Early unilateral laryngeal paralysis after pulmonary resection with mediastinal dissection for cancer.

BACKGROUND: The purpose of this study was to document the symptoms, evolution, management, and outcome in a large series of patients with an early unilateral laryngeal paralysis after mediastinal lymph node dissection and pulmonary resection for cancer. METHODS: In this retrospective series of 69 patients, treatment relied on isolated speech therapy in 18 patients and surgical medialization of the paralyzed vocal cord in 51 patients. Duration of follow-up varied from 2 to 109 months, with a mean duration of 15 months. Treatment included isolated speech therapy and laryngeal medialization in 18 patients and 51 patients, respectively. RESULTS: Symptoms included swallowing impairment and dysphonia noted in 63.7% and 98.5% of patients, respectively. Recovery of motion of the paralyzed larynx varied from 2.8% in patients in whom the operative report mentioned that the inferior laryngeal or Xth cranial nerve had been transected, to 23.5% in patients in whom the operative report did not mention nerve transection. Recovery of motion did not occur past the ninth month that followed thoracic surgery. When performed, medialization of the paralyzed larynx resulted in an overall 95.4% and 96% improvement rate for swallowing impairment and dysphonia, respectively, but 1 patient also died of aspiration-related pneumonia. CONCLUSIONS: In patients with an early unilateral laryngeal paralysis after pulmonary resection with mediastinal lymph node dissection for cancer, laryngeal medialization has a beneficial impact on swallowing, speech, and voice, resulting in a better quality of life. Persistent swallowing impairment after laryngeal medialization must be managed aggressively, given the risk for delayed pneumonia and even death from aspiration.

Nasolacrimal duct oncocytoma: an unusual cause of chronic epiphora.

Epiphora has traditionally fallen under the purview of ophthalmologists. However, owing to the development of endoscopic dacryocystorhinostomy, this condition has been increasingly observed in otolaryngologic practice. We report the case of a woman with a 4-month history of right epiphora and dacryocystitis. Nasal endoscopy revealed the presence of a tumor at the inferior meatus. Histopathologic examination of a biopsy specimen identified the tumor as an oncocytoma. Surgical excision via a lateral rhinotomy approach was performed. At 3 years postoperatively, the patient was disease-free. Lacrimal sac and nasolacrimal duct tumors are rare, but they should be considered as a possible etiology in patients with acquired epiphora because most of these tumors are malignant.

[Isolated unilateral laryngeal nerve paralysis in adults. An inception cohort of 591 patients managed in a French--university--teaching hospital]. / Paralysies laryngées unilatérales isolées de l'adulte: etude d'une cohorte de 591 patients pris en charge en centre hospitalo-universitaire.

UNLABELLED: We analyzed an inception cohort of 591 adults with isolated unilateral laryngeal paralysis managed at a French teaching hospital during the period 1990-2008. Symptoms, causes, treatment and outcome were compared between two periods (1990-2000 vs 2001-2008), using the Chi squared test and Mann Whitney U test. Dysphonia, swallowing impairment and respiratory impairment were present in respectively 98.3%, 34.8% and 4.1% of cases, The causes of paralysis were surgical and non surgical in respectively 65.1% and 21.1% of cases. Cancer (mainly lung cancer) was present in 59.6% of cases, and 22% of these patients were receiving palliative treatment. Thoraco-mediastinal surgery and thyroid-parathyroid surgery accounted for 79.4% of surgical causes. Malignancies accounted for 76.8% of non surgical causes. Within the idiopathic group (13.8% of the cohort), a tumor lying along the path of the paralyzed nerve was detected in 3.7% of cases. Larynx motion was recovered in 19.6% of cases; nerve transection, the etiology, and the time since symptom onset were predictive factors for motion recovery. Treatment consisted of laryngeal medialisation and isolated speech therapy in 40.1% and 59.9% of cases, respectively. The current success rate of laryngeal medialisation is 90.3%. CONCLUSIONS: The three main causes of unilateral laryngeal nerve paralysis were tumors, surgery and cardiovascular disorders (surgical and non surgical). Laryngeal medialisation is now a major component of rehabilitation in our center.

Vascular anatomical basis of clavicular non-union.

The middle third of the clavicle is commonly involved in any injury and account for 5-10% of all fractures in adults. Although non-unions are rare, their treatment has not been well defined yet. This report describes the arterial supply of the clavicle to clarify the pathological mechanism and the surgical procedure of non-unions. This study was based on delineation of the thoraco-acromial and suprascapular arteries with colored latex on 17 specimens (ten cadavers). Observations were made after macroscopic dissection and maceration. The main blood supply to the middle third of the clavicle was the periosteal. This supply came from the two branches of the thoraco-acromial trunk that penetrated the pectoralis major muscle and the deltoid muscle. In 13 cases, these two periosteal branches were anastomosed between these two muscle attachments. Periosteal vascularization was always seen on the superior surface and the anterior border of the bone, but never on the inferior surface or the posterior border. The suprascapular artery contributed to supply the middle third of the clavicle by several periosteal branches and also by an independent branch. This branch was born proximally near the internal, middle thirds union and passed along the posterior face of the subclavius muscle and pierced the bone through the nutria foramina located near the external, middle thirds union. Nevertheless, intraosseous arteries were noted only in four cases. In these cases, they were never more than 2cm long. Our results showed that the periosteal blood supply located between the muscles insertions and the arterial supply from the suprascapular artery could be twice compromised in case of important displacement or severe fracture. If treatments of clavicular fractures or non-unions cannot preserve the periosteal blood supply, bone grafting should be indicated.