Wojciech Scierski

Local Complications after Laser Arytenoidectomy due to Bilateral Vocal Cord Paralysis

Summary The total laser arytenoidectomy is currently one of the most frequent endoscopic procedures in bilateral vocal cord paralysis. The laser introduction in such cases in the early eighties resulted in great advancement. However, the best method – free of complications – does not exist yet. The aim of the study was to analyse the rate, character and reasons of local complications. 40 patients with bilateral vocal cord paralysis were treated in II ENT Department Silesian Medical University. All of them underwent total laser arytenoidectomy with posterior cordectomy due to persistent bilateral vocal cord paralysis. Vocal cord paralysis occurred in 38 patients after thyroidectomy and 2 cases were classified as idiopathic. Among 40 operated patients the local complications appeared in 3 of them (7,5%). After the complications were totally excised in re-operation, a histopathological analysis was done. The significant degree of inflammation responsible for prolonged healing and the appearance of granulation was shown. The presence of the tracheostomy during the healing process is suspected to be a potential reason of this complication. Also, the other factors influencing on healing process were analysed. The necessity of anti-inflammatory prevention during and after the surgery was emphasized. The only complication of laser surgery observed was granulation tissue appearence.

Obstructive sleep apnea syndrome and snoring in patients with bilateral vocal cord paralysis.

Abstract. The analysis of the correlation between bilateral vocal cord paralysis and the occurrence of obstructive sleep apnea syndrome and snoring is presented. The aim of the study was to establish whether the decrease of the air flow in the upper airway in patients with bilateral vocal cord paralysis involves OSAS and/or snoring occurrence and whether arytenoidectomy affects an improvement of breathing parameters measured during sleep. Fourteen patients with bilateral vocal cord paralysis underwent Poly-MESAM examination before and 3 months after arytenoidectomy. They had never complained of snoring before. The Epworth sleepiness scale was used to quantify excessive daytime somnolence. The RDI, DI, mean saturation and percentage of snoring, loud snoring and sleep without snoring were estimated and compared pre- and postoperatively. The results were compared by the Students t-test for dependent values. No significant differences were shown between the Epworth scores before and after the treatment. The RDI, DI and mean saturation were normal before and after the operation. The percentage of loud snoring decreased and the percentage of sleep without snoring increased significantly after arytenoidectomy in both cases. The mechanism of snoring in patients with vocal cord paralysis seems to be similar to OSAS. The difference consists in the level of flow limitation. On the basis of the results there is no reason to diagnose OSAS and UARS in patients with bilateral vocal cord paralysis. On the other hand, the intensive snoring that occurs after paralysis was significantly reduced as a result of arytenoidectomy.

A Review of Selected Factors of Salivary Gland Tumour Formation and Malignant Transformation

Salivary gland tumours represent about 6% of head and neck neoplasms and about 0.5% of all malignancies in humans. Tumour growth and malignant transformation are complex processes involving various actions of molecules. Furthermore, some malignant salivary gland tumours are deemed to be caused by dedifferentiation or malignant transformation of benign tumours. The mechanisms of this transformation depend on a variety of different elements, such as cell cycle regulators, oncogenes, proteins, angiogenesis factors, and adipocytokines. The authors used PubMed, Medline, and Google websites to find and review the most significant papers related to malignant transformation in benign salivary gland tumours.

Possibilities of surgical correction of vocal cord palsy after thyroid gland operations

INTRODUCTION Surgery of the thyroid gland remains the main cause of bilateral vocal cord palsy (VCP). Ventilation problem is the main problem in such situations. There are a couple of corrective surgical procedures in the case of VCP. The aim of our study was to show the possibility of widening of the glottis, and to evaluate the techniques and effects of surgical treatments due to bilateral VCP resulting from thyroid gland surgery. MATERIAL AND METHODS Five methods of surgical treatment were used: laser-assisted posterior cordectomy, according to Denis and Kashima; laser-assisted bilateral medial arytenoidectomy, as proposed by Crumley; laser-assisted posterior ventriculocordectomy, as described by Pia; laser-assisted total arytenoidectomy with posterior cordectomy, as presented by Ossoff; and laterofixation, according to Lichtenberger. The postoperative patients subjective improvement was assessed using visual analogue scale. RESULTS Between 1998 and 2014 we operated on 270 patients with bilateral VCP. Paresis occurred as the result of the iatrogenic effect of thyroid gland surgery in 255 patients (94.4%) vs. 15 (7.6%) from other causes. The majority of our patients (77.6%) had undergone laser arytenoidectomy with posterior partial cordectomy, and in 13.7% of them Lichtenberger laterofixation had been performed. Ossoff s surgery gives good ventilation results: successful decannulation (62.9% after first surgery; 97.6% final rate) and significant subjective ventilation improvement in 96% of patients. CONCLUSIONS Ossoff s laser arytenoidectomy with posterior cordectomy is a safe procedure that gives acceptable ventilation improvement. Patients report satisfactory quality of life and the possibility of returning to active professional life. Laterofixation should be considered as an alternative for tracheotomy rather than permanent procedure.