RESUMO
BACKGROUND: Patient's pursuing aesthetic surgery often inquire about the success of the procedure. Having objective data for these patients improves preoperative counseling. To assess patient satisfaction after aesthetic chondrolaryngoplasty using specifically developed outcomes assessment instrument and to evaluate the anatomy of the vocalis insertion on the thyroid cartilage and its effect on the extent of surgical resection. METHODS: Retrospective survey of patients who underwent chondrolaryngoplasty from 2006 to 2012. Patients answered 6 questions on a 5-point Likert scale assessing satisfaction from a physical, emotional, and social quality of life perspective. We separately undertook cadaveric dissection to examine the ligamentous attachment of the vocal fold to the thyroid cartilage.All patient were seen in a private practice affiliated with a university medical center.One hundred ninety-eight patients underwent chondrolaryngoplasty during the study period; we were able to contact 112.The main outcome measure is patient satisfaction using a 5-point Likert Scale. RESULTS: Sixty percentage of patients were either "very" or "completely" satisfied with the appearance of their neck and Adam's apple. Only 13% still reported that their neck/Adam's apple still appeared unsatisfactorily prominent or masculine. No patients had permanent voice change, and greater than 90% of patients had no significant voice change of any duration; any voice change was temporary. The most frequent comments from less satisfied patients were the amount of remaining prominence and the size or location of the scar. CONCLUSIONS: Aesthetic chondrolaryngoplasty is a safe and effective surgery to reduce the prominence of the thyroid cartilage. Patients should be aware that because of the need to preserve voice it may not be 100% effective from an aesthetic perspective.
RESUMO
IMPORTANCE: Otolaryngologists are asked to evaluate children who a parent, physician, or someone else believes is slow in developing speech. Therefore, an otolaryngologist should be familiar with milestones for normal speech development, the causes of delay in speech development, and the best ways to help assure that children develop the ability to speak in a normal way. OBJECTIVE: To provide information for otolaryngologists that is helpful in the evaluation and management of children perceived to be delayed in developing speech. EVIDENCE ACQUISITION: Data were obtained via literature searches, online databases, textbooks, and the most recent national guidelines on topics including speech delay and language delay and the underlying disorders that can cause delay in developing speech. Emphasis was placed on epidemiology, pathophysiology, most common presentation, and treatment strategies. Most of the sources referenced were published within the past 5 years. RESULTS: Our article is a summary of major causes of speech delay based on reliable sources as listed herein. CONCLUSIONS AND RELEVANCE: Speech delay can be the manifestation of a spectrum of disorders affecting the language comprehension and/or speech production pathways, ranging from disorders involving global developmental limitations to motor dysfunction to hearing loss. Determining the cause of a child's delay in speech production is a time-sensitive issue because a child loses valuable opportunities in intellectual development if his or her communication defect is not addressed and ameliorated with treatment. Knowing several key items about each disorder can help otolaryngologists direct families to the correct health care provider to maximize the child's learning potential and intellectual growth curve.
