Partial laser arytenoidectomy in the management of bilateral vocal fold immobility. A modification nased on functional anatomical study of the cricoarytenoid joint

To establish the anatomical relationships of the arytenoid and cricoid cartilages and apply these findings to design an arytenoidectomy based on a sound anatomical basis. We prospectively conducted this study between 1996 and 2002 at the Main University Hospital of Alexandria, Egypt. In 50 patients, we endoscopically measured the length of the vocal process and the distance between the vocal process tip and upper border of the cricoid cartilage. We sagittally and axially sectioned 25 total laryngectomy specimens to verify the position of the arytenoids and their relation to the cricoid. The anatomical findings led to the design of a laser partial arytenoidectomy and cordotomy [L-PAC], which we used in 45 patients with bilateral cord paralysis in adduction. The anatomical findings showed that the cricoarytenoid joint did not contribute to the airway in any of the measured specimens. Using L-PAC, we decannulated 100% of the patients and no patient needed postoperative tracheostomy at any time. Only 3 patients experienced minimal postoperative aspiration to liquids [6.7%]. We achieved reasonable phonation as assessed by a speech analysis battery. However, 3 patients [6.7%] needed contralateral L-PAC. The present extra-articular technique, L-PAC, showed its superiority to previous endoscopic or transcervical complete arytenoidectomy techniques in providing an effective balance between the protective, respiratory, and to a lesser extent the phonatory functions

Head and neck lipomas: presentation variability

Head and neck lipoma has seldom drawn attention in the literature except for separate case reports. Study presentation variability of head and neck lipomas as well as relative importance and efficiency of preoperative diagnostic methods used. Patients diagnosed as having head and neck lipomas presented to the Otolaryngology-Head and Neck Surgery Department, Alexandria Faculty of Medicine were included in this study. Preoperative clinical, laboratory and radiological evaluation was conducted peroperatively. Surgical excision was done and postoperative histopathological examination confirmed the diagnosis. Twenty-four patients had 26 lipomas. Males predominated [62.5%]. The posterior subcutaneous neck was the most common site. Three patients had deep lipomas affecting the hypopharynx, larynx and parotid gland; all were correctly diagnosed preoperatively. Computed tomography [CT] scans with specific radiodensity recording was the preferred preoperative investigation. Lipomas should be considered in the differential diagnosis of soft-tissue head and neck masses even in rare locations. CT or magnetic resonance imaging [MRI] scans can accurately diagnose a lipoma preoperatively thereby allow for better treatment planning