF50 – 47%; MEF25 – 46%, the increase in the distance between the vocal folds averaged 50% according to endoscopic control. Therefore, it has been established that the use of Botulinum toxin A improves the bronchial tree patency, spirometry parameters and respiration in patients with bilateral laryngeal paralysis.