Serdar Özer

Comparison of voice and swallowing parameters after endoscopic total and partial arytenoidectomy for bilateral abductor vocal fold paralysis: a randomized trial.

IMPORTANCE Total arytenoidectomy is claimed to increase risk of aspiration and cause more voice loss than other operations performed for bilateral abductor vocal fold paralysis (BVFP). However, objective evidence for such a conclusion is lacking. There is no study comparing swallowing and voice after total and partial arytenoidectomy. OBJECTIVE To compare voice and swallowing parameters after endoscopic total and partial arytenoidectomy for BVFP. DESIGN, SETTING, AND PARTICIPANTS In this prospective, randomized, double-blind, case-control study conducted at a tertiary referral university, the study population comprised 20 patients with BVFP. INTERVENTIONS Endoscopic total and partial arytenoidectomy. MAIN OUTCOMES AND MEASURES Decannulation, duration of operation, Voice Handicap Index, acoustic and aerodynamic analysis, postoperative breathing ability, subjective comparison of preoperative and postoperative voice, speech intensity, and functional outcome swallowing scale. RESULTS Median duration of partial and total arytenoidectomies were 59 and 49 minutes, respectively. This difference was statistically significant (P = .04). Comparisons of preoperative and postoperative Voice Handicap Index, acoustic and aerodynamic measures, postoperative breathing ability, subjective comparison of preoperative and postoperative voice, speech intensity, and functional outcome swallowing scale were not statistically significantly different between both groups. CONCLUSIONS AND RELEVANCE Endoscopic total and partial arytenoidectomy are very successful static surgical options for BVFP. Partial takes longer than total arytenoidectomy. They both provide a comfortable airway, acceptable voice, and acceptable deglutition. It may be a sound practice to perform partial arytenoidectomy initially for primary BVFP cases and reserve total arytenoidectomy for revision cases. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT01824849.

A new transnasal approach to nasolabial cyst: endoscopic excision of nasolabial cyst.

Nasolabial cyst (NC) is one of the midface lesions that are seen rarely. Nasolabial cyst is generally seen in females typically on the fourth and fifth decades and localized unilaterally. Diagnosis usually depends on clinical evaluation. Sublabial excision is the classic method, but endoscopic marsupialization is suggested in current literature. An NC that is totally excised endoscopically is introduced in this article. This is the first case of NC excised endoscopically that is described in English literature.

Pharyngocutaneous fistula after salvage laryngectomy.

Abstract Conclusion: Preoperative chemoradiotherapy (CRT) was associated with a significantly higher rate of pharyngocutaneous fistula (PCF). Objective: PCF is the most frequent complication following total laryngectomy. Although organ-preserving radiotherapy (RT) or CRT offer good locoregional control, many patients still require salvage laryngectomy. The aim of this study was to evaluate the factors that predispose patients to PCF, with a focus on preoperative RT, induction chemotherapy (ICT), and CRT. Methods: This was a retrospective case series; 151 patients who underwent TL were reviewed. Preoperative RT, ICT, CRT, and some surgical parameters were analyzed as potential risk factors. Results: The overall PCF rate was 13%. CRT was the only preoperative treatment that had a significant effect on PCF (35.3%, p = 0.004, odds ratio (OR) = 10.75). Surgery extended to the pharynx (p = 0.005, OR = 8.34) and vacuum drain duration (p = 0.012, OR = 5.16) were observed to be associated with PCF.

Recurrent Contact Granuloma Experience With Excision and Botulinum Toxin Injection

IMPORTANCE Contact granuloma is a difficult-to-treat laryngeal disorder associated with vocal abuse, habitual throat clearing, and laryngopharyngeal reflux. It has a high propensity for persistence and recurrence despite many treatment alternatives. OBJECTIVE To present our experience with recurrent contact granuloma treated with microlaryngoscopic excision and botulinum toxin injection. DESIGN Case series. The follow-up period had a mean (range) of 41 (11-88) months. SETTING Tertiary referral university clinic. PARTICIPANTS Twenty patients with recurrent, grade 3 and grade 4 contact granuloma whose lesion was excised at least once after failure of conservative treatments. INTERVENTIONS Microlaryngoscopic excision and botulinum toxin type A injection into the region of the bilateral thyroarytenoid and lateral cricoarytenoid muscles. MAIN OUTCOMES AND MEASURES Disappearance of contact granuloma. RESULTS Seventeen patients were cured of their contact granuloma. Three patients experienced recurrences: 2 received botulinum toxin injection only as outpatients and recovered. The other patient required reexcision and reinjection under general anesthesia. These 3 patients were free of granuloma at their last follow-up. CONCLUSIONS AND RELEVANCE After failed conservative treatment, microlaryngoscopic excision and botulinum toxin type A injection is successful in the treatment of recurrent contact granuloma. Removing recurrent granulomas can result in a low recurrence rate if botulinum toxin type A is added at the time of removal.

The effect of midline crossing of lateral supraglottic cancer on contralateral cervical lymph node metastasis

Abstract Conclusion: The degree of midline crossing of lateral supraglottic cancer does not significantly change its rate of contralateral cervical metastasis. The rate of occult metastasis is too high to take the risk of contralateral regional recurrence. We support routine bilateral neck dissection even in lateral supraglottic cancers with no or minimal midline crossing. Objectives: Data on the rate of contralateral cervical metastasis of laterally located supraglottic cancer, the effect of its degree of midline crossing on contralateral cervical metastasis, and its treatment are still controversial. Methods: This was a retrospective cohort, chart review involving 305 surgically treated patients with T1–3 squamous cell carcinoma of the supraglottic larynx. In all, 184 patients had bilateral neck dissection; 86 N0 contralateral necks were followed up. Thirty-five patients who needed postoperative radiation therapy because of the primary tumor or ipsilateral neck dissection specimen also received radiation therapy to the contralateral neck. The degree of midline crossing at the epiglottis was measured on a laryngectomy specimen with a ruler and expressed as ‘no,’ ‘<5 mm’ or ‘≥5 mm.’ Results: The rates of occult and overall contralateral metastasis in our series were 16% and 28%, respectively. There was no statistically significant difference between contralateral neck metastasis and recurrence rates in the neck dissection, follow-up, and irradiation groups according to the degree of midline crossing.

Total and Partial Laser Arytenoidectomy for Bilateral Vocal Fold Paralysis.

Introduction. Treatment for bilateral vocal fold paralysis (BVFP) has evolved from external irreversible procedures to endolaryngeal laser surgery with greater focus on anatomic and functional preservation. Since the introduction of endolaryngeal laser arytenoidectomy, certain modifications have been described, such as partial resection procedures and mucosa sparing techniques as opposed to total arytenoidectomy. Discussion. The primary outcome measure in studies on BVFP treatment using total or partial arytenoidectomy is avoidance of tracheotomy or decannulation and reported success ranges between 90 and 100% in this regard. Phonation is invariably affected and arytenoidectomy worsens both aerodynamic and acoustic vocal properties. Recent reports indicate that partial and total arytenoidectomies have similar outcome in respect to phonation and swallowing. We use CO2 laser assisted partial arytenoidectomy with a posteromedially based mucosal flap for primary cases and reserve total arytenoidectomy for revision. Lateral suturing of preserved mucosa provides tension on the vocal fold leading to better voice and leaves no raw surgical field to unpredictable scarring or granulation. Conclusion. Arytenoidectomy as a permanent static procedure remains a traditional yet sound choice in the treatment of BVFP. Laser dissection provides a precise dissection in a narrow surgical field and the possibility to perform partial arytenoidectomy.

Sole effect of genioglossus advancement on apnea hypopnea index of patients with obstructive sleep apnea

Abstract Conclusion: Selected patients might have benefited from genioglossus advancement (GA), even it was applied solely. GA provided significant reduction on the apnea hypopnea index (AHI), with a 53% surgical success. Objectives: The aim of this study was to evaluate the impact of GA on AHI of patients with obstructive sleep apnea (OSA). Method: From January 2008 to April 2014 patients who underwent a genioglossus advancement procedure alone were included into the study and records of these cases were analyzed retrospectively. Pre-operative and post-operative values of body mass index (BMI), Epworth Sleepiness Scale (ESS), nocturnal polysomnographic data including AHI, mean, and minimum oxygen saturation were compared. Results: There were 16 males and one female patient with the mean age of 46 years. The AHI showed a significant reduction from 27.5 ± 8 pre-operatively to 17.3 ± 12.6 post-operatively. The pre-operative and post-operative mean O2 saturation value improved from 92.1 ± 2.4% to 93.4 ± 1.7%. Pre-operative ESS scores decreased significantly from 7.7 ± 1.6 to 4.8 ± 1.9. There were no significant difference between pre- and post-operative values of BMI and minimum O2 saturation. The success rate was found to be 53%, which was based on success criteria as an AHI of <20 with at least 50% reduction.

New laryngoscope for endoscopic arytenoidectomies

OBJECTIVE During an endoscopic arytenoidectomy, an intubation tube must be elevated anteriorly with the laryngoscope to ensure an adequate surgical field. This paper describes a new laryngoscope that has a canal along the outer wall of the body and a ridge which runs along the canal. METHOD Ten patients underwent endoscopic total arytenoidectomy using this new laryngoscope and 10 patients underwent the same operation using a regular laryngoscope. RESULTS The duration of all operations ranged between 25 and 65 minutes, with a median duration of 42.5 minutes. The median duration with the new laryngoscope was 39 minutes, and that with the regular laryngoscope was 49 minutes; this difference was statistically significant (p < 0.05). CONCLUSION This new laryngoscope shortened the duration of the endoscopic arytenoidectomy and facilitated the procedure by enlarging the surgical field. This new laryngoscope may be a beneficial surgical instrument for posterior endoscopic laryngeal operations.

A Rare Location of Angiofibroma in the Inferior Turbinate in Young Woman

Introduction Juvenile nasopharyngeal angiofibroma is a rare benign neoplasm in the nasopharynx. The tumor tends to be locally aggressive and is typically seen in adolescent boys. Extranasopharyngeal angiofibromas have been reported sporadically in the literature. They most commonly originate from the maxillary sinus. Objectives A 26-year-old woman was referred to our clinic with intermittent epistaxis from the right nasal passage for the previous 2 months. Maxillofacial magnetic resonance imaging showed a lobular, contoured mass originating from the right inferior turbinate and hanging in the right nasal cavity, with dense contrast enhancement denoting hypervascularity. Resumed Report Vascular feeding of the mass was seen from the right internal maxillary artery with angiography, and this branch was embolized. On the following day, the patient underwent transnasal endoscopic excision of the mass. An approximately 3-cm-diameter mass was excised by partial turbinectomy, and the posterior edge of the remaining turbinate was cauterized. Conclusion Extranasopharyngeal angiofibromas are rarely seen, and the inferior turbinate is an extremely rare location for them. This young woman is the first case reported in the English literature of angiofibroma originating from the inferior turbinate. We should consider these neoplasms can be found in female, nonadolescent patients with extranasopharyngeal localization, and we should not perform biopsy because of its massive bleeding.

Novel endoscopic treatment of pharyngocele: Endoscopic suture pharyngoplasty

Pharyngocele or a lateral pharyngeal diverticulum (LPD) are rare lesions, which are bulgings of the pharyngeal mucosal surface through one of the weak areas of the pharynx.