A promising new technique for closed reduction of arytenoid dislocation.

OBJECTIVES: To study the effect of a new technique for closed reduction of dislocated arytenoids. METHODS: The study included 21 females (72.4 per cent) and eight males (27.6 per cent) with a diagnosis of arytenoid dislocation. There were 18 cases of left arytenoid dislocation and 11 of right arytenoid dislocation. Twenty-eight cases had anteromedial dislocation and one had posterolateral dislocation. All patients were treated with closed reduction using custom-made metal rods and an operating microscope, under general anaesthesia. RESULTS: Post-operatively, 21 patients' voices returned completely to normal (including full vocal fold mobility), five had an improved voice and three failed to show any improvement. There were no post-operative complications. CONCLUSION: This new closed reduction technique is a safe procedure for patients with dislocated arytenoids. It is repeatable and the outcome is reliable and effective. Closed reduction can be a useful treatment for arytenoid dislocation.

A study of 111 cases of globus hystericus.

Videofluorography (VFG) and manometry were used to evaluate 111 patients who were diagnosed with globus hystericus. Most of the globus patients were affected by functional diseases and the underlying pathology could be revealed by VFG in 73.9 per cent of the series and by manometry in 80.2 per cent. There were 10.8 per cent of the series in which VFG and manometry yieled normal findings. The most common abnormality determined by manometry was esophageal aperistalsis. The most common abnormality revealed by VFG was cricopharyngeal bar. VFG was sensitive for morphologic detection while manometry was sensitive for motility study. Functional disorders can result in morphologic abnormality and vice versa. Therefore, VFG and manometry complement each other and are invaluable tools in the investigation of globus patients.

Management of cervical paragangliomas.

Two cases of vagal body tumours are reported for their surgical consequences of immediate post-operative airway obstruction in one case, and tachycardia hypotension and severe dysphagia requiring cricopharyngeal myotomy in another. An unusual case of carotid body tumour which had the same clinical picture was also reported for comparative surgical treatment. The surgical management of both tumours was reviewed and it was found that 28-43 per cent of carotid body tumour resection would have vascular operation while dissection of vagal body tumour usually did not. The angiographic diagnostic criteria for vagal body tumour were also reviewed and found to be inadequate. Additional angiographic criterion was proposed.

The treatment of fetishism and socially inappropriate sexual behavior in a young male with dull normal intelligence.

A young adult male with dull normal intelligence who had a fetish to female undergarments and was engaging in socially inappropriate sexual behavior was evaluated and treated in a multimodal treatment approach. Mild and diffuse encephalopathies were noted through EEG recordings. No definite epileptiform abnormalities or focal supratentorial lesions were seen and the pattern was consistent with patients with post-encephalitis. Treatment of this patient involved the use of anti-androgen and antianxiety pharmacotherapy along with counseling to provide basic sex education and specific education for socially accepted sexual behavior. Follow-up evaluation several yrs later indicated good treatment results. This case illustrates potential sources of sexually deviant behavior and treatment options. Promising new drug treatments are available which act as sexuoerotic tranquilizers as well as treatments for underlying or concomitant psychiatric disorders. In this case, however, family dynamics and poor sex education seemed to account for most of this patient's difficulties. Counseling and psychoeducation proved to be quite effective in resolving problematic behavior.

Transposition of the lingual thyroid.

Two cases of lingual thyroid were reported. Both were treated by the transposition procedure moving the gland from the base of tongue to the sublingual space. Postoperatively, both patients remained in euthyroid state requiring no exogenous thyroid supplement.