[Management of bilateral vocal cord paralysis with laser cordectomy]. / Manejo de la parálisis bilateral de cuerdas vocales mediante cordectomía con láser.

BACKGROUND: Bilateral vocal fold paralysis (BVFP) is characterized by fold immobility in complete adduction or abduction, secondary to a vagus nerve lesion, through the recurrent laryngeal nerve. The manifestation is variable dyspnea and stridor, fatal if the airway is not secured. There are endolaryngeal and extralaryngeal techniques to increase the glottic opening, improving ventilation and deglutition, and the possibility of decannulation and phonation. METHODS: Case series consisting of BVFP patients, treated with posterior cordectomy, from January 2004 to January 2010. Clinical charts were reviewed to obtain data and registries of presurgical and postsurgical control endolaryngoscopies. RESULTS: Nineteen patients were identified. Twelve (63.2 %) had a tracheotomy cannula in place, and seven (36.8 %) didn't. Total thyroidectomy was the principal cause of the BVFP in 17 patients (89.5 %). A right cordectomy was performed on 10 patients (52.6 %). At 12 months, endolaryngoscopy detected a 40.26 % average increase in the glottic opening (p < 0.05), allowing for decannulation in 10 (83.3 %) of the tracheotomy patients. CONCLUSIONS: Laser cordectomy is a simple procedure for the treatment of BVFP, with few complications, permitting oronasal ventilation, decannulation and phonation.

INTRODUCCIÓN: la parálisis bilateral de cuerdas vocales se caracteriza por inmovilidad de las cuerdas en aducción o abducción completa secundaria a lesión del nervio vago a través de los nervios laríngeos recurrentes. Se manifiesta por disnea con estridor variable que puede ocasionar la muerte si no se despeja la vía aérea. Existen técnicas intra y extralaríngeas para aumentar la luz glótica y mejorar la ventilación, la deglución y la posibilidad de decanulación y emisión de voz funcional. MÉTODOS: se realizó un estudio de serie de casos en el que se incluyeron pacientes con parálisis bilateral de cuerdas vocales tratados mediante cordectomía posterior entre enero de 2004 y enero de 2010. Se revisaron los expedientes clínicos para obtener los datos y registros endolaringoscópicos de control pre y posquirúrgico. RESULTADOS: se identificaron 19 pacientes; 12 (63.2 %) tenían instalada una cánula de traqueotomía y siete (36.8 %) no. La causa de la parálisis bilateral de las cuerdas vocales fue la tiroidectomía total en 17 (89.5 %). A 10 (52.6 %) se les realizó cordectomía derecha. A los 12 meses de seguimiento, con endolaringoscopia se observó 40.26 % de ganancia de luz glótica (p < 0.05). Se logró la decanulación en 10 pacientes portadores de traqueotomía (83.3 %). CONCLUSIONES: la cordectomía con láser es un procedimiento sencillo para tratar la parálisis bilateral de cuerdas vocales, con pocas complicaciones, permite la ventilación oronasal, la decanulación y la fonación.

[Necrotizing mediastinitis in deep neck infections]. / Mediastinitis purulenta en infecciones profundas de cuello.

INTRODUCTION: Mediastinitis is a rare complication of deep neck abscesses with a high mortality. An accelerated extension to the mediastinum can happen before the identification of the primary site of infection, delaying diagnosis and treatment. OBJECTIVE: To report the results of treatment of patients with mediastinitis as a complication of deep neck infection. MATERIAL AND METHODS: Case series. Consecutive patients with mediastinitis secondary to deep neck abscesses, from March 2001 to February 2004. RESULTS: We studied five patients: three males (60%) and two females (40%), mean age 42.2 +/- 18.4 years. In all patients there was at least a 3-day delay before appropriate diagnosis was made. Hospitalization ranged between 1 and 56 days. Symptoms were fever in five cases (100%), dysphagia in four (80%), dyspnea in four (80%), retrosternal pain in three (60%), orthopnea in two (40%), and tachycardia in one (20%). Primary infection sites were of dental origin in four cases (80%) and upper respiratory tract infection in one. Surgical management consisted of cervical and mediastinal drainage with tracheotomy in all patients (100%). Three also required pleurostomy and two required gastrostomy to improve nutritional status. Mean number of surgical procedures was 5.4 +/- 1.8. All patients developed respiratory insufficiency requiring mechanical ventilation. Mortality was 60%. CONCLUSIONS: The delayed diagnosis was common in this case series. The length of hospitalization was long because patients required management with ventilatory support and multiple surgical procedures to limit the infectious process. High mortality is an indication for the early identification and treatment of all cases.