Laryngeal Surgery Research Articles

Comparative Results of Vocal Fold Injury According to the Fiber-Based Laser in a Rabbit Vocal Fold Model

We assessed the safety of flexible fiber-based lasers including the potassium-titanyl-phosphate (KTP), CO2, and Holmium lasers using a rabbit vocal fold model and provided the safety evidence of laser before human clinical trial. In all, 120 male New Zealand white rabbits were used. Each laser was used to induce acute and chronic vocal fold injuries in 40 rabbits. The same laser energy with the same intensity and frequency were used in all cases, and we evaluated outcomes via surface scanning electron microscopy (SEM) and histological examination 1 day after injury. Histological and high-speed vocal fold vibration examinations were evaluated 1 month after injury. Surface injury roughness grading was done via SEM, and the Acute injury ratio and lamina propria (LP) ratio were also calculated. The dynamic glottal gap was measured through functional analyses based on recordings from a high-speed digital camera. The Holmium laser caused significantly more vocal fold damage than did the KTP and CO2 lasers as revealed by SEM and evaluation of acute and chronic injuries. Functional analysis with high-speed digital camera indicated that the holmium laser reduced dynamic glottal gap compared with the normal vocal fold, where the other lasers did not. The histological and functional analyses of rabbit vocal fold experiments indicated that fiber-based laryngeal laser surgery for vocal fold lesions could be performed relatively safely using a KTP or CO2 laser.

Supracricoid Laryngectomy: Siriraj’s Experience

Objective: To evaluate the initial functional outcomes of laryngeal cancer patients who underwent supracricoid laryngectomy (SCL) in Siriraj Hospital. Materials and Methods: A retrospective review of patients who underwent SCL with cricohyoidoepiglottopexy or cricohyoidopexy for glottic and supraglottic squamous cell carcinoma in the Department of Otorhinolaryngology, Faculty of Medicine Siriraj Hospital between 2000 and 2020. Results: Twenty-two patients underwent SCL. Twenty patients who met the criteria were recruited for the present study. The initial functional results from the T1 and T2 glottic or transglottic cancers in terms of time to decannulation, at 11 days, and time to nasogastric tube removal, at 16 days were achieved. Conclusion: SCL is one of surgical options to treat early laryngeal cancer in cases that were not suitable for conventional conservation laryngeal surgery, translaryngeal laser microsurgery, and cases that failed radiotherapy. This surgical technique could also be an alternative choice for certain advanced laryngeal cancers to avoid total laryngectomy. Keywords: Supracricoid laryngectomy; Functional and oncologic outcomes; Supraglottic and glottic cancer

Successful 10-year outcomes after supracricoid partial laryngectomy for selected glottic squamous cell carcinoma classified as T3N0M0: A STROBE analysis

PurposeTo evaluate long-term oncological outcome for patients with selected glottic squamous cell carcinoma (SCC) classified as T3N0M0 treated by supracricoid partial laryngectomy (SCPL). Materials and methodsAnalysis of an inception cohort of 46 patients with isolated untreated SCC classified as T3N0M0 and minimum 10-year follow-up, consecutively treated by SCPL between 1982 and 2012 in a French university teaching hospital. The main endpoint was 5- and 10-year actuarial survival and local control estimates. Accessory endpoints comprised cause of death, screening for variables decreasing survival and increasing risk of local recurrence, oncologic consequences of local recurrence, and laryngeal preservation rate. ResultsFive- and 10-year actuarial survival was 78.1%, and 53.3%, respectively. The main causes of death were intercurrent disease and metachronous second primary, each in 33.3% of cases. Postoperative mortality (aspiration pneumonia) was 2.1%. There were no significant correlations between survival and any study variables. Five- and 10-year local control was 90.5%. Overall local recurrence varied significantly (P=0.003), from 2.3% with negative margins (R0) to 100% with positive margins (R1) and/or dysplasia. Local recurrence was associated with a significantly (P<0.005) increased risk of nodal failure and distant metastasis, and reduced survival. Overall laryngeal preservation was 89.1%. ConclusionThe present results suggest that SCPL should continue to be taught and that this type of partial laryngeal surgery should be included in the various organ-sparing strategies considered in advanced laryngeal cancer.

Retrospective Analysis of Otorhinolaryngology Related Elective Surgeries Performed in a Tertiary Care Centre, North Kerala, India

Introduction: Due to a better understanding of the disease process, surgical workshops, conferences, and better patient awareness, the trend of Ear Nose Throat (ENT) related surgeries has changed significantly over the years. Aim: To analyse the profile of various ENT-related elective surgeries performed over three years in a tertiary care centre. Materials and Methods: This retrospective observational study was conducted in the Department of ENT, in a tertiary care centre, North Kerala, India. Patients of both sexes and of all age groups who underwent elective ENT surgeries in the Department from January 2017- December 2019 were included in the study. Data analysis was done from 1/12/2020 to 1/6/2021 period. Emergency surgeries were excluded from the study. Data was collected from hospital records and analysed using appropriate statistical methods. Results: A total of 2895 patients underwent various major and minor procedures in the period of January 2017 to December 2019 in the study institute. The majority of procedures were tympanomastoid surgeries (n=896, 30.94%), which were followed by sinonasal surgeries including advanced endoscopic surgeries (n=670, 23.14%), tonsilloadenoid surgeries (n=550, 18.98%) and excision of various solid and cystic lesions from head and neck region (n=310, 10.70%). The remaining number contributed by various other procedures like laryngeal surgeries (n=99, 3.4%) and other miscellaneous procedures (n=370, 12.78%) which include preauricular sinus excision, punch biopsies, tongue tie release, styloidectomy, excision of rhinosporidiosis from nose and nasopharynx, nasal bone fracture reduction and young’s operation. Conclusion: The most common elective procedures performed in the study period were tympanomastoid surgeries. In the present study, there was an increasing trend of all major and minor surgeries in the department in subsequent years.

Optimizing Surgical Conditions with the Use of a Modified Spontaneous Respiration, Intravenous Anesthesia and High-Flow Nasal Oxygen for Pediatric Laser Laryngeal Surgery

Optimizing Surgical Conditions with the Use of a Modified Spontaneous Respiration, Intravenous Anesthesia and High-Flow Nasal Oxygen for Pediatric Laser Laryngeal Surgery

Effect of Individualized Nutrition Intervention Care Combined with Swallowing Training on Postoperative Nutritional Status in Patients with Laryngeal Cancer

Introduction: Laryngeal carcinoma accounts for 13.9% of head and neck tumors, and squamous cell carcinoma is the main pathological type. At present, the treatment of laryngeal cancer is mainly surgical treatment or postoperative radiotherapy. The surgery is delicate, complex, time-consuming and traumatic. Postoperative patients are prone to dysphagia, leading to an increase in the incidence of malnutrition. Malnutrition can cause a series of negative effects, including weight loss, increased incidence of infection, reduced tolerance of anti-tumor treatment, and extended length of hospital stay. Therefore, how to effectively improve the nutritional status of laryngeal cancer patients through nursing intervention has become an important topic of nursing research. Objective: Investigate the effect of individualized nutrition intervention care combined with swallowing training on postoperative nutritional status in patients with laryngeal cancer. Methods: A total of 120 consecutive patients who underwent laryngeal surgery at our hospital for the first time between May 2018 and May 2021 were selected for the study and equally divided into the control group and the study group by the random number table method, with 60 patients in each group. Patients in the control group were given swallowing function training and health counseling, and the study group adopted individualized nutrition intervention care based on the control group. The nutritional status, swallowing function, and quality of life (QOL) of the patients were assessed using the Patient-generated Subjective Global Assessment (PG-SGA), MD Anderson Dysphagia Inventory (MDADI), and Quality of Life Questionnaire-Core30 (QLQ-C30) before the intervention and three months after the intervention. Results: Before the intervention, the scores of MDADI, PG-SGA, and QLQ-C30 were not significantly different between the two groups (P > 0.05), and three months after the intervention, the scores of MDADI and QLQ-C30 increased and the score of PG-SGA decreased in the study group, with significant differences (P 0.05). At three months after the intervention, patients in the study group had higher scores on MDADI, QLQ-C30 and lower scores on PG-SGA than the control group, with significant differences (P < 0.05); There were significant differences in the scores of MDADI, PG-SGA, and QLQ-C30 between the two groups before and after intervention (P < 0.05). Conclusion: Combining individualized nutrition intervention care with swallowing training improves the postoperative nutritional status, swallowing function, and QOL of patients with laryngeal cancer.

The inside-out surgical anatomy of the paraglottic space a video-guided endoscopic dissection.

The paraglottic space is an essential anatomic compartment of the larynx. It is central to the spread of laryngeal cancer and to the choice of conservative laryngeal surgery and many phonosurgical procedures. Since its description, 60 years ago, the surgical anatomy of the paraglottic space was sparsely revisited. Amid the era of endoscopic and transoral microscopic functional surgery of the larynx, we provide here a long-awaited description of the inside-out anatomy of the paraglottic space. Using an endoscope equipped with a 3D camera, we dissected 10 hemilarynges from 5 fresh frozen cadavers from the inside out. Before dissection, we labeled the vessels through injecting them with colored latex. We explored the paraglottic space emphasizing its shape, boundaries, and contents. We documented our findings through endoscopic photography and video recordings. The paraglottic space is a spacious tetrahedral space located parallel not only to the glottic, but also to the subglottic and the supraglottic compartments of the laryngeal lumen. It has musculo-cartilaginous, musculo-fibrous, and mucosal boundaries. It is separated from the pyriform sinus only by mucosa. A cushion of fat surrounds its vascular and to a lesser extent its neural contents. Harbored intrinsic laryngeal muscles are endoscopically identifiable within the space, namely the thyroarytenoid, the lateral, and posterior cricoarytenoid muscles. The endoscopic description of the paraglottic space partly fills the knowledge gap on the laryngeal anatomy from the inside out. It opens the door for novel diagnostic methods and for ultraconservative functional laryngeal interventions under endoscopic control. N/A.

Design of a Novel Tendon-Sheath-Driven Upper Limb Exoskeleton for Assisting Surgeon Performing Microlaryngoscopic Surgery

Abstract Microlaryngoscopic surgery is a type of laryngeal surgery performed by surgeons using microsurgical instruments under the observation of a specially designed laryngoscope. While performing a microlaryngoscopic operation, the surgeons must maintain their arms' position for a long time, which can cause arms' soreness and affect the accuracy of the operation. In this study, a tendon-sheath-driven upper limb auxiliary exoskeleton (TULAE) is proposed and developed. The flexible cables are compressed by a wave-shaped pressing mechanism to fix the TULAE's rotating joints. The TULAE can assist surgeons in laryngoscopy operations by providing suitable support for their arms to reduce the surgical risks caused by muscle fatigue. The TULAE has four degrees-of-freedom (DOFs) on each arm. The shoulder flexion/extension, shoulder abduction/adduction, and elbow internal rotation/external rotation can be fixed by the control box. The shoulder internal rotation/external rotation is a passive DOF obtained using hinges. The TULAE's shoulder, upper arm and forearm links are designed with lengths adjustable to accommodate wearers of different heights and weights. A large-scale but risk-free workspace is analyzed through rigid body kinematics using the spinor method. The control hardware of the TULAE is developed based on the open-source Arduino board. Finally, the experimental results show that this TULAE can significantly reduce the range of wrists shaking and assist surgeons in laryngoscopy surgery.

Acoustic and videoendoscopic effects of temporary vocal fold augmentation in an office-based setting: a quasi-experimental study

BackgroundVocal-fold augmentation is a continuously developing treatment modality for glottic insufficiency. Patients with glottic insufficiency attend the phoniatrics clinics with increasing frequency. Glottic insufficiency may be due to vocal-fold paralysis, paresis, atrophy, sulcus vocalis, scarring, and vocal-fold deficiency after laryngeal surgery. A variety of materials exist for injection augmentation. This follow-up study aimed to assess the short-term as well as long-term outcomes of vocal-fold injection with calcium hydroxyapatite (CaHA) in patients with glottic gap 1–3 mm.MethodThis study included 25 patients with glottic insufficiency who underwent injection augmentation with CaHA. All patients were scheduled for voice evaluation using a comprehensive subjective and objective battery of assessments. Assessments were performed before the procedure and after the procedure at 2 months and at 1 year.ResultsPerceptual voice quality assessed with the GRBAS scale improved and the results were stable after 1 year. Shimmer and HNR improved continuously through the follow-up sessions, while jitter and f0 showed slight improvement after CaHA injection.ConclusionVoice improvement after injection of CaHA requires a minimum of 2 months to develop and may last for a long period.

Current Trends in Endoscopic Ear Surgery.

Current Trends in Endoscopic Ear Surgery.

A Case of Thyroid Chondrosarcoma

We herein report a rare case of thyroid chondrosarcoma in which laryngeal preservation surgery was performed. The patient was a man in his 40s. A hard mass was palpated on the right lateral side of the thyroid cartilage. Enhanced computed tomography showed a tumor on the right lateral side of the thyroid cartilage with partial destruction of the thyroid cartilage. Ultrasonography-guided fine-needle aspiration cytology suggested the lesion was a tumor of cartilage origin. We therefore diagnosed a thyroid cartilage tumor. We performed partial laryngectomy. Intraoperative findings revealed a hard tumor contiguous with the thyroid cartilage deep in the right omohyoid muscle. The right two-thirds of the thyroid cartilage were cut longitudinally, and the tumor was removed. The pathological diagnosis was a grade 2 chondrosarcoma of thyroid cartilage origin. Two years after surgery, there was no recurrence. There have been 37 cases of laryngeal chondrosarcoma reported in Japan, and only 8 were of thyroid cartilage origin. Surgical treatment was selected in all cases, with 16 cases treated by total laryngectomy and 21 cases by partial laryngectomy. Recurrence was reported in five cases, including local recurrence in three cases, cervical recurrence in one case, and distant metastasis in one case.

Friedrich Trendelenburg's tracheal tampon-cannula

The aim of this historical vignette is to analyze the role of Friedrich Trendelenburg's tracheal balloon cannula in the development of laryngeal surgery in the early 1870s. The purpose of this cannula was to prevent bleeding into the airway in cases of extensive laryngeal surgery requiring a tracheostomy.

성대 마비의 치료

Vocal fold paralysis can occur for various reasons, and vocal fold paralysis treatment is important to improve the quality of life and secure airway according to voice. There are several methods of unilateral and bilateral vocal fold paralysis; voice therapy, injection laryngoplasty, laryngeal framework surgery, reinnervation procedures, tracheostomy, arytenoidectomy, cordotomy, cordectomy, and laterofixation of vocal cord. This review paper aims to discuss the treatment principles of unilateral and bilateral vocal fold paralysis.

The smoker’s larynx: a histopathological study

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; Larynx of chronic smokers was clinically evaluated under high powered magnification as well as on histopathology to study the effect of fumes of nicotine on the vocal cords.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; 32 chronic smokers undergoing Lewis suspension micro laryngeal surgery were selected from the laryngology clinics of Dayanand Medical College and Hospital, Ludhiana. Intraoperative findings were recorded and the specimens were sent for histopathological examination. The study was undertaken in a period of one and a half years (June 2009-December 2010). &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; Maximum patients 31% (10 patients) underwent microlaryngeal surgery were smokers in the middle age group (40-50 years) and minimum 9.3% (3 patients) were above 60 years of age. Vocal polyp/polypoidal change was seen in 7 (21.87%) patients was the predominant finding followed by a chronic hypertrophic change 5 (15.62%) patients. leucoplakia 4 (12.5%) cases, tubercular caseation 3 (9.3%), vocal nodules 4 (12.5%) and vocal cysts 1 (3.125%) were the other findings in our series.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Nicotine fumes affect the epithelium of the vocal cord leading to hypertrophic or hyperplastic transition. Vocal cord polypoidal change, squamous cell carcinoma and chronic hypertrophic laryngitis, in that order were the lesion in our series.&lt;/p&gt;

A descriptive study of benign lesions of the larynx; therapeutic management and outcomes

Introduction. Papilloma is more common among neoplastic lesions, and vocal cord polyps are more common among nonneoplastic lesions. The objective of this study is to investigate the epidemiological factors, clinical features, etiopathogenesis and management methods of benign lesions of the larynx. Materials and Methods. It is a prospective study on 40 benign lesions of the larynx, in a tertiary referral medical period of 18 months (from March 2018 to October 2019). Detailed history and ENT examination as well as relevant investigations were performed. Results. Vocal cords were involved in 92.5% of cases, and both supraglottis in 7.5% of cases. Vocal cord polyp lesions were more common than papilloma lesions. Preoperative conservative voice therapy was recommended, and 70% of cases showed improvement. Coblation assisted laryngeal surgery and excision was performed in 1 case, while 11 cases were treated by microlaryngeal surgery. Voice rest and voice therapy was given to all post operative cases. Follow-up ranged from 2 to 18 months, and improvements were seen in 8 cases that were treated by surgery. All cases that underwent conservative treatment improved symptomatically. Conclusions. The most likely causes of treatment failure are due to ongoing predisposing factors such as voice abuse, smoking and alcohol consumption, lack of commitment to voice therapy and non-compliance with recommendations by patients.

A Retrospective Study to Assess the Accuracy of Frozen Sections in Laser Laryngeal Surgery.

The basis of good vocal outcomes following Transoral Laser Microlaryngeal Cordectomy (TLMC) is the narrow margin that is oncologically accepted for the glottis. Our objective is to evaluate the reliability of frozen section (FS) compared to paraffin section (PS) during TLMC and during laser laryngeal surgery when an incisonal or excisional biopsy is being performed. Retrospectively, records of 159 sequential patients who underwent CO2 laser laryngeal surgery with intraoperative FS were reviewed along with the final PS. Group A patients were TLMC patients where FS was utilized for free margin confirmation (42 specimens) and Group B patients were those in whom FS was performed for primary diagnosis (122 specimens). A total of 164 samples were included where specimens submitted for FS were also processed for PS. Concordance was observed in 156 samples, discordance in 8, with 4 cases belonging to each group. FS was reported as false negative in 5 and false positive in 3 cases. In Group A where FS was utilized for free margin confirmation, the sensitivity was found to be 60%, specificity and positive predictive value (PPV) 100%, and negative predictive value (NPV) 88.9%. In Group B where FS was performed for primary diagnosis, the sensitivity was found to be 98.4%, specificity 95.1%, PPV 95.2%, and NPV 98.3%. A 100% PPV of FS in group A suggests that positive FS margins during TLMC may be safely relied upon in making decisions to upgrade the type of cordectomy being performed. A NPV of 88.9% in group A suggests that despite a clear frozen margin report during TLMC, 11.1% of patients would need further treatment. A PPV of 95.2% in group B suggests that although FS analysis is important for guiding further management, decisions regarding major laryngeal surgery should not be undertaken based solely on FS.

Predictive Outcomes of Deep Learning Measurement of the Anterior Glottic Angle in Bilateral Vocal Fold Immobility.

(1) To compare maximum glottic opening angle (anterior glottic angle, AGA) in patients with bilateral vocal fold immobility (BVFI), unilateral vocal fold immobility (UVFI) and normal larynges (NL), and (2) to correlate maximum AGA with patient-reported outcome measures. Patients wisth BVFI, UVFI, and NL were retrospectively studied. An open-source deep learning-based computer vision tool for vocal fold tracking was used to analyze videolaryngoscopy. Minimum and maximum AGA were calculated and correlated with three patient-reported outcomes measures. Two hundred and fourteen patients were included. Mean maximum AGA was 29.91° (14.40° SD), 42.59° (12.37° SD), and 57.08° (11.14° SD) in BVFI (N=70), UVFI (N=70), and NL (N=72) groups, respectively (p < 0.001). Patients requiring operative airway intervention for BVFI had an average maximum AGA of 24.94° (10.66° SD), statistically different from those not requiring intervention (p=0.0001). There was moderate negative correlation between Dyspnea Index scores and AGA (Spearman r=-0.345, p=0.0003). Maximum AGA demonstrated high discriminatory ability for BVFI diagnosis (AUC 0.92, 95% CI 0.81-0.97, p < 0.001) and moderate ability to predict need for operative airway intervention (AUC 0.77, 95% CI 0.64-0.89, p < 0.001). A computer vision tool for quantitative assessment of the AGA from videolaryngoscopy demonstrated ability to discriminate between patients with BVFI, UVFI, and normal controls and predict need for operative airway intervention. This tool may be useful for assessment of other neurological laryngeal conditions and may help guide decision-making in laryngeal surgery. III Laryngoscope, 133:2285-2291, 2023.

Total laryngectomy: 3D anatomy

Despite the advent of non-surgical treatment options for laryngeal cancer, as well as partial laryngeal surgery for larynx cancer, total laryngectomy remains an important tool in the treatment of larynx cancer and non-functional larynx. With the use of 3-dimensional stereoscopic imaging techniques, total laryngectomy is herein reviewed with an emphasis on understanding the anatomic relationships encountered and considered during this procedure. Despite the advent of non-surgical treatment options for laryngeal cancer, as well as partial laryngeal surgery for larynx cancer, total laryngectomy remains an important tool in the treatment of larynx cancer and non-functional larynx. With the use of 3-dimensional stereoscopic imaging techniques, total laryngectomy is herein reviewed with an emphasis on understanding the anatomic relationships encountered and considered during this procedure.

Effect of socioeconomic status on wait times for patients undergoing treatment for laryngeal conditions in a universal healthcare system.

As one of the world's only fully publicly administered, universal healthcare systems, Canada intends to provide equitable access to services for all patients. Socioeconomic status (SES) can affect treatment wait times with implications on health outcomes; however, this has not been evaluated in the setting of laryngeal disease, which incorporates urgent and elective conditions, in a universal healthcare system. This study aims to identify whether SES-affected treatment wait times for laryngeal therapies in this system. A retrospective review was conducted on a cohort of patients with laryngeal disease at an academic, tertiary center who underwent laryngeal surgery over a three-year period. Data retrieved through medical records; surgical and voice therapy wait times were normalized to each practitioner's average wait time for respective diagnostic categories. Income was used to assess SES and was derived from Statistics Canada census information based on patient postal codes. Data analysis identified 578 patients (59% male). Mean wait time to surgery for all conditions was 123.5 (95% confidence interval 113.1-133.9) days. Analysis of variance analysis found no difference in wait times between different SES groups (p= .28), regardless of laryngeal disease category. Patients with cancer or airway obstruction had shorter wait times compared with benign conditions (p< .0001). SES did not affect treatment wait times for laryngeal therapies in a universal healthcare system. Wait times were shorter for oncologic and obstructive conditions compared with benign conditions, reflecting an ability to accommodate clinical needs without impacting care access at the detriment of different SES statuses. 4.

Nurse-led telephone follow-up according to the revised nursing outcomes classification for laryngeal carcinoma surgery patients: a randomized controlled trial

BackgroundThis study used the revised nursing outcomes classification (NOC) outlined in our previous study, “Core nursing outcomes for otorhinolaryngology head-neck,” for telephone follow-up of patients who had laryngeal carcinoma surgery in China. This randomized controlled trial aimed to compare nurse-led telephone follow-up according to the revised NOC with traditional telephone follow-up.MethodsA total of 100 postoperative patients were recruited from March 2018‒March 2020. Patients were randomly assigned to nurse-led telephone follow-up groups as either revised NOC follow-up (n = 51) or traditional follow-up (n = 49). The investigated outcomes included nursing outcomes, quality of life, and self-care abilities.ResultsThe baseline characteristics of patients were well balanced. We noted that improvements in nursing outcomes in the intervention group were significantly better than for those in the control group (P = 0.018), primarily regarding psychosocial health (P < 0.001) and health knowledge and behavior (P < 0.001). Moreover, patient outcomes in the intervention group were associated with greater improvements in quality of life than those in the control group (P < 0.001), especially for social conditions (P < 0.001), emotional health (P < 0.001), functional status (P < 0.001), and additional attention (P = 0.001). Finally, compared with the control group, significant improvements were observed in self-care abilities in the intervention group (P = 0.002), mainly regarding general self-care abilities (P = 0.016) and development self-care abilities (P < 0.001).ConclusionThis study found that nurse-led telephone follow-up according to the revised NOC improved nursing outcomes, quality of life, and self-care abilities.Trial registration:ChiCTR2100045941.