Nicolas E. Maragos

Swallow Function in Patients Before and After Intra‐Arterial Chemoradiation

Objectives/Hypothesis To prospectively evaluate swallow function in patients with advanced head and neck cancer before and after completion of intra‐arterial chemoradiation therapy and planned neck dissection.

The study of vocal fold vibratory patterns in patients with unilateral vocal fold paralysis before and after type I thyroplasty with or without arytenoid adduction

Type I thyroplasty and arytenoid adduction have been used for the treatment of symptomatic unilateral vocal fold paralysis since the mid‐1970s. To this date, the vibratory patterns of the vocal folds in patients with unilateral vocal fold paralysis undergoing thyroplasty have not been studied in depth. Abnormal vibration of the vocal fold mucosa often contributes to voice problems in persons diagnosed with vocal diseases or disorders. The preoperative and postoperative videostroboscopic vibratory patterns including mucosal wave, amplitude, glottic closure, and symmetry were studied in 12 patients who underwent unilateral type I thyroplasty separately or in combination with an arytenoid adduction. The observed changes and clinical implications are discussed.

Airway Compromise in Thyroplasty Surgery

Objectives Airway compromise arising from thyroplasty procedures including Isshiki type I through IV thyroplasties, arytenoid adduction, and arytenoid fixation is uncommon yet potentially life threatening. Identification of incidence of obstruction and probable causes is important for preoperative planning, consultation, and postoperative care.

The posterior thyroplasty window: anatomical considerations.

Objectives: Explain surgical technique of performing a posterior thyroplasty window. 1 Describe the internal laryngeal anatomy and structures available through the posterior window approach. Describe posterior window approach.

Arytenoid adduction and type I thyroplasty in the treatment of aphonia.

Arytenoid adduction is a procedure used to medialize the paralyzed vocal fold, closing the posterior glottis. Isshiki type I thyroplasty allows medialization of the anterior membranous vocal fold. Using the arytenoid adduction, in combination with Isshiki type I thyroplasty as needed, five patients were treated for aphonia. Surgical results were evaluated with voice recordings, electroglottography, and photoglottography. Jitter ratio, shimmer ratio, and signal-to-noise ratio were measured. Laryngeal stroboscopy and glottography were used to assess the mucosal wave and vibratory nature of the vocal folds. After operation, vocal function was restored. Analysis of data from these five aphonia patients revealed improved glottic phonatory function. The arytenoid adduction in combination with the Isshiki type I thyroplasty is an effective technique for aphonia caused by a significant posterior glottic gap with unilateral vocal-cord paralysis.

Pyriform sinus mucosa stabilization for prevention of postoperative airway obstruction in arytenoid adduction.

Objectives: The Isshiki arytenoid adduction procedure directly closes the open posterior glottis. Postoperative airway obstruction that necessitates emergent tracheotomy is an important complication in arytenoid adduction patients when the standard posterior thyroplasty window is used to approach the posterolateral larynx. Immediate postoperative fiberoptic laryngoscopy shows ipsilateral edema and/or hematoma of the arytenoid and supraglottic mucosa, with occasional obstructing inspiratory collapse. In this study, I sought to modify the posterior window approach during arytenoid adduction surgery, and thereby decrease the incidence of immediate postoperative airway obstruction. Methods: I performed a retrospective chart review of 246 arytenoid adduction patients, looking for immediate postoperative airway compromise. Results: There were no episodes of postoperative airway obstruction that necessitated tracheotomy in the first 30 patients in whom I approached the posterolateral larynx using the classic Isshiki techniques. Nine of the succeeding 132 adduction patients required emergent tracheotomy when the standard posterior window technique was used instead of a classic Isshiki approach (6.8%). In the most recent 84 patients, I used one tacking suture to stabilize the elevated pyriform sinus mucosa to the upper margin of the posterior window cartilage at closure. Four of the 84 patients had audible postoperative airway turbulence that abated with medical treatment, and 1 patient required an emergent tracheotomy (1.2%; p = .0495). Conclusions: Suture stabilization of the pyriform sinus mucosa is effective and is recommended for prevention of posterior glottic airway obstruction after arytenoid adduction when the posterior window technique is used.

Physiologic assessment of isshiki type III thyroplasty

Isshiki type III thyroplasty is a laryngeal framework surgical procedure that lowers a patients pitch. To objectively assess the procedure, preoperative and postoperative voice recordings, as well as electroglottography and photo‐glottography were performed. Jitter, shimmer, and glot‐tographic quotients were measured to assess changes in vibratory pattern. The mean and range of frequencies in contextual speech was also determined. Analysis of the preoperative and postoperative data from two patients with over 1 year follow‐up showed a decrease in frequency of vibration. Postoperatively, the vocal folds still vibrated in a regular pattern as described by the myoelastic‐aerody‐namic theory. There was no increase in jitter or shimmer quotient. The Isshiki type HI thyroplasty appears capable of lowering fundamental frequency of speech without adversely affecting the vibratory mode of the vocal folds.

Extraskeletal Ewing's Sarcoma Occurring as a Mass in the Neck

Extraskeletal Ewings sarcoma is a rare malignant neoplasm. Arising from a primitive mesenchymal stem cell and primarily affecting young adults, this lesion demands aggressive therapy, including surgical treatment, radiation therapy, and chemotherapy.

Granulocytic sarcoma (chloroma) of the epiglottis

Granulocytic sarcoma (GS), or chloroma, is a myeloblastic tumor composed of immature cells of the myelogenous series that form true tumor masses. The term chloroma is derived from the green color of the tumor on gross sectioning; this color is due to the presence of a myeloperoxidase. This solid tumor is associated with leukemias and other myeloproliferative disorders and can occur at different stages of hematologic malignant tumors, as a primary manifestation before the development of blood and bone marrow involvement or in later stages of an established leukemic process. GS can occur anywhere in the body, but shows a propensity for periosteum, soft tissue and bone, lymph nodes, and skin. Here we present a case of GS of the epiglottis-a rare site for this lesion, but of interest and importance to physicians who specialize in this anatomic region.

Thyroplasty in the previously irradiated neck: A case series and short‐term outcomes

External beam radiation to the neck is widely considered a contraindication for thyroplasty due to concern for infection and implant extrusion. We present a case series of our experience regarding thyroplasty performed in a previously radiated field.