Analysis of the Effectiveness of Arytenoidectomy and Posterior Cordectomy with the Use of CFD Airflow Measurements in Patients with BVFP: A Retrospective Study.

Purpose: Bilateral vocal fold paralysis (BVFP) is a rare larynx disease manifested by dyspnea, which often requires surgical treatment. The aim of the study is to determine the effectiveness of unilateral arytenoidectomy with posterior cordectomy in the treatment of BVFP using the computational fluid dynamics (CFD) method. Methods: This study included 33 patients with BVFP who underwent unilateral laser arytenoidectomy with posterior cordectomy. Glottis area measurements and spirometry, as well as a self-assessment of respiratory efficiency were performed before the surgery and after the recovery period. Using the CFD method, computer models of the glottis were made. Then, changes in air pressure gradient and maximum air velocity at the level of glottis were calculated, and local fields of pressure and air velocities were obtained. Results: The values of glottal surface area (S), spirometry parameters (forced expiratory volume in one second (FEV1), forced vital capacity (FVC), and peak expiratory flow (PEF)), inlet air velocity at the glottal level as well as patients self-assessment of respiratory efficiency turned out to be significantly higher after the operation. The values of maximum velocity at the glottal level, pressure gradient at the glottal level turned out to be significantly lower after the surgery. We observed that the greater the increase in glottal surface area, the greater the decrease in self-assessment scales (visual analogue scale (VAS) and Medical Research Council (MRC)). Increased levels of spirometry parameters after the surgery correlated with smaller decrease of PEF-dependent pressure gradient at the glottal level (PEFΔP CFD). Conclusion: Unilateral laser arytenoidectomy with posterior cordectomy is an effective method for the treatment of BVFP. CFD is a useful tool to determine and visualize the effectiveness of surgical treatment in BVFP.

The assessment of phonatory and ventilatory functions in patients after microsurgery for Reinke's edema.

BACKGROUND: Short and long-term results of microsurgical treatment with the mini-microflap technique in patients with Reinke's edema (RE) were assessed based on the phonatory and ventilatory functions of the larynx. OBJECTIVES: To assess the short and long-term results of microsurgical treatment with the mini-microflap technique in patients with RE based on the phonatory and ventilatory functions of the larynx. MATERIAL AND METHODS: Twenty patients diagnosed with advanced stage of RE confirmed with laryngovideostroboscopy (LVS) were enrolled in the study. Phonatory function disturbances were additionally assessed on the basis of Maximum Phonation Time (MPT) measurement, Voice Handicap Index (VHI) and Voice-Related Quality of Life (V-ROOL) questionnaires. Ventilatory function was assessed using spirometry. The aforementioned complex examinations were conducted prior to surgery and 1, 6 and 9 months following the surgery. RESULTS: Good postsurgical results were obtained in subjective and objective evaluation, which assessed the phonatory function and ventilatory parameters. Post-surgery increase in MPT, VHI and VQROL was noticed in all patients in 3 check points (p < 0.001). The results demonstrate postsurgical improvement for some LVS parameters, including assessment of glottis closure (p < 0.003) observed 6 months after the surgery. An improvement in most of the ventilation parameters was observed also 6 months after surgery (p < 0.001). For the spirometry flow parameter PEF, significant improvement was noted in each check point (p1 < 0.004, p6 < 0.001, p9 < 0.001). The study revealed a correlation between phonatory parameter - MPT and PEF observed 1 month after the procedure (p = 0.026), confirming the interdependence of ventilatory efficiency and phonatory condition of larynx. CONCLUSIONS: Mini-microflap surgery brings satisfactory clinical effect in patients with advanced stages of RE by optimization of phonatory and ventilatory functions of the larynx.

Risk Factors of Recurrence and Malignant Transformation of Sinonasal Inverted Papilloma.

Sinonasal inverted papilloma is a relatively rare disease; however, it is prevalent enough for every ENT practitioner to encounter it several times throughout medical routines. Despite the developments in experimental and clinical medicine as well as surgical techniques, our knowledge of this disease is still inadequate. With improved imaging and better diagnostic techniques, proper diagnosis and qualification for surgical approaches leave no doubt. Although the endoscopic approach seems to be the gold standard for such condition, some cases may additionally require an external approach. Regardless of the type of surgery, postoperative management is crucial for both healing and long-term follow-up. Unfortunately, the procedures are still lacking in explicit and standardized postoperative management guidelines. Moreover, an important issue is still the need for a biomarker indicative of inverted papilloma and its malignant transformation. Several particles, within the spotlight of the researchers, have been SCCA, Ki-67, Bcl-2, Wnt proteins, and many more. Nevertheless, the topic requires further investigations.