There are several lasers available for office-based or suspension microlaryngoscopy laser procedures in the treatment of laryngeal diseases. Each has advantages and disadvantages given the depth of penetration per unit of power, absorption in water, spectral absorption characteristics, mode of delivery, safety, and cost. It is important to note that while the proper selection of indication of treatment based on a laser wavelength is critical, of equal importance is selecting the appropriate power setting, focal length (or spot size), and time of exposure. The photoangiolytic lasers precisely target hemoglobin within the microcirculation of the highly vascularized tissue and may have better hemostatic effects and preservation of surrounding normal tissue than the CO2 laser. Although the choice of laser is purely theoretical and cannot be accurately concluded which parameters of laser (wattage and pulse width) were best to use, photoangiolytic laser surgery is safe and effective for specific laryngeal lesions. In this review, indications for photoangiolytic laser procedures for various laryngeal diseases, laser settings and surgical techniques for specific laryngeal lesions including sulcus vocalis, laryngeal dysplasia, and recurrent respiratory papillomatosis will be introduced. Pros and cons of in-office laser surgery using photoangiolytic laser and flexible CO2 laser will also be addressed.

There are several lasers available for office-based or suspension microlaryngoscopy laser procedures in the treatment of laryngeal diseases. Each has advantages and disadvantages given the depth of penetration per unit of power, absorption in water, spectral absorption characteristics, mode of delivery, safety, and cost. It is important to note that while the proper selection of indication of treatment based on a laser wavelength is critical, of equal importance is selecting the appropriate power setting, focal length (or spot size), and time of exposure. The photoangiolytic lasers precisely target hemoglobin within the microcirculation of the highly vascularized tissue and may have better hemostatic effects and preservation of surrounding normal tissue than the CO2 laser. Although the choice of laser is purely theoretical and cannot be accurately concluded which parameters of laser (wattage and pulse width) were best to use, photoangiolytic laser surgery is safe and effective for specific laryngeal lesions. In this review, indications for photoangiolytic laser procedures for various laryngeal diseases, laser settings and surgical techniques for specific laryngeal lesions including sulcus vocalis, laryngeal dysplasia, and recurrent respiratory papillomatosis will be introduced. Pros and cons of in-office laser surgery using photoangiolytic laser and flexible CO2 laser will also be addressed.

BACKGROUND AND OBJECTIVES: Allergic rhinitis (AR) and rhinitis medicamentosa (RM) have different mucosal color and pathophysiology. To investigate whether the mucosal color and nasal blood flow are different between the diseases in spite of same symptoms, we designed this study. Materials and Methods: 20 patients with allergic rhinitis and 21 patients with rhinitis medicamentosa were compared with 20 normal volunteers using mucosal color grading and Laser Doppler flowmetry. The Laser Doppler flowmetry was performed with a Periflux 4001 (Perimed, Jrtlla, Sweden) and perfusion unit (PU), velocity unit (VU), and concentration Unit (CU) were measured. The Laser Doppler flowmetry data in AR and RM were compared with those of the normal subjects, and between AR and RM. RESULTS: The perfusion score of AR and RM were lower than the control (p<0.05) and it was statistically significant that the mucosal color of AR were pale and of RM were reddish, comparing to the control group (p<0.05). CONCLUSION: The nasal blood flow was decreased with AR and RM compared to control but the mucosal color of AR and RM were different because of the difference of pathophysiology of diseases. When diagnosing RM, observation of mucosal color and measurement of nasal blood flow will be helpful besides the history of long-term use of nasal decongestant.
Healthy Volunteers ; Humans ; Laser-Doppler Flowmetry* ; Perfusion ; Rhinitis*

BACKGROUND AND OBJECTIVES: Ablation of the thyroid remnants using radioiodine (RI) after surgical removal of differentiated thyroid cancer could induce radiation-related salivary gland dysfunction. The purpose of this study is to review our experience with therapeutic sialendoscopy for RI-induced sialadenitis. MATERIALS AND METHODS: We reviewed medical charts of all patients with RI-induced sialadenitis treated with sialendoscopy retrospectively. The study included 14 patients who underwent sialendoscopy for the treatment of RI-induced sialadenitis after failing conservative management. RESULTS: 14 patients (11 women, 3 men) with a mean age of 43.8 years (range, 26-60) underwent interventional sialendoscopy for the treatment of RI-induced sialadenitis that is unresponsive to conservative management. Symptoms arising from the parotid gland were seen in 12 (86%) of patients, whereas symptoms arising from the submandibular gland were seen in 2 (14%). 7 patients (50%) presented symptoms in bilateral parotid or submandibular glands. The mean dose of RI was 203.2 mCi (range, 150-500) received as a single dose. The mean duration from RI ablation therapy to sialendoscopy was 11.1 months (range, 0.5-29). Sialendoscopy was possible in all patients. Ductal stenosis and mucus plugs and debris were the most common types of ductal pathology. Sialendoscopy improved the symptoms in 79% (11/14) of patients, with no serious complications reported in mean follow up of 4 months (range, 1-12). CONCLUSION: Therapeutic interventional sialendoscopy appears to provide symptom improvement in most patients. Sialendoscopy is effective tool for improving symptoms due to RI-induced sialadenitis in patients who are unresponsive to conservative managements.
Constriction, Pathologic ; Female ; Follow-Up Studies ; Humans ; Iodine ; Mucus ; Parotid Gland ; Retrospective Studies ; Salivary Glands ; Sialadenitis ; Submandibular Gland ; Thyroid Gland ; Thyroid Neoplasms

BACKGROUND AND OBJECTIVES: The objectives were to analyze the results of the laryngeal framework surgery (LFS) in one institute during 12 years. We reviewed the present position of LFS in the phonosurgery field and discussed the prospects for this type of surgery in the future. SUBJECTS AND METHOD: One hundred seventy nine charts of patients who underwent LFS in Yongdong Severance hospital from 1992 to 2003 were reviewed. Types of procedures were made according to the classification/ nomenclature of European Laryngological Society. RESULTS: One hundred ninty seven operations had been performed during 12 years in 179 patients. Type I thyroplasty was the most common procedure (28.9%). Type I thyroplasty+Arytenoid adduction (26.4%), Type III thyroplasty (16.8%), Arytenoid adduction (15.2%), Injection medialization (11.2%), Type IV thryroplasty (1.5%) followed in the order of most commonly operated choices. Of 197 cases, 18 cases were revision. There was only one major complication (dyspnea). A variety of dysphonias, which include vocal fold paralysis (71.5%), various pitch problems (mutational dysphonia (14%), androphonia (1.1%)), glottal insufficiency (12.8%), and some cases of spasmodic dysphonia (0.6%), had been treated with LFS. CONCLUSION: Laryngeal framework surgery is a new type of surgery that aims to improve the voice by restructuring the laryngeal framework. This type of surgery has become increasingly popular, because it has been found to be safe and effective.
Dysphonia ; Humans ; Laryngoplasty ; Paralysis ; Treatment Outcome ; Vocal Cords ; Voice ; Voice Disorders

Xerostomia is a subjective sensation of a dry mouth which is frequently encountered in otorhinolaryngologic practice. There are a variety of salivary and nonsalivary causes of xerostomia such as side effects of medication, systemic disorders, radiation and Sjögren's syndrome. The patients with xerostomia have difficulties in chewing, swallowing, speaking, tasting and mataining oral hygiene. Because of the ageing population, and the concomitant increase in medicated individuals, otorhinolaryngologists can expect to be presented with xerostomia in an increasing number of patients in the coming years and therefore should be familiar with its diagnosis and treatment. A systematic approach should be needed to determine the etiology of xerostomia and the management of xerostomia should be multidisciplinary and multimodal. This review summarizes the current literature on the diagnosis, and complications of xerostomia, and on the management of patients with xerostomia.
Deglutition ; Diagnosis* ; Humans ; Mastication ; Mouth ; Oral Hygiene ; Saliva ; Sensation ; Xerostomia*

BACKGROUND AND OBJECTIVES: Aging causes atrophy in mucosa of vocal folds, resulting in various deleterious changes in phonation. Eventually, these changes impair an elderly individual's ability to communicate with others and affect their quality of life. This investigation was carried out to determine the morphological characteristics of vocal folds in two different aged groups of rats, and to perform a validation of a rat model of age-related changes in larynx. SUBJECTS AND METHOD: Larynges were obtained from 12 rats, of which 6 rats were 6 months old and the others 18 months old. The middle portion of each vocal folds were stained with haematoxylin and eosin (H&E), Masson's trichrome (MT), Alcian blue (AB) and compared. RESULTS: Extracellular matrix in lamina propria of vocal folds presented lower density in 18 months-old rats than in 6 months-old rats (p<0.05). Also more severe fibrosis was observed in 18 months-old rats than in 6 months-old rats (p<0.05). Six months-old rats showed higer concentration of hyaluronic acid than did 18 months-old rats (p<0.05). CONCLUSION: Aged vocal folds showed increased fibrosis and decreased density of collagen and hyaluronic acids in the lamina propria compared to young vocal fold.
Aged ; Aging ; Alcian Blue ; Animals ; Atrophy ; Collagen ; Eosine Yellowish-(YS) ; Extracellular Matrix ; Fibrosis ; Hyaluronic Acid ; Larynx ; Mucous Membrane ; Phonation ; Quality of Life ; Rats ; Vocal Cords

Although tonsillectomy is a common surgical procedure in the otolaryngological department, subcutaneous emphysema after tonsillectomy is a rare complication. While most of the cases are benign and self-limiting, severe sequelae, such as tracheal compression, pneumopericardium, are possible. We present two patients with cervical emphysema after tonsillectomy, and focus on explaining the possible pathologic mechanisms, diagnosis, appropriate management, and nature course of cervical emphysema after tonsillectomy.
Diagnosis ; Emphysema* ; Humans ; Mediastinal Emphysema ; Pneumopericardium ; Subcutaneous Emphysema ; Tonsillectomy*

OBJECTIVES: Radioiodine (RI) therapy is known to subject cellular components of salivary glands (SG) to oxidative stress leading to SG dysfunction. However, the protective effects of antioxidants on RI-induced SG damage have not been well investigated. The authors investigated the morphometric and functional effects of epigallocatechin-3-gallate (EGCG) administered prior to RI therapy and compared this with the effects of amifostine (a well-known antioxidant) in a murine model of RI sialadenitis. METHODS: Four-week-old female C57BL/6 mice (n=48) were divided into four groups; a normal control group, a RI-treated group (0.01 mCi/g mouse, orally), an EGCG and RI-treated group, and an amifostine and RI-treated group. Animals in these groups were divided into 3 subgroups and euthanized at 15, 30, and 90 days post-RI treatment. Salivary flow rates and lag times were measured, and morphologic and histologic examinations and TUNEL (terminal deoxynucleotidyl transferase biotin-dUDP nick end labeling) assays were performed. Changes in salivary (99m)Tc pertechnetate uptake and excretion were followed by single-photon emission computed tomography. RESULTS: Salivary flow rates and lag times to salivation in the EGCG or amifostine groups were better than in the RI-treated group. Histologic examinations of SGs in the EGCG or amifostine group showed more mucin-rich parenchyma and less periductal fibrosis than in the RI-treated group. Fewer apoptotic cells were observed in acini, ducts, and among endothelial cells in the EGCG or amifostine group than in the RI group. In addition, patterns of (99m)Tc pertechnetate excretion were quite different in the EGCG or amifostine group than in the RI group. CONCLUSION: EGCG supplementation before RI therapy could protect from RI-induced SG damage in a manner comparable to amifostine, and thus, offers a possible means of preventing SG damage by RI.
Amifostine ; Animals ; Antioxidants ; DNA Nucleotidylexotransferase ; Endothelial Cells ; Female ; Fibrosis ; Humans ; In Situ Nick-End Labeling ; Mice ; Models, Animal ; Oxidative Stress ; Salivary Glands* ; Salivation ; Sialadenitis ; Sodium Pertechnetate Tc 99m ; Thyroid Neoplasms ; Tomography, Emission-Computed ; Tomography, Emission-Computed, Single-Photon

A gossypiboma (also called textiloma or retained surgical sponge) of the neck is rarely reported compared to intraabdominal or intrathoracic gossypibomas and also can be misdiagnosed as metastatic lymph nodes. A patient was referred to our clinic for a supraclavicular neck mass 6 months after thyroidectomy and neck dissection for papillary thyroid carcinoma in another hospital. It was initially considered an isolated neck recurrence, but it was finally diagnosed as gossypiboma by a pathological examination of the surgically-excised specimen. Characteristic findings of computed tomography or positron emission tomography/computed tomography might be helpful to differentiate the gossypiboma from malignant neck mass or other inflammatory conditions. It is essential for clinicians to be aware of this disease entity in differential diagnosis of neck recurrence because a gossypiboma in the neck can be misinterpreted as a malignancy to induce unwarranted radical surgery.
Carcinoma ; Diagnosis, Differential ; Electrons ; Humans ; Lymph Nodes ; Neck Dissection ; Neck* ; Recurrence* ; Surgical Sponges ; Thyroid Neoplasms ; Thyroidectomy