Staged endoscopic treatment of laryngeal amyloidosis.
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Adult↗
Biomedical subjects
R H Ossoff
Publications and source records attributed to R H Ossoff.
Value of videostroboscopic parameters in differentiating true vocal fold cysts from polyps.
Differentiating between benign true vocal fold (TVF) cysts, polyps, and nodules on the basis of their gross appearance would be advantageous in determining the need for surgical therapy. A retrospective study of 32 patients covering 31 months was done to assess the ability to differentiate these lesions on the basis of stroboscopic parameters. Stroboscopic examinations were evaluated for symmetry, amplitude, periodicity, mucosal wave, and closure. Preoperative diagnoses were validated with operative and histologic confirmation. Mucosal wave was absent or diminished in 100% of TVF cysts and present or increased in 80% of TVF polyps (P < .05). Thirty-one percent of original histopathologic diagnoses were modified after pertinent clinical information was provided to the pathologist. Therefore, stroboscopic evaluation of mucosal wave is helpful in preoperative differentiation of TVF cysts and polyps, and providing clinical information to the pathologist is critical for useful histologic information.
Adult↗
Thermal injury patterns and tensile strength of canine oral mucosa after carbon dioxide laser incisions.
The amount of collateral damage in laser surgery is affected by the precision of the beam delivery. To test a new control system, the authors of this study produced surgical incisions in the canine oral mucosa and then documented histologic and tensile strength changes during the wound healing process. The incisions were made by three different methods: scalpel, manually controlled carbon dioxide (CO2) laser, and computer-controlled C02 laser. Both types of laser incisions took longer to heal than the scalpel incisions. The laser incisions were accompanied by a zone of thermal damage lateral to the incision. With the computer-controlled laser incision, the area of thermal damage was reduced, the laser-induced delay in wound healing was less, and tensile strength was relatively greater. The data indicate that surgical performance is improved by critical beam control.
Animals↗
Alternating unilateral botulinum toxin type A (BOTOX) injections for spasmodic dysphonia.
Injection of botulinum toxin type A (BOTOX) into both thyroarytenoid muscles is an accepted treatment for spasmodic dysphonia. The authors of this study identified patients who could not tolerate the interval of breathy voice that immediately follows bilateral injections. These patients were offered a protocol in which the injection side was alternated on subsequent treatments. Eighteen patients who received at least two bilateral injections and two unilateral injections were reviewed. Alternating unilateral injections yielded a shorter breathy interval by an average of 12.7 days (P=.0007) and a shorter duration of return of spasmodic symptoms by an average of 26.0 days (P=.0006). Compared with bilateral injections, alternating unilateral injections yielded an average (median) of 3.2 more days of strong voice per day of breathy voice (P=.001). However, unilateral injections had a shorter average interval of strong voice (27.4 days; P=.007), as well as a slightly higher failure rate (4.9% vs. 1.1%). The authors conclude that alternating unilateral botulinum toxin type A injections are useful in patients with spasmodic dysphonia who have difficulty with the breathy voice that follows bilateral injection.
Adult↗
Vocal fold paralysis following the anterior approach to the cervical spine.
The anterior cervical approach is commonly used for access to the cervical spine. Vocal fold paralysis (VFP), a complication of this approach, is underrepresented in the literature. A review of the database of the Vanderbilt Voice Center revealed 289 patients with VFP, including 16 patients who developed paralysis as a result of an anterior cervical approach. The paralysis was on the right side in all but 1 patient. Compared to patients who developed VFP after thyroidectomy and carotid endarterectomy, patients with VFP after an anterior cervical approach have a higher incidence of aspiration and dysphagia, suggesting the presence of trauma to the superior laryngeal and pharyngeal branches as well as the recurrent branch of the vagus nerve. Two patients had partial return and 1 patient had complete return of vocal fold movement within 10 months. Of the remaining 13 patients, 8 underwent vocal fold medialization with improvement of symptoms. Two patients are 6 and 7 months postinjury and await vocal fold medialization. Two patients are 27 months and 45 months postinjury and are considering vocal fold medialization. The remaining patient was lost to follow-up. An anatomic-geometric analysis of the right and left recurrent laryngeal nerves was performed by using measurements obtained from computed tomography scans of 8 patients with idiopathic unilateral VFP, as well as experience gained through surgical and cadaveric dissections. We conclude 1) the anterior cervical approach may place multiple branches of the vagus nerve at risk; 2) because of anatomic-geometric factors, the right-sided anterior cervical approach may carry a greater risk to the ipsilateral recurrent laryngeal nerve than does the left; and 3) an understanding of the anatomy and geometry presented herein allows relatively safe exposure from either side of the neck.
Adult↗
Immunohistochemical characterization of benign laryngeal lesions.
It has been proposed that laryngeal nodules and polyps represent injury to the basement membrane zone of the vocal fold. Repeated trauma from shearing forces produced by excessive or abusive phonation leads to basement membrane zone disruption and thickening. This thickening, along with poorly understood vascular changes, creates the characteristic clinical appearance of the vocal nodule or polyp. As such, to better understand vocal fold nodules it is imperative to characterize the extracellular matrix in this area of injury. Secondary to the small size and relatively acellular nature of these lesions, hematoxylin and eosin (H & E) preparations of histologic material are unsatisfying. A previous study examined this area with immunohistochemical techniques to better characterize its contents. The report, however, contained little information with regard to the clinical appearance of the lesions prior to excision. Therefore, we were prompted to review histologic material from 31 patients who underwent microsurgical excision of 41 benign lesions, vocal nodules (4), polyps (19), polypoid corditis (4), and cysts (14) with immunohistochemical techniques to characterize the patterns of fibronectin and collagen type IV within these lesions. Normal human vocal folds were stained for control. All material was correlated with the H & E preparations and the clinical diagnosis. Collagen type IV and fibronectin appeared present in relatively abnormal patterns in the areas adjacent to the lesion. This study validates earlier results. In addition, correlation with clinical data allows association of immunohistochemical staining patterns with clinical diagnosis.
Adolescent↗
Long-term follow-up of recurrent laryngeal nerve avulsion for the treatment of spastic dysphonia.
Long-term follow-up of 3 to 7 years is reported on 18 patients who had undergone recurrent laryngeal nerve avulsion (RLNA) for the treatment of adductor spastic dysphonia (SD). Data on neural regrowth after previous recurrent laryngeal nerve section (RLNS) are presented in 2 of these 18 patients. We introduced RLNA as a modification of standard RLNS to prevent neural regrowth to the hemiparalyzed larynx and subsequent recurrence of SD. We have treated a total of 22 patients with RLNA, and now report a 3- to 7-year follow-up on 18 of these 22 patients. Resolution of symptoms was determined by routine follow-up assessment, perceptual voice analysis, and patient self-assessment. Sixteen of 18, or 89%, had no recurrence of spasms at 3 years after RLNA as determined at routine follow-up. Two of the 16 later developed spasms after medialization laryngoplasty for treatment of weak voice persistent after the avulsion. This yielded a total of 14 of 18, or 78%, who were unanimously judged by four speech pathologists to have no recurrence of SD at the longer follow-up period of 3 to 7 years. Two of these 4 patients were judged by all four analysts to have frequent, short spasms. The other 2 were judged by two of four analysts to have seldom, short spasms. Three of 18 patients presented with recurrent SD after previous RLNS. At the time of subsequent RLNA, each patient had evidence of neural regrowth at the distal nerve stump as demonstrated by intraoperative electromyography and histologic evaluation of the distal nerve stump. One remained free of SD following RLNA, 1 was free of spasms at 4 years after revision avulsion but developed spasms after medialization laryngoplasty, and the final patient developed spasms 3.75 years after revision RLNA. Medialization laryngoplasty with Silastic silicone rubber was performed in 6 of 18, with correction of postoperative breathiness in all 6, but with recurrence of spasm in 3. Spasms resolved in 1 of these with downsizing of the implant. We conclude that RLNA represents a useful treatment in the management of SD in patients not tolerant of botulinum toxin injections.
Adult↗
Electrical pacing of the paralyzed human larynx.
This study represents the first attempt to electrically pace the paralyzed human larynx. The goal was to determine if electrical stimulation of the posterior cricoarytenoid muscle could produce functional abduction of the vocal fold in pace with inspiration. An external apparatus was used to sense inspiration and reanimate the unilaterally paralyzed larynx of a thyroplasty patient. Stimuli were delivered through a needle electrode to locate and pace the abductor muscle. The magnitude of electrically induced abduction was comparable to spontaneous movement on the normal side. The abduction was appropriately timed with inspiration: this finding demonstrated that this simple pacing system could effectively modulate stimulation with patient respiration.
Adolescent↗
Laser applications in otolaryngology.
The perception of the laser has changed as lasers have moved from the laboratory into everyday conventional surgery. The physician's perception of the laser has expanded from the simple light scalpel to a tool with a variety of applications. This issue of Otolaryngologic Clinics of North America is designed to explain how lasers are used today in otolaryngology-head and neck surgery and to indicate new directions for the laser tomorrow.
Endoscopy↗
Laser applications in adult laryngeal surgery.
In adult microlaryngeal surgery appropriate application of the laser can result in improved therapeutic outcomes. Used injudiciously, however, the laser will impart heat energy which can irreversibly alter postoperative laryngeal vibratory characteristics. This article discusses the equipment, safety precautions, and clinical applications of lasers in adult laryngeal surgery because the laser remains a valuable tool for the treatment of specific laryngeal diseases.
Adult↗
Laser applications in otolaryngology. Conclusion and future outlook.
The field of medicine has embraced and utilized many advanced technologies. The use of the laser will continue to be important as computer assisted surgery and robotics are used in conjunction with lasers to improve patient care. This concluding article reviews the laser and present scenarios for possible future surgical procedures with the laser.
Ear Diseases↗
Endoscopic vocal fold microflap: a three-year experience.
Surgical techniques for the removal of vocal fold (VF) disorders that arise within the lamina propria must permit the preservation and/or restoration of VF vibratory characteristics. The endoscopic VF microflap is designed to do such. A retrospective study was undertaken to evaluate the efficacy of this procedure. Forty microflaps (7 bilateral, 1 revision) were performed on 32 patients. Charts and surgical pathology findings were reviewed. Preoperative and 3-month postoperative video recorded voice samples and stroboscopic examination results were compared. Findings on perceptual voice analysis did not significantly change. Stroboscopic examinations revealed improved postoperative VF closure in 27 of 29 patients with impaired preoperative closure and return of mucosal wave in 18 of 24 VFs operated on for the excision of cysts or polyps. When present preoperatively (6 patients), the mucosal wave was preserved. Most patients (28 of 30) rated themselves as clinically improved. The endoscopic VF microflap is efficacious in the treatment of selected VF disorders. The surgical technique is discussed.
Adult↗
Reinnervation of the allograft larynx in the rat laryngeal transplant model.
The rat model for a vascularized laryngeal allograft is duplicated with significant technical modifications. We report the addition of unilateral host-to-allograft recurrent laryngeal nerve anastomosis to this model. Long-term survival experiments determine the feasibility of reinnervation studies of the allograft larynx with this new mode. A total of 59 transplants have been performed on histocompatible Munich Wistar rats, 36 with attempted unilateral allograft reinnervation. Because of the initially high operative mortality rates, additions and modifications of the original technique resulting in reproducibly enhanced survival are detailed. Factors critical to the functional study of this model with regard to reinnervation are elucidated. Preliminary data on allograft reinnervation are reported as confirmed by videodocumentation of vocal fold mobility, evoked and spontaneous electromyography, and glycogen-depletion studies.
Animals↗
A tissue-culture model for the study of canine vocal fold fibroblasts.
A tissue-culture model has been developed for the study of fibroblasts from the canine vocal fold. Laryngeal tissue (lamina propria) obtained from euthanized dogs is rinsed, cut into 1-mm3 pieces, and incubated in 5% carbon dioxide at 37 degrees C. A confluent monolayer is established within several days. Detectable levels of elastin in the tissue culture supernatant are measured by an indirect enzyme-linked immunosorbent assay. Various external agents have been shown to affect elastin production. The effects of KTP laser irradiation, hydrocortisone (1.3 mumol/L), transforming growth factor-beta (10 ng/mL), and human leukocyte elastase have been measured. Thus the canine vocal fold fibroblast tissue culture is established as a model for further investigations to improve wound healing and to understand the wound-healing process following laryngeal microsurgery.
Animals↗
Prevention of pharyngocutaneous fistulas by means of laser-weld techniques.
Although much has been written on methods of dealing with pharyngocutaneous fistulas once they have formed, there are few reports of methods of preventing fistula formation from occurring. We examined the use of laser-weld techniques with the neodymium:yttrium aluminum garnet (Nd:YAG) and diode lasers to seal pharyngotomy closures. Laser-weld techniques have been used successfully in many other tissues, but reports documenting use in the upper aerodigestive tract are minimal. Indocyanine-green dye-enhanced collagen and fibrinogen were studied as laser solder materials for the diode laser. Twenty-nine experimental animals were studied. Neither the Nd:YAG nor the diode laser was successful in preventing fistula formation. Tensiometric studies documented significant strength of the laser welds ex vivo, but this finding was not clinically significant.
Anastomosis, Surgical↗
Operative evaluation of airway obstruction.
Endoscopic evaluation is a crucial component in the assessment of chronic airway obstruction. Acute airway obstruction is a potentially devastating complication of this invasive procedure. This article discusses a systematic approach to endoscopically assessing the airway safely and obtaining the information necessary for long-term management of the chonically obstructed airway.
Airway Obstruction↗
Laser treatment of lower airway stenosis.
This article reviews the various laser techniques used in the endoscopic treatment of lower airway stenosis. The tests of lasers and laser settings used are presented along with the various success rates for the particular techniques. Also presented in this article are the criteria for differentiating those patients who are likely to have a good response to endoscopic techniques versus those patients who should have open techniques performed.
Endoscopy↗
Hoarseness: contemporary diagnosis and management.
"Hoarseness" is the term used by most people to describe a change in normal voice quality. It is a very nonspecific term somewhat similar to a patient's complaint of dizziness when describing symptoms from light-headedness to true vertigo. Hoarseness may imply breathiness, roughness, voice breaks, or unnatural changes in pitch. Laryngologists use the general term "dysphonia" to describe abnormal voice quality with no specific etiology implied. A complaint of hoarseness may represent serious disease and, therefore, should not be ignored, especially if it persists for more than two weeks. Before we proceed with a discussion of abnormal voice, it is imperative to understand normal voice production and the relative anatomy.
Acute Disease↗