Two Cases of Mucosal Bridge Crossing the Membrane of Vocal Folds / 대한이비인후과학회지

Mucosal bridges of vocal fold have been described as a parallel band to vocal folds with the presence of sulcus vocalis. However, the type of mucosal bridge crossing each vocal fold has not been well documented in the literature. Herein, we present two cases of mucosal bridge found in the vocal fold connecting the mid-portions of true vocal folds. Two patients who had no history of laryngeal trauma, surgery or oro-tracheal intubation visited our clinic due to voice change. Laryngoscopic examination revealed that they had a mid-portion mucosal band without any other mucosal lesions. Two patients underwent laryngomicrosurgery with pulsed dye laser. After the surgery, they showed significant improvement of voice quality.

Surgical Treatment of Sulcus Vocalis Using KTP Laser

Sulcus vocalis remains a surgical challenge despite many recent advances in laryngomicrosurgeries. We previously reported that 585-nm Pulsed dye laser (PDL) exerts favorable outcome in treatment of sulcus vocalis due to its therapeutic effects of collagen rearrangement and improved wound remodeling. In spite of the usefulness of PDL glottoplasty for treating sulcus vocalis, the device is no more available in the country. It prompted us to focus another angiolytic laser ; 532-nm KTP laser which has similar mechanisms of action and has been used for treatment of other laryngeal lesions elsewhere. Herein, we present a case of sulcus vocalis successfully treated with KTP laser. A patient underwent laryngomicrosurgery with angiolytic KTP laser (KTP glottoplasty) by the same surgical procedure with PDL glottoplasty. After the surgery, the patient presented improved voice outcome in time without complications.

A Case of Suspension Laryngoscope Assisted Removal of Migrating Cervical Screw after Anterior Cervical Fusion / 대한이비인후과학회지

Anterior cervical approaches to the cervical spine have been widely and safely used in spine surgery in recent years; however, they also have posed some otorhinolaryngological complications. We present a case of suspension laryngoscope assisting in the removal of a cervical screw. The patient was a 63-years-old man who was operated on traumatic cervical herniated disc. Surgical interference included C5 corpectomy, iliac bone autograft, anterior cervical fusion at C4-C6 level using an anterior cervical plate and screws. Five years later, he presented a foreign body sensation in the neck and odynophagia. The laryngoscopic exam showed the medial wall of the right pyriform sinus protrusion and the migration of an upper screw was observed in plain films and computed tomography of the cervical spine. The suspenson laryngoscope and C-arm fluoroscope were used for the transpharyngeal screw removal. The removal of the screw in question was successful with no complications. We report this case with a review of the literature.

Comparison of Propofol-Remifentanil and Sevoflurane-Remifentanil Anesthesia for Suspension Laryngoscopic Surgery

BACKGROUND: Suspension laryngoscopic surgery may cause acute hemodynamic changes such as hypertension and tachycardia and requires rapid recovery. The purpose of this study was to compare the hemodynamic responses, and emergence and recovery profiles between propofol-remifentanil and sevoflurane-remfentanil anesthesia. METHODS: Forty patients (ASA I, II) undergoing suspension laryngoscopic surgery were randomly allocated to either a propofol group (Group P) or sevoflurane group (Group S). Anesthesia was induced with target concentration of 5microg/ml using propofol target controlled infusion (TCI) in group P and thiopental sodium 5 mg/kg in group S, respectively. In both groups, after succinylcholine 1 mg/kg IV bolus injection, remifentanil was infused with a target concentration 5 ng/ml using remifentanil TCI for tracheal intubation. Anesthesia was maintained with N2O 2 L/min, O2 2 L/min, remifentanil (2.5-7.0 ng/ml), succinylcholine infusion (0.15 mg/kg/ min) in both groups, with propofol (2.0microg/ml) was used in group P and sevoflurane 3.0 vol% in group S. We compared hemodynamic status, and emergence and recovery profiles during and after operation. RESULTS: MAP and HR after tracheal intubation and suspension laryngoscopy insertion showed significantly smaller changes in group P and were more stable compared with group S. The suction time of the catheter response was shorter in group P compared with group S, and sedation was less deeper in group P than group S. Other recovery profiles were comparable between groups. CONCLUSIONS: During propofol-remifentanil anesthesia, hemodynamics were not increased by intubation or suspension laryngoscopy, and the early emergence and good recovery profiles of patients were appeared favorably compared with sevofluraneremifentanil anesthesia.

Continuous Measurement of Suspension Force during Suspension Laryngoscopy: Preliminary Report / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Although suspension laryngoscopy is a very common procedure in the otolaryngoloical field and suspension force (Fs) is suspected to be related with the complications or laryngeal exposure, Fs has not been objectively measured yet. The objective of this study is to measure suspension force continuously during suspension laryngoscopy. SUBJECTS AND METHOD: Sixteen patients who had undergone laryngoscopic surgery were evaluated. The value measured with a load cell during the procedure was converted to Fs with calculation. The maximum force (Fsmax) and the mean force (Fsmean) were evaluated. The angle between the laryngoscope and the chest holder(angle alpha), and the angle between the chest holder and the horizontal plane (angle beta) were gauged. RESULTS: The mean values of Fsmax and Fsmean were 14.2 and 25.5 kgf, respectively. The mean values of angle alpha and angle beta were 124.0+/-4.3 degrees, and 19.0+/-2.6 degrees, respectively. CONCLUSION: The continuous measurement of the suspension force was executed successfully and quantitatively with a simple method.

Change of Taste and Sensory after Tonsillectomy and Laryngomicrosurgery / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Postoperative taste and sensory changes are regarded as unusual and minor complications of tonsillectomy and laryngomicrosurgery. This study aimed to identify incidence, cause, and duration of postoperative taste and sensory changes. SUBJECTS AND METHOD: With 20 patients who underwent tonsillectomy and 20 patients who underwent laryngomicrosurgery, we have prospectively studied postoperative taste and sensory changes using questionnaires with regard to symptoms at 1(st), 7(th) , 14(th) and 28(th) days after the surgery. The thresholds of sweet, sour, salty and bitter tastes were measured by spatial taste test. Also, we have checked pre-operatively and post-operatively about the serum level of zinc and copper. RESULTS: Five patients (25%) who underwent tonsillectomy and 3 patients (15%) who underwent laryngomicrosurgery suffered from changes in tastes. Four patients (20%) and 5 patients (25%) showed the sensory change. Especially, the bitter taste threshold changed in the posterior tongue (p<0.05). Post-operative zinc deficiency was detected on 1 patient. Subjective taste and sensory change disappeared within 28 days. In spatial taste test, the threshold for bitter taste increased on the 1st post-operative day at the posterior tongue, but it returned almost to the preoperative level within 28days. CONCLUSION: Taste and sensory change after tonsillectomy and laryngomicrosurgery are not unusual complications. If there were no neural damage, taste and sensory change were transient and disappeared within 28 days. The main cause of transient taste and sensory change seemed to be due to the compression of tongue, and sometimes, to postoperative zinc deficiency.

Effects of Alfentanil on the Hemodynamic Responses and Recovery Profiles during Laryngoscopic Surgery / 대한마취과학회지

BACKGROUND: Laryngoscopy, tracheal intubation and suspension laryngoscopy may cause acute hemodynamic responses such as hypertension and tachycardia. Thus, anesthetic technique during laryngoscopic surgery should be focused on sufficient anesthetic depth and rapid recovery. We investigated the effects of alfentanil to hemodynamic responses and recovery during laryngoscopic surgery. METHODS: Seventy five patients of ASA class 1 or 2 scheduled for laryngoscopic surgery were randomly divided into three groups. Each group received intravenous normal saline 2 ml (control group), alfentanil 10 microgram/kg (A10 group), alfentanil 20 microgram/kg (A20 group) respectively and then followed by induction of thiopental sodium 5 mg/kg and succinylcholine 1 mg/kg. The systolic blood pressure, diastolic blood pressure, heart rate were measured at baseline, immediately and 1 minute after intubation, immediately and 1, 2, 3 minutes after placement of suspension laryngoscopy. The time of suction catheter response, eye opening and extubation were evaluated during recovery periods. RESULTS: The hemodynamic responses to tracheal intubation were blocked in the A10, A20 groups compared with control group. But the hemodynamic responses to placement of suspension laryngoscopy were blocked only by A20 group. The time of eye opening and extubation were no significant differences among groups. CONCLUSIONS: Alfentanil 20 microgram/kg effectively alleviate the hemodynamic responses by tracheal intubation and suspension laryngoscopy during laryngoscopic surgery.

A Clinical Study and Treatment of the Cysts on Epiglottis, Vallecula, and Tongue Base / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Cysts on the epiglottis, vallecula, and tongue base are relatively common and usually need surgery with laser under the adjustable laryngoscope. The present study was performed to evaluate the clinical outcome and usefulness of an adjustable laryngoscope and a customized electrocautery. SUBJECTS AND METHOD: Retrospective study was performed in 41 patients with cysts on epiglottis, vallecula, and tongue base and we analyzed the clinical characteristics and treatment outcome by using an adjustable laryngoscopic surgery. RESULTS: There were 33 cases of epiglottic cyst, 4 cases of vallecular cyst, and 4 cases of tongue base cyst. Histopathologic results revealed 34 epithelial cysts and 3 tonsillar cysts. Of 4 tongue base cysts, 2 cases were thyroglossal duct cysts. Excision was done in 35 cases and marsupialization in 6 cases. The adjustable laryngoscope offered a good surgical view on the lingual surface of epiglottis and vallecula but revealed limitations for the tongue base; the customized electrocautery did not cause significant surgical problems or tissue damage. Seven patients had persistent symptoms such as those of gastroesophageal reflux after surgery. Recurrence was observed in 2 cases at 5 months following the operation and at 3 1/2 years, respectively. CONCLUSION: Cysts on the epiglottis, vallecula, and tongue base were successfully operated with a customized electrocautery under the adjustable laryngoscope. Patients with vague symptoms such as those of gastroesophageal reflux need to be carefully selected for the surgery and long-term follow-up is required for recurrence.