Vocal Cord Immobility Research Articles

The role of cricoarytenoid joint ankylosis in bilateral vocal cord immobility.

To stratify the severity of cricoarytenoid joint fixation (CAJF) by surgery and understand the role of it played in the bilateral vocal fold immobility (BVFI). The second objective emphasizes on the significance of the preoperative differential diagnosis from neurogenic immobility with medical history and endoscopic findings. A retrospective review was conducted of 74 patients between 2005 and 2022. Careful medical history inquiry, and videolaryngoscopy are conducted to recruit the appropriate surgical candidates. All patients underwent arytenoid remobilization (AR) followed by vocal fold medialization with arytenoid adduction (AA) or lateralization with suture lateralization (SL). The severity of CAJF is graded during the operation or inferred based on the period from operation to recurrence. A total of 18 patients, aged between 18 and 76years, were analyzed. Among them, 14 cases were classified as the adducted type with ventilation problems, with three presenting with dyspnea, and 11 requiring artificial airways. Additionally, four patients presented with the abducted type, characterized by aphonia. Meanwhile, two additional cases were considered for comparison but were not included in this cohort of 18 subjects due to incorrect diagnosis and inappropriate management. Using AR procedure, the AA procedure offered three aphonia subjects a voiced sound without airway impairment and the SL procedure decannulated 100% (11/11) of the artificial airways and improved the airway patency in 100% (3/3) of the non-tracheostomized subjects despite the severity of CAJF. The severity of joint ankylosis was distributed as follows: In the aphonia group, there were three subjects with grade I, one subject with grade II, and 0 subjects with grade III. In the ventilation group, there was one subject with grade I, seven subjects with grade II, and six subjects with grade III. In contrast, the two cases used for comparison experienced recurrent dyspnea and failed decannulation because the AR procedure was not performed. The follow-up period was averaged in 58 and 14months at least. From this experience, it is the accurate preoperative diagnosis instead of the severity of CAJF that determines the successful rate in airway patency and voiced phonation if the AR procedure is utilized. Careful medical history inquiry and videolaryngoscopic examination can correctly differentiate the mechanical from neurogenic origin without the help of EMG. Evidence of level: 4.

Vocal Cord Function Return After Larynx Preservation is Associated With Recurrence‐Free Probability

ObjectivesVocal cord fixation is one of the main upstaging features of laryngeal cancer. In our previously conducted retrospective study, vocal cord (VC) mobility restoration after chemoradiotherapy was a favorable prognostic variable. In this prospective study, we examined the significance of VC mobility restoration after definitive treatment as a prognostic variable.MethodsIn this prospective cohort study, we enrolled 30 patients with squamous cell carcinoma of the larynx with VC impairment/fixation (T2/3, T4a) who underwent definitive chemoradiotherapy with complete response. Video laryngoscopy before and at 3 months after treatment was used to evaluate VC mobility. The primary endpoint of the study was the local recurrence‐free probability. Secondary endpoints included recurrence‐free probability, disease‐specific survival (DSS), and overall survival (OS).ResultsThe median age of patients was 62 years (IQR 54–67). The primary subsites were the glottis (n = 13) and supraglottis (n = 14). After treatment, 18 (60%) patients had a full recovery of VC mobility, and 12 (40%) patients' VCs were fixed or impaired. Five‐year local recurrence‐free probability was worse in the VC‐impaired group compared to a group with restored VC mobility (46% vs. 85%, p = 0.012). Recurrence‐free probability, OS, and DSS differences were not statistically significant in both groups. VC mobility restoration predicted local recurrence‐free probability on univariable analysis (HR 6.15, 95% CI 1.23–30.6).ConclusionIn this prospective study, we show that the absence of VC mobility restoration is associated with worse local recurrence‐free probability after definitive laryngeal preservation treatment. Patients with persistent vocal cord immobility warrant closer follow‐up to detect recurrence early.Level of EvidenceIII Laryngoscope, 2024

Vocal cord immobility after lateral pharyngotomy extraction of the impacted dentures in the upper esophagus: A Case Report

Impaction of foreign bodies in the esophagus is a frequent emergency in otorhinolaryngology. However, diagnosing and managing denture impaction in the esophagus presents greater challenges compared to other foreign bodies, often leading to various complications. This study reported a rare case of vocal cord immobility after the evacuation of denture impaction in the esophagus using lateral pharyngotomy. The patient, a 73-year-old man, experienced throat discomfort after swallowing a denture an hour before admission. According to the CT scan carried out, a 3.7 cm long denture was found around the T3-T5 spine level and was located 3 mm lateral right to the descendant aorta and 4 mm posterior of the trachea. During esophagoscopy extraction, the denture was stuck in the upper esophagus and was successfully evacuated by lateral pharyngotomy. Subsequently, the patient developed vocal cord immobility, and this case underscores the importance of considering vocal cord complications following the extraction of a denture impaction in the esophagus.

Surgical and Functional Outcomes of Posterior Cordotomy and Partial Arytenoidectomy with CO2 LASER in the Treatment of Bilateral Vocal Cord Immobility: A Single Institution Experience.

Background/Objectives: The purpose of this study is to investigate surgical and functional outcomes of patients affected by bilateral vocal cord immobility (BVCI) and treated with posterior cordotomy and partial arytenoidectomy. Methods: We performed a retrospective analysis on pre- and postoperative findings on a series of 27 patients affected by BVCI and treated with posterior cordotomy and partial arytenoidectomy from January 2017 to January 2022. Perceptual voice evaluations were performed using the GRBAS scale. The patients were requested to estimate the level of voice handicap experienced in their life using the Italian version of Voice Handicap Index 10 (VHI 10) questionnaire, while swallowing difficulties were self-evaluated through the Italian version of the Eating Assessment Tool (EAT-10) questionnaire. Results: Respiratory distress was evaluated according to the American Medical Research Council Dyspnoea Scale (MRC_DS) before and 1 year after the surgery. The mean of the preoperative values was 3.86 (±0.4), while 1 year after the procedure, we witnessed a significant (p ≤ 0.001) improvement, with a mean value of 1.09 (±0.9). After surgery, an overall worsening in voice quality was perceived, with a worsening in the GRBAS score. In contrast, the VHI10 does not show a statistically significant worsening. EAT 10 did not demonstrated worse scores after the surgery; rather, it showed a trend of improvement (preoperative EAT10 5.5 ± 5.8, postoperative 3.3 ± 2.9, p = 0.064). Conclusions: According to our results, posterior cordotomy plus partial arytenoidectomy is an effective procedure that provides stable and rapid respiratory improvement whilst preserving swallowing and the self-perception of voice quality.

859 Bilateral Vocal Cord Palsy Secondary to Rheumatoid Arthritis: A Case Report

Abstract Introduction Rheumatoid arthritis (RA) affects the larynx in 13-75% of cases and is usually subclinical. Airway obstruction due to vocal cord fixation occurs late in RA and presents as an inspiratory stridor. Case presentation An 85-year-old woman presented to A&E Resus with tachypnoea, stridor and drowsiness. An ABG showed hypercapnic respiratory failure. A flexible nasendoscopy was performed which revealed adducted vocal cords with paradoxical breathing. The patient had been admitted with a similar presentation before which was attributed to her longstanding RA. Potential surgical options including tracheostomy, vocal cord lateralisation and vocal cord/arytenoid removal were considered but ultimately, these options were deemed unsuitable for the patient. Conclusions Stridor is a late but life-threatening complication of RA that has viable surgical options of tracheostomy and vocal cord lateralisation; however, the appropriateness of such procedures should always be correlated with the patient’s clinical status and background.

A Clinico- Etiological Evaluation of Vocal Cord Paralysis

Introduction: This is a case study of 61 cases admitted in our hospital to study the various etiologies of vocal cord immobility (including both paralysis and paresis of vocal cord) and to study the incidence of vocal cord immobility.Vocal cord paralysis is a common symptom of the disease which can be originated from laryngeal nerve paralysis following laryngeal carcinoma, oesophageal carcinoma, bronchogenic cancers, thyroid neoplasms, surgical procedures in neck and thorax, post anaesthesia complication,or neurologic diseases. Materials and methods: The present study includes all the cases having vocal cord paralysis presenting in out-patient department of Otorhinolaryngology, examination of larynx externally,by indirect laryngoscopy and direct laryngoscopy was done.All the routine and systemic examination were done. Results: In our study, left vocal cord was the most commonly involved and was observed in 40(65.5%) patients, with neoplasm being the most common cause in 19(31.1%) patients. Right vocal cord involvement was found in 20(32.8%) patients, with neoplasm being the most common cause in 13 (21.3%) patients. The ratio of left side and right side involvement of vocal cord was 2:1 in our study. The longer course of the Left Recurrent Laryngeal Nerve might account for the difference. Conclusion: In our study the etiology which was found to be more common was neoplasms then that of idiopathic causes. The reason behind this could be advanced investigation procedures which allows us to do a thorough work upon any case, but even after that we have found some of Idiopathic causes as well.

Lymphoma recurrence presenting as vocal cord fixation.

Lymphomas of the larynx are a rare finding. Those with lymphoma of the larynx often present with symptoms such as vocal hoarseness, throat pain, dysphagia, and weight loss. This is a case of a 74-year-old man who presents with new onset of hoarseness and dysphagia. He has a previous history of diffuse large B-cell lymphoma (DLBCL) but was thought to be in remission at the time of presentation. On nasolaryngoscopy, there was a large, right sided, sub-mucosal mass with right vocal cord fixation. Physical exam and computed topography of the neck did not identify any adenopathy. Biopsy confirmed the recurrence of DLBCL isolated to the larynx at the time of diagnosis. The patient was treated with chemotherapy and fully recovered his vocal cord motion with resolution of his hoarseness and dysphagia. Physicians should consider lymphoma in patients presenting with laryngeal complaints especially in patients with a history of lymphoma.

PET-CT detection of local residual laryngeal carcinoma after definitive (chemo)radiotherapy

BackgroundPositron emission tomography and computed tomography (PET-CT) is currently recommended in evaluating the treatment response after (chemo)radiotherapy ([C]RT). In the larynx, post-treatment changes and physiological uptake make image interpretation more challenging compared to other head and neck sites. Previous research has not addressed imaging factors specifically in the larynx that would help in distinguishing the residual disease and explain the unique challenges of that anatomic area. The study cohorts are small and heterogenous. Our objective was to investigate the ability of PET-CT in diagnosing local residual laryngeal carcinoma, and to uncover imaging factors that could be used in differentiating the residual disease from post-treatment and physiological changes. In the same study cohort, we also aimed to uncover prognostic factors for local residual or recurrent disease.MethodsOur retrospective study cohort included 73 patients with T2-T4 laryngeal carcinoma undergoing (C)RT with curative intention, and post-treatment non-contrast-enhanced PET-CT at 2–6 months. Findings were compared between local residual and non-residual disease. Local residual disease was defined as a persistent tumor growth with no evidence of remission in between, confirmed by biopsy, and evident within 6 months from the end of RT. PET-CT was evaluated using a 3-step scale: negative, equivocal, and positive.ResultsNine (12%) had a local residual tumor and 11 (15%) developed local recurrence, based on the biopsy. The median follow-up of surviving patients was 64 months (range, 28–174). In univariate analysis, primary tumor diameter greater than 2.4 cm (median value), and vocal cord fixation were prognostic for local residual or recurrent disease. Sensitivity, specificity, PPV, and NPV were 100%, 75%, 36%, and 100%, respectively, when the equivocal interpretation was grouped with the positive interpretation. All local residuals, and 28% (18/64) non-residuals, had a primary tumor area SUVmax of over 4.0 (p < 0.001). CT showed a persistent mass at the primary tumor area in 56% of residuals, and in 23% of non-residuals (p > 0.05). By combining SUVmax>4.0 and mass, specificity improved to 91%.ConclusionsNPV of post-treatment PET-CT in laryngeal carcinoma is high, but equivocal and positive results have low PPV and require further diagnostics. All local residuals had SUVmax over 4.0. The combination of SUVmax over 4.0 and mass on CT increased specificity, but the sensitivity was low.

Tracheostomy dependence following “organ preservation” (chemo)radiation protocol for laryngeal and hypopharyngeal cancers

Patients receiving primary (chemo)radiotherapy for laryngeal or hypopharyngeal cancer risk developing severe laryngeal dysfunction and becoming tracheostomy dependent, detracting from the benefits of organ preservation. We aim to describe the airway outcomes for this cohort and identify risk factors for developing tracheostomy dependence. Patients with laryngeal or hypopharyngeal cancer who were recommended for and underwent primary (chemo)radiotherapy over a 6-year period were identified from a tertiary hospital Head and Neck cancer database. Patient, tumor, and treatment details were collected and analyzed. Of 166 patients, 18.7% (N=31) required tracheostomy insertion. Advanced tumor classification was the only significant predictor (p < 0.00001). Successful decannulation was observed in 12.9% (N=4). Decannulation was observably less successful with advanced tumors, bilateral vocal cord immobility, tracheostomies inserted under emergency conditions. We quantified tracheostomy insertion rates and dependence in patients undergoing "organ-preserving" (chemo)radiotherapy, to assist in the pre-treatment counseling of patients opting for this approach.

Unilateral Vocal Cord Immobility in a Massive Pericardial Effusion Secondary to Lung Carcinoma

Ortner syndrome or cardiovocal syndrome is characterized by vocal cord immobility due to recurrent laryngeal nerve palsy resulted from a cardiovascular pathology. It is due to the compression of the recurrent laryngeal nerve along its pathway, from the enlargement of the pulmonary artery, aorta and dilatation of left atrium. We report a middle-aged lady presented with hoarseness after four months of breathlessness. Laryngoscopy revealed that left vocal cord immobility and computed tomography showed a globular-shaped heart with a lung mass and multiple mediastinal lymphadenopathies. We highlight the multiple possible causes for the Ortner syndrome in this case.

Surgical management of laryngeal bilateral abductor palsy: comparative study between carbon dioxide and diode lasers

This study aims to compare the results of both CO2 laser and diode laser combined arytenoidectomy with posterior cordectomy in managing patients with bilateral vocal fold paralysis. A prospective study involved 80 bilateral vocal cord immobility patients in adduction. They are divided into two groups according to the laser used, whether CO2 (with a wavelength of 10.6 µm) or diode (with a wavelength of 980 nm). We used mMRC (Modified Medical Research Council) dyspnea scale to assess dyspnea in our patients, while the voice was evaluated by both maximum phonation time and the voice handicap index. Quantitative variables were described using means and standard deviations, while categorical variables were described using frequencies and were compared using the chi-square test, Fisher exact test, and Monte Carlo test. There was a statistically non-significant difference between the studied groups regarding mMRC dyspnea scale and Voice Handicap Index preoperatively and postoperatively. There is a statistically significant difference between the two groups regarding maximum phonation time postoperatively (significantly higher in the CO2 laser group) (p < 0.001). The CO2 laser and diode laser could be used safely for the management of bilateral vocal cord paralysis. The CO2 laser maintains better voice parameters and less postoperative pain, while the diode laser gives less operative time, lower cost, and simplicity of use.

Feasibility and accuracy of laryngeal ultrasound for the assessment of vocal cord mobility in children

ObjectiveTranscutaneous laryngeal ultrasonography has been utilized to document vocal cord mobility in the adult perioperative thyroidectomy setting with variable success. The aims of this study were to assess the feasibility of using transcutaneous ultrasound in vocal cord visualization in children, to determine the accuracy in detecting vocal cord immobility compare to flexible laryngoscopy, and to identify any barriers that may affect its utility. MethodsThis is a prospective blinded-assessor study. Transcutaneous laryngeal ultrasound and flexible laryngoscopy were performed in two pediatric settings: perioperative thyroid surgery and inpatient consultation for airway, voice, or swallowing concerns. The video recordings of ultrasound and laryngoscopy were assessed by two fellowship-trained pediatric otolaryngologists independently. ResultsA total of 83 paired laryngoscopy and ultrasound assessments were performed, 39 for perioperative thyroidectomy and 44 for inpatient consultation. The majority had normal vocal cord mobility (65/83, 78%), while 16 had unilateral cord palsy and 2 had bilateral palsy. The vocal cords were successfully visualized on ultrasound in 82/83 (99%) evaluations. Compared to gold standard laryngoscopy, the sensitivity for diagnosing vocal cord palsy on ultrasound was 53–83%, and the specificity was 97–98%. The sensitivity for detecting asymmetric vocal cord movement was 56–88%, and the specificity was 99%. The agreement between ultrasound and laryngoscopy diagnoses were 87–94% (κ = 0.58–0.83, moderate to near perfect agreement). The intra-rater agreement was 95–100% (κ = 0.64–1.0), and inter-rater agreement was 90% (κ = 0.66). Both subjects with bilateral vocal cord palsy had incorrect ultrasound diagnoses by both observers. ConclusionWe were able to utilize transcutaneous laryngeal ultrasound to successfully visualize vocal cord mobility in almost all pediatric patients with a high degree of specificity. The modality has limitations in the assessment of bilateral vocal cord palsy, and its sensitivity was observer-dependent. Level of evidence4.

Larynx preservation: recommendations for decision-making in T3 laryngeal cancer patients

HintergrundDerzeit gilt das größere, nicht mehr durch Teilresektionen behandelbare T3-Larynxkarzinom als optimaler Kandidat für einen Larynxorganerhalt (LP) mittels primärer Radiochemotherapie (pRCT). Wann wäre eine primäre Strahlentherapie (pRT) ggf. auch ohne Chemotherapiezusatz vertretbar, und wann selbst beim T3 doch eher die totale Laryngektomie mit risikoadaptierter adjuvanter Therapie (TL±aR[C]T) zu empfehlen?MethodikIn der Literatur wurde nach Parametern gesucht, die bei nichtrandomisierten zweiarmigen LP-Studien als Kriterium für den Einschluss in den chirurgischen anstelle des konservativen Arms genannt wurden oder die sich nach konservativer Therapie als signifikante Prognosemarker herausstellen. Hieraus Entwicklung eines Beratungsinstruments für die Therapieentscheidung.ErgebnisseAls signifikante Prognosemarker beschrieben wurden das Tumorvolumen, das Vorhandensein und die Art der Stimmbandfixierung, das Ausmaß der Knorpelinfiltration, der N‑Status und die laryngeale Dysfunktion.DiskussionBeim T3-Larynxkarzinom scheint eine reine pRT vertretbar zu sein, wenn das Volumen < 3,5 ccm für glottische bzw. < 6 ccm für supraglottische Tumoren beträgt und keine weiteren Risikofaktoren vorliegen. Die pCRT kann als Standard des konservativen LP bei Tumoren mit einem Volumen zwischen 6 ccm und 12 ccm gelten, bei einer Stimmbandfixierung Succo I/II, einer allenfalls minimalen Knorpelinfiltration und einer hohen nodulären Tumorlast. Bei Tumoren mit einem Volumen > 12 ccm, einem Stimmbandfixierungsmuster Succo III/IV, ausgedehnter oder multipler Knorpelinfiltration oder relevanter laryngealer Dysfunktion sollte primär die TL±a[C]RT empfohlen werden.

From expert opinion practice: Vocal cord immobility after intubation: Recurrent nerve paresis or arytenoid luxation?

From expert opinion practice: Vocal cord immobility after intubation: Recurrent nerve paresis or arytenoid luxation?

Suture lateralization in congenital bilateral vocal cord immobility in neonates and infants: A hybrid approach

IntroductionBilateral vocal cord immobility (BVCI) is a leading cause of stridor and airway obstruction in neonates which may arise idiopathically, as a result of birth trauma, or in the setting of Central nervous system lesions such as Arnold-Chiari malformation. Although many children with BVCI may be managed conservatively, surgical intervention may be necessary in those patients with ongoing upper airway obstruction. Many interventions have been described including, tracheostomy, cordotomy, cricoid splitting procedures, and arytenoidectomy. Vocal cord suture lateralization has the advantage of being both reversible and less morbid than other surgical interventions for BVCI. This study describes a novel variation of the suture lateralization procedure which aids in correct placement of the suture thus minimizing multiple needle passes and associated laryngeal edema. MethodsA retrospective chart review was undertaken of five patients undergoing suture lateralization of the vocal cord for BVCI at a single institution over a 10 year period. Post-operative voice and swallow outcomes were recorded. ResultsOf five patients undergoing this procedure four returned to normal diet. One was diagnosed with a progressive neurological disorder and was persistently fed via gastrostomy tube. Three of the five patients spontaneously recovered vocal cord function and went on to have normal voice after suture removal. ConclusionSuture lateralization is a safe and effective means of alleviating upper airway obstruction in BVCI. It has the advantages of being reversable and minimally invasive; however, optimal suture placement is both vital and challenging. The novel technique described in this study allows identification of landmarks as and aid to suture placement thus reducing the need for multiple needle passes into the lumen of the larynx.

Immunoglobulin G4-related disease presenting with pulmonary manifestations, lymphadenopathy, and vocal cord immobility

Immunoglobulin G4-related disease (IgG4-RD) is an immune-mediated state, which includes a group of disorders that can affect nearly any organ. Pulmonary involvement can present with nonspecific signs, symptoms, and highly variable radiological picture. Recognition of the disorder mainly relies on histopathological findings and immunohistochemical staining. Serum IgG4 levels also help in diagnosis. Glucocorticoids are the first choice for treatment. As this condition mimics many infective, inflammatory, and malignant disorders, a comprehensive diagnostic workup is required before reaching the diagnosis. We report a case of IgG4-RD with pulmonary manifestations, lymphadenopathy, and vocal cord immobility.

Concurrent Chemoradiotherapy With Docetaxel, Cisplatin, and 5-Fluorouracil for T3 N0 Glottic Carcinoma Without Vocal Cord Fixation.

We retrospectively evaluated the efficacy and toxicity of concurrent chemoradiotherapy (CCRT) with docetaxel, cisplatin, and 5-fluorouracil (TPF) for T3 N0 glottic carcinoma without vocal cord fixation. Twenty-five patients underwent TPF-CCRT without elective nodal irradiaion (ENI). After the RT of 40 Gy, five patients (20%) without tumor regression underwent surgery. Others underwent RT with a median total dose of 66 Gy. Of the five patients who underwent surgery after the RT of 40 Gy, two showed residual carcinoma pathologically and the other three were confirmed to have complete pathological response to the treatment. The 5-year local control rate was 87%. No patients exhibited regional failure. No acute toxicities of grade 5 or late toxicities ≥grade 3 were observed. TPF-CCRT provides excellent tumor control with acceptable toxicities. CCRT while omitting ENI is a reasonable approach for T3 N0 glottic carcinoma without vocal cord fixation.

ETIOPATHOGENESIS OF VOCAL CORD PARESIS AND PALSY IN A TERTIARY CARE CENTRE- A PROSPECTIVE STUDY

The purpose of this study was to identify the patients with vocal cord paresis and palsy and to establish the etiology based on the study performed in a tertiary care centre. The study was done prospectively in the Department of ENT in Mahatma Gandhi Medical College &amp; Hospital, Jaipur, for 1 year, from September 2020 to August 2021. 50 patients with vocal cord paresis and palsy were identied and examined by using exible or rigid laryngoscopy to make the etiological diagnosis. The etiology of vocal cord immobility was determined by history and complete head and neck examination. Patients in whom no cause was found, a CT scan from base of skull upto thorax was done before labelling them as idiopathic. Most patients presented with complaints of change in voice (92%). Other common presenting complaints included difculty in breathing, difculty in swallowing, vocal fatigue and cough. Unilateral vocal cord paralysis (88%) was more common than bilateral paralysis (12%), of which left (58%) was more commonly affected than right (42%) vocal cord because of longer intrathoracic course of left recurrent laryngeal nerve. The most common age group affected was 51–60 years (26%) followed by 61–70 years (18%). Males (60%) were affected more than females (40%) in a ratio of 3:2 and among the affected males 80% were known smokers. The most common cause of vocal cord paresis and palsy was found to be malignancy larynx (36%), followed by idiopathic (28%). Other causes included carcinoma of lung, thyroid and oesophagus, inammatory, traumatic, systemic diseases like Rheumatoid Arthritis and Hypertension leading to stroke. Identifying the exact etiopathogenesis of vocal cord paresis and palsy in patients has been a challenge and is very important in order to establish a proper diagnostic and treatment protocol for these patients.

Organ preservation surgery for pyriform sinus carcinoma with vocal cord fixation: functional and oncological outcomes.

Pyriform sinus carcinoma with vocal cord fixation is stratified as stage T3 and above, and non-surgical treatment is generally preferred according to the guidelines, aiming to preserve laryngeal function. However, long-term survival is often compromised by deep infiltration of the tumor. Vertical hemipharyngolaryngectomy (VHPL) was previously reported to be a feasible surgical approach for organ preservation. The aim of this study was to evaluate the functional and oncological outcomes of VHPL in patients. Patients who underwent VHPL type II (total VHPL, which includes the removal of a vertical section of the thyroid cartilage through the anterior commissure to the upper border of the cricoid cartilage) for pyriform sinus cancer with vocal cord fixation at the authors' institute between 1999 and 2015 were retrospectively analyzed. Functional outcomes concerning swallowing and decannulation were evaluated. Successful functional preservation was defined as laryngeal preservation as well as oral realimentation and decannulation within 6months after surgery. The oncological outcomes were measured by overall survival (OS) and disease-free survival (DFS) with Kaplan-Meier curves and comparisons were performed between the VHPL-treated patients and patients who underwent non-surgical treatment within the same period. A total of 23 patients (stage T3, 17 patients; stage T4, 6 patients) whose initial treatment was VHPL type II were studied, and a cohort of 123 patients was selected as the control group. Pedicle and free flap reconstructions were performed on 12 and 11 patients, respectively. Postoperative radiation and chemoradiation was performed on 14 and 3 patients, respectively. Flap failure and pharyngeal fistula were detected in 2 and 5 patients, respectively. Oral realimentation and decannulation within 6months were achieved in 82.6% (19 patients) and 87.0% (20 patients) of patients, respectively, and the total functional preservation rate of the study cohort at 6months was similar to that of the control cohort. (78.3% vs. 82.9%, p = 0.28). After a median follow-up period of 49months, 9 recurrences and 8 deaths had occurred in the study cohort. According to the Kaplan-Meier analysis, the study cohort had superior DFS (5-year DFS 60.3% vs. 44.6%, p = 0.04) and similar OS (5-year OS 63.8% vs 57.0% p = 0.28) compared with those in the control group. VHPL yielded favorable oncological and functional outcomes in patients with unilateral pyriform sinus carcinoma and vocal cord fixation.

Long-term laryngotracheal complications following cardiac surgery.

Long-term laryngotracheal complications have not been described in adult patients undergoing cardiac surgery. The purpose of this study was to determine the incidence of and risk factors for laryngotracheal complications following cardiac surgery. A retrospective chart review of patients at high risk for laryngotracheal complications following cardiac surgery between 2006 and 2016 was performed. High-risk patients were reviewed to determine the presence of laryngotracheal complications including laryngotracheal stenosis, keyhole deformity, or vocal cord immobility. Logistic regression was used to identify predictors of long-term laryngotracheal complications. Of 11,417 patients who underwent cardiac surgery, 1099 were identified as at high risk. Of these, 24 (2.2%) developed laryngotracheal complications following their surgery and intensive care unit (ICU) stay. Laryngotracheal stenosis and keyhole deformity were present in 13 (1.2%) and 6 (0.5%) patients, respectively. Logistic regression demonstrated older age (age ≥ 70 odds ratio [OR] 0.31, 95% confidence interval [CI] 0.12-0.83) was protective, while readmission to ICU for ventilation (OR 3.11, 95% CI 1.17-8.25) and receiving a tracheostomy (OR 7.83, 95% CI 2.22-27.6) were associated with laryngotracheal complications. The incidence of long-term laryngotracheal complications following cardiac surgery was 2.2%. Readmission to ICU for ventilation and having a tracheostomy performed were associated with laryngotracheal complications.