A rare case of laryngeal dystonia associated with neurosyphilis: Response to botulinum toxin injection.

We report a unique case of laryngeal dystonia in a 43-year-old male with neurosyphilis who underwent successful treatment with botulinum toxin injection. To date there have been no reports of laryngeal dystonia associated with neurosyphilis. The patient initially presented with strained and stuttering voice despite systemic penicillin therapy. After 2 months of speech therapy with limited relief, the patient received botulinum toxin injection to each thyroarytenoid muscle. Postinjection videostroboscopy showed marked improvement of voice quality.

Laser-assisted management of congenital and acquired pediatric airway disorders: case reports and review of the literature.

OBJECTIVES: As laser surgery advances are made in the treatment of adult disorders, lasers are likewise increasingly being used in the treatment of pediatric otolaryngologic disorders. We evaluated outcomes of laser surgery in a group of infants and children with congenital and acquired airway disorders. MATERIALS AND METHODS: The medical charts of infants and children who were treated for airway disorders between July 2005 and January 2007 at a tertiary care children's hospital were reviewed. Data included relevant history and physical examination, diagnostic work-up, management, and follow-up assessment. RESULTS: Seven patients who had laser surgery for airway lesions were identified. Two infants aged 3-12 wk had laryngomalacia, failure to thrive, and apnea. In one infant, CO(2) laser-assisted supraglottoplasty, in combination with microlaryngeal scissors, resulted in continuing weight gain in one infant at 15 mo after surgery, and no apnea episodes at 4 wk in the other infant. A 2-month-old infant underwent laser-assisted laryngeal cleft repair. Two patients diagnosed with recurrent respiratory papillomatosis at age 6-15 mo underwent multiple CO(2) and KTP laser ablations of laryngotracheal papillomas. Microdebrider removal of papillomas was initiated due to the large size of the papillomas. Two patients aged 5-11 y were burn victims with stridor, hoarseness, or difficulty breathing. After CO(2) ablation of subglottic stenosis and posterior glottic webs, voice and breathing improved and stridor resolved. CONCLUSION: Congenital and acquired airway lesions in ;infants and children can be treated with the laser. A combined approach with other techniques may be considered to decrease the duration of the procedure when applicable.

Electromechanical reshaping of septal cartilage.

OBJECTIVES: This study describes the process of tissue electroforming and how shape changes in cartilage can be produced by the application of direct current (DC). The dependence of shape change on voltage and application time is explored. STUDY DESIGN: Basic investigation using ex vivo porcine septal cartilage grafts and electromechanical cartilage deformation focused on development of a new surgical technique. METHODS: Uniform flat porcine nasal septal cartilage specimens were mechanically deformed between two semicircular aluminum electrodes. DC current was applied to establish charge separation and electrical streaming potential. Voltage (0-3.5 V) and application time (0-5 minutes) were varied. Shape change was measured, and shape retention was calculated using analytic representation. The effect of the direction of applied current on shape change was evaluated by switching the polarities of electrodes and using parameters of 0 to 5.5 V and 5 minutes. Temperature during reshaping was monitored with a thermocouple, and surface features were evaluated using light microscopy. RESULTS: Reshaped specimen demonstrated mechanical stability similar to native cartilage tissue. Shape retention strongly correlated with increasing voltage and application time. Only a small current (<0.1 A) through the tissue was measured. Temperature change was less than 2 degrees C during electroforming, suggesting that electroforming likely results from some nonthermal mechanisms. Surface features indicated that electrodeposition may occur depending on electrode material and magnitude of the applied voltage. CONCLUSIONS: These findings demonstrate that cartilage can be reshaped through the process we have described as "electroforming" by generating intrinsic differences in charge separation with negligible heat production.

Measurement of the elastic modulus of rabbit nasal septal cartilage during Nd:YAG (lambda = 1.32 microm) laser irradiation.

BACKGROUND AND OBJECTIVES: The objective of this study was to quantitatively measure changes in the elastic moduli of rabbit nasal septal cartilage during laser heating. While the efficacy of laser cartilage reshaping has been established for use in nasal surgery, few studies have investigated the temperature-dependent viscoelastic behavior of cartilage. STUDY DESIGN/MATERIALS AND METHODS: Cyclic force versus displacement curves were generated during the Nd:YAG laser (lambda = 1.32 microm, 10 second exposure time, 21.22 W/cm2) irradiation of cartilage specimens secured in cantilevered geometry. Samples were irradiated three times with 30 second cooling intervals between each laser exposure. Measurements were recorded before, during, and after laser irradiation, and then following complete rehydration in normal saline (NS) for 1 hour at 25 degrees C. Elastic modulus was calculated assuming linear viscoelastic behavior. RESULTS: The elastic modulus in native tissue decreased during and after successive laser exposures from about 6 to 3.5 MPa. After rehydration, the modulus returned to near-baseline value. Surface temperature reached a maximum of 65 degrees C. CONCLUSIONS: The laser irradiation of cartilage using parameters similar to those used in reshaping does not produce significant irreversible changes in the mechanical properties of the tissue. Measurement of the elastic modulus is an effective means of characterizing alterations in cartilage mechanical behavior during and after laser heating.