Amal S. Quriba

Posterior pharyngeal flap for velopharyngeal insufficiency patients: A New Technique for Flap Inset

To describe a modification of the originally described superiorly based pharyngeal flap as a secondary operation to correct velopharyngeal insufficiency (VPI) in patients with nonsyndromic repaired cleft palate.

Powered instrumentation for transnasal endoscopic partial adenoidectomy in children with submucosal cleft palate

OBJECTIVES Partial adenoidectomy is the selective removal of the obstructing part of adenoid tissue, thus relieves obstruction symptoms and preserves the velopharyngeal valve action. Patients with palatal dysfunction are candidates for the technique. This study describes the use of microdebrider, transnasally (guided by the nasal endoscope) to perform partial adenoidectomy in patients with submucosal cleft palate, who presented with adenoidal hypertrophy and also it discusses its effects on nasal obstruction and speech. SUBJECTS AND METHODS This prospective study was carried out on twenty-three submucosal cleft palate patients who were referred to the ORL-HN department; Zagazig University Hospitals complaining of respiratory obstruction and sleep disturbances due to adenoids hypertrophy. After preoperative nasoendoscopic and speech evaluation, transnasal endoscopic, power-assisted partial adenoidectomy was done for all patients. All patients were followed up at regular visits including nasoendoscopy and speech evaluation. RESULTS The procedure insured fast, safe, reliable, under vision and well controlled steps. Intraoperatively no major complications were recorded. During follow up, nasal obstruction and respiratory obstruction symptoms were improved. Speech outcome results were reported. CONCLUSION The study demonstrates the feasibility of using the microdebrider for performing transnasal partial adenoidectomy (under endoscopic guidance). The procedure is precise, rapid, safe and well-tolerated with the advantage of direct visualization of a traditionally difficult-to-expose area. The study reported improvement of respiratory obstruction symptoms with good speech results.

Voice Outcome after Gore-Tex Medialization Thyroplasty

Introduction Although medialization thyroplasty utilizing Gore-Tex (Gore and Associates, Newark, Delaware, United States) has been discussed in the literature, few reports have assessed voice quality afterward, and they did not use a full assessment protocol. Objective To assess the improvement in voice quality after medialization thyroplasty utilizing Gore-Tex in patients with glottic insufficiency of variable etiology. Methods Eleven patients with glottic insufficiency of different etiologies that failed compensation were operated by type 1 thyroplasty utilizing Gore-Tex. Pre- and postoperative (1 week, 3 months, and 6 months) voice assessment was done and statistical analysis was performed on the results. Results In all postoperative assessments, there was significant improvement in the grade of dysphonia (p < 0.004) and highly significant reduction in the size of glottic gap and prolongation of maximum phonation time (p < 0.0001). The difference in voice parameters in the early (1 week) and the late (3 and 6 months) postoperative period was not significant. None of the patients developed stridor or shortness of breath necessitating tracheotomy, and there was no implant extrusion in any patient during the study period. Conclusion Gore-Tex medialization provides reliable results for both subjective and objective voice parameters. It leads to a satisfactory restoration of voice whatever the etiology of glottic incompetence is. This technique is relatively easy and does not lead to major complications. Further studies with larger number of patients and more extended periods of follow-up are still required to assess the long-term results of the technique regarding voice quality and implant extrusion.

Voice Changes after Late Recurrent Laryngeal Nerve Identification Thyroidectomy.

OBJECTIVES To assess voice changes in patients after thyroidectomy where the recurrent laryngeal nerve (RLN) was found late in the thyroid dissection and where the RLN was not injured (late RLN identification technique). METHODS This study was conducted on 64 patients who underwent thyroidectomy by late RLN identification technique. Voice was assessed preoperatively, 1 week, 3 months, and 6 months after surgery using the voice assessment protocol and Voice Problem Self-Assessment Scale. The study group was divided into two subgroups (hemithyroidectomy: N = 13 and total thyroidectomy: N = 51). Voice assessments of both subgroups were then compared with a control group (N = 20) of patients who recently underwent extracervical surgeries. RESULTS All voice analysis differences between the control group and the individual study subgroup were nonsignificant. Dysphonia in the study group was significantly worse at 1 week and 3 months postoperatively but became nonsignificant at 6 months postoperatively. The deviations from the preoperative acoustic analysis were significant only in the first week postoperative comparison for fundamental frequency, noise-to-harmonic ratio, and maximal phonation time and thereafter became nonsignificant. Significant Voice Problem Self-Assessment Scale mean score increase (worsening) was also detected only at first week postoperatively. CONCLUSION Minimal voice changes were reported early after late RLN identification thyroidectomy in absence of RLN injury and disappeared gradually in a few months. Those changes are comparable with that of other extracervical surgeries, making thyroidectomy with late RLN identification a relatively safe technique as regard voice.

Early functional outcome of two surgical protocols used in the repair of complete unilateral cleft lip palate: a comparative study

Background and objectiveThe outcome of different treatment protocols for primary management of patients with complete unilateral cleft lip palate (UCLP) may vary considerably. This study aimed to compare the results of quality of speech and velopharyngeal sphincter mechanism between two surgical protocols used in the repair of complete UCLP. Patients and methodsThis study was conducted in Zagazig University Hospitals from February 2009 to April 2012 on 30 patients. The patients were categorized into two groups: group A, which consisted of 15 patients who underwent cleft lip repair and cleft hard palate repair with a vomer flap in same sitting; and group B, which consisted of 15 patients who underwent only cleft lip repair at first sitting. At the age of 12 months in both groups, repair of the remaining cleft palate was performed. ResultsA significant difference between groups A and B at all postoperative comparisons was found in terms of grade of nasality, grade of closure of the velopharyngeal valve, and nasal emission of air. ConclusionEarly repair of the hard palate with simultaneous cleft lip repair can be considered as a reliable alternative procedure to one-stage palatoplasty and appeared to have better early functional results in the treatment of complete UCLP.

Use of autologous platelet-rich plasma in complete cleft palate repair.

Evaluate the effect of topical application of autologous platelet‐rich plasma (PRP) in primary repair of complete cleft palate and then compare the result with another group of patients using the same surgical technique, without application of PRP with regard to the incidence of oronasal fistula, velopharyngeal closure, and grade of nasality.

Auditory neural encoding of speech in adults with persistent developmental stuttering

Background Stuttering is a speech disorder with frequent and protracted prolongations, repetitions, and silent blocks that hamper proper speech production. It develops during the preschool years with a prevalence of 5%, decreasing to 1% in adulthood to be referred to as persistent developmental stuttering. Auditory processing deficit is proposed to be one of the contributing factors to developmental stuttering. Objective This study aimed to determine the pattern of auditory processing affection if any in stuttering disorder. This might be helpful for improving management approaches in the future. Patients and methods Eleven adults with persistent developmental stuttering and 11 comparative age-matched normally fluent participants were examined with auditory brainstem response (ABR) and mismatch negativity to evaluate the brainstem and cortical processing of speech syllables, respectively. Results All participants exhibited normal brainstem processing of nonspeech (click) stimuli, whereas 72.7% of stutterers revealed prolongation of peak latency of all waves of speech-evoked ABR. An additional peak latency delay of mismatch negativity response was found in 81.8% of stutterers. Conclusion Auditory processing abnormality is proposed to be the underlying deficit in a subset of stutterers.

Cephalic de-mucosalized superiorly-based pharyngeal flap: A modified mucosa-preserving technique for velopharyngeal insufficiency

INTRODUCTION Superiorly-based pharyngeal flap (PF) is the most frequently employed surgical technique to correct velopharyngeal insufficiency (VPI). Bared posterior pharyngeal wall might prolong the period of convalescence with throat pain and discomfort. Delayed donor site healing problems and subsequent fibrosis with downward migration of the transposed flap might be one a cause of failure and might necessitate revision. AIM OF THE WORK To present a modified technique of PF aiming at dealing with the problems of donor site defects via immediate self-mucosal covering of the cephalic portion of the bed. METHODS This case series study was conducted on patients with persistent VPI. All patients underwent the new modified technique of cephalic de-mucosalized pharyngeal flap (CDPF). The basic premise was to harvest a laterally-based mucosal flap from the upper part of the posterior pharyngeal wall. A superiorly-based pharyngeal flap (with a bared cephalic segment and a mucosalized caudal segment) was elevated off the posterior pharyngeal wall and inserted in the soft palate. Then the laterally-based mucosal flap was spread over the superior part of donor site of the posterior pharyngeal wall. RESULTS 13 VPI patients were included in this study. Their age ranged from 5 to 12 years with a mean of 5.6 ± 1.2. The follow-up period ranged from 8 to 14 months. All flaps and beds were completely healed within 2-3 weeks and no patients showed flap dehiscence, infection or palatal fistula. Postoperative speech assessment showed significant improvement of velopharyngeal function, resonance balance, and reduction in nasal emission. CONCLUSIONS The modified technique provides an immediate self-mucosa cover to the superior part of the posterior pharyngeal wall, thus it could promote primary healing at the donor site with a short period of convalescence. CDPF separates the two opposing raw surfaces of the flap and the posterior pharyngeal wall. The mucosal flap might guard against downward migration of the flap.

Linear Measurements of Vocal Folds and Laryngeal Dimensions in Freshly Excised Human Larynges

INTRODUCTION Understanding the morphology of the larynx, one of the most complex organs of the human body, is an important step toward understanding the detailed laryngeal anatomy, and physiology. Different studies have described the linear measurements of the larynx in different measuring methods, but no studies have been structured to describe vocal fold length in freshly excised larynges. OBJECTIVES The aim of this study was to describe exact anatomical measurements of vocal folds and some laryngeal structures in freshly excised larynges, and to compare such measurements between males and females. This can help improve the diagnostic and therapeutic procedures in the laryngology field. SUBJECTS AND METHODS This study was applied on 21 patients having different types of laryngeal carcinoma: 11 males and 10 females with the age range 41-75 years old. Every patient was assessed using laryngeal endoscopy and photography, and the length of the membranous vocal fold was measured using a millimeter-graded ruler that was photographed with focus with the same magnification used in the video laryngoscopy of the glottis. Then patients were exposed to total laryngectomy, and excised larynges were used for a direct measuring of the membranous and cartilaginous vocal folds. Then measures of men and women were compared statistically. Measures of excised larynges were also compared with those of the video endoscopy using a video-printed ruler. CONCLUSION Freshly excised larynges can be used for accurate quantitative measuring of the vocal fold length and laryngeal dimensions. There are considerable differences in all measured dimensions between males and females.

Nasalance Changes Following Various Endonasal Surgeries

Introduction There is change in nasalance post endonasal surgery which is not permanent. Objectives The objective of this study is to evaluate the long-term nasalance changes following different types of endonasal surgeries. Methods We included in this study patients who underwent sinonasal surgery at the Otorhinolaryngology Department in Zagazig University Hospitals from February 2015 until March 2016. We divided the patients into two groups according to the surgeries they underwent: Group (A) was the FESS group and group (B), the septoturbinoplasty group. We checked nasalance using a nasometer before and after the sinonasal surgery. Results Nasalance increased at one month after the operation in both groups. However, it returned to nearly original levels within three months postoperatively. Conclusion FESS, septoplasty, and turbinate surgery may lead to hypernasal speech. This hypernasal speech can be a result of change in the shape and diameter of the resonating vocal tract. Hypernasal speech in these circumstances may be a temporary finding that can decrease with time. Surgeons should inform their patients about the possibility of hypernasality after such types of surgery, especially if they are professional voice users.