Potential of robotic systems in phonosurgery.

There has been rapid growth in the utilization of robotic surgery in the head and neck. Its utilization in the phonosurgical space has lagged owing to difficulty with access and exposure to the laryngeal site, small working space due to the size of the larynx and the need to work around an endotracheal tube. The goal of this work is to explore recent developments in robotic microlaryngeal surgery. At this time robotic instrumentation is available; however, the range of instruments is not as extensive to match the current microlaryngeal instrumentation that exists for traditional endoscopic surgery. Studies have demonstrated the ability to perform phonosurgery safely with currently available robotic systems but exposure is less than ideal. Work is been undertaken to develop specialized transoral robotic retractors which will improve visualization and allow the robotic instrument to reach the glottis, which has traditionally been the most difficult to area to access.  Additional studies will be needed to assess the application of these systems to more patient populations, and prospective research will be required to compare outcomes of traditional phonosurgery to robotic phonosurgery.

Voice and Swallowing Outcomes of Unilateral Vocal Fold Paralysis: Comparing Younger Adult and Geriatric Patients.

Objective To compare voice and swallowing outcomes after treatment in younger adult (<65 years) and geriatric (≥65 years) patients with unilateral vocal fold paralysis (UVFP). Study Design Case series with chart review. Setting Tertiary care center. Subjects and Methods The cases of patients presenting to a tertiary voice clinic with UVFP between June 2005 and February 2015 were reviewed. Clinical characteristics and outcomes in a geriatric subset were compared with those in younger adult group. Results A total of 206 patients met our inclusion criteria (n = 110, <65 years; n = 96, ≥65 years). Etiology was most commonly iatrogenic (59.2%), and computed tomography led to diagnosis for 62.3% of patients for whom it was obtained. The Voice Handicap Index improved on average by 31.3 points after treatment ( P < .001), with equal improvement between the patient subsets ( P = .71). Swallowing, as objectively assessed by the National Outcomes Measurement System for modified barium swallow, showed a statistically significant improvement in the patient population as a whole (-0.9, P = .02) but was not significantly different within the subgroups (younger, P = .07; geriatric, P = .25). Conclusion Geriatric patients have similar voice and swallowing outcomes as younger adults and should be treated equally aggressive.