Indirect laryngeal surgery of vocal fold polyps: a dying or evolving art?

Objective: Vocal fold polyps (VFPs) are the most common benign laryngeal lesions that require surgery and are routinely managed by microlaryngoscopy (MLS) under general anaesthesia. Prior to introduction of MLS, VFPs were removed using indirect laryngoscopic surgery (ILS) in local anaesthesia, a procedure that required substantial surgical skill to operate with an unmagnified mirror view of the larynx. With the adoption of wireless endoscopy equipment and personal computers, we tried to simplify this technique so that it can be easily performed in the office. This study aimed to assess the effectiveness of ILS by comparing voice outcomes with MLS. Materials and methods: ILS and MLS were performed in six patients each. Treatment outcomes were measured using a voice self-assessment and objective acoustic analysis. The total cost of both procedures was calculated. Results: Both techniques allowed successful removal of VFPs in all patients, without significant intergroup differences in voice outcomes. The cost of ILS was significantly lower. Conclusions: Despite the pilot nature of the study and the small sample size, our data indicate the potential value of this technique which, considering its simplicity and economic value could be used as an alternative to MLS in carefully selected patients.

Emergency Tracheostomy Due to a Myasthenic Crisis in a Post-COVID Patient: Report of a Case.

Myasthenia gravis is an autoimmune disorder caused by the production of antibodies that block either acetylcholine receptors or structural receptors of the neuromuscular junction. There is expanding evidence that novel coronavirus (2019-nCoV) disease can lead to the development of an autoimmune response. Myasthenic crisis, a life-threatening respiratory muscle weakness severe enough to necessitate intubation or tracheostomy, can be a potential complication of myasthenia gravis. In this report, we describe the case of a 57-year-old man with acute respiratory insufficiency requiring emergency tracheostomy. His health condition rapidly deteriorated 1 week after initiating systemic corticosteroid treatment for a suspected adult-onset asthma exacerbation. The patient had a history of COVID-19 infection and thymectomy, which were noted in his medical records. Serological testing and electrodiagnostic evaluation confirmed the diagnosis of myasthenia gravis. The patient was treated with plasma exchange, continuous neostigmine infusion, and prednisone. He was successfully decannulated and discharged with anticholinesterase inhibitors and long-term immunosuppression therapy. It is important to consider neurological disorders in the differential diagnosis for patients presenting with respiratory insufficiency, particularly during the COVID-19 pandemic.

Late diagnosis of a submandibular gland carcinoma in Covid-19 pandemic.

The Covid-19 pandemic has created exceptional challenges for patients and medical care systems. Among many factors influencing postponed cancer diagnosis, mask-wearing created difficulties in initial diagnosis of head and neck tumours. This report features a patient who had been covering a submandibular tumour under a surgical mask for more than 6 months. He visited his general practitioner due to a significant weight loss, but he neither took his mask off, nor was he asked to do so. When he reported to our emergency room, we noticed a massive ulcerous mass in the right submandibular region. Histological examination confirmed primary squamocellular carcinoma of submandibular salivary gland. During the Covid-19 pandemic, significant clinical observations may be missed if a surgical mask or respirator are not removed during examination with the potential for increased incidence of medical malpractice claims.

Life-Threatening Stridor due to Laryngeal Tuberculosis in the COVID-19 Era: Report of a Case.

Laryngeal tuberculosis is the most frequent granulomatous disease of the larynx and it is prone to be diagnosed as cancer. COVID-19 pandemic caused considerable disruption in tuberculosis service provisions both in the primary care and hospital settings. This report describes a rare case of life-threatening stridor in a patient who presented with an ulceroproliferative laryngeal mass later confirmed as laryngeal tuberculosis. Urgent tracheostomy was performed. The patient's sputum and the computed tomography of the chest revealed a pulmonary, as well as laryngeal tuberculosis. The patient was commenced on a 24 week course of anti-tuberculous treatment which was interrupted because of a mild course of hospital-acquired coronavirus infection. 3 months after initial treatment for tuberculosis, his sputum cultures became negative. Flexible laryngoscopy was performed at our department 4 months after commencement of treatment, demonstrating complete regression of the lesion and symmetrical laryngeal mobility, hence the patient was successfully decannulated and discharged to be followed up to his community hospital. In the time of COVID-19 pandemic, we should never underestimate other severe infectious diseases.