Ferhan Oz

Lipoid proteinosis of the larynx.

Lipoid proteinosis is a rare disease that presents with hyaline deposits in many tissues. It involves predominantly the skin and upper aerodigestive tract, presenting with small yellowish papules and hoarseness. It may involve the central nervous system and cause intracerebral calcifications. Laryngeal lesions may resemble singers nodule or chronic laryngitis. The pathogenesis of the disease is not clear although several studies suggest a defective collagen production and/or lysosomal storage disease. In this article two cases with skin and larynx involvement are reported.

Tracheal reconstruction using alcohol-stored homologous cartilage and autologous cartilage in the rabbit model

OBJECTIVE Reconstruction of laryngotracheal stenosis continues to pose a significant challenge. Cartilage grafts have been in use for almost a century, but despite good clinical results, many questions concerning the survival and growth of implanted cartilage persist. To reduce donor site morbidity, the use of homologous cartilage has been investigated. This study compared alcohol-stored homologous auricular cartilage with autologous auricular cartilage for anterior graft laryngotracheal reconstruction in a rabbit model. METHODS Autologous and alcohol preserved homologous auricular cartilage was transplanted to the resected anterior tracheal wall of the twenty New Zealand rabbits. Rabbits were sacrificed 6 weeks after surgery and histologic analysis was performed on the implanted cartilage grafts. RESULTS The autografts were significantly more likely than the homografts to demonstrate viable cells (95% vs. 30%, P<0.05) and less likely to exhibit significant resorption, fibrosis or necrosis (P<0.05). Resorption and necrosis were most common in areas of trauma to the graft. Complete epithelialization occurred in all of the autografts but in only 65% of the homografts (P<0.05). New cartilage formation and integration of the implanted grafts was poor with both types of grafts. CONCLUSION Autologous cartilage appears to have better survival than alcohol preserved homologous cartilage when used for anterior graft laryngotracheal reconstruction in a rabbit model.

Paradoxical vocal cord motion--haloperidol usage in acute attack treatment.

Paradoxical vocal cord motion (PVCM) is an uncommon disease characterized by vocal cord adduction during inspiration and/or expiration. It can create shortness of breath, wheezing, respiratory stridor, or breathy dysphonia. Possible etiological factors include asthma, underlying psychologic condition, gastroesophageal acid reflux disease, respiratory irritants exposure, central neurologic diseases, viral upper airway infections, and postsurgical procedures. Many treatment modalities were performed for acute attack of PVCM, including reassurance and onsite maneuvers, benzodiazepines, heliox, and so forth. We report a patient with PVCM who had stridor and dyspnea for 10 days and responded to intravenous haloperidol treatment.

Stridor associated with essential laryngeal myoclonus

An isolated abnormal rhythmic laryngeal movement is a very rare condition. In most cases, this movement is related with palatal movements, of which it is only one component. Usually, abnormal palatolaryngeal movements refer to the well-known concept of palatal myoclonus, recently also designated as palatal tremor. Palatal myoclonus can be symptomatic or essential. Involvement of the larynx, either in its inner or outer part, is possible in both forms, although it is more common in symptomatic cases. Symptomatic palatal or palatolaryngeal myoclonus is due to a brainstem and/or a cerebellar lesion in the olivary-dentatorubro pathways, inducing an inability to inhibit the firing of cranial nerve motor nuclei. There are few reports of abnormal palatolaryngeal movement due to a cortical epileptic process or a peripheral nerve lesion. In more than 80% of cases, the presenting complaints are related to the underlying neurological disease; audible ear clicks are reported in only 8% of the patients. Essential palatal or palatolaryngeal myoclonus is a different entity, as there is no related neurological disease, and longlasting audible ear clicks are the presenting complaint in 90% of the patients. An isolated abnormal rhythmic laryngeal movement is a very unusual condition. In most cases, this movement is a component of palatal movements. Here, we present an unusual case in which the stridor was associated with isolated abnormal laryngeal movements. A 50-year-old man with no specific medical condition was first referred to a hospital in May 1990 because of stridor. The problem had started 1 year earlier, and he was wrongly diagnosed with bilateral vocal cord paralysis. Microlaryngeal surgery was performed, and the left arytenoid cartilage was removed. Afterward the patient was referred to us for evaluation of a persistent stridor. Laryngologic examination revealed bilateral rhythmic contractions of the vocal cords hitting together at a rate varying from 60 to 80 beats per minute. The abnormal movement of the vocal cords was observed during inspiration and it was synchronous with the contraction of extra-laryngeal muscles. There were no simultaneous movements of the soft palate, tym-

Laryngotracheal Blunt Trauma

Laryngotracheal trauma is probably underestimated because the consequence of such trauma can range from mild hoarseness to complete airway compromise Narrowing of the airway results in breathing difficulty. These are the patients registered in emergency archives. Complication rates among these patients are as high as 15-25%. The team in charge of the patient must keep in mind that the airway will become worse with time as the edema increases. The elasticity of the cartilage framework contributes to its recoil, saving the airway even if the external pressure or the blow is strong enough to exceed the resistance of this structure. The larynx and trachea are vulnerable only to direct blows to the anterior neck. The object of contact has to approach the larynx in a horizontal manner. If the object is in vertical position relative to the body, the impact is blocked by the facial skeleton and/or sternum and clavicle heads. Fiberoptic laryngoscopy has become the initial evaluation tool. In case the endolarynx cannot be assessed with flexible laryngoscopy due to laryngeal edema, direct laryngoscopy should be carried out under general anesthesia. All of the upper aerodigestive tract mucosa should be examined Cartilage frame fractures are rare in the pediatric age group, but soft tissue edema and hematoma are more common. In elderly people, the cartilage framework is usually calcified and has undergone osseous transformation. The laryngotracheal fractures in this age group are more common and usually more severe. Posterior or lateral dislocations of the arytenoids may occur at this stage when the thyroid cartilage is pressed against the vertebra by external pressure. Posterior dislocation of the arytenoids is reported to be more common. It is usually associated with traumatic orotracheal intubation rather than external trauma. Dislocations can be confused with vocal cord paralysis. Electromyography is an important tool to differentiate the two conditions. In the rare case of complete disruption between the cricoid cartilage and the trachea, the strap muscles and the surrounding fascia can serve as a temporary airway until the patient is managed by intubation or tracheotomy. Once the injuries are addressed and the patient is stabilized and assessed, the larynx and cervical trauma should be repaired surgically as soon as possible. A patient with minimal soft tissue edema, mobile vocal cords, and no difficulty with breathing can be observed closely without any surgical intervention.