Surgical and Functional Outcomes of Posterior Cordotomy and Partial Arytenoidectomy with CO2 LASER in the Treatment of Bilateral Vocal Cord Immobility: A Single Institution Experience.

Background/Objectives: The purpose of this study is to investigate surgical and functional outcomes of patients affected by bilateral vocal cord immobility (BVCI) and treated with posterior cordotomy and partial arytenoidectomy. Methods: We performed a retrospective analysis on pre- and postoperative findings on a series of 27 patients affected by BVCI and treated with posterior cordotomy and partial arytenoidectomy from January 2017 to January 2022. Perceptual voice evaluations were performed using the GRBAS scale. The patients were requested to estimate the level of voice handicap experienced in their life using the Italian version of Voice Handicap Index 10 (VHI 10) questionnaire, while swallowing difficulties were self-evaluated through the Italian version of the Eating Assessment Tool (EAT-10) questionnaire. Results: Respiratory distress was evaluated according to the American Medical Research Council Dyspnoea Scale (MRC_DS) before and 1 year after the surgery. The mean of the preoperative values was 3.86 (±0.4), while 1 year after the procedure, we witnessed a significant (p ≤ 0.001) improvement, with a mean value of 1.09 (±0.9). After surgery, an overall worsening in voice quality was perceived, with a worsening in the GRBAS score. In contrast, the VHI10 does not show a statistically significant worsening. EAT 10 did not demonstrated worse scores after the surgery; rather, it showed a trend of improvement (preoperative EAT10 5.5 ± 5.8, postoperative 3.3 ± 2.9, p = 0.064). Conclusions: According to our results, posterior cordotomy plus partial arytenoidectomy is an effective procedure that provides stable and rapid respiratory improvement whilst preserving swallowing and the self-perception of voice quality.

Flexible endoscopic phonosurgery for treatment of functional sequelae after laryngeal oncologic surgery: a narrative review.

Flexible endoscopic phonosurgery (FEPS) is one of the most recent and constantly evolving operative techniques in the field of minimally invasive laryngeal surgery. Thanks in part to the possibility of using new technologies, such as digital endoscopes, laser fibres, and different laryngeal injection materials, its fields of application have rapidly expanded. This narrative review describes the current possible indications of FEPS ranging from injection laryngoplasties in cases of vocal cord paralysis or mass defect, to the correction of dysphagia after open partial horizontal laryngectomies. Use of microscissors, microforceps, and laser fibres also allows this technique to be applied for removal of superficial vocal cord lesions, avoiding general anaesthesia in an increasing number of patients.

Phonosurgical Injection Approaches for Voice Restoration After Open Partial Horizontal Laryngectomies: A Pilot Study.

OBJECTIVE: The aim of the present study is to evaluate the efficacy of phonosurgical corrective approaches based on injection laryngoplasties and pharyngoplasties followed by speech therapy for voice restoration after unsatisfactory phonatory results of open partial horizontal laryngectomies. METHODS: Ten patients with not satisfying phonatory results despite speech therapy after type II or type III open partial horizontal laryngectomies (OPHLs) were included. Each patient underwent a voice restoration program based on phonosurgery (injection laryngoplasty and/or injection pharyngoplasty) with hyaluronic acid and/or calcium hydroxyapatite, followed by post-surgical voice rehabilitation. Voices were recorded and analysed through spectrographic, aerodynamic, perceptual, laryngoscopic and self-assessment evaluations before the treatment (T0), after 1 month (T1) and after three months (T2). RESULTS: Significant improvements in the patients voices were found between T0, T1 and T2 concerning acoustic, perceptual, aerodynamic, laryngoscopic and self assessment evaluations. CONCLUSIONS: The results of the present study support phonosurgical injection procedures followed by speech therapy as an effective strategy for voice restoration after type II or type III OPHLs in selected patients.

Surgical fenestrated approach to the maxillary sinus like alternative to Caldwell-Luc technique.

INTRODUCTION: In the last few years the surgical treatment of patients with maxillary sinus disease has shifted from more invasive maneuvers to more conservative approaches in order to save intraoral mucosa. Recently, some authors have proposed a modification to the classical Caldwell-Luc's approach (CL) for the removal of dental implants displaced into the maxillary sinus. The modified approach involves a fenestrated approach to the maxillary sinus. The bony pedicled windows of maxillary sinus in some selected cases may limit some of the most common complications and it may reduce healing times. EVIDENCE ACQUISITION: Evaluation of the middle term results of a maxillary fenestrated sinus approach as an alternative technique to CL and review of literature. EVIDENCE SYNTHESIS: From 2013 to 2017 thirty-one patients were treated with the CL modified technique, most of which for foreign bodies, displacement of endodontic material and implants in the maxillary sinus, large mucoceles and odontogenic maxillary sinusitis. All patients were subjected to clinical, and in some cases radiological, from 6 months to 18 months follow-up. Different combinations of Keywords and MeSH term were used for the bibliographic research in the main search engines (PubMed, Cochrane library, Medline). Inclusion criteria - fenestrated approach to the maxillary sinus, postoperative complications, description of the operative case. CONCLUSIONS: No complications occurred in the intraoperative period and during the months of follow-up. There has been no recurrence of the starting problem and all treated patients were free from residual maxillary pathology 18 months after surgery. Four works meeting the inclusion criteria were identified. The surgical fenestrated approach to the maxillary sinus is a valid alternative to the classical Caldwell-Luc techniques that, alone or in combination with endoscopic sinus surgery, allow to treat foreign bodies of maxillary sinus, of mucoceles and other diseases of the maxillary sinus. The proposed technique does not require particular surgical skills, it does not increase the operating time and can also be performed under local anesthesia.

Preoperative and postoperative electroneurographic facial nerve monitoring in patients with parotid tumors.

OBJECTIVE: To assess the value of clinical (House-Brackmann grading) and neurophysiological (conventional electroneurography) monitoring of the facial nerve before and after (at day 10 and day 80) microsurgical parotidectomy in a group of patients with parotid tumors. STUDY DESIGN AND SETTING: From January 7, 1999, to February 27, 2001, 33 patients were evaluated for parotid neoplasms confirmed by cytologic examination: 27 were benign and 6 were malignant epithelial tumors. All patients underwent preoperative electroneurography of the affected side and the normal contralateral side. RESULTS: Preoperatively, 27 of 33 patients with benign lesions had normal facial nerve function on clinical and neurophysiological evaluation, while 3 of 6 patients with malignant lesions showed compound muscle action potential abnormalities of amplitude and latency, in the absence of facial nerve deficits. At the first postoperative evaluation, 2 of 6 patients with epithelial cancer and 4 of 27 patients with benign tumors had an absence of voluntary activity and compound muscle action potentials after nerve stimulation at the stylomastoid foramen; 1 patient with a malignant lesion and 5 patients with benign tumors had a transient facial palsy with amplitude reduction or latency prolongation of compound muscle action potential. This abnormality persisted in 2 of 27 patients at the second evaluation performed at day 80 after surgery. In 2 of 6 patients with malignant lesions, the day-80 electroneurogram showed a complete absence of nerve conduction. CONCLUSION: Electroneurography is a sensitive tool for monitoring clinically silent facial nerve function deficits in the context of preoperative tumor-induced damage and postsurgical early and late follow-up of nerve function.

[Endocrine disorders in liver diseases]. / Disfunzioni endocrine in corso di epatopatie.

Liver is involved in the biological actions of a large number of circulating hormones. Liver diseases are often associated with hormonal disorders owing to the duration, severity or beginning time of the disease. Sometimes the cellular dysfunction of the liver is directly responsible for the endocrine disease, as in liver cirrhosis; sometimes, the dysfunction causing organic or functional liver impairment is at the origin of the endocrine damage: this is easily remarkable during systemic diseases as idiopathic haemochromatosis, in which iron deposition in the endocrine parenchyma is responsible of the dysfunction of many hormones' synthesis and secretion. This review gives a summary of the relations between liver diseases and endocrinological dysfunctions, dwelling upon the most recent literature acquisitions.