Impact of cordectomy on nocturnal muscle effort indexes in a patient with respiratory stridor caused by hereditary motor neuropathy
Francesco MariNiccolò NassiBeatrice BertiRoberto BaggiLorenzo MirabileRaffaele PiumelliRenzo Guerrini
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Abstract:
Introduction
respiratory dysfunction during sleep caused by vocal cord involvement with stridor and diaphragmatic paralysis has been described in patients with Charcot-Marie-Tooth hereditary neuropathy type 2C (CMT2C).Aims and objective
evaluate the positive effect of early cordectomy on muscular respiratory effort indexes in a pediatric patient with respiratory stridor due to complete bilateral vocal cord paralysis caused by mutation in TRPV4 gene.Methods
serial PSG evaluations performed before and immediately after cordectomy.Results
Respiratory Mechanical Instability (RMI) parameters evaluation disclosed the need of increase of respiratory muscular effort to obtain the good respiratory function during sleep. Laryngoscopic surgery was performed and serial cardiorespiratory monitorings confirmed the reduction of RMI parameter along the time.Conclusions
early cordectomy could be used in patients with bilateral vocal cord paralyses due to CMT2C to reduce the stridor and the nocturnal muscular efforts.Keywords:
Cordectomy
Epiglottis
Vocal Cord Paralysis
Cordectomy
Vocal Cord Paralysis
Arytenoid cartilage
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Cordectomy
Vocal Cord Paralysis
Cordotomy
Laryngeal paralysis
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Bilateral abductor vocal cord paralysis remains a difficult management problem for otolaryngologists. The techniques currently used fall into four main types: arytenoidectomy, cordectomy, cord lateralization and laryngeal re-innervation. These techniques invariably require a tracheostomy either prior to or at the time of the main procedure. A technique for managing patients without performing a tracheostomy which is as effective as the previously mentioned procedures and with no greater morbidity in terms of voice production was initially described by Ejnell, et al (1984). The results in three patients using this technique which involves vocal cord lateralization under endoscopic control confirms its ease and efficacy. All three patients were relieved of their presenting dyspnea and had satisfactory postoperative voice production. This appears to be an effective technique for the treatment of patients with bilateral abductor laryngeal paralysis which obviates the need for tracheostomy and its attendant complications.
Cordectomy
Vocal Cord Paralysis
Laryngeal paralysis
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Objective To study the curative effect and clinical application of unilateral vocal cord transection and partial cordectomy on the treatment of bilateral vocal cord paralysis. Methods 9 patients suffering from secondary bilateral vocal cord paralysis received unilateral vocal cord transection and partial cordectomy under direct laryngoscope. All the patients were followed up postoperatively and the curative effect was analyzed. Results One patient received the surgical procedures without tracheotomy and got complete remission of dyspnea postoperatively. 8 patients received tracheotomy. 7 of them got extubated 2 months postoperatively and 1 was extubated after the revision surgical procedure. Dyspnea was completely relieved in all patients. Although hoarseness got aggravated,the conversational voice was competent enough for daily life. Conclusions Unilateral vocal cord transection and partial cordectomy has good effect on the treatment for bilateral vocal cord paralysis. With advantages of unnecessity of expensive instruments, simplicity in methodology, good clinical effect and rare surgical complications, these procedures are worthy of recommendation in general hospitals.
Cordectomy
Tracheotomy
Vocal Cord Paralysis
Cordotomy
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Epiglottis
Laryngomalacia
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Acute onset stridor in a neonate following general anaesthesia is commonly attributed to laryngeal oedema secondary to anaesthetic airway trauma. The authors present a case of recurrent laryngeal nerve injury resulting in vocal cord paralysis causing stridor following central venous catheterisation under general anaesthesia in a neonate. This was managed expectantly and resolved spontaneously over a period of 6 months.
Vocal Cord Paralysis
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Epiglottis
Airway obstruction
Respiratory sounds
Laryngomalacia
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We herein report the successful management of a condition mimicking acquired laryngomalacia using conservative methods in an elderly man with a progressive neurological disorder. The patient developed stridor and was transferred to the intensive-care unit. Flexible laryngoscopy revealed a collapsed epiglottis during inspiration, as seen in acquired laryngomalacia, with mucinous material firmly adhered to the epiglottis. The stridor resolved after the removal of this material. Pathology revealed keratinized material, suggesting a collection of sputum or epithelial tissue. Thus, flexible laryngoscopy can differentiate the cause of airway obstruction and avoid unnecessary endotracheal intubation in patients with neurological disorders.
Epiglottis
Laryngomalacia
Airway obstruction
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ABSTRACTObjective: To describe the initial outcomes of endoscopic CO2 laser posterior cordectomy and partial arytenoidectomy among patients with bilateral vocal cord paralysis in our institution.
Methods:
Design: Case Series
Setting: Tertiary National University Hospital
Participants: 17 Patients
Results: Seventeen (17) patients who underwent transoral posterior cordectomy and partial arytenoidectomy using carbon dioxide laser were included in the study consisting of 14 females and 3 males. Iatrogenic injury was the most common cause of bilateral vocal cord paralysis in this subset of patients. Five patients who tolerated decannulation and another six who had no preoperative tracheostomy all reported subjective improvement in breathing. All of them were also observed to have resolution of stridor and increased respiratory comfort compared to their preoperative condition. The most common postoperative complication was granuloma formation at the medial arytenoidectomy site occurring only in 4 patients. None of the patients complained of aspiration episodes or dysphagia during the postoperative period.
Conclusion: Our initial experience with transoral endoscopic posterior cordectomy and partial arytenoidectomy using carbon dioxide laser has good postoperative outcomes among patients with bilateral vocal cord paralysis.
Cordectomy
Vocal Cord Paralysis
Carbon dioxide laser
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We investigated the long-term results of autologous fat injections for unilateral vocal cord paralysis and laryngofissure and cordectomy defects.We evaluated the efficacy of autologous fat injections in 21 patients (16 males, 5 females; mean age 57 years; range 24 to 72 years) with unilateral vocal cord paralysis (n=11) and cordectomy defects (n=10) in the light of computed acoustic analysis, phonatory functions, and videolaryngostroboscopic findings and the effect of injections on swallowing. The mean follow-up was 14 months (range 10 to 22 months).Voice quality improved in 14 patients. Glottic insufficiency recurred in three patients in the early period, and in two patients in the late period. Phonatory functions showed significant improvement in all parameters except for jitter and functional interference (p<0.05). Videolaryngostroboscopy showed significant improvement in glottic closure, but mucosal waves remained unchanged. Of 18 patients with swallowing disorders, aspiration symptoms improved in 15 patients. Patients with unilateral vocal cord paralysis had better results compared to those with cordectomy defects.Autologous fat injections may be considered effective in patients with cordectomy defects or unilateral vocal cord paralysis.
Cordectomy
Vocal Cord Paralysis
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