Balázs Sztanó

Endoscopic Arytenoid Lateropexy for Isolated Posterior Glottic Stenosis

Objectives/Hypothesis: A posterior glottic stenosis (PGS) may limit the abduction of the arytenoid cartilages. One option for the treatment of dyspnea in lower grade stenoses is endoscopic laterofixation of the vocal cords after scar excision. In our prospective study, we assess a refined method for effective endoscopic mobilization and lateropexy of the arytenoid cartilages.

A New Thread Guide Instrument for Endoscopic Arytenoid Lateropexy

The varied etiology of bilateral vocal cord immobility (BVCI) requires a wide range of surgical approaches. A new endolaryngeal thread guide instrument (ETGI) is presented here for a minimally invasive endoscopic lateropexy of the arytenoid cartilage, which might serve as a basis for a simple solution for the main types of BVCI.

A comparison between transoral glottis-widening techniques for bilateral vocal fold immobility

Comparison of different endoscopic glottis‐widening procedures designed for bilateral vocal cord immobility (BVCI) is a challenge. This is because a statistically efficient analysis and comparable clinical series is hard to obtain considering the variable aspects of the results and the evaluation methods. This study of a large number of cadaver larynges provides comparable, objective data for the evaluation of the possible postoperative breathing and voicing function.

The combined endoscopic management of congenital laryngeal web

Laryngeal web in the anterior commissure is a rare congenital anomaly often leading to severe dyspnea. Endoscopic procedures based on a simple transsection in these cases may worsen the condition because vocal folds have a tendency for fibrosis and granulation tissue formation after surgical interventions. Thus the traditional treatment of choice is the demanding, externally performed laryngotracheal reconstruction generally with a rib cartilage graft and longer period of stenting. This report presents the successful endoscopic management of a congenital laryngeal web in a 2-year-old boy, who previously underwent an uneffective scar laser transsection that led to excessive glotto-subglottic refibrosis. After the CO(2)-laser transsection the authors applied Mitomycin-C and inserted a combined silicon stent by extra-endolaryngeal technique. After the removal of the stent the patient could be decannulated and his voice improved. The application of these minimally invasive endoscopic techniques was successful, hence it may be an effective alternative treatment option for laryngeal webs.

Comparison of endoscopic techniques designed for posterior glottic stenosis—A cadaver morphometric study

Posterior glottic stenosis may cause more or less severe dyspnea. The popular endoscopic procedures have only a limited role in the treatment. Considering our clinical experiences, endoscopic arytenoid abduction lateropexy (EAAL) after proper mobilization of the fixed joints provides an effective option even in high‐grade stenoses.

A new solution for neonatal bilateral vocal cord paralysis: Endoscopic arytenoid abduction lateropexy

Bilateral vocal cord paralysis in early childhood is a life‐threatening condition, which often requires immediate intervention. One of the treatment options is a quick, reversible simple suture vocal cord lateralizing technique, whereby the arytenoid cartilage is directly lateralized to the normal abducted position. Considering pediatric laryngeal anatomy, a small endolaryngeal thread guide instrument was designed for precise suture insertion.

Minimally invasive endoscopic treatment for pediatric combined high grade stenosis as a laryngeal manifestation of epidermolysis bullosa

Epidermolysis bullosa refers to a clinically and genetically heterogeneous group of inherited mucocutaneous diseases. Laryngotracheal lesions are momentous regarding the risk of sudden airway obstruction. The traditional treatment is tracheostomy. This case report highlights the advantages of minimally invasive interventions. A successful combined endoscopic management of a life-threatening respiratory crisis is presented in a 4-year-old child. Combined commissure stenosis with supraglottic spread was treated by CO2 laser dissection and bilateral endoscopic arytenoid abduction lateropexy, supplemented with mitomycin C application. Due to expectable less scarring, the combination of these modern methods may be an efficient solution in these vulnerable respiratory tracts.

Endoszkópos arytaenoid abdukciós lateropexia foniátriai eredményei átmeneti kétoldali gégebénulás esetén

INTRODUCTION Dyspnea caused by bilateral vocal cord paralysis often requires surgical intervention to prevent acute asphyxiation. The regeneration of the laryngeal nerves may last weeks or months and it is difficult to predict the outcome. In the past decades, several open and endoscopic surgical techniques have been introduced for treatment to avoid tracheostomy, however, these procedures with resection of the glottis resulted in irreversible changes in the laryngeal structure, thus the voice quality decreased over a long-term period. AIM Endoscopic arytenoid abduction lateropexy is an accepted reversible, minimally invasive technique that provides an immediate patent airway by the lateralisation of the arytenoid cartilage with a suture. The aim of our study was to analyze the phonatory and respiratory outcomes of this treatment concept. METHOD Two patients suffering from bilateral vocal cord palsy were treated with endoscopic arytenoid abduction lateropexy. After recovery of the vocal cord movements, the sutures were removed. Spirometric and phoniatric results of the two patients were analysed after suture removal. RESULTS Good spirometric parameters and normal voice quality were detected in both cases. CONCLUSIONS These results prove the high reversibility of the minimally invasive endoscopic arytenoid abduction lateropexy. Lateralization suture can be removed in the case of vocal cord movement recovery, and phonation may be physiological. Orv Hetil. 2018; 159(29): 1188-1192.

A laryngealis electromyographia szerepe a hangszalag-mozgászavarok diagnosztikájában és az alkalmazott kezelés kiválasztásában

Absztrakt: A hangszalag-immobilitast okozo korkepek terapias lehetősegeinek fejlődese megkovetelte a diagnosztikai modszerek parhuzamos megujulasat is. Az utobbi evekben ez a tendencia vezetett a mar 70 eve ismert laryngealis electromyographia ujrafelfedezesehez. A nemzetkozi irodalom attekintesevel es sajat tapasztalataik alapjan a szerzők bemutatjak az eljaras alkalmazasanak indikaciojat, technikai kovetelmenyeit es modszertanat, kulonos tekintettel az eredmenyek ertekelesere. A laryngealis electromyographia lehetőve teszi a beidegzesi zavarbol es a mechanikus fixaciobol adodo hangszalag-immobilitas elkuloniteset. Hangszalagbenulas eseten tovabba segitseget nyujt az idegserules fokanak objektiv megbecsuleseben, a betegseg prognozisanak felallitasaban, az esetleges hangrestagito beavatkozas indikaciojaban es pontos tipusanak meghatarozasaban. A dinamikus rehabilitacios beavatkozasok varhato egyre szelesebb elterjedese sem kepzelhető el az eljaras rutinszerű alkalmazasa nelkul. Ezek a lehetősegek mindenke...The development of the therapeutic possibilities of vocal cord immobility necessitated the parallel renewal of diagnostic methods. In the last years, laryngeal electromyography, which was first introduced more than 70 years ago, has been re-discovered. After reviewing the international literature and their own experience, the authors present the indications, technical requirements, method and, particularly, the evaluation of the results of this procedure. Laryngeal electromyography makes the differentiation between mechanical fixation and immobility with neurological origin of the vocal folds possible. In case of laryngeal paralysis/paresis it also evaluates objectively the severity of neural injury, the prognosis of the disease and the necessity of any glottis-widening procedure. The widespread application of dynamic rehabilitation interventions is not conceivable without the routine application of laryngeal electromyography, so this sensitive diagnostic tool has to be introduced in all laryngological centers. Orv Hetil. 2018; 159(8): 303-311.

A laryngomalacia endoszkópos ultrapulzációs-lézeres (ultra dream pulse) sebészete. A módszer hazai bevezetése során szerzett tapasztalataink

INTRODUCTION Congenital stridor and dyspnoe are caused by laryngomalacia in most cases. AIM In this article we present a new, surgical method for treating severe laryngomalacia in patients under the age of 1, where ultrapulsated (UDP) laser beam is used for supraglottoplasty. Ultra dream pulse laser creates lesser thermical side damage in the tissue, therefore the risk of postoperative laryngeal oedema and scarring is lower. METHOD We present 10 cases and the endoscopic UDP-laser surgery of patients under the age of 1 with severe laryngomalacia. RESULTS After the surgery the stridorous symptoms disappeared, and there was no evidence of postoperative laryngeal oedema, there was no need for reoperation or tracheotomy in any of the cases. CONCLUSION UDP-laser surgery of laryngomalacia is proven to be a safe and effective surgial modality. During the follow up visits we experienced neither recurrence of stridor nor laryngeal scarring. Orv Hetil. 2017; 158(33): 1288-1292.Absztrakt: Bevezetes: A veleszuletett csecsemőkori dyspnoe es inspiratorikus stridor leggyakoribb oka a laryngomalacia. Celkitűzes: Jelen osszeallitasban a szerzők egy uj, minimalisan invaziv, ultrapulzacios (ultra dream pulse) lezeres gegesebeszeti modszert mutatnak be, amely joval kisebb karbonizacios zonat hoz letre, mint a korabbi CO2-lezeres beavatkozasok, igy kisebb az esely a posztoperativ gegeodema es hegesedes kialakulasara. Modszer: A szerzők 2012 es 2015 kozott 10, egy evnel fiatalabb, sulyos foku stridort okozo laryngomalacias betegen vegeztek endoszkopos ultrapulzacios-lezeres supraglottoplasticat. Eredmenyek: A beavatkozas utan a stridoros panaszok javultak, a korai posztoperativ időszakban odema egy esetben sem jelentkezett, a kesőbbiek soran hegesedes sem alakult ki, tracheotomiat nem kellett vegezni, reoperaciora nem kerult sor. Kovetkeztetes: A kesői utankoveteses vizsgalatok soran visszaesest egy alkalommal sem tapasztaltunk. Orv Hetil. 2017; 158(33): 1288–1292.