A Ten-Year Kuala Lumpur Review on Laser Posterior Cordectomy for Bilateral Vocal Fold Immobility

Bilateral vocal fold immobility (BVFI) is commonly caused by injury to the recurrent laryngeal nerve (RLN) and leads to stridor and dyspnea of varying onsets. A retrospective study was done at the Department of Otorhinolaryngology of Universiti Kebangsaan Malaysia Medical Centre on laser microsurgical posterior cordectomy for BVFI. The objectives were to identify the average duration of onset of stridor from the time of insult and to evaluate the outcome of laser posterior cordectomy as a surgical option. From 1997 to 2007, a total of 31 patients with BVFI were referred for surgery. Twelve patients had tracheostomy done prior to the procedure, whereas 19 patients were without tracheostomy. Ten patients were successfully decannulated, and only 4 patients had complications related to the procedure. The minimum onset of stridor was 7 months, maximum onset of stridor was 28 years, and the mean onset of stridor was 8.7 years. The commonest complication observed was posterior glottic adhesion following bilateral posterior cordectomy. Laser endolaryngeal posterior cordectomy is an excellent surgical option as it enables successful decannulation or avoidance of tracheostomy in patients with BVFI. The onset of stridor took years after the insult to the recurrent laryngeal nerves.

Hoarseness due to cardiovascular disease: Two cases of cardiovocal syndrome

@#<p style="text-align: justify;"><strong>OBJECTIVE</strong>: To report two cases of cardiovocal syndrome (or Ortner's syndrome) due to cardiovascular disease.</p> <p style="text-align: justify;"><strong>METHODS</strong>:<br /><strong>Design</strong>: Case report<br /><strong>Setting</strong>: Tertiary University Hospital<br /><strong>Subjects</strong>: Two</p> <p style="text-align: justify;"><strong>RESULTS</strong>: Two patients with Cardiovocal syndrome, one due to an aortic saccular aneurysm and the other due to severe mitral stenosis underwent surgery to correct the underlying cardiovascular disease. Post-operatively, the hoarseness resolved completely in the patient with mitral stenosis but persisted in the patient with aortic saccular aneurysm.</p> <p style="text-align: justify;"><strong>CONCLUSION</strong>: Cardiovascular disease should be considered as a differential diagnosis in a patient with hoarseness. A high index of suspicion is needed to make an early diagnosis which can lead to surgical correction of the potentially life-threatening, underlying cardiovascular disease.</p>

Necrotizing Fasciitis of the Head and Neck: Surgical Outcomes in Three Cases

Necrotizing fasciitis of the head and neck is a rare, rapidly progressive infection involving the skin, subcutaneous tissue and fascia. We report three cases of necrotizing fasciitis that differ in their presentation and outcome. The first case involves a patient who presented with progressively enlarging anterior neck swelling that was later complicated by dehydration and reduced consciousness. The second case is a patient with neck swelling and ipsilateral otorrhea. The third case concerns a patient with a buccal ulcer complicated by ipsilateral facial swelling. All of them underwent a fasciotomy with wound debridement with the addition of a cortical mastoidectomy in the second case. Two of these patients recovered well. Unfortunately, the third case succumbed to death due to airway compromise and septicaemia. We advocate the importance of eradicating the source of infection followed by frequent, meticulous wound dressing and strict blood sugar control to obtain better outcomes in managing necrotizing fasciitis of the head and neck. However, involvement of the airway carries a grave prognosis despite aggressive treatment.