No abstract

Although laryngeal papillomatosis is clinically well defined, the mechanisms and treatment modalities of laryngeal HPV infection need further investigations.

Vocal fold augmentation by injection under direct visual control is a quick and simple operation. However, when autologous fat or bovine collagen is used, resorption creates a problem. The low metabolic requirements and the relatively stable histologic character of free fascial grafts make autologous fascia a fascinating material in vocal fold augmentation. This research project was carried out to establish a suitable method to transplant fascia into a vocal fold and to assess its impact on the voice. A piece of fascia lata was chopped with a scalpel. The material was injected in the lateral aspect of the thyroarytenoid muscle using a pressure syringe. Nine subjects with a paralyzed vocal fold were analyzed after the injection. The postoperative voice, rated by a panel of experienced listeners, was significantly better than the preoperative (P < 0.05). Five of nine voices were rated normal or near normal after the procedure. The mean maximal phonation time increased significantly (P < 0.01). All patients considered that their voice had improved, and eight of nine regarded it as good. No one reported deterioration of the result during the follow-up (mean duration, 10 months; range, 3 to 18 months).

Acute laryngeal croup is most often associated with PIV, RSV, rhinovirus, and enterovirus. Rhinovirus and enterovirus appeared equally often in croup and in wheezing illness. During late fall, they were found in 39% and 40%, respectively, of the tested samples.

The latent and subclinical infections of human papillomavirus (HPV) have gained more interest following the association of this virus to squamous cell cancer. So far, little is known about the prevalence of latent HPV infections in the larynx. We studied specimens from patients suffering from chronic laryngitis, noduli of polyps of the vocal cords by polymerase chain reaction (PCR). Six out of 32 cases (19%) were found to have HPV DNA in the epithelium. The disease itself, sex, age or cigarette smoking were not related to the occurrence of HPV DNA. These results suggest that the number of HPV-positive patients observed might reflect the prevalence of latent HPV infections in the vocal cord mucosa.

Previous reports have warned that tonsillectomy or uvulopalatopharyngoplasty (UPPP) may alter patients' speech by increasing the amount of nasal resonance as well as by changing voice timbre due to enlargement of the vocal tract. However, very few objective investigations, excluding nasality problems, have been carried out. We studied eight patients who underwent surgery for UPPP and recorded pre- and postoperative speech. The speech samples were then rated by seven experienced listeners, and acoustic spectra of two long vowels,/a/ and /e/, were analyzed using a computer program (MacSpeech Lab II). The listeners were unable to make a distinction between pre- and postoperative voice samples in the recordings studied. Acoustic analysis showed that the fundamental frequency as well as the first and second formants remained essentially unchanged. Present findings show that UPPP should not have a significant effect on voice characteristics as long as excessive nasality is not produced.

In this study, we aimed to assess the long-term effects of the mucosal layer plastic surgery of the vocal folds performed on the voices of male-to-female transgenders. This retrospective cohort study enrolled 22 patients who were operated during 2004-2010 by a combined technique of transmucosal anterior suturing and stiffening of the vocal folds through a longitudinal cordotomy incision using CO2 laser. Long-term effects were assessed based on completed questionnaires on four different categories including subjective evaluation of patient's own voice perception and a standardized voice inventory (VHI), as well as an acoustic assessment and videolaryngoscopic examination. Out of the 22 patients contacted, 16 returned the questionnaires, and 13 of them participated in the subsequent acoustic analysis and videolaryngoscopic assessment. Results of the study were as follows: The total VHI score, after the procedure, was 32. F0 increased significantly for both the vowel/a/ and text from 157 to 207 Hz and 139 to 162 Hz, respectively. Perturbation measures did not show a significant change. F0 did not correlate with the VHI score. One patient had symptomatic anterior perforation that needed re-operation. The combination of transmucosal anterior suturing and stiffening of the vocal folds by laser cordectomy results in significant elevation of the F0 in the long term and in acceptable levels of VHI score compared to other reports. In conclusion, the results of the procedures show that it is enough to get the mucosal edges sutured together without the need to suture either the ligaments or the muscle of the vocal folds. The need for revision is minimal with this procedure.

There is evidence that rigid fixation of zygomaticomaxillary suture enhances the recovery of the infraorbital nerve compared with other means of surgical treatments. There is, however, no agreement as to whether any surgery decreases the number of sensory disturbance in cases with little or no dislocation, or whether infraorbital numbness alone should be considered an indication for surgery. An operation may even increase the edema and hemorrhage around the nerve. This retrospective study was carried out among patients with infraorbital hypesthesia but little or not at all dislocated midfacial fractures. Two special types of trauma patients were selected; those with a blow-out fracture but an intact infraorbital rim (BO) and those with a zygomaticomaxillary complex fracture (ZMC). A questionnaire was sent to the patients (n = 226) 2.2 years (mean) after the accident. There were 128 responses (BO n = 41, ZMC n = 87). Of these, 27 BO and 29 ZMC patients had been treated by observation. An orbital exploration had been carried out in 14 BO patients, and 58 ZMC patients had received malar bone elevation without rigid fixation. At the end of the follow-up period nontreated patients had fewer symptoms than those who had had surgery. This was clearer in the ZCM group (symptom free 69% vs. 52%) than in the BO group (69% vs. 50%). The differences between surgically and nontreated BO or ZMC patients, however, were statistically nonsignificant. According to our findings, exploration of the orbital floor or an attempted elevation of a minimally or nondislocated fracture of the ZMC does not enhance the recovery of the infraorbital nerve. On the contrary, the procedure may itself increase the morbidity and sensory dysfunction. Further studies are needed to determine whether the results could be improved by selective decompression of the infraorbital nerve and a rigid fixation.