Takaharu Nito

Collagen Injection as a Supplement to Arytenoid Adduction for Vocal Fold Paralysis

Objectives: Dysphonia associated with vocal fold paralysis can persist even after successful medialization procedures, including arytenoid adduction. It is hypothesized that laryngeal collagen injection could improve phonation following arytenoid adduction in selected patients. Our objective was to evaluate how collagen injection could result in measurable improvements in vocal function and voice quality. Methods: Forty patients with unilateral vocal fold paralysis who had undergone arytenoid adduction underwent transoral injection of non—cross-linked bovine dermal collagen by means of indirect laryngoscopy and a curved injection device. A control group of 40 patients underwent arytenoid adduction but not collagen injection. The patients voice quality was assessed perceptually with the GRBAS scale, and vocal function was assessed by acoustic and aerodynamic measures (maximum phonation time and transglottal DC flow). The relative glottal area was also assessed by videostroboscopy. Results: Significant improvements in vocal function and voice quality were observed with collagen injection for those patients who did not achieve satisfactory glottal competence with arytenoid adduction alone. Glottal area measurements revealed that glottic insufficiency was significantly reduced after arytenoid adduction as well as after collagen injection. Conclusions: The findings suggest that collagen injection could be an effective supplementary treatment for improving voice following arytenoid adduction. It has the advantage of being a minimally invasive outpatient office procedure. The long-term efficacy of the procedure should be explored.

Analyses of risk factors for postoperative airway compromise following arytenoid adduction.

Conclusion. This study suggests that placing no drainage tube and postoperative bleeding are risk factors for postoperative airway compromise (PAC) following arytenoid adduction (AA). Objectives. In this study, we aimed to elucidate the risk factors for PAC following AA. Patients and methods. The data for 184 consecutive patients who underwent AA were analyzed retrospectively. Univariate and forward stepwise multivariate logistic regression analyses were performed. Results. Placing no drainage tube was a significant risk factor for PAC as determined by both univariate and multivariate analyses. Postoperative bleeding was a significant risk factor for severe airway compromise requiring emergency airway treatment.

Parathyroid adenoma causing spontaneous cervical hematoma: a case report.

A case of parathyroid adenoma causing a spontaneous cervical hematoma is reported. A 55-year-old woman presented with painful swallowing, dysphagia, and dyspnea. Primary hyperparathyroidism and a parathyroid tumor on the left side of the neck had been found 2 years earlier. Fiberoptic laryngoscopy and computed tomography (CT) showed a narrowing of the airway as a result of a retropharyngeal hematoma, and tracheostomy was carried out. Parathyroidectomy was performed 5 months after the absorption of the hematoma, with no complications. A pathological diagnosis revealed a parathyroid adenoma with hemosiderin deposition and fibrosis. Serum calcium and intact parathormone levels normalized postoperatively. Although a spontaneous cervical hematoma resulting from parathyroid tumors rarely occurs, it may lead to an airway compromise. Physicians should be aware of this if such tumors are managed conservatively without surgery.