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

use of mitomycin-C for respiratory papillomas: clinical, histologic and biochemical correlation

To assess the clinical effects of mitomycin-C [MMC] on human papilloma virus [HPV]-infected tissues of the airway. We included 10 patients with previous histologic diagnosis of recurrent respiratory papillomas [RRP] in this prospective study, conducted at the Department of Otolaryngology-Head and Neck Surgery, University of Alexandria, Egypt, between January 2000 and December 2002. Under general anesthesia, each patient underwent laser excision of all visible papillomas, followed by topical application of 1 cc of 0.5 mg/ml MMC. The procedure was repeated weekly until no visible papillomas could be microscopically detected. We histopathologically studied the obtained specimens and tested for the presence of HPV DNA using polymerase chain reaction [PCR] technique. We collected blood samples from all patients and from another 10 healthy volunteers for determination of serum interleukin-2 [IL-2] level using enzyme-linked immunosorbent assay technique. We achieved clinical remission in 8 of the patients [80%], a fact that was confirmed histopathologically and by PCR data. The mean serum IL-2 levels +/- SD was significantly lower in papilloma patients [83.6 +/- 28.83 pg/ml] than in control subjects [196.3 +/- 42.46 pg/ml] [p<0.01]. Among patients with RRP, serum IL-2 levels +/- SD was lower in initial samples [83.6 +/- 28.83] than follow-up [95.7 +/- 27.98 and 112.3 +/- 33.8 and 129.4 +/- 34.04] and remission samples [154 +/- 37.84 pg/ml]. Our result suggests that topical application of MMC may act adjunctively to laser surgery for RRP