Augmentation-lateralization for Unilateral Vocal Fold Palsy With Airway Obstruction: A New Concept in Laryngology.

OBJECTIVES: This study presents an efficient, safe, effective, and novel technique of reconstructive transoral laser microsurgery (R-TLM) for the treatment of unilateral vocal fold paralysis (UVFP) with airway obstruction. It is based on the augmentation of the immobile and potentially flaccid and atrophic side while lateralizing the arytenoid and posterior part of the vocal fold, thus improving breathing without sacrificing phonation and commonly improving it. STUDY DESIGN: Retrospective cohort study through data from medical records and operative notes. METHODS: Patients with UVFP with exertional dyspnea with or without dysphonia were included in this report. The vocal fold is augmented by harvesting the aryepiglottic fold soft tissues and the upper part of the arytenoid and placing them into the paraglottic space as a pedicled microflap, thus augmenting the anterior two thirds of the vocal fold while lateralizing the remaining arytenoid and posterior third of the vocal fold by an internal traction suture to improve airway. Postoperative breathing, phonation and swallowing were assessed. RESULTS: Twenty two cases are reported in the study. Follow-up evaluations ranged from 6 to 12 months. All cases showed successful and durable improvement of breathing and phonation. None required tracheostomy or gastrostomy pre- or postoperatively. CONCLUSIONS: Augmentation-lateralization is a novel, safe, and effective minimally invasive technique that allows airway improvement with good results on phonation in patients with challenging UVFP with airway obstruction.

Safety of use of the ENDOSWIR near-infrared optical imaging device on human tissues: prospective blind study.

Cancer surgery requires removing the tumor tissue in necessary and sufficient quantities. Spectral optical imaging in the short-wave infrared (900-1700 nm) could provide an intraoperative guidance to the surgeon based on the absorption of the tissues without contrast agent. Our objective was to ensure the safety of our ENDOSWIR device on human tissues. Histological analysis of fresh human tonsils exposed to the SWIR light or not was compared and showed no histological differences. This demonstrates the safety of using the SWIR device on human tissues and allows us to initiate a clinical study for the resection of tumors intraoperatively.

Correlation Between Cochlear Length, Insertion Angle, and Tonotopic Mismatch for MED-EL FLEX28 Electrode Arrays.

OBJECTIVE: To investigate the relationship between cochlear length, insertion angle, and tonotopic mismatch and to compare the tonotopic mismatches with respect to the spiral ganglion and the organ of Corti. STUDY DESIGN: Retrospective. SETTING: Tertiary referral center with cochlear implant program. PATIENTS: Analyses of patients' computed tomography images after cochlear implant surgery. INTERVENTION: Cochlear implantation with 28-mm-long straight lateral wall electrode arrays. MAIN OUTCOME MEASURE: Cochlear length, insertion angle, and insertion depth were assessed using the OTOPLAN software. Tonotopic mismatch for each electrode contact was estimated using the Greenwood (organ of Corti) and the Stakhovskaya (spiral ganglion) maps and compared. RESULTS: 106 cochleae were analyzed. 99% of the electrode arrays were located in the tympanic ramp. The insertion was complete in 96% of cases. The mean cochlear length was 34.5 mm and the mean insertion angle of the apical electrode was 545°. Cochlear length was negatively correlated with the insertion angle of the contacts E1 to E9 (all p < 0.004). The tonotopic mismatch was greater at the organ of Corti than at the spiral ganglion. It was also greater at the organ of Corti in larger cochleae (correlation with mismatch for E1 r = 0.421, p < 0.0001) and in the apical than in the middle and basal regions of the cochlea. CONCLUSION: Small cochlea size corresponded to higher insertion angle and reduction of tonotopic mismatch on a 28-mm-long straight lateral wall electrode array. Tonotopic mismatch could be minimized preoperatively by choosing electrode arrays according to the individual cochlear morphology and postoperatively by appropriate frequency fitting.