Mark S. Courey

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, die 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.

Voice-Related Quality of Life in T1 Glottic Cancer: Irradiation versus Endoscopic Excision

Objectives: Several studies have explored posttreatment voice outcomes for early glottic cancer with varying results. To further clarify the voice-related quality of life (QOL) of T1 glottic cancer patients treated by external beam radiotherapy (EBRT) compared to endoscopic carbon dioxide laser excision (CLE), we performed a meta-analysis. Methods: We performed a meta-analysis review for the years 1966 to 2005 for the Voice Handicap Index (VHI), laryngeal cancer, voice outcome, voice quality, and quality of life. Studies in which the VHI was assessed at least 3 months after treatment for T1 glottic cancer were identified and analyzed by meta-analysis techniques. Results: Six studies with 208 patients (6 T1b and 202 T1a) treated with CLE and 91 patients (6 T1b and 85 T1a) treated with EBRT were identified. The posttreatment VHI scores were similar for the EBRT- and CLE-treated patients (p = .1, Wilcoxon rank sum test). Conclusions: We conclude that CLE and EBRT provide comparable levels of voice handicap for patients with T1 glottic cancer.

Prevalence and causes of dysphonia in a large treatment‐seeking population

To determine the prevalence and common causes of dysphonia as diagnosed by primary care physicians (PCPs) and otolaryngologists and to evaluate differences in etiologies offered by these providers.

Current practice in injection augmentation of the vocal folds: Indications, treatment principles, techniques, and complications

To identify contemporary indications, treatment principles, technique, injection materials, complications, and success rates of vocal fold injection augmentation.

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.

Reanimation of the Paralyzed Human Larynx With an Implantable Electrical Stimulation Device

Objectives/Hypothesis Electrical stimulation of the posterior cricoarytenoid muscle, when paced with inspiration, offers a physiological approach to restore ventilation in bilateral laryngeal paralysis without any of the disadvantages associated with conventional treatment.

Risk factors and demographics in patients with spasmodic dysphonia.

Objectives Spasmodic dysphonia has been characterized as a functional, psychogenic, or movement disorder with no known etiology or cure. In the present study, risk factors associated with other movement disorders were evaluated in patients with spasmodic dysphonia.

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.

Effect of Temporary Vocal Fold Injection Medialization on the Rate of Permanent Medialization Laryngoplasty in Unilateral Vocal Fold Paralysis Patients

To determine whether temporary vocal fold injection affects the need for permanent medialization laryngoplasty in patients with unilateral vocal fold paralysis (UVFP).

Carbon Dioxide Laser Endoscopic Diverticulotomy Versus Open Diverticulectomy for Zenker's Diverticulum

Objectives/Hypothesis To compare open and CO2 laser–assisted endoscopic surgical management of Zenkers diverticulum.