Yun Su Yang

Surgical results of the intraoral removal of the submandibular gland

Objectives Most patients with benign submandibular disorders have been treated surgically without difficulty via the transcervical approach. An alternative to the standard transcervical approach has been reported such as an intraoral approach. Subjects and Methods Retrospective chart review of the 77 patients with benign submandibular disorders. All patients underwent an excision of the submandibular gland via intraoral approach. Results Early postoperative complications developed in 74.0% of the temporary lingual sensory paresis followed by 70.1% of temporary limitation of tongue movement. However, these complications soon resolved in all patients spontaneously. Two cases of postoperative bleeding and 1 case of abscess formation were developed. Whereas late complications developed in 4 cases of residual salivary gland and abnormal sense of mouth floor and 1 case of gustatory sweating (Freys) syndrome. Conclusion The major advantages of this approach are no external scar, no injury to the marginal mandibular nerve. The disadvantage is a more difficult dissection to transcervical approach before proper expert, especially in the severe adhesion of salivary gland to surrounding tissue.

Characteristic travelling patterns of non-recurrent laryngeal nerves

BACKGROUND The non-recurrent laryngeal nerve is subject to potential injury during thyroid surgery. Intra-operative identification and preservation of this nerve can be challenging. Its presence is associated with an aberrant subclavian artery and the developmental absence of the brachiocephalic trunk. This study aimed to evaluate the incidence of non-recurrent laryngeal nerves and present a new classification system for the course of these nerves. METHODS Non-recurrent laryngeal nerves were identified on the right side in 15 patients who underwent thyroidectomy. The incidence of non-recurrent laryngeal nerves (during thyroidectomy) and aberrant subclavian arteries (using neck computed tomography) was evaluated, and the course of the nerves was classified according to their travelling patterns. RESULTS The overall incidence of non-recurrent laryngeal nerves was 0.68 per cent. The travelling patterns of the nerves could be classified as: descending (33 per cent), vertical (27 per cent), ascending (20 per cent) or V-shaped (20 per cent). CONCLUSION Clinicians need to be aware of these variations to avoid non-recurrent laryngeal nerve damage. A retroesophageal subclavian artery (on neck computed tomography) virtually assures a non-recurrent laryngeal nerve. This information is important for preventing vocal fold paralysis. Following a review of non-recurrent laryngeal nerve travelling patterns, a new classification was devised.

The effect of total thyroidectomy on the speech production.

Objectives Voice and speech alternations that can occur after total thyroidectomy are usually due to recurrent or superior laryngeal nerve injury. These alterations may also be associated with other extralaryngeal factors, such as neck muscle dysfunction and scar contracture of the neck. We performed a prospective acoustic analysis on speech changes after surgery, in the absence of laryngeal nerve injury. Methods Patients aged 19 to 58 years undergoing total thyroidectomy, in the absence of laryngeal/pulmonary disease, previous neck surgery, or other malignant diseases, were recruited prospectively. For the running speech analysis, the speaking fundamental frequencies (SFo), range of SFo and speaking intensity were evaluated before surgery, 7 days, and 1 and 3 months after surgery. For consonant analysis, the acoustic distinctions of stop consonant, the voice onset time (VOT), vowel duration and closure duration were evaluated at the same periods. Results SFo and range of SFo were specifically diminished after surgery, while speaking intensities were not changed significantly after surgery. The thyroidectomized speakers displayed systematically varied VOT for the consonant production, which was phonetically representative. However, VOT after surgery could be longer in the strong aspirated and glottalized stops, but not in the lax stop than before surgery. The vowel and closure durations were not affected before and after surgery. Conclusion Patients with thyroidectomy have some difficulty of pitch control and consonant articulation during speaking. VOT is also one of the meaningful acoustic parameters and provide a reference for comparing acoustic measures before and after thyroidectomy.

Case of bilateral pneumolabyrinth presenting as sudden, bilateral deafness, without temporal bone fracture, after a fall.

OBJECTIVE We report a case of bilateral pneumolabyrinth presenting as sudden, bilateral deafness, without temporal bone fracture, after a fall. CASE REPORT A 49-year-old man presented with sudden, bilateral deafness and whirling vertigo, without any other neurological manifestations. Temporal bone computed tomography clearly demonstrated the presence of air in the vestibule and cochlea on both sides. However, there was no definite fracture line, ossicular chain anomaly or soft tissue density in the temporal bone or middle-ear cavity. The patient was treated conservatively. Unfortunately, there was no improvement in his hearing. CONCLUSION Pneumolabyrinth is an uncommon condition in which air is present in the vestibule or cochlea. It is rarely found, even with fractures violating the otic capsule or with transverse fractures of the temporal bone. In addition, its bilateral occurrence is extremely rare. In this article, we describe a case of bilateral pneumolabyrinth presenting as sudden, bilateral deafness, without temporal bone fracture, an occurrence which has not previously been reported.