Laryngeal Paralysis Research Articles

Effects of a novel, 3D printed bilateral arytenoid abductor on canine laryngeal airway resistance ex vivo

BackgroundLaryngeal paralysis is a disease process most commonly seen in older, large breed dogs. When both arytenoid cartilages are affected dogs can develop life-threatening respiratory compromise, therefore surgical intervention is recommended. While there are multiple surgical procedures that have been described to treat laryngeal paralysis, there remains a considerable risk for postoperative complications, most commonly aspiration pneumonia. The objective of this ex vivo experimental study was to evaluate the effects of a novel, 3D printed bilateral arytenoid abductor on laryngeal airway resistance in canine cadaver larynges. Laryngeal airway resistance was calculated for each specimen before (control) and after placement of a 3D printed, bilateral arytenoid abductor. The airway resistance was measured at an airflow of 10 L/min with the epiglottis closed and at airflows ranging from 15 L/min to 60 L/min with the epiglottis open. The effects of the bilateral arytenoid abductor on laryngeal airway resistance were evaluated statistically.ResultsWith the epiglottis open, median laryngeal airway resistance in all larynges with a bilateral arytenoid abductor were significantly decreased at airflows of 15 L/min (0.0cmH2O/L/sec), 30 L/min (0.2cmH2O/L/sec), and 45 L/min (0.2cmH2O/L/sec) compared to the controls 15 L/min (0.4cmH2O/L/sec; P = 0.04), 30 L/min (0.9cmH2O/L/sec; P = 0.04), and 45 L/min (1.2cmH2O/L/sec; P = 0.04). When the epiglottis was closed, there was no significant difference in laryngeal resistance between the control (18.8cmH2O/L/sec) and the abducted larynges (18.1cmH2O/L/sec; P = 0.83).ConclusionsPlacement of a bilateral arytenoid abductor reduced laryngeal resistance in canine cadaver larynges compared to the controls when the epiglottis was open. With the epiglottis closed, there was no loss of laryngeal resistance while the device abducted the arytenoid cartilages. The results of this ex vivo study is encouraging for consideration of further evaluation of the bilateral arytenoid abductor to determine an appropriate material and tolerance of this device in vivo.

Propensity-Matched Analysis of the Short-Term Outcome of Robot-Assisted Minimally Invasive Esophagectomy Versus Conventional Thoracoscopic Esophagectomy in Thoracic Esophageal Cancer.

In this matched-cohort study, we investigated the short-term outcome of robot-assisted minimally invasive esophagectomy (RAMIE) compared with conventional minimally invasive thoracoscopic esophagectomy (MIE) in esophageal cancer patients. One hundred eighty-nine patients with thoracic esophageal cancer scheduled to undergo thoracic esophagectomy between 2020 and 2021 were assigned to either RAMIE or MIE. Then, we retrospectively evaluated the postoperative surgical complications between two groups in a propensity-matched analyzation. Based on the propensity-matched score, 50 patients who underwent RAMIE or MIE were selected. Thoracic surgery time in RAMIE/MIE group were 233.1/173.3min (p < 0.01), respectively. No significant intergroup differences were observed regarding incisional anastomotic leakage (RAMIE group 4.0% vs. MIE group 6.0%) and pneumonia (RAMIE group 8.0% vs. MIE group 12.0%; p = 0.68). The respective incidences of recurrent laryngeal nerve paralysis were 34.0 and 8.0% in the MIE and RAMIE groups, respectively (p < 0.01). In the matched cohort, no differences were observed between the groups in the success accomplishment of the clinical management pathway (RAMIE group 94.0% vs. MIE group 88.0%). Although patients who underwent RAMIE had longer operation times, the incidence of recurrent laryngeal nerve paralysis was lower than with MIE. Further study in a prospective multi-institutional setting are required to confirm the superiority of RAMIE compared with MIE.

A novel classification of tracheal defects and the reconstruction strategies: A retrospective study based on 106 cases.

The study aims to present a novel classification of tracheal defects and the corresponding reconstruction strategies. The retrospective study was designed to analyze patients with diagnosed primary or secondary tracheal tumors from 1991 to 2020. Surgical techniques, complications and prognosis were reviewed. Airway status and patient outcomes were the principal follow-up measures. Tracheal defects were classified into two plane sizes (vertical (V) and horizontal (H) planes). Vertical defects were further categorized into three groups based on their tracheal ring numbers (V1, ≤ 5 rings; V2, 6-10 rings; and V3, > 10 rings). Tracheal defects with horizontal plane size H1 and H2 represent defects less and more than one-half the circumference of trachea. Thus, suitable reconstruction strategies were planned primarily based on "V" and "H" classifications. The reconstruction strategies performed were sleeve resection followed by an end-to-end anastomosis, window resection with sternocleidomastoid myoperiosteal flap reconstruction, defects conversion with rotation anastomosis, and modified tracheostomy with secondary flap reconstruction. A total of 106 patients diagnosed with tracheal defects were enrolled in the study, of whom 59 patients underwent sleeve resection followed by end-to-end anastomosis; 40 patients received window resection alongside sternocleidomastoid (SCM) myoperiosteal flap reconstruction; five patients received converting defects with rotation anastomosis and two patients underwent modified tracheostomy with secondary stage flap reconstruction. Lumen stenosis occurred in three V2H1 defect cases and were treated by a second reconstruction surgery. Iatrogenic unilateral recurrent laryngeal nerve paralysis occurred in two patients with the V3H2 defect type, who were treated by temporary tracheotomy and partial vocal cord resection and extubated successfully during follow-up. All 106 patients achieved airway patency with adequate laryngeal function at the end of follow-up. No anastomotic dehiscence or bleeding occurred in any patient postoperatively. Though a significant number of multicenter studies concerning the reconstruction and classification of tracheal defects are needed, the study herein provides a novel classification of tracheal defects, which is primarily developed on the defect size. Therefore, the study might serve as a potential source for identifying suitable reconstruction strategies for practitioners.

Clinical and Anatomical Factors Affecting Recurrent Laryngeal Nerve Paralysis During Thyroidectomy via Intraoperative Nerve Monitorization.

BackgroundDespite all the technical developments in thyroidectomy and the use of intraoperative nerve monitorization (IONM), recurrent laryngeal nerve (RLN) paralysis may still occur. We aimed to evaluate the effects of anatomical variations, clinical features, and intervention type on RLN paralysis.MethodThe RLNs identified till the laryngeal entry point, between January 2016 and September 2021 were included in the study. The effects of RLN anatomical features considering the International RLN Anatomical Classification System, intervention and monitoring types on RLN paralysis were evaluated.ResultsA total of 1,412 neck sides of 871 patients (672 F, 199 M) with a mean age of 49.17 + 13.42 years (range, 18–99) were evaluated. Eighty-three nerves (5.9%) including 78 nerves with transient (5.5%) and 5 (0.4%) with permanent vocal cord paralysis (VCP) were detected. The factors that may increase the risk of VCP were evaluated with binary logistic regression analysis. While the secondary thyroidectomy (OR: 2.809, 95%CI: 1.302–6.061, p = 0.008) and Berry entrapment of RLN (OR: 2.347, 95%CI: 1.425–3.876, p = 0.001) were detected as the independent risk factors for total VCP, the use of intermittent-IONM (OR: 2.217, 95% CI: 1.299–3.788, 0.004), secondary thyroidectomy (OR: 3.257, 95%CI: 1.340–7.937, p = 0.009), and nerve branching (OR: 1.739, 95%CI: 1.049–2.882, p = 0.032) were detected as independent risk factors for transient VCP.ConclusionPreference of continuous-IONM particularly in secondary thyroidectomies would reduce the risk of VCP. Anatomical variations of the RLN cannot be predicted preoperatively. Revealing anatomical features with careful dissection may contribute to risk reduction by minimizing actions causing traction trauma or compression on the nerve.

Real-time detection of the recurrent laryngeal nerve in thoracoscopic esophagectomy using artificial intelligence.

Artificial intelligence (AI) has been largely investigated in the field of surgery, particularly in quality assurance. However, AI-guided navigation during surgery has not yet been put into practice because a sufficient level of performance has not been reached. We aimed to develop deep learning-based AI image processing software to identify the location of the recurrent laryngeal nerve during thoracoscopic esophagectomy and determine whether the incidence of recurrent laryngeal nerve paralysis is reduced using this software. More than 3000 images extracted from 20 thoracoscopic esophagectomy videos and 40 images extracted from 8 thoracoscopic esophagectomy videos were annotated for identification of the recurrent laryngeal nerve. The Dice coefficient was used to assess the detection performance of the model and that of surgeons (specialized esophageal surgeons and certified general gastrointestinal surgeons). The performance was compared using a test set. The average Dice coefficient of the AI model was 0.58. This was not significantly different from the Dice coefficient of the group of specialized esophageal surgeons (P = 0.26); however, it was significantly higher than that of the group of certified general gastrointestinal surgeons (P = 0.019). Our software's performance in identification of the recurrent laryngeal nerve was superior to that of general surgeons and almost reached that of specialized surgeons. Our software provides real-time identification and will be useful for thoracoscopic esophagectomy after further developments.

食道癌手術における術後反回神経麻痺の検討

食道癌手術における術後反回神経麻痺の検討

Selective Electrical Surface Stimulation to Support Functional Recovery in the Early Phase After Unilateral Acute Facial Nerve or Vocal Fold Paralysis.

This article addresses the potential clinical value of surface electrical stimulation in the acute phase of denervation after the onset of facial nerve or recurrent laryngeal nerve paralysis. These two nerve lesions are the most frequent head and neck nerve lesions. In this review, we will work out several similarities concerning the pathophysiology features and the clinical scenario between both nerve lesions, which allow to develop some general rules for surface electrical stimulation applicable for both nerve lesions. The focus is on electrical stimulation in the phase between denervation and reinnervation of the target muscles. The aim of electrostimulation in this phase of denervation is to bridge the time until reinnervation is complete and to maintain facial or laryngeal function. In this phase, electrostimulation has to stimulate directly the denervated muscles, i.e. muscle stimulation and not nerve stimulation. There is preliminary data that early electrostimulation might also improve the functional outcome. Because there are still caveats against the use of electrostimulation, the neurophysiology of denervated facial and laryngeal muscles in comparison to innervated muscles is explained in detail. This is necessary to understand why the negative results published in several studies that used stimulation parameters are not suitable for denervated muscle fibers. Juxtaposed are studies using parameters adapted for the stimulation of denervated facial or laryngeal muscles. These studies used standardized outcome measure and show that an effective and tolerable electrostimulation of facial and laryngeal muscles without side effects in the early phase after onset of the lesions is feasible, does not hinder nerve regeneration and might even be able to improve the functional outcome. This has now to be proven in larger controlled trials. In our view, surface electrical stimulation has an unexploited potential to enrich the early therapy concepts for patients with unilateral facial or vocal fold paralysis.

Montgomery® implant extrusion after type I thyroplasty. A CARE case report

GoalTo document the first case of Montgomery® implant extrusion after type I thyroplasty for unilateral laryngeal nerve paralysis in adults. CaseThree years after onset of right idiopathic unilateral laryngeal nerve paralysis resulting in severe dysphonia not improved by speech therapy, a 45-year-old Caucasian woman consulted to improve her voice. Maximum phonation time (MPT) was 5seconds. Voice Handicap Index (VHI) was 64. Type I thyroplasty with n°10 Montgomery® implant was performed without difficulties. Immediate postoperative course was uneventful. One month after thyroplasty, the patient considered her voice normal, with 8sec MPT and VHI of 23. At 4 months, there was implant extrusion through the cervical skin, with 9sec MPT and VHI of 18. ConclusionWhen performing type I thyroplasty with Montgomery® implant, the otorhinolaryngologist must not only take care to position the implant properly within the thyroid lamina but also ensure that the inner flanges of the implant are well deployed, to achieve proper retention.

Comparison of immediate and short-term outcomes of cricoarytenoid and thyroarytenoid lateralization in dogs with idiopathic laryngeal paralysis.

To compare the immediate and short-term outcomes of thyroarytenoid lateralization (TAL) and cricoarytenoid lateralization (CAL) for the treatment of canine laryngeal paralysis in dogs. A prospective, clinical trial. Fourteen client-owned dogs referred to our hospital because of bilateral laryngeal paralysis. Dogs with confirmed laryngeal paralysis were randomly assigned to the CAL or TAL group. Video images of the rima glottidis obtained preoperatively, immediately postoperatively (t0), and 15 days postoperatively (t1) were digitized. The rima glottidis area was measured using image-analysis software. An increase in the rima glottidis area was expressed as a percentage of the preoperative area. The rima glottidis area increased by a mean of 152% at t0 and 127% at t1 for the TAL group and 205% at t0 and 199% at t1 for the CAL group compared with preoperative values. The increase in the rima glottidis area differed (P < .05) between the 2 groups at all postoperative time points. A reduction of the area occurred at t1 in both groups. There was no difference between t0 and t1 (P > .05) in the CAL group but there was a large difference (P < .05) in the TAL group. Cricoarytenoid lateralization and TAL were both effective for surgical abduction of the arytenoid cartilage. Although a reduction (P < .05) in the rima glottidis area occurred in the TAL group at t1, we observed no associated clinical signs. Cricoarytenoid lateralization and TAL result in good short-term outcomes in dogs with laryngeal paralysis.

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.

Recurrent Laryngeal Nerve Paralysis Following Thyroidectomy: Analysis of Factors Affecting Nerve Recovery

Paralysis of the recurrent laryngeal nerves (RLNs), albeit decreased over the years, leaves the surgeon helpless as there is not much that can be done once it occurs. Nimodipine has been suggested as a remedy that could accelerate the recovery of the nerve. Our study aimed to examine the factors that affect the recovery rate (RR) and time to recovery (TTR) of post-thyroidectomy RLN paralysis, with an emphasis on the use of nimodipine. A total of 197 patients who had undergone thyroid and parathyroid surgeries were retrospectively reviewed from October 2016 to August 2019. Patients who had RLN paralysis following surgery were assessed. The medical records were retrospectively analyzed to look for possible factors that may influence RLN recovery. A total of 289 nerves were at risk. Temporary RLN paralysis rate was 7.9% while 1.7% was permanent. Age (odds ratio [OR]=4.8) and intra-operative extra-thyroid extension (OR=9.0) were independent risk factors for RLN paralysis. The rate of recovery was 82.1%. Loss of signal (LOS; P=.066) was a factor trending for an impact on RR but not nimodipine (P > .05). The mean TTR was 32 days. LOS, nimodipine, and steroid use, among others, were factors trending for an impact on the TTR. Although not reaching statistical significance, nimodipine and steroids might influence TTR but not the RR. Larger studies are warranted to address the effect of nimodipine on the outcome of RLN paralysis. 4 Laryngoscope, 132:1692-1696, 2022.

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.

Unilateral Laryngeal Paralysis Secondary to Otitis Media/Interna in Two Cats

ABSTRACT Two adult cats were presented for coughing, gagging, dysphonia, exaggerated swallowing attempts, unilateral vestibular dysfunction, and/or Horner syndrome. In both cats, unilateral laryngeal paralysis was identified on the side ipsilateral to other neurological deficits. Cross-sectional imaging was consistent with otitis media/interna. In both cats, there also was extensive cellulitis surrounding the tympanic bulla and dissecting through tissue planes to involve the opening of the tympano-occipital fissure on the side ipsilateral to the laryngeal paralysis. Laryngeal paralysis was presumed secondary to involvement of the vagus nerve as it emerged from the tympano-occipital fissure. Antibiotic therapy resulted in resolution of clinical signs in both cats and restored laryngeal function as evidenced by visual examination of the larynx in one cat.

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.

ВЛИЯНИЕ ИНТРАОПЕРАЦИОННОГО НЕЙРОФИЗИОЛОГИЧЕСКОГО МОНИТОРИНГА НА ВАРИАНТ АНЕСТЕЗИОЛОГО-РЕАНИМАЦИОННОГО ОБЕСПЕЧЕНИЯ В ХИРУРГИИ ЩИТОВИДНОЙ ЖЕЛЕЗЫ

Objective: To assess the effect of intraoperative neurophysiological monitoring (IONM) on the incidence of life-threatening complications of the surgical treatment of thyroid diseases in the operating room and intensive care unit. Methods: A retrospective analysis of the medical records of 212 patients aged 31 to 72 was carried out. Depending on the treatment modality, they were divided into two groups. In group I (study group, n=96), IONM was used during surgery, and in group II (control group, n=116) – the surgery was performed without IONM. The effectiveness of IONM was assessed based on the number of complications and tracheal reintubation in the postoperative period. Results: IONM contributed to a statistically significant decrease in the number of postoperative complications. Thus, injury to the recurrent laryngeal nerve (RLN) was noted in 1 (1.0%) patient in the study group versus 17 (14.6%) in the control group (p&lt;0.05); hoarseness was present in 3 (3.1%) and 35 (30.1%) cases in the study and control groups, respectively (p&lt;0.05). In addition, although statistically insignificant, there was a reduced rate of tracheal reintubation: in two (2.1%) and (6.0%) patients in the study and the control groups, respectively (p&gt;0.05). Of these, 5 (4.3%) patients needed surgeries due to bilateral injury to the RLN. The decrease in the incidence of complications, in turn, contributed to a reduction in both the average lengths of stays in the intensive care unit (6.2±0.5 days and 7.4±0.3 days in the study and the control groups, respectively, p&gt;0.05) and the overall treatment time (59.1±1.7 and 121.3±4.8 patient days in the study and the control groups, respectively, p&lt;0.05). Conclusion: IONM in thyroid surgery can reduce the number of complications, such as damage to the recurrent laryngeal nerve, although it does not exclude them entirely. The data obtained allow us to recommend using IONM in everyday practice. Keywords: Recurrent laryngeal nerve paralysis, the thyroid gland, neurophysiological monitoring, thyroidectomy, postoperative complications, tracheal reintubation.

Efficacy and Safety of Ultrasound-Guided Radiofrequency Ablation for Primary Hyperparathyroidism: A Prospective Study.

ObjectiveTo assess the efficacy and safety of ultrasound (US)-guided radiofrequency ablation (RFA) in patients with primary hyperparathyroidism (PHPT).Materials and MethodsThis prospective study enrolled 39 participants (14 male, 25 female; mean age, 59.5 ± 15.3 [range, 18–87] years) between September 1, 2018, and January 31, 2021. All participants had parathyroid lesions causing PHPT, proven biochemically and through imaging. The imaging features of the PHPT nodules, including the shape, margin, size, composition, and location, were evaluated before treatment. Serum intact parathyroid hormone, calcium, and phosphorus levels; parathyroid nodule volume; and PHPT-related symptoms were recorded before and after treatment. We calculated the technical success, biochemical cure, and clinical cure rates for these patients. Complications were evaluated during and after the ablation.ResultsComplete ablation was achieved in 38 of the 39 nodules in the 39 enrolled participants. All the patients were treated in one session. The technical success rate was 97.4% (38/39). The mean follow-up duration was 13.2 ± 4.6 (range, 6.0–24.9) months. At 6 and 12 months post-RFA, the biochemical cure rates were 82.1% (32/39) and 84.4% (27/32), respectively, and the clinical cure rates were 100% (39/39) and 96.9% (31/32), respectively. Only 2.6% (1/39) of the patients had recurrent PHPT. At 1, 3, 6, and 12 months after technically successful RFA, 44.7% (17/38), 34.3% (12/35), 15.8% (6/38), and 12.5% (4/32) of participants, respectively, had elevated eucalcemic parathyroid hormone levels. Recurrent laryngeal nerve paralysis occurred in 5.1% (2/39) of the patients, who recovered spontaneously within 1–3 months.ConclusionUS-guided RFA was effective and safe for PHPT patients. RFA may be an alternative treatment tool for patients who cannot tolerate or refuse to undergo surgery.

THYROID SURGERY: A COMPARISON OF COMMON COMPLICATIONS BETWEEN EXPERTS AND SURGEONS IN TRAINING

Objective: To determine the frequency of common complications of thyroid surgery by two types of surgeons.&#x0D; Study Design: Comparative cross sectional.&#x0D; Place and Duration of Study: Combined Military Hospital Rawalpindi &amp; Combined Military Hospital Peshawar, from Jan 2013 to Dec 2017.&#x0D; Methodology: This study was conducted to assess the role of surgical skills in complications of thyroid surgery. Surgeons performing surgery for more than 5 years were considered expert and less than 5 years of experience were considered trainee for this specific surgery. Complications by both were analyzed by SPSS-21 and descriptive statistics were applied.&#x0D; Results: A total of 482 surgeries were performed. Out of 407 were female and 75 were males. Mean age was 43.55 ± 10.9 years. Expert surgeons performed 300 cases and 16 (5.3%) experienced some complication in 6 months of follow up.182 cases were performed by surgeons with lesser experience and 14 (7.5%) cases developed complications over the period of follow up. Recurrent laryngeal nerve paralysis occurred in 2 (0.67%) of experienced surgeons cases while 6 cases (3.2%) of less experienced surgeons had the similar complication.&#x0D; Conclusion: While the overall complication rates are not much different between experienced and lesser experienced surgeons, the rate of recurrent laryngeal nerve paralysis is significantly more, though still within the acceptable international complication rate for this particular surgery.

A large and late mediastinal metastasis from a uterine smooth muscle tumour of uncertain malignant potential: A case report.

IntroductionSmooth muscle tumours of uncertain malignant potential (STUMP) are mesenchymal uterine tumours with a malignant potential found somewhere between that of benign leiomyomas and leiomyosarcomas. Only three cases of STUMP pulmonary metastasis exist in the literature.Case presentationWe report the case of a 63 year-old female patient presenting with dysphonia secondary to recurrent laryngeal nerve paralysis due to an enormous mediastinal STUMP metastasis, 14 years after having undergone a total hysterectomy with bilateral salpingo-oophorectomy. A successful left pneumonectomy was performed and the mass weighing 1570 g was histologically confirmed as a STUMP metastasis.DiscussionOnly three cases of pulmonary metastasis from STUMP have been reported in the recent literature and no robust information exists about the metastatic nature of STUMP. No cases exist in the literature of a successful pneumonectomy performed for a STUMP metastasis of such large dimensions presenting after many years from the diagnosis of the primary uterine lesion. Physicians should keep in mind that the finding of a smooth muscle tumour in the lung of a woman should promptly raise the suspicion of a metastatic uterine malignancy, even several years after diagnosis of the primary lesion.ConclusionDespite the size, invasiveness and late presentation of the STUMP metastasis, the surgery was successful and the patient no longer requires oxygen therapy.

Tracheostomy in COVID-19 acute respiratory distress syndrome patients and follow-up: A parisian bicentric retrospective cohort.

Tracheostomy has been proposed as an option to help organize the healthcare system to face the unprecedented number of patients hospitalized for a COVID-19-related acute respiratory distress syndrome (ARDS) in intensive care units (ICU). It is, however, considered a particularly high-risk procedure for contamination. This paper aims to provide our experience in performing tracheostomies on COVID-19 critically ill patients during the pandemic and its long-term local complications. We performed a retrospective analysis of prospectively collected data of patients tracheostomized for a COVID-19-related ARDS in two university hospitals in the Paris region between January 27th (date of first COVID-19 admission) and May 18th, 2020 (date of last tracheostomy performed). We focused on tracheostomy technique (percutaneous versus surgical), timing (early versus late) and late complications. Forty-eight tracheostomies were performed with an equal division between surgical and percutaneous techniques. There was no difference in patients' characteristics between surgical and percutaneous groups. Tracheostomy was performed after a median of 17 [12-22] days of mechanical ventilation (MV), with 10 patients in the "early" group (≤ day 10) and 38 patients in the "late" group (> day 10). Survivors required MV for a median of 32 [22-41] days and were ultimately decannulated with a median of 21 [15-34] days spent on cannula. Patients in the early group had shorter ICU and hospital stays (respectively 15 [12-19] versus 35 [25-47] days; p = 0.002, and 21 [16-28] versus 54 [35-72] days; p = 0.002) and spent less time on MV (respectively 17 [14-20] and 35 [27-43] days; p<0.001). Interestingly, patients in the percutaneous group had shorter hospital and rehabilitation center stays (respectively 44 [34-81] versus 92 [61-118] days; p = 0.012, and 24 [11-38] versus 45 [22-71] days; p = 0.045). Of the 30 (67%) patients examined by a head and neck surgeon, 17 (57%) had complications with unilateral laryngeal palsy (n = 5) being the most prevalent. Tracheostomy seems to be a safe procedure that could help ICU organization by delegating work to a separate team and favoring patient turnover by allowing faster transfer to step-down units. Following guidelines alone was found sufficient to prevent the risk of aerosolization and contamination of healthcare professionals.

Predictive indicators of an unfavorable prognosis for the restoration of laryngeal functions in unilateral lesions of the recurrent laryngeal nerve in thyroid surgery

Recurrent laryngeal nerve (RLN) damage in thyroid surgery is a very dangerous complication. An otolaryngologist, especially at pri­mary care institutions,should administer conservative or surgical treatment in a timely manner and depending on the type of nerve damage (transient, permanent), i. e., to analyze possible prognosis of the disease. Only few studies to predict disease developmentin RLN have been performed. One of the most modern and informative methods is laryngeal electromyography using needle electrodes, but despite the sufficient number of patients with this pathology, in most medical institutions in Ukraine it is not performed, given the technical difficulties of implementation, invasiveness and difficulty in interpreting the results of this method.Aim — to analyze the laryngoscopic signs of paresis and paralysis of the larynx in thyroid surgery and to identify the most significant from them, which together can serve as prognostic criteria of the lack of recovery of laryngeal mobility (paralysis).Materials and methods. A single-site prospective study was conducted in the years 2018—2021 that involved 164 patients with postoperative laryngeal movement disorders, who were divided into two groups: subjects with laryngeal paralysis (n = 33) and patients with laryngeal paresis (n = 131). All patients underwent phoniatric examination. The following signs have been identified: general signs, including age, number of operations, scope of surgical intervention, and 18 laryngoscopicsigns, each of them had two to seven grades. For the convenience, the grades were coded with numbers and, if possible, arranged in ascending order of severity. The obtained results were processed with Fisher angular transformation.Results. Among 18 laryngoscopic and general signs, 10main (predictors) were identified, that affect the absence or presence of laryngeal paralysis. They included:elements of mobility of the paralyzed vocal cords (VC) (absent), flotation of the «paralyzed» VC (insignificant and pronounced), mobility of the arytenoid cartilage (absent), closure of the VC (complete non-closure), synchronicity of oscillations VC (absence of movement of the paralyzed VC), restriction of the movement of the «paralyzed» VC (absent (the GE is motionless), level of the VC in the vertical plane (not on the same level), the tension of the median edge of the VC (incurvate), patient’s age &gt; 45 years, the position of the «paralyzed» VC (median and intermedian). The mathematical analysis showed that none of the isolated laryngoscopic signs can be used as an independent criterion in assessing the predictions of the laryngeal mobilityrestoration.Conclusions. Prognostic laryngoscopic signs of recurrent laryngeal nerve damage in the thyroid surgery allow to create a prognostic model of recovery or lack of recovery of laryngeal motility, which is important for the appointment of timely adequate treatment.