Single stage transoral cordectomy and medialization thyroplasty in early glottic squamous cell carcinoma: A case report

Objective@#To present the case of a 78-year-old man with Glottic SCCa stage I who underwent single stage transoral cordectomy type IV with medialization thyroplasty under general anesthesia. @*Methods@#Design: Case Report. Setting: Tertiary Government Training Hospital. Patient: One. @*Results@#Postoperatively, patient was able to phonate and gave a VHI score of 12 and GRBAS score of 4. He was able to resume oral feeding without any signs of aspiration. Postoperative flexible laryngoscopy showed fully mobile vocal cords with good approximation in the midline. @*Conclusion@# This report suggests that vocal cord medialization via thyroplasty may be performed after cordectomy in a single stage, providing acceptable postoperative voice as well as good swallowing outcome

The Analysis of the Recurrence Factors of CO2 Laser Surgery for Tis,T1 and T2 Glottic Cancer / 听力学及言语疾病杂志

Objective To study the risk factors for recurrence in glottic cancer at Tis,T1 and T2 stage after CO2 laser endoscopic resection.Methods We conducted a retrospective analysis of 180 Tis,T1 and T2 glottic cancer cases treated by CO2 laser surgery.Of the total cases,the Tis stage lesion was found in 22 cases,the T1a in 90,the T1b in 32 and the T2 in 36 cases.Tumor recurrence was set as the time-related endpoint.The recurrence factors were analyzed by univariate and multivariate analysis,including age,gender,T classification,type of cordectomy,tumorgrading,motility of vocal fold and the possible anteior commissure.Results There was a significant statistical difference between the recurrence rate and T classification,and the type of cordectomy(P＜0.05).The recurrence rates of Tis,T1a,T1b and T2 were 9.1％,13.3％,18.8％ and 38.9％,respectively.In type-Ⅰ,Ⅱ,Ⅲ,Ⅳ and Ⅴ of cordectomy,the recurrence rates were 0,3.57％,15.0％,19.60％ and 36.84％.Conclusion The recurrence rate is closely associated with T classification and the type of cordectomy.With the higher T classification and the type of cordectomy,the recurrence rate is dramatically higher.

Invasive treatment to control neuropathic pain / Tratamento invasivo para o controle da dor neuropática

ABSTRACT BACKGROUND AND OBJECTIVES: Distress, allied to neuropathic pain persistence and its refractory nature, often leads patients to accept invasive procedures. Neuropathic pain control is a major medical challenge requiring approaches and decisions especially based on effectiveness, risks and costs. This study aimed at reviewing these aspects related to major invasive procedures. CONTENTS: Major invasive procedures to control neuropathic pain are presented. Initially, classically reversible anesthetic blocks; then invasive neuromodulation techniques using electric current application and the magnetic field generated by it becomes a target to be stimulated, inhibited or modified in the nervous system (central, peripheral or autonomic); and, finally, ablative procedures including anesthetic methods administering neurolytic agents rather than anesthetics and neurosurgeries using different methods to injure the nervous system to control painful neuropathic discomfort. CONCLUSION: Patients eligible to invasive procedures to control neuropathic pain have, in addition to pain itself, a mixed distress including the collection of repeated delusions at every treatment failure. They have reserved prognosis with regard to total cure and, unfortunately, relieve obtained with invasive treatment in general does not reach persistent and high rates. In such adverse situation, these partial results of decreasing original pain intensity may be interpreted as acceptable, provided the impact on final quality of life is positive. Maybe, the rare exceptions are good results obtained with typical idiopathic/cryptogenic neuralgias ironically excluded from the stricter interpretation of the new pathophysiologic classification of neuropathic pains.

RESUMO JUSTFICATIVA E OBJETIVOS: O sofrimento aliado à persistência e refratariedade da dor neuropática frequentemente leva seu portador a aceitar tratamentos invasivos. O controle da dor neuropática representa um desafio médico importante necessitando adoção de condutas e decisões baseadas, principalmente, em efetividade, riscos e custos. O escopo deste estudo foi a revisão desses aspectos relacionados aos principais procedimentos invasivos CONTEÚDO: São apresentados os principais procedimentos invasivos utilizados para o controle da dor neuropática. Inicialmente, os bloqueios anestésicos, classicamente reversíveis; depois as técnicas de neuromodulação invasiva que utilizam a aplicação de corrente elétrica e o campo magnético por ela gerado em alvos a serem estimulados, inibidos ou modificados, no sistema nervoso (central, periférico ou autônomo); e, finalmente, os procedimentos ablativos que incluem os métodos anestésicos que administram agentes neurolíticos ao invés de anestésicos, e, as neurocirurgias que utilizam métodos diversos de produção de lesões no sistema nervoso para o controle do desconforto doloroso neuropático. CONCLUSÃO: Os pacientes que se apresentam como candidatos a receberem indicações de procedimentos invasivos para controle de dores neuropáticas, possuem além do inerente à própria dor, sofrimento misto, que inclui a coleção de desilusões reiteradas a cada insucesso de tratamento. Possuem prognóstico reservado no que tange a plena cura, e, infelizmente, o alívio obtido com o tratamento invasivo, em geral, não atinge taxas persistentes e elevadas. Nessa situação tão adversa esses resultados parciais de redução da intensidade da dor original possam ser interpretados como aceitáveis desde que o impacto na qualidade de vida final seja positivo. Talvez, as raras exceções, recaiam sobre os bons resultados obtidos com as neuralgias típicas, idiopáticas/criptogenéticas, ironicamente, excluídas da interpretação mais rígida da nova classificação fisiopatológica das dores neuropáticas.

Descripción de aa percepción del impacto en la alidad de la voz en pacientes mmanejados con cordectomía posterior y aritenoidectomía parcial por estenosis glótica / Description o thhe perceived impact on the quality of voice i patients managged with posterior cordectomy and partial arytenoidectomy because of glottic stenosis / Descrição daperccepção do impacto na qualidade da voz em pacientes tratados com cordectomia posterior e aritenoidectomia parcial por estenose glótica

La estenosis glótica es una afección poco frecuente, secundaria a inmovilidad bilateral de cuerdas vocales, debida principalmente a parálisis de origen neurogénico o a fibrosis cicatricial y en la cual se presenta una incapacidad, generalmente severa, para el paso de aire hacia los pulmones a través de la glotis. Lo anterior hace que con frecuencia se deba recurrir a la realización de una traqueostomía como medida transitoria para asegurar la vía aérea. Para corregir la estenosis y recuperar la permeabilidad glótica, estos pacientes deben ser sometidos a una cirugía cuyo objetivo es separar las cuerdas vocales, para permitir de nuevo el paso de aire a la vía aérea inferior. Sin embargo, el hecho de abrir el espacio glótico separando las cuerdas vocales, va a llevar ineludiblemente a grados variables de alteración en la calidad de la voz, lo cual debe ser siempre informado al paciente antes de su intervención. En el presente estudio se realiza una revisión descriptiva, retrospectiva de los casos tratados por el autor mediante cordectomía posterior y aritenoidectomía parcial entre febrero de 2008 y marzo de 2011. Se reporta en ellos la percepción subjetiva de la afectación en su voz utilizando una versión española del índice de incapacidad vocal adaptada de la versión en inglés del "Voice Handicap Index"-10 (VHI-10). De un total de 32 pacientes sometidos a cirugía por estenosis glótica obstructiva, 28 (17 mujeres y 11 hombres) con edades comprendidas entre los 24 y 79 años cumplieron los criterios de inclusión. A todos los pacientes se les pudo corregir la estenosis y retirar la traqueostomía recuperando la capacidad de respirar por la vía natural. Como resultado se encontró que el índice promedio de incapacidad vocal posterior a la cirugía fue de 10.4 en 18 pacientes, cuya causa era una parálisis bilateral y de 14.2 en 6 pacientes con fibrosis cicatricial como factor desencadenante de la estenosis. En otros 4 pacientes con causas diferentes, el índice promedio fue similar a los anteriores. Estos valores reflejan una percepción de incapacidad vocal leve. En conclusión, la percepción de incapacidad vocal posterior a la cirugía para recuperar la permeabilidad glótica es leve, generándose así un valor agregado al éxito terapéutico, al lograr recuperar la vía aérea natural en los pacientes sin alterar sustancialmente su calidad vocal.

Glottic stenosis is a rare condition secondary to bilateral vocal cord immobility due primarily to paralysis of neurogenic origin or scarring fibrosis with subsequently disability, often severe, for the passage of air into de lungs through the glottis. This means that often we must resort to performing a tracheostomy as a temporary measure to secure the airway. To recover the glottal patency these patients should undergo surgery which aims to separate the vocal cords to again allow the passage of air into the lower airway. However, the fact of opening de glottic space separating the vocal cords inevitably produces varying degrees of alteration in voice quality. In the present study we make a retrospective descriptive review of cases treated by the author with posterior cordectomy and partial arytenoidectomy between February 2008 and March 2011, and we reported their subjective perception of involvement in their voice using a Spanish version of vocal disability index adapted from the English version of the "Voice Handicap Index" -10 (VHI-10). Of a total of 32 patients undergoing surgery for obstructive glottic stenosis, 28 (17 women and 11 men) aged between 24 and 79 years met the inclusion criteria. In all patients it was possible to remove the tracheostomy recovering the ability to breathe by the natural route and the resulting vocal disability index was in average 10.4 in 18 patients with bilateral paralysis, 14.2 in 6 patients with cicatricial fibrosis. In the other 4 remaining patients the average rate was similar to the previous ones. These values reflect a perception of mild vocal inability. In conclusion, in our series the vocal perception of disability following surgery to regain glottal permeability is slight thus creating added value to therapeutic success at recovering the natural airway in these patients.

A estenose glótica é uma afecção pouco frequente, secundária à imobilidade bilateral das cordas vocais, devida principalmente a paralisia de origem neurogênica ou à fibrose cicatricial na qual se apresenta uma incapacidade, geralmente severa, para a passagem do ar aos pulmões através da glote. Isso faz com que com frequência se deva recorrer à realização de uma traqueostomia como medida transitória para garantir a via aérea. Para corrigir a estenose e recuperar a permeabilidade glótica, estes pacientes devem ser submetidos a uma cirurgia cujo objetivo é separar as cordas vocais, para permitir de novo a passagem do ar à aérea inferior. Porém, o fato de abrir o espaço glótico separando as cordas vocais, vai levar inevitavelmente a graus variáveis de alteração na qualidade da voz, isso deve ser sempre informado ao paciente antes de sua intervenção. No presente estudo realiza-se uma revisão descritiva, retrospectiva dos casos tratados pelo autor mediante cordectomia posterior e aritenoidectomia parcial entre fevereiro de 2008 e março de 2011. Reporta-se neles a percepção subjetiva da afetação na sua voz utilizando uma versão espanhola do índice de incapacidade vocal adaptada da versão em inglês do "Voice Handicap Index"-10 (VHI-10). De um total de 32 pacientes submentidos à cirurgia por estenose glótica obstrutiva, 28 (17 mulheres e 11 homens) com idades compreendidas entre 24 e 79 anos cumpriram os critérios de inclusão. A todos os pacientes foi possível corrigir a estenose e retirar a traqueostomia recuperando a capacidade de respirar pela via natural. Como resultado encontrou-se que o índice médio de incapacidade vocal posterior à cirurgia foi de 10.4 em 18 pacientes, cuja causa era uma paralisia bilateral e de 14.2 em 6 pacientes com fibrose cicatricial como fator desencadeante da estenose. Em outros 4 pacientes com causas diferentes, o índice médio foi similar aos anteriores. Estes valores refletem uma percepção de incapacidade vocal leve. Em conclusão, a percepção de incapacidade vocal posterior à cirurgia para recuperar a permeabilidade glótica é leve, gerando-se dessa forma um valor agregado ao sucesso terapêutico, ao conseguir recuperar a via aérea natural nos pacientes sem alterar substancialmente sua qualidade vocal.

Laser posterior cordectomy for bilateral abductor vocal cord palsy: A case report

Bilateral abductor vocal cord palsy is comparatively a rare vocal cord lesion, especially in a patient with no history of neck mass, previous surgery or trauma. Many patients are not stridulous. A patient presenting with stridor may need emergency airway management before the other treatment is commenced. We report a case of bilateral abductor palsy which required an emergency tracheostomy and subsequently a laser posterior cordectomy.

Treatment Results of Laser Cordectomy and Radiation Therapy for Early Glottic Cancer / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Early glottic cancer can be effectively treated with conservation laryngeal surgery, radiation therapy, and endoscopic laser surgery. The aim of this study was to compare the clinical results between laser cordectomy and radiation therapy for early glottic cancer and to evaluate the role of laser cordectomy. MATERIALS AND METHOD: From 1988 to 1998, 89 patients with T1-T2/N0 glottic cancer were treated initially with radiation therapy or laser cordectomy. There were 67 T1 and 22 T2 tumors. Fifty-two patients were treated by radiation therapy (RT), and thirty-seven patients were treated by endoscopic laser cordectomy. The method of primary treatment, local control rate, survival rate and larynx preservation were retrospectively evaluated. RESULTS: With the median follow-up period of 48.2 months, the local control rates in laser cordectomy and radiation therapy were 88.9%, 89.7% for T1, and 90.0% and 61.5% for T2 tumors, respectively. The 3-year survival rate was 88.9% and 87.2% for T1 and 80.0% and 61.5% for T2. Larynx preservation rate was 83.4% in T1 and 70.0% in T2 patients. These results of laser cordectomy were superior to those treated by radiation therapy. CONCLUSION: In T1b glottic cancer, radiation therapy gave better results than laser cordectomy, whereas for T2 glottic cancer, laser cordectomy was superior to radiation therapy in initial control of tumor. Compared with radiation therapy, laser cordectomy afforded a greater likelihood of larynx preservation and more options for further treatment in case of failure. We conclude that the laser cordectomy is a good surgical alternative for properly selected early glottic cancer.