Experimental model for controlled endoscopic subepithelial vocal fold injury in rats

Purpose: To present a detailed, reproducible, cost-efficient surgical model for controlled subepithelial endoscopic vocal fold injury in the rat model. Methods: Six male Sprague Dawley rats were enrolled in the experiment. The left vocal folds were used to carry out the injury model, and the right vocal fold served as control. After deep sedation, the rats were placed on a custom operating platform. The vocal fold injury by subepithelial stripping was carried out using custom-made microsurgical instruments under endoscopic guidance. Data were analyzed for procedural time and post-procedural pain. Microcomputed tomography (micro-CT) scan and histologic images were obtained to assess the length, area, and depth of injury to the vocal fold. Results: The mean procedural time was 112 s. The mean control vocal fold length was 0.96 ± 0.04 mm. The mean vocal fold injury length was 0.53 ± 0.04 mm. The mean vocal fold surface was 0.18 ± 0.01 mm2 with a mean lesion area of 0.05 ± 0.00 mm2. Mean vocal fold injury depth was 375.4 ± 42.8 µm. The lesion length to vocal fold length ratio was 0.55 ± 0.03, as well as lesion area to vocal fold surface area was 0.29 ± 0.02. Conclusions: Our described experimental vocal fold injury model in rats is found to be fast, safe, cost-efficient, and reproducible with a rapid learning curve.

Ligadura segregada de la arteria tiroidea superior. Minimizar la lesión posterior a la tiroidectomía en el rama externa del nervio laríngeo superior. Un nuevo enfoque práctico / Segregated ligation of the superior thyroid artery minimize post-thyroidectomy injury to the external branch of superior laryngeal nerve, a novel practical approach

External division of the superior laryngeal nerve supplies the crico-thyroid muscle to excite length and thickness of the vocal fold. Thus, increasing voice tone. The vicinity with the superior thyroid vessels sets the external branch of the superior laryngeal nerve in danger every time the superior end of the thyroid is dissected. Thus, the aim of present study is to assess the rate and complication of external branch of the superior laryngeal nerve injury post- thyroidectomy when segregated ligation of superior thyroid vessels closes to thyroid capsule without prior nerve identification and without nerve stimulator or intraoperative neuro-monitoring. The presented study is a prospective, non- randomized clinical study included 1450 patients who underwent thyroidectomy which either (total thyroidectomies, near total thyroidectomies or lobectomy and isthmectomy) in the Department of Surgery/AL-Diawania Teaching Hospital in Diawania City, Iraq, between January 2000 and February 2018. All patients underwent thyroidectomy through segregated ligation of superior thyroid artery very closely to thyroid capsule without prior nerve identification and without nerve stimulator or intraoperative neuromonitoring. Postoperative indirect laryngoscopy vocal cord examination with long term follow up through physical examination and clinical history to evaluate nerve integrity. In present study, the total cases with EBSLN injury were 38 (2.6%), in which the transient EBSLN injury occurred in 28 (1.9%) of patients and permanent injury occurred in 10 (0.7%) of patients and majority of cases with EBSLN injury were occur in patients with large size goiter 29 (2%) more than small size goiter 9 (0.6%) And these differences were statistically significant differences, (P<0.005). In addition to, the majority of cases with EBSLN injury were occur in male {25(1.7%)} more than female patients {13(0.9%)} And these differences were statistically significant differences, (P<0.005). Segregated ligation of superior thyroid artery is a safe technical option, cost effective, time preserved and need surgical skills to minimized risk of injury to the external laryngeal nerve

Proposed computerized protocol for epidemiological study of patients undergoing microsurgery of the larynx

Introduction: The merging of medicine with information technology facilitates the retrieval of stored data, aiding the conduct of research with greater scientific rigor. Studies in the field of otorhinolaryngology, specifically in the area of laryngology and voice, are of fundamental importance, since 70% of the economically active need their voice to work. Objective: To create a computerized protocol of the diseases of the larynx, apply and validate it, and use it to evaluate patients undergoing laryngoscopic microsurgery of the larynx. Method: We created a database of ENT diseases through a literature review of textbooks and scientific articles. Next, we computerized the data and incorporated it into the SINPE©, creating a master protocol (ENT diseases) and a specific protocol (laryngeal diseases). Data were collected prospectively from patients undergoing laryngeal microsurgery in the ENT Hospital of Paraná. The collected data were analyzed with graphs through the SINPE© Analyzer module. Results: We evaluated 245 patients aged 9-79 years, and determined that 36.61% (93 patients) underwent surgery for the presence of polyps on the vocal folds, 12.6% (32) underwent surgery for papillomatosis, and 11.83% (29) underwent surgery for intracordal cysts. Conclusions: The creation of an electronic database of clinical ENT diseases was feasible. We were also able to implement and validate the protocol. The database may be released to physicians involved in clinical data collection and retrieval of information to conduct scientific research in an organized manner. The most common laryngeal disorders identified were polyps, papilloma, and intracordal cysts...

Immediate effects of the phonation into a straw exercise / Efeitos imediatos do exercício de fonação no canudo

Immediate effects of an exercise with the vocal tract semi-closed. OBJECTIVE: To investigate the immediate effects of the phonation exercise in a straw in individuals with and without vocal fold lesions. MATERIALS AND METHODS: Prospective study. 48 individuals, aged between 18 and 55 years participated in the study, and they were distributed into two groups: GL- with a benign vocal fold lesion; GSL- without a lesion. The following analyses were carried out before and after the straw phonation exercises: voice self-analysis, [ε] vowel auditory-perception analysis, selected parameters acoustics (VoxMetria 2. 6) and videolaryngoscopy. RESULTS: The vocal self assessment indicated a statistically significant improvement on voice emission in GL individuals (p=0. 015). There were no statistically significant differences before and after the exercise and between the groups, in the videolaryngoscopy, acoustic and auditory-perception assessments. CONCLUSIONS: The straw phonation exercise caused positive effects, seen upon voice self-assessment, indicating an easier and better voice upon phonation.

Efeitos imediatos de um exercício de trato vocal semiocluído. OBJETIVO: Investigar os efeitos imediatos do exercício de fonação no canudo em indivíduos com e sem lesão nas pregas vocais. MATERIAL E MÉTODO: Estudo Prospectivo. Participaram deste estudo 48 indivíduos, entre 18 e 55 anos, distribuídos em dois grupos: GL- com lesão benigna na prega vocal; GSL- sem lesão. Foram realizadas antes e após a realização do exercício de fonação no canudo as seguintes análises: autoavaliação da voz, análises perceptivo-auditiva da vogal [ε], acústica de parâmetros selecionados (VoxMetria 2.6) e videolaringoscopia. RESULTADOS: A autoavaliação vocal indicou melhora estatisticamente significante na emissão da voz no GL (p=0,015). Não houve diferença estatisticamente significante nos momentos pré e pós-exercício e entre os grupos, nas avaliações perceptivo-auditiva, acústica e videolaringoscópica. CONCLUSÃO: O exercício de fonação no canudo promoveu efeitos positivos verificados na autoavaliação vocal, indicando voz mais fácil e melhor à fonação.

Thyroidectomy with safe vocal cord functions

To compare the prevalence of vocal cord dysfunctions due to recurrent laryngeal nerve [RLN] injuries in thyroidectomy with and without identification of RLN. A prospective comparative study. The study was conducted in the Department of Surgery, Allied Hospital Faisalabad from October 1[st], 2008 to September 30[th], 2009. With an informed and explained consent, the study was conducted on two groups of patients who had thyroidectomy for the treatment of primary goitre. Patients were distributed on alternate basis irrespective the type of goitre into groups A and B for [thyroidectomy with identification of RLN] and [thyroidectomy with out identification of RLN] respectively. Patients of both groups were compared for the prevalence of post- operative vocal cord dysfunctions in association with recurrent laryngeal nerve injuries. Groups A and B had 52 and 53 patients respectively. Post-thyroidectomy vocal cord functions were remained safe in all the patients of group A. However, 3 [5.66%] patients of group B showed altered vocal cord functions in post operative follow up. Prevalence of RLN injuries in Group A and B remained 0% and 3 [2.97%] respectively. Out of three RLN injuries in group B, 2[1.98%] were transient and 1[0.99%] was permanent. Preservation of vocal cords functions and recurrent laryngeal nerves in thyroidectomy is more likely with the exposure and identification of RLN up to larynx

Seção interna do ligamento vocal: nova técnica para tratamento do sulco vocal / Internal section of the vocal ligament: a new technique for the treatment of the sulcus vocalis

O sulco vocal é uma lesão em forma de fenda ou depressão longitudinal na prega vocal que provoca importante impacto negativo na qualidade vocal. Seu dignóstico e tratamento continuam sendo um grande desafio para os médicos laringologistas...

The sulcus vocalis is a congenital laryngeal lesion that provokes important negative impact in the vocal quality. Its diagnosis and treatment remains a great challenge for the laryngologists. To present a new micro-surgical technique for the treatment of the sulcus vocalis defined as internal section of the vocal ligament...

Penetrating laryngotracheal trauma resulting in vocal cord avulsion

Penetrating neck trauma present difficult management issues by virtue of their rarity. Undiagnosed laryngotracheal injuries have serious implications, especially in the context of multiple trauma, where other injuries overshadow that of the laryngotracheal complex. This is a case of a schizophrenic patient with multiple self-inflicted cuts on his throat and abdomen. Injuries include open, comminuted laryngeal complex lacerations with vocal cord avulsion, as well as evisceration of small bowel. Adequate assessment using both direct laryngoscopy and rigid endoscopy, coupled with open exploration, allowed optimal exposure and fixation of the larynx in the anatomical configuration. The post-operative outcome of the airway and voice remained satisfactory at follow-up. A high index of suspicion coupled with adequate surgical approach allowed establishment of a functional larynx.