Diode Laser for Laryngeal Surgery: a Systematic Review

Abstract Introduction The diode laser has been frequently used in the management of laryngeal disorders. The portability and functional diversity of this tool make it a reasonable alternative to conventional lasers. However, whether diode laser has been applied in transoral laser microsurgery, the ideal parameters, outcomes, and adverse effects remain unclear. Objective The main objective of this systematic review is to provide a reliable evaluation of the use of diode laser in laryngeal diseases, trying to clarify its ideal parameters in the larynx, as well as its outcomes and complications. Data Synthesis We included eleven studies in the final analysis. From the included articles, we collected data on patient and lesion characteristics, treatment (diode laser's parameters used in surgery), and outcomes related to the laser surgery performed. Only two studies were prospective and there were no randomized controlled trials. Most of the evidence suggests that the diode laser can be a useful tool for treatment of different pathologies in the larynx. In this sense, the parameters must be set depending on the goal (vaporization, section, or coagulation) and the clinical problem. Conclusion: The literature lacks studies on the ideal parameters of the diode laser in laryngeal surgery. The available data indicate that diode laser is a useful tool that should be considered in laryngeal surgeries. Thus, large, well-designed studies correlated with diode compared with other lasers are needed to better estimate its effects.

The effectiveness of the head-turn-plus-chin-down maneuver for eliminating vallecular residue

ABSTRACT Purpose When swallowing efficiency is impaired, residue accumulates in the pharynx. Cued or spontaneous swallows in the head neutral position do not always successfully clear residue. We investigated the impact of a novel maneuver on residue clearance by combining a head turn with the chin down posture. Methods Data were collected from 26 participants who demonstrated persistent vallecular residue after an initial head neutral clearance swallow in videofluoroscopy. Participants were cued to perform a head-turn-plus-chin-down swallow, with the direction of head turn randomized. Pixel-based measures of residue in the vallecular space before and after the maneuver were made on still frame lateral images using ImageJ software. Measures of % full and the Normalized Residue Ratio Scale (NRRS) were extracted. Univariate analyses of variance were used to detect significant reductions in residue. Results On average, pre-maneuver measures showed residue filling 56-73% of the valleculae, depending on stimulus consistency (NRRS scores: 0.2-0.4). More than 80% of pre-swallow measures displayed NRRS ratios > 0.06, a threshold previously linked to increased risk of post-swallow aspiration. Conclusion The head-turn-plus-chin-down maneuver achieved significant reductions in residue for thin and nectar-thick fluids, suggesting that this maneuver can be effective in reducing persistent vallecular residue with these consistencies.

Avaliaçäo videofluoroscópica do significado funcional da epiglote no homem adulto / Videofluoroscopic evaluation of the functional signification of the epiglotis in adult man

Com vista a definir o significado funcional da epiglote analisamos sua dinâmica e correlaçoes por meio do método videofluoroscópico em 53 exames, sendo 26 de voluntários sadios, 25 de pacientes com queixa de disfagia e 2 de portadores de divertículo faríngeo. Os exames registram a fase de repouso, mastigaçao e os esforços de deglutiçao durante a ingestao de saliva, água, soluçao de sulfato de bário e volumes variados de massa de miolo de pao, contrastada com bário em pó. Observamos que durante a deglutiçao, a apiglote apresenta seqüência de movimento que pode ser descrita como de três tempos. Um primeiro de elevaçao com arqueamento de convexidade anterior dependente da traçao transmitida pelo ligamento hioepiglótico e da projeçao posterior da extremidade livre do epiglote determinada pela língua. Um segundo, de rotaçao posterior, determinado pela elevaçao da laringe contra o hióide que se limita pelo ajustamento das pregas vestibulares com o tubérculo da epiglote e um terceiro de eversao da extremidade livre, além do plano horizontal que pode estar ausente nas deglutiçoes de menor valor pressórico. Todos os tempos da dinâmica epiglótica sao passivos. Pudemos concluir que a participaçao da epiglote na proteçao das vias aéreas nao se limita ao tempo de deglutiçao. Essa participaçao deve-se, durante a deglutiçao e a regurgitaçao (vômica), ao ajustamento passivo da porçao intralaríngea de sua face posterior (tubérculo da epliglote) às pregas vestibulares. Nos tempos que antecedem e sucedem a deglutiçao, quando existem escapes de resíduos e pequenos volumes da cavidade oral, a epiglote, pela sua participaçao na formaçao das valéculas e como inserçao das pregas ariepiglóticas, protege a via respiratória. A essa participaçao da epiglote associa-se o tensionamento das pregas ariepiglóticas, que garantem a formaçao de canais laterais. A elevaçao e anteriorizaçao da laringe associada à abertura da transiçao faringoesofágica que ocorre em sincronismo com ejeçao do bolo deglutido, mostraram-se como importantes fatores no mecanismo de proteçao laríngea. O aumento da resistência laríngea do qual a epiglote participa, só é eficiente quando há franca e sincrônica abertura da transiçao faringoesofágica. Nesse contexto a epiglote é elemento secundário na proteçao das vias aéreas.