Superior Laryngeal Nerve Paralysis Research Articles

Analysis of vocal fold movement characteristics in patients with laryngeal neurogenic injury

Objective:To analyze the characteristics of vocal fold movement and glottic closure in patients with laryngeal neurogenic injury. Methods:A total of 185 patients with vocal fold paralysis diagnosed by laryngeal electromyography as neurogenic damage to cricothyroid muscle, thyreoarytenoid muscle and posterior cricoarytenoid muscle were enrolled, they were divided into unilateral vocal fold paralysis group and bilateral vocal fold paralysis group, respectively, and superior laryngeal paralysis group, recurrent laryngeal nerve paralysis group and vagal nerve paralysis group according to nerve injury. The characteristics of vocal fold movement and glottic closure were analyzed under strobe laryngoscope. The qualitative evaluation of vocal fold movement was fixed vocal fold, reduced vocal fold movement and normal vocal fold movement, and the qualitative evaluation of glottic closure was glottic closure and glottic imperfection. The results were analyzed statistically. Results:The proportion of normal, reduced and fixed vocal fold motion in bilateral vocal fold paralysis group was significantly different from that in unilateral vocal fold paralysis group（P<0.05）, the composition of normal and reduced vocal fold motion in bilateral vocal fold paralysis group（47.70%） was significantly greater than that in unilateral vocal fold paralysis group（12.27%）. There was no significant difference between the proportion of glottic closure and glottic imperfecta in bilateral vocal fold paralysis group and unilateral vocal fold paralysis group（P<0.05）. The proportion of decreased vocal fold motion in superior laryngeal nerve paralysis group（50.00%） was higher than that in recurrent laryngeal nerve paralysis group（9.32%） and vagal nerve paralysis group（9.00%）. The proportion of decreased and fixed vocal fold motion in superior laryngeal nerve paralysis group, recurrent laryngeal nerve paralysis group and vagal nerve paralysis group was statistically significant（P<0.05）.There was no significant difference in glottic closure among the three groups（P<0.05）. Conclusion:Vocal fold movement characteristics of patients with laryngeal neurogenic injury were mainly vocal fold fixation, or normal or weakened vocal fold movement. There may be missed diagnosis of unilateral vocal fold paralysis in clinical practice. In half of the patients with superior laryngeal nerve palsy, vocal fold movement is characterized by vocal fold fixation.

Prospective study on the outcomes of harmonic scalpel assisted thyroidectomy in a tertiary care centre in South Kerala

&lt;p class="abstract"&gt;&lt;strong&gt;Background:&lt;/strong&gt; To estimate the outcomes of thyroidectomy using harmonic scalpel in terms of intra-operative and post-operative blood loss, operating time, incidence of post-operative hypocalcaemia, incidence of recurrent laryngeal nerve and superior laryngeal nerve palsy and post-operative pain.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Methods:&lt;/strong&gt; The patients are selected consecutively as and when they were presented during the study period. The study involved 23 patients out of which 17 underwent total thyroidectomy and 6 underwent hemithyroidectomy, all using harmonic scalpel. A complete history, physical examination and appropriate investigations were done to arrive at the correct diagnosis. Surgery was done and all the parameters were accurately assessed. &lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Results:&lt;/strong&gt; The mean intra-operative and post-operative blood loss in thyroidectomy by harmonic scalpel was 92.2 ml and 20.6 ml respectively. The mean operative time for thyroidectomy using harmonic scalpel was 58.2 minutes that includes 38 minutes for hemi thyroidectomy and 65.3 minutes for total thyroidectomy. Out of 23 patients, only 1 patient (4.3%) had transient hypocalcaemia in the post operative period. Three patients (13%) had transient unilateral recurrent laryngeal nerve palsy and none had superior laryngeal nerve palsy. The pain assessment by visual analog scale (VAS) score at 24 hours and 48 hours after harmonic scalpel assisted thyroidectomy were 3.87±0.97 and 2.35±1.30 respectively.&lt;/p&gt;&lt;p class="abstract"&gt;&lt;strong&gt;Conclusions:&lt;/strong&gt; Harmonic scalpel gives effective and reliable hemostasis, shortens the operative time, reduces the complications and improved pain control and hence may be considered as an effective tool in thyroidectomy.&lt;/p&gt;

INTRA- AND POSTOPERATIVE COMPLICATIONS IN 80 CASES OF GIANT THYROID GLAND TUMOUR

Thyroid Surgery is commonly performed by the general surgeons throughout the world. It is indicated as elective treatment for thyroid neoplasm. During surgery injury to RLN is common complication. Damage to the RLN has been reported as most common iatrogenic complications associated with surgeries of the thyroid gland. Injury to the RLN is most frequent and important cause of morbidity in thyroidectomies. Today most of the complications of thyroid surgery are related to either metabolic derangement or injury to recurrent laryngeal nerve. Other complications include hypoparathyroidism, hematoma, seroma, infection at surgical site, superior laryngeal nerve palsy. Hence before any thyroid surgery patient must be precisely informed the possible complications and their remedies. The present study aims to evaluate intra operative and post operative complications in 80 cases of giant thyroid gland tumours.

Early Complications after Thyroid Surgery

Background: In this study we shall deal with the early complications after thyroid surgery and compare the complication rate with the extent of resection (subtotal, near total and total thyroidectomy). Patients and Methods: Early complications after thyroid surgery were studied in A prospective study in One hundred patients. Data was collected in the pre-designed proforma. And they are classified according to age and sex of the patients, clinical conditions and training state of the surgeon. Descriptive statistics was used to calculate frequency of each complication in the early post-thyroidectomy period. Results: Most of the patients were females and lie at the (30-39) age group. Clinically, most of them are presented with simple multinodular goitre. Subtotal thyroidectomy is the most commonly used type of resection. The frequency of complications after total thyroidectomy is more than other types. And identification of the (RLN) will minimize the incidence of injury. These complications were (4%) tension haematoma, (11%) hypocalcaemia, (4%) respiratory obstruction, (8%) developed recurrent laryngeal nerve paralysis, (2%) superior laryngeal nerve paralysis, and (1%) wound infection. Surgeon’s experience is so important, in which there is less complications when the operation is performed by a consultant surgeon. Conclusions: Surgery may be associated with significant numbers of post-operative complications according to the type of surgery. Total thyroidectomy confers certain advantages over less extended procedures, but it is associated with higher morbidity. Due to the risk of an unsuspected malignancy and goiter relapse following conservative surgery and increased risk of complications following reoperation, total thyroidectomy is emerging as an attractive surgical option.

Incidental Laryngeal Findings on Bedside Flexible Endoscopic Evaluation of Swallowing in a Community Hospital Setting.

The purpose of this study was to evaluate the incidence of laryngeal pathology found during bedside flexible endoscopic evaluation of swallowing (FEES) in a community hospital. A retrospective study among patients who underwent a bedside FEES examination from May 2018 to May 2019. Criteria to perform a bedside FEES exam were patients who were identified through nursing screening swallowing evaluation and failed a bedside clinical evaluation of swallowing by a speech language pathologist. Patient demographics, recent intubation, duration of intubation, dysphonia complaints, laryngeal exam findings, consultation to otolaryngology and intervention were reviewed. Seventy-five patients had an inpatient bedside FEES. All (100%) had subjective complaints of swallowing. 29 (38.66%) had laryngeal pathology identified on FEES examination including unilateral vocal fold immobility (9), fungal infections (6), vocal fold lesion (3), edema (3), erythema (3), vocal process granuloma (2), unilateral TVF Hemorrhage (1), unilateral TVF paresis (1), suspected superior laryngeal nerve palsy (1). Seventeen of the twenty-nine (58.6%) examinations with incidental laryngeal finding received an otolaryngology referral. Twenty-three of the twenty-nine patients with laryngeal findings (79.3%) were intubated during the hospitalization. Bedside FEES is a well-established method to evaluate swallowing function in an inpatient population. Even in a community hospital, routine FEES examinations led to a high rate of detection of clinically significant laryngeal pathology.

Evaluation and management of thyroid incidentalomas detected prior to the parathyroid surgery

BackgroundWe investigated the management of thyroid incidentalomas associated with cases of parathyroid lesions in order to suggest a practical approach to their management from a surgical point of view. Methods639 patients underwent radiological and ultrasound investigation of the thyroid area because of parathyroid disorders and parathyroidectomy and had at least three years of follow-up. All follow-up data for these cases were investigated from the moment the lesion was detected and up to the last report. ResultsOut of 639 cases, incidental or asymptomatic thyroid nodules were found in 179 patients (28%), of which, 22 patients were operated (parathyroidectomy + thyroidectomy) and 157 remained with the nodules. For these patients, the average period of follow-up was 7 years 5 mo. Following the results of the follow-up, 52 patients (33%) were suggested to have surgery of the thyroid gland and 49 were operated (16 total thyroidectomies and 33 hemithyroidectomies). The complications after the second surgery included recurrent laryngeal nerve palsy (n = 3), superior laryngeal nerve palsy (n = 1), permanent hypocalcaemia (n = 8), and surgical damage to the internal jugular vein (n = 1). All complications occurred at the previously operated side of the neck. ConclusionWhile surgery remains the management of choice for malignant thyroid incidentalomas, for benign cases, if an asymptomatic thyroid nodule was detected inside the thyroid lobe on the side of planned parathyroidectomy and if the size of the nodule is ˃1.5 cm we suggest combined parathyroidectomy + hemithyroidectomy.

Assessment of morbidity and mortality of thyroid surgery

Background: To find out the incidence and types of complications after thyroidectomy.To analyze the factors related to the complications of thyroid surgery.Material and method: The study was carried out at Shahid Suhrawardy medical college and Hospital, Dhaka from July 2007 to June 2008. Fifty patients were selected for the study who were treated by thyroidectomy. The mean patient's age at the time of surgery was 41.9±8.1 years ranged from 10 to 60 years. Data were collected in a prescribed data collection sheet. Then all data were compiled and analyzed.Result: 12% of the patients had transient hypoparathyroidism, 4% had haemorrhage, 2% had permanent hypoparathyroidism, 4% had temporary recurrent laryngeal nerve (RLN) palsy and 2% had permanent recurrent laryngeal nerve palsy. Other rare complications were superior laryngeal nerve palsy, hematoma, and wound infection.Conclusion: Improved surgical techniques and proper management of complications reduce the postoperative morbidity and mortality of thyroid surgery. In spite of all measures, keen observation in postoperative period is very important to find out the complications for early intervention.Anwer Khan Modern Medical College Journal Vol. 6, No. 2: July 2015, P 15-19

English

BACK GROUND: Thyroidectomy is a common surgery with an extremely low mortality, with specific morbidities which are related to the experience of the surgeon. Very low morbidity rates with specialised centers. Thyroid surgery is associated with few complications and no fatality. Post-operative complications may be as insignificant as edema of the flap or as dangerous and life threatening as hemorrhage or respiratory obstruction. Complications are less with sound surgical technique and good preoperative preparation. OBJECTIVES: 1. The objective of the study is to compare complication rates of Bilateral sub total thyroidectomy (SBT), near total thyroidectomy (NTT) Hemithyroidectomy (Total lobectomy and isthmusectomy), and Total thyroidectomy (TT) in cohort of patients undergoing surgery for various thyroid disorders. 2. To compare complication rates after thyroidectomy for benign diseases and malignant diseases. 3. To identify ways to avoid the post operative complications. METHODOLOGY: It is a prospective study conducted from September 2016 to August 2017 in one hundred patients who underwent thyroidectomy surgery in our hospital which includes ninety three female and seven male patients. All basic investigation along with vocal cord examination and special investigation like thyroid profile and serum calcium is done in all patients in the study group. Meticulous pre operative preparation is done in all cases. FNAC is done in all cases of goitre under study group. Finally the outcome of various thyriodectomy procedures and their post operative complications along with nature of histopathological reports were compared. The morbidity and mortality associated with each procedure and nature of the disease were compared in this study. RESULTS: In our study flap edema occurred more frequently, that too more frequent after total thyroidectomy (12%). Seroma occurred in eight cases (8 %) but subsided rapidly. The incidence of recurrent laryngeal nerve (vocal cord) palsy is 7 % and superior laryngeal nerve palsy in four patients (4%). These complications were transient. Recovered spontaneously over the time. Post operative hypo parathyroidism occurred in four patients who underwent total thyroidectomy for malignant thyroid disorders. These incidence is due to surgical clearance for malignant disease. This study also reveals complication rates were more for total thyroidectomy than any other procedures. Incidences of other complications are also higher in bilateral total thyroidectomy. Thyroid storm, oesophageal injury and death were nil in our study group. This study revealed that the hemithyroidectomy is an extremely safe procedure without any complication. CONCLUSION: The following conclusions are drawn from this study: 1. This study shows that the total thyroidectomy or hemithyroidectomy can be done with very low complication rate in cases of benign thyroid disease affecting the whole gland. 2. Recurrent laryngeal nerve palsy , hypo parathyroidism induced hypocalcemia were occuring in total thyroidectomy procuredes in malignant thyroid disorder patients than benign disorders. 3. Thyroid carcinoma, recurrent goiter, toxic goiter and total thyroidectomy are risk factors for post operative complication. 4. There is a risk of recurrence with bilateral subtotal thyroidectomy. Because total thyroidectomy carries a risk of complication similar to that for bilateral subtotal thyroidectomy, it is no logical to avoid total resections. Therefore near total or total thyroidectomy may be the operation of choice for multinodular goiter. 5. Complications and sequelae of thyroid surgery can yet be reduced by careful evaluation of the surgical and medical therapeutic options to have more precise surgical indications, a thorough knowledge of the surgical anatomy, a rigorous surgical technique, a systematic dissection of recurrent laryngeal nerve and meticulousness during the procedure. 6. I conclude that the operative skills and experience of the Surgeon and the malignant nature of the disease are the determining factors for the complications in thyroidectomy procedures.

Neuromuscular compensation mechanisms in vocal fold paralysis and paresis.

Vocal fold paresis and paralysis are common conditions. Treatment options include augmentation laryngoplasty and voice therapy. The optimal management for this condition is unclear. The objective of this study was to assess possible neuromuscular compensation mechanisms that could potentially be used in the treatment of vocal fold paresis and paralysis. In vivo canine model. In an in vivo canine model, we examined three conditions: 1) unilateral right recurrent laryngeal nerve (RLN) paresis and paralysis, 2) unilateral superior laryngeal nerve (SLN) paralysis, and 3) unilateral vagal nerve paresis and paralysis. Phonatory acoustics and aerodynamics were measured in each of these conditions. Effective compensation was defined as improved acoustic and aerodynamic profile. The most effective compensation for all conditions was increasing RLN activation and decreasing glottal gap. Increasing RLN activation increased the percentage of possible phonatory conditions that achieved phonation onset. SLN activation generally led to decreased number of total phonation onset conditions within each category. Differential effects of SLN (cricothyroid [CT] muscle) activation were seen. Ipsilateral SLN activation could compensate for RLN paralysis; normal CT compensated well in unilateral SLN paralysis; and in vagal paresis/paralysis, contralateral SLN and RLN displayed antagonistic relationships. Methods to improve glottal closure should be the primary treatment for large glottal gaps. Neuromuscular compensation is possible for paresis. This study provides insights into possible compensatory mechanisms in vocal fold paresis and paralysis. NA Laryngoscope, 127:1633-1638, 2017.

Preliminary report on meticulous operation of thyroid lobectomy

Thyroid lobectomy can be programmed to operate as "step by step". Each step must be performed meticulously with quality control, so as to minimize the complications of surgery. From May 2013 to Auguest 2014, the meticulous thyroid operation was conducted in 72 cases (144 lobectomies). Pre- and post-operative evaluations by strobe laryngoscopy, parathyroid hormone (PTH), and blood calcium examinations were conducted in all cases. Four cases (5.6%) had transient recurrent laryngeal nerve paralysis after surgery, but no permanent recurrent laryngeal nerve paralysis. There was no transient or permanent superior laryngeal nerve paralysis. Transient hypoparathyroidism occurred in 10 cases, with no permanent hypoparathyroidism. No case presented with postoperative bleeding or infection. "Meticulous operation of thyroid lobectomy" may minimize effectively the complication of surgery.

Aerodynamic and Nonlinear Dynamic Acoustic Analysis of Tension Asymmetry in Excised Canine Larynges

To model tension asymmetry caused by superior laryngeal nerve paralysis (SLNP) in excised larynges and apply perturbation, nonlinear dynamic, and aerodynamic analyses. SLNP was modeled in 8 excised larynges using sutures and weights to mimic cricothyroid (CT) muscle function. Weights were removed from one side to create tension asymmetry, mimicking unilateral SLNP. Two sets of weights were used, 1 light and 1 heavy. Five conditions were evaluated: (a) no tension, (b) symmetrical light tension, (c) asymmetrical light tension, (d) symmetrical heavy tension, and (e) asymmetrical heavy tension. Perturbation parameters were not significantly different across conditions: percent jitter, χ(2)(4) = 3.70, p = .451; percent shimmer, F(4) = 0.95, p = .321. In addition, many measurements were invalid (error values >10). Second-order entropy was significantly different across conditions, F(4) = 5.432, p = .002, whereas correlation dimension was not, F(4) = 0.99, p = .428. Validity of these nonlinear dynamic parameters was demonstrated by low standard deviations. Phonation threshold pressure, χ (2)(4) = 22.50, p < .001, and power, χ (2)(4) = 9.50, p = .05, differed significantly across conditions, whereas phonation threshold flow did not, χ (2)(4) = 4.08, p = .396. Nonlinear dynamic analysis differentiated between symmetrical and asymmetrical tension conditions, whereas traditional perturbation analysis was less useful in characterizing type 2 or 3 vocal signals. Supplementing acoustic with aerodynamic parameters may help distinguish among laryngeal disorders of neuromuscular origin.

Bilateral Internal Superior Laryngeal Nerve Palsy of Traumatic Cervical Injury Patient Who Presented as Loss of Cough Reflex after Anterior Cervical Discectomy with Fusion

Injury to the bilateral internal branch of superior laryngeal nerve (ibSLN) brings on an impairment of the laryngeal cough reflex that could potentially result in aspiration pneumonia and other respiratory illnesses. We describe a patient with traumatic cervical injury who underwent bilateral ibSLN palsy after anterior cervical discectomy with fusion (ACDF). An 75-year-old man visited with cervical spine fracture and he underwent ACDF through a right side approach. During the post-operative days, he complained of high pitched tone defect, and occasional coughing during meals. With a suspicion of SLN injury and for the work up for the cause of aspiration, we performed several studies. According to the study results, he was diagnosed as right SLN and left ibSLN palsy. We managed him for protecting from silent aspiration. Swallowing study was repeated and no evidence of aspiration was found. The patient was discharged with incomplete recovery of a high pitched tone and improved state of neurologic status. The SLN is an important structure; therefore, spine surgeons need to be concerned and be cautious about SLN injury during high cervical neck dissection, especially around the level of C3-C4 and a suspicious condition of a contralateral nerve injury.

Complete transposition of carotid bifurcation: can it be an additional risk factor of injury to the cranial nerves during carotid endarterectomy?

The internal carotid artery (ICA) usually, lies posterolaterally to the external carotid artery (ECA). Sometimes a complete carotid transposition can occur, with the ECA in a lateral position and the ICA on the medial side can occur. Our study evaluated the significance and impact that this anomaly may have on cranial nerve injuries. From January 2008 to November 2010, 296 patients underwent 360 consecutive primary carotid endarterectomy (CEA) procedures. During carotid isolation, we detected an unexpected lateral position of the ECA in 11 cases (3.6%). χ(2) analysis and the Student's t-test were used to compare the incidence of cranial nerve injuries between the 11 patients with the lateral ECA who underwent CEA (group A) and 11 randomized patients with a normal bifurcation (group B). Statistical significance was inferred at χ(2)>3.84 and P<0.05. A statistical difference in the incidence of superior laryngeal nerve paralysis was detected between groups A and B (18.1%, 2/11 in group A vs. 0%, 0/11 in group B; χ(2)>3.84; P<0.05). No differences in incidence of injury were detected for the other cranial nerves. A very meticulous mobilization of the ECA and ICA is needed to perform CEA, but superior laryngeal nerve injury can occur despite the use of a safe and meticulous surgical technique.

ＣＥＡの術野展開におけるゴムフック吊り上げ法の有用性

We report on our surgical technique, “the rubber band and hook method,” for carotid endarterectomy (CEA). Since carotid stenosis is frequently high-positioned in the Japanese population, even a small transposition of the carotid artery downwards makes it safer and easier to manipulate the distal internal carotid artery. With rubber bands and small skin hooks, we mobilize the carotid artery by holding up the carotid sheath. The author (S.O.) performed 60 CEAs from 2001 to 2006 using this method. No perioperative stroke or hematoma formation that required surgical removal was observed. Postoperative angiography confirmed optimal patency in all cases. We observed, however, 1 persistent case (1.6%) and 2 transient cases (3.3%) of hoarseness due to superior laryngeal nerve palsy related to surgical maneuvers. In this article, we report the effectiveness of our technique in ensuring the operative field along with the potential benefit to reduce bleeding by not separating the backside of the carotid artery. We also underscore the need of meticulous manipulation in securing the distal internal carotid artery and superior thyroid artery to prevent the superior laryngeal nerve palsy.

Voice Change Following Thyroid and Parathyroid Surgery

Voice complications following thyroid and parathyroid procedures have long been recognized in the literature. However, there is little clear data on the nature, severity, and duration of any changes. No single previous study has comprehensively addressed the multiple issues involved. Most studies have been retrospective, preventing control over extraneous variables, or are small prospective studies using limited assessment measures. Emphasis has been on damage (paralysis) to the recurrent laryngeal nerve (RLN). The effects of surgery on the more subtle (but equally important) aspects of voice disorders have received little attention. This prospective study of 67 participants used multidimensional voice outcomes measures to assess changes in voice following thyroid and parathyroid surgery. Strict exclusion criteria minimized the effects of extraneous variables. Participants were assessed preoperatively to establish a baseline and at least twice more postoperatively. Generally speaking, the patient vocal performance and expert perceptual rating data suggest an incidence of 0% for all operation types. Mild changes at the early postoperative stages had settled in all cases by the 3-month postoperative assessment. Videostroboscopic evaluation revealed an interesting picture of six patients who appeared to have improved vocal function postsurgery, 15 patients who showed signs of neurological damage at their first postoperative examination, and only five "permanent" RLN paralyses at 12 months postsurgery. The potential for improvement in voice quality postsurgery has not previously been reported in the literature as far as we are aware. Symptoms consistent with RLN and superior laryngeal nerve palsy were present both pre- and postoperatively. Apparent nerve damage did not necessarily result in dysphonia. The potential for undiagnosed nerve damage preoperatively has rarely been reported in the literature. These results may have medico-legal implications, in addition to influencing surgical risk management and informed patient consent.

Strobokymographic and Videostroboscopic Analysis of Vocal Fold Motion in Unilateral Superior Laryngeal Nerve Paralysis

The clinical diagnosis of superior laryngeal nerve paralysis (SLNp) is infrequently made, because of the heterogeneity of clinical presentations and laryngoscopic findings. Laryngeal electromyography (LEMG) can provide the definitive diagnosis of this abnormality. With increasing use of LEMG in clinical practice, this condition is now more frequently appreciated by otolaryngologists. A characteristic, but infrequently reported, videostroboscopic vocal fold motion termed Gegenschlagen ("dashing-against-each-other") has previously been described to occur in unilateral SLNp. We encountered such motion in a clinical case, which we subsequently verified as unilateral SLNp by means of LEMG. This characteristic glottic motion was then verified in an in vivo canine model of phonation after unilateral SLNp. Videostrobokymography was performed to generate kymograms that illustrated this vocal fold motion clearly. Kymograms of both human and canine subjects with SLNp demonstrated an undulating motion of the horizontally shifting glottic space as the medial edges of the vocal folds chased each other 90 degrees out of phase. As one vocal fold mucosal edge was opening, the other was closing, and this repeated motion appeared as vocal folds chasing or dashing against each other. Although not uniformly seen in all cases, this vocal fold motion appears to be unique to SLNp.

VOCAL FOLD HEIGHT ASYMMETRY AND EFFECTS ON PHONATION ONSET AND VIBRATORY BEHAVIOR IN EXCISED HUMAN LARYNGES.

Superior laryngeal nerve (SLN) paralysis results in abnormalities in voice, but it is not clear what occurs at the level of the vocal fold. One theory is that SLN paralysis leads to vocal fold height asymmetry, with the paralyzed vocal fold at a higher vertical position than the normal fold. We examined vocal fold height asymmetry to determine whether this could explain symptoms experienced by patients with SLN paralysis. It was hypothesized that the height asymmetry of the cords contributes to the breathiness, hoarseness, and vocal fatigue that appear in SLN paralysis because the vocal cord mismatch causes an incomplete glottal closure. This allows for air to escape and thus results in decreased vocal efficiency. Using an excised larynx model with induced cord height asymmetry, the team measured changes in vocal fold open quotient, glottal midline, vibratory behavior, and subglottic pressure and flow at phonation onset. Arytenoid adduction sutures allowed for glottic approximation, and sutures placed on the vocal processes created the height asymmetry. A high-speed camera was used to record images. Height asymmetry was found to cause an increased vocal fold open quotient, higher phonation-onset subglottic pressure and flow, vocal fold desynchronization, a shifting glottal midline, and complex vibratory behavior with numerous modes of vibration. Individuals with SLN paralysis may have to exert more pressure and airflow because of these factors, causing fatigue and hoarseness, and may also have less closure of their vocal cords, as indicated by the increased open quotient, contributing to breathiness. This suggests that vocal fold height asymmetry can potentially explain the symptoms of SLN paralysis.

Therapeutic effects and complications of percutaneous anterior screw fixation for odontoid fractures

To investigate the therapeutic effects and complications of percutaneous anterior screw fixation for odontoid fractures. Twenty-eight patients with odontoid fractures, 21 males and 7 females, aged 38.6 (21-72), 12 with type II fractures and 16 with type III fractures, including 10 cases with shallow type III fractures, according to Anderson's classification system, underwent percutaneous anterior odontoid screw fixation with one screw implant. Five to seven days after the operation the patients got out of bed to conduct dirigation. Prostheses were used for 8-12 weeks post-operationally. The patients were followed up for 43.2 months (26-62 months). Radiological examination, including X-ray and CT examinations, and clinical examinations were carried out to observe the therapeutic effects. Radiological examination showed bony union in 25 cases (89.3%), and non-union developed in 2 cases, 1 case was switched to posterior fusion surgery because of redisplaced fracture. The union rate was 83.3% in the type II fracture, and was 93.8% in the type III. Majority of the patients resumed an excellent cervical motion. No severe complication such as esophagus and carotid artery injury related with puncture was found. One patient had temporary superior laryngeal nerve paralysis, The screw tail was detained at the superior margin of C3 vertebral body in 5 cases, the screw penetrate the tip of odontoid process in 1 case, and the screw thread failed to pass the fracture site entirely in 1 case. An innovative alternative method with the advantages of convenient procedure, less bleeding, gentle injury for surrounding tissue, and rapid recovery, percutaneous anterior odontoid screw fixation is similarly effective as open anterior odontoid screw fixation, for the treatment of odontoid fractures. Related complication is rare and not severe. The surgery has.

Dynamic voice assessment using flexible laryngoscopy—how I do it: a targeted problem and its solution

Flexible laryngoscopy is a staple of the otolaryngologist’s office examination. This technique is frequently used for evaluation of gross pathologies of the larynx and pharynx as well as assessment of mobility of the vocal folds. By incorporation of a specific set of phonatory and vegetative tasks, the depth and detail of information gathered using flexible laryngoscopy can be greatly enhanced. Because the patient remains in a near-physiologic position, incorporation of these tasks into the flexible laryngoscopic examination provides essential information for the diagnosis of a variety of functional and neurologic disorders of the larynx and pharynx. Videostroboscopy can be performed by using the flexible laryngoscope, potentially circumventing the need for rigid endoscopic evaluation of small vocal fold lesions. By using this technique, subtle abnormalities of vocal fold motion can be detected, thus assisting in the diagnosis of vocal fold paresis and superior laryngeal nerve palsy. Here we describe a rapid but thorough method for evaluation of neurologic and functional voice and breathing disorders using flexible laryngoscopy (Table 1).

Cervical spine multilevel decompression/reconstruction with anterior/posterior internal fixation

Cervical spine multilevel decompression/reconstruction with anterior/posterior internal fixation