Vocal fold paralysis (VFP) refers to neurological causes of reduced or absent movement of one or both vocal folds. Bilateral VFP (BVFP) is characterized by inspiratory dyspnea due to narrowing of the airway at the glottic level with both vocal folds assuming a paramedian position. The primary objective of intervention for BVFP is to relieve patients’ dyspnea. Common clinical options for management include tracheostomy, arytenoidectomy and cordotomy. Other options that have been used with varying success include reinnervation techniques and botulinum toxin (Botox) injections into the vocal fold adductors. More recently, research has focused on neuromodulation, laryngeal pacing, gene therapy, and stem cell therapy. These newer approaches have the potential advantage of avoiding damage to the voicing mechanism of the larynx with an added goal of restoring some physiologic movement of the affected vocal folds. However, clinical data are scarce for these new treatment options (i.e., reinnervation and pacing), so more investigative work is needed. These areas of research are expected to provide dramatic improvements in the treatment of BVFP.
Botulinum Toxins ; Cordotomy ; Dyspnea ; Electric Stimulation Therapy ; Genetic Therapy ; Larynx ; Paralysis* ; Recurrent Laryngeal Nerve Injuries ; Review Literature as Topic* ; Stem Cells ; Synkinesis ; Tracheostomy ; Vocal Cord Paralysis ; Vocal Cords*

Intubation may lead to several dental complications. Furthermore, a tooth damaged during intubation may be subsequently dislocated. In the present case, the upper primary incisor was avulsed during intubation and, unbeknownst to the anesthesiologist, displaced to the larynx. We report here on the findings and indicate appropriate treatment. Intubation for general anesthesia in children can result in tooth damage and/or dislocation of primary teeth with subsequent root resorption. Prevention is key, and thus it is critical to evaluate the patient's dental status before and after intubation. Furthermore, anesthesiologists and dentists should pay close attention to this risk to prevent any avulsed, dislocated, or otherwise displaced teeth from remaining undetected and subsequently causing serious complications.
Anesthesia ; Anesthesia, General ; Child ; Dentists ; Dislocations ; Humans ; Hypopharynx* ; Incisor ; Intubation ; Intubation, Intratracheal* ; Larynx ; Root Resorption ; Tooth ; Tooth Injuries ; Tooth, Deciduous*

We report a 57-year-old man with bilateral cranial nerve IX and X palsies who presented with severe dysphagia. After a mild head injury, the patient complained of difficult swallowing. Physical examination revealed normal tongue motion and no uvular deviation. Cervical X-ray findings were negative, but a brain computed tomography revealed a skull fracture involving bilateral jugular foramen. Laryngoscopy indicated bilateral vocal cord palsy. In a videofluoroscopic swallowing study, food residue remained in the vallecula and pyriform sinus, and there was reduced motion of the pharynx and larynx. Electromyography confirmed bilateral superior and recurrent laryngeal neuropathy.
Brain ; Brain Injuries* ; Cranial Nerve Diseases ; Craniocerebral Trauma ; Deglutition ; Deglutition Disorders ; Electromyography ; Glossopharyngeal Nerve ; Humans ; Laryngoscopy ; Larynx ; Middle Aged ; Paralysis* ; Pharynx ; Physical Examination ; Pyriform Sinus ; Skull Fracture, Basilar ; Skull Fractures ; Tongue ; Vocal Cord Paralysis

Tracheal intubation with Macintosh laryngoscope (MAC) might result in severe cardiovascular complications. The results of conducted studies investigating the effects of videolaryngoscopies on hemodynamic response of tracheal intubation are conflicting. We know little about the effects of videolaryngoscopies on cardiac output changes during tracheal intubation. We compared cardiac output (COP) and hemodynamic responses in normal blood pressure (n=60) and hypertensive patients (n=60) among 3 intubation devices: the MAC, the UE videolaryngoscopy ® (UE), and the UE video intubation stylet ® (VS). Cardiac index (CI), stroke volume index (SVI), heart rate (HR), systolic blood pressure (SBP) and diastolic blood pressure (DBP) were recorded using LidcoRapid (V2)® preinduction, preintubation, and every minute for the first 5 min after intubation. We assessed oropharyngeal and laryngeal structures injury as well. Intubation time was significantly shorter than MAC groups (P<0.001) only in UE group of normotensive and hypertensive patients. In normotensive patients, there were no significant differences in any of COP variables or hemodynamic variables among the three devices. In hypertensive patients, SBP and DBP in the MAC group were significantly higher (P<0.05 or <0.01) than the UE and VS groups at 1, 2 and 3 min after intubation, but there were no significant differences in CI, SVI and HR among the three devices. There was no significant difference in oropharyngeal and laryngeal structures injury among all groups. It was concluded that both the UE and VS attenuate only the hemodynamic response to intubation as compared with the MAC in hypertensive patients, but not in normotensive patients.
Adult ; Aged ; Blood Pressure ; physiology ; Cardiac Output ; physiology ; Female ; Hemodynamics ; Humans ; Hypertension ; physiopathology ; surgery ; Intubation, Intratracheal ; instrumentation ; methods ; Laryngoscopy ; instrumentation ; methods ; Larynx ; anatomy & histology ; injuries ; Male ; Middle Aged ; Oropharynx ; anatomy & histology ; injuries ; Video-Assisted Surgery ; methods ; Young Adult

OBJECTIVE: To explore the extralaryngeal furcation variation of the recurrent laryngeal nerve (RLN) in total thyroidectomy. METHOD: The clinical data of 216 RLNs from 108 patients undergone total thyroidectomy were retrospectively analyzed. RESULT: RLN was found during every operation and exposed in whole course until access into larynx. Twenty (9.26%) pieces of RLNs showed bifurcated or trifurcated RLNs before access into larynx. Ratio of furcation is lower than that reported before internationally. Bifurcations of RLNs on the left were more than that on the right. CONCLUSION The protection of RLN is important for thyroid operation, especially in total thyroidetomy. Variation of extralaryngeal furcation of RLN usually leads to injury of RLN. Understanding of variation of RLN could decrease nerve function related complication.
Humans ; Larynx ; Recurrent Laryngeal Nerve ; pathology ; Recurrent Laryngeal Nerve Injuries ; diagnosis ; Retrospective Studies ; Thyroid Gland ; surgery ; Thyroidectomy

Phonatory and swallowing symptoms after thyroidectomy are well-known implications of laryngeal nerve injuries. The laryngeal nerve injuries, superior and inferior, are major complication that results in changes both to voice quality and production of high-pitched sounds, which is of utmost importance for voice professionals. However, these functional and subjective voice and swallowing symptoms were often neglected by clinicians. Most voice and swallowing alterations after thyroidectomy are self limited and are not related to demonstrable impaired nerves function. Several causes have been supposed to interpret these symptoms. They have been attributed to arytenoid trauma after endotracheal intubation, surgical trauma, modification of the vascular supply of the larynx, local pain in the neck, cricothyroid dysfunction, strap muscle mal-function, laryngotracheal fixation with impairment of vertical movement, and psychologic reaction to the operation. Because of the impact of patient's perception on postoperative outcome in recent years, some groups have extensively investigated this functional post-thyroidectomy syndrome. All the published studies demonstrate that most patients who undergo thyroidectomy have at least some subjective vocal and/or swallowing complaints early after the opera-tion. Despite increasing interest, prospective data about the long-term outcomes of functional postthyroidectomy syndrome are lacking. This paper is to review the long-term trend and evolution of voice and swallowing symptoms after thyroidectomy in the absence of laryngeal nerve injury.
Deglutition ; Humans ; Intubation, Intratracheal ; Laryngeal Nerve Injuries ; Larynx ; Neck ; Thyroidectomy ; Voice ; Voice Quality

We report a patient with traumatic atlanto-occipital dislocation who presented with dysphagia as the chief complaint. A 59-year-old man complained of swallowing difficulty for 2 months after trauma to the neck. On physical examination, there was atrophy of the right sternocleidomastoid and upper trapezius muscles, and the tongue was deviated to the right. In a videofluoroscopic swallowing study, penetration and aspiration were not seen, food residue remained in the right vallecula and pyriform sinus, and there was decreased motion of the soft palate, pharynx and larynx. Electromyography confirmed a right spinal accessory nerve lesion. Magnetic resonance imaging confirmed atlanto-occipital dislocation. Dysphagia in atlanto-occipital dislocation is induced by medullary compression and lower cranial nerve injury. Therefore, in survivors who are diagnosed with atlanto-occipital dislocation, any neurological symptoms should be carefully evaluated.
Accessory Nerve ; Atlanto-Occipital Joint ; Atrophy ; Cranial Nerve Injuries ; Cranial Nerves ; Deglutition ; Deglutition Disorders ; Dislocations ; Electromyography ; Humans ; Larynx ; Magnetic Resonance Imaging ; Muscles ; Neck ; Palate, Soft ; Pharynx ; Physical Examination ; Pyriform Sinus ; Survivors ; Tongue

OBJECTIVETo evaluate the therapeutic effect of clarithromycin combined with tanshinone in the treatment of rhinosinusal and laryngeal radiation injury induced by radiotherapy in patients with nasopharyngeal carcinoma (NPC).

METHODSA total of 255 NPC patients with rhinosinusal and laryngeal radiation injury following radiotherapy were randomized into 3 groups for treatment with clarithromycin (group A, n=69), tanshinone (group B, n=69), and clarithromycin + tanshinone (group C, n=69), and the clinical outcomes of the patients were evaluated.

RESULTSIn all the 3 groups the patients responded favorably to the treatments and showed obvious improvements (P<0.05). The therapeutic effects were similar between groups A and B (P>0.05), but the patients in group C showed the most obvious improvements (P<0.05).

CONCLUSIONSClarithromycin combined with tanshinone can be an effective regimen for treatment of rhinosinusal and laryngeal radiation injury induced by radiotherapy in NPC patients.

Adult ; Aged ; Carcinoma ; Clarithromycin ; therapeutic use ; Combined Modality Therapy ; Diterpenes, Abietane ; therapeutic use ; Female ; Humans ; Larynx ; pathology ; Male ; Middle Aged ; Nasopharyngeal Neoplasms ; radiotherapy ; Nose ; pathology ; Paranasal Sinuses ; pathology ; Pharynx ; pathology ; Radiation Injuries ; drug therapy ; Young Adult

Adult ; Bronchoscopy ; Female ; Humans ; Intubation, Intratracheal ; adverse effects ; methods ; Laryngostenosis ; etiology ; prevention & control ; Larynx ; injuries ; Male ; Wounds and Injuries ; surgery ; Young Adult

OBJECTIVE: Cricothyrotomy and tracheostomy are performed by physicians in various disciplines. It is important to know the comprehensive anatomy of the laryngotracheal region. Hemorrhage, esophageal injury, recurrent laryngeal nerve injury, pneumothorax, hemothorax, false passage of the tube and tracheal stenosis after decannulation are well known complications of the cricothyrotomy and tracheostomy. Cricothyrotomy and tracheostomy should be performed without complications and as quickly as possible with regards the patients' clinical condition. METHODS: A total of 40 cadaver necks were dissected in this study. The trachea and larynx and the relationship between the trachea and larynx and the surrounding structures was investigated. The tracheal cartilages and annular ligaments were counted and the relationship between tracheal cartilages and the thyroid gland and vascular structures was investigated. We performed cricothyrotomy and tracheostomy in eleven cadavers while simulating intensive care unit conditions to determine the duration of those procedures. RESULTS: There were 11 tracheal cartilages and 10 annular ligaments between the cricoid cartilage and sternal notch. The average length of trachea between the cricoid cartilage and the suprasternal notch was 6.9 to 8.2 cm. The cricothyroid muscle and cricothyroid ligament were observed and dissected and no vital anatomic structure detected. The average length and width of the cricothyroid ligament was 8 to 12 mm and 8 to 10 mm, respectively. There was a statistically significant difference between the surgical time required for cricothyrotomy and tracheostomy (p < 0.0001). CONCLUSION: Tracheostomy and cricothyrotomy have a low complication rate if the person performing the procedure has thorough knowledge of the neck anatomy. The choice of tracheostomy or cricothyrotomy to establish an airway depends on the patients' clinical condition, for instance; cricothyrotomy should be preferred in patients with cervicothoracal injury or dislocation who suffer from respiratory dysfunction. Furthermore; if a patient is under risk of hypoxia or anoxia due to a difficult airway, cricothyrotomy should be preferred rather than tracheostomy.
Anoxia ; Cadaver ; Cartilage ; Cricoid Cartilage ; Dislocations ; Hemorrhage ; Hemothorax ; Humans ; Intensive Care Units ; Laryngeal Muscles ; Larynx ; Ligaments ; Neck ; Operative Time ; Pneumothorax ; Recurrent Laryngeal Nerve Injuries ; Thyroid Gland ; Trachea ; Tracheal Stenosis ; Tracheostomy