Daniel S. Fink

Effects of 2 different swallowing exercise regimens during organ-preservation therapies for head and neck cancers on swallowing function.

This study investigated the effects of 2 different swallowing exercise regimens performed during radiation therapy with/without chemotherapy on swallowing function.

Subjective and objective voice outcomes after transoral laser microsurgery for early glottic cancer.

Transoral laser microsurgery (TLM) continues to gain popularity as a treatment modality for early glottic cancer. Oncologic outcomes have been well‐defined, but there are little data to date describing functional outcomes accounting for stage of resection.

Stimulation threshold greatly affects the predictive value of intraoperative nerve monitoring.

Using a standardized, graded, intraoperative stimulation protocol, we aimed to delineate the effects of various stimulation levels applied to the recurrent laryngeal nerve on the postoperative predictive value of intraoperative nerve monitoring.

Interarytenoid botulinum toxin injection for recalcitrant vocal process granuloma.

This study evaluated the efficacy of botulinum toxin type A injected into the interarytenoid muscle to treat recalcitrant vocal process granulomas.

Lobular capillary hemangioma of the nasal cavity in a five-year-old boy.

Afive-year-old male was referred to the pediatric otolaryngology clinic with recurrent right anterior epistaxis and unilateral nasal obstruction. There was no history of systemic disease, neurologic changes, trauma, or foreign body insertion. He had no significant medical or surgical history. Upon examination, he was noted to have an obstructing friable right intranasal mass (Fig 1). Anterior rhinoscopy was normal on the opposite side. The remainder of his head and neck examination was normal. Imaging studies revealed a lobular heterogeneous nasal mass causing mass effect on the septum and lateral nasal wall. There was no erosion or remodeling of bone, and no extension outside of the nasal cavity. No prominent feeding vessels were identified. The mass was excised endoscopically using image guidance. Intraoperatively, the mass was noted to have a single pedicle attachment to the nasal septum. Under direct visualization, the posterior septal attachment was lysed. Due to the size of the mass, it could not be extracted through the nose. It was pushed into the nasopharynx and removed transorally. The final histopathologic diagnosis was lobular capillary hemangioma. On follow-up at eight months, the patient reported resolution of his epistaxis and improved nasal breathing, and fiberoptic endoscopy revealed no evidence of recurrence. Lobular capillary hemangioma (LCH), formerly known as pyogenic granuloma, is a benign vascular lesion of the skin and mucosa. These lesions are more common in male children and in female adults during pregnancy. The head and neck are the most frequent sites of occurrence, with cutaneous or lip lesions presenting most commonly, followed by oral mucosa and nasal mucosa. LCH of the nasal mucosa can present with recurrent unilateral epistaxis and unilateral nasal obstruction or rhinorrhea. Most nasal lesions occur in Little’s area on the anterior septum, in the nasal vestibule or inferior turbinate. Repetitive trauma or manipulation has been suspected as a causative factor. LCH can evolve rapidly over the course of a few weeks but does not demonstrate the proliferative and involutional phases characteristic of classic hemangioma of infancy. Diagnosis involves a complete history and physical, with endoscopic evaluation of the nasal cavities. Imaging with CT and MRI can be useful for narrowing the differential diagnosis and defining a treatment plan. The definitive treatment is complete removal. Endoscopic excision is the preferred technique to ensure localization of the mucosal origin and to avoid facial incisions. Embolization and adjuvant therapies are unwarranted. With complete resection, recurrences are rare. This case report was deemed exempt from human studies committee review.

Balloon Dilation Complication during the Treatment of Subglottic Stenosis: Background of the FDA Class 1 Recall for the 18 × 40-mm Acclarent Inspira AIR Balloon Dilation System

Objectives: Balloon dilation for subglottic stenosis allows for a controlled radial expansion of the airway and is considered superior to older techniques of airway dilation. We report the case of a 39-year-old woman with idiopathic subglottic stenosis who had entrapment of an inflated balloon in her subglottis due to device failure while undergoing balloon dilation of the stenotic area. Methods: We present a case report and a review of the literature. Results: As a result of this and other reported incidents, on March 13, 2012, the US Food and Drug Administration issued a class 1 recall of the 18 × 40-mm Acclarent Inspira AIR Balloon Dilation System (Acclarent Inc, Menlo Park, California). Conclusions: This is the first report describing a dislodged inflated balloon in the subglottis as a complication of dilation for idiopathic subglottic stenosis. Awareness of this possibility, as well as preparedness with the proper instruments, is vital for prevention of a catastrophic emergency during an otherwise low-risk procedure.

Repair of pharyngocutaneous fistula after total laryngectomy: A novel endoscopic approach

Pharyngocutaneous fistula (PCF) is a common and challenging complication of laryngectomy. The purpose of this study was to evaluate the results of endoscopic repair of postlaryngectomy PCF.

Effect of Increased Body Mass Index on Complication Rates during Laryngotracheal Surgery Utilizing Jet Ventilation

Objective Jet ventilation has been used for >30 years as an anesthetic modality for laryngotracheal surgery. Concerns exist over increased risk with elevated body mass index (BMI). We reviewed our experience using jet ventilation for laryngotracheal stenosis to assess for complication rates with substratification by BMI. Study Design Case series with chart review. Setting Tertiary care center. Subjects and Methods A total of 126 procedures with jet ventilation were identified from October 2006 to December 2014. Complications were recorded, including intubation, unplanned admission, readmission, dysphonia, oral trauma, pneumothorax, pneumomediastinum, and tracheostomy. Lowest intraoperative oxygen saturation and maximum end-tidal CO2 (ETCO2) levels were recorded. Results Among 126 patients, 43, 77, and 6 had BMIs of <25, 25-35, and 36-45, respectively. In the BMI <25 group, there was 1 unplanned intubation. Mean maximum ETCO2 was 36.51 with no hypoxemia observed. In the BMI 25-35 group, 2 patients required intubation, and 1 sustained minor oral trauma. The mean maximum ETCO2 was 38.85, with 4 patients having oxygen saturation <90%. In the BMI 36-45 group, 2 patients required intubation. The mean maximum ETCO2 was 41 with no hypoxemia observed. BMI and length of stenosis were statistically significant variables associated with incidence of intraoperative intubation. Conclusion Increased BMI was associated with an increase in highest ETCO2 intraoperatively. However, this was not associated with an increase in major complications. Jet ventilation was performed without significant adverse events in this sample, and it is a viable option if used with an experienced team in the management of laryngotracheal stenosis.

Injection Laryngoplasty Using Micronized Acellular Dermis for Vocal Fold Paralysis: Long-term Voice Outcomes.

Objectives Micronized acellular dermis has been used for nearly 15 years to correct glottic insufficiency. With previous demonstration of safety and efficacy, this study aims to evaluate intermediate and long-term voice outcomes in those who underwent injection laryngoplasty for unilateral vocal fold paralysis. Technique and timing of injection were also reviewed to assess their impact on outcomes. Study Design Case series with chart review. Setting Tertiary care center. Subjects and Methods Patients undergoing injection laryngoplasty from May 2007 to September 2012 were reviewed for possible inclusion. Pre- and postoperative Voice Handicap Index (VHI) scores, as well as senior speech-language pathologists’ blinded assessment of voice, were collected for analysis. The final sample included patients who underwent injection laryngoplasty for unilateral vocal fold paralysis, 33 of whom had VHI results and 37 of whom had voice recordings. Additional data were obtained, including technique and timing of injection. Results Analysis was performed on those patients above with VHI and perceptual voice grades before and at least 6 months following injection. Mean VHI improved by 28.7 points at 6 to 12 months and 22.8 points at >12 months (P = .001). Mean perceptual voice grades improved by 17.6 points at 6 to 12 months and 16.3 points at >12 months (P < .001). No statistically significant difference was found with technique or time to injection. Conclusion Micronized acellular dermis is a safe injectable that improved both patient-completed voice ratings and blinded reviewer voice gradings at intermediate and long-term follow-up. Further investigation may be warranted regarding technique and timing of injection.

Secondary tracheoesophageal puncture using transnasal esophagoscopy in gastric pull-up reconstruction after total laryngopharyngoesophagectomy

There is debate about the optimal voice restoration method and technique for patients who have undergone total laryngopharyngectomy, esophagectomy, and gastric pull‐up. The purpose of this study was to report a series of patients who underwent awake, secondary tracheoesophageal puncture (TEP) after this procedure.