Objective: Unilateral vocal cord palsy is a major cause of dysphonia. With umpteen number of causes being attributed to it and changing trends in etiology from place-to-place and over time, it is of utmost importance to arrive at a correct diagnosis to plan further management and to determine the prognosis. The aim was to evaluate the etiological profile of unilateral vocal cord palsy in our institute that is a tertiary referral center over the past 10 years. Materials and Methods: Case records of all patients diagnosed with unilateral vocal cord palsy who presented to Deenanath Mangeshkar Hospital, Pune, Maharashtra, India between 2003 and 2013 were retrospectively reviewed. The exclusion criteria included patients with laryngeal/hypopharyngeal malignancies, intubation trauma, congenital vocal cord palsy and cricoarytenoid joint ankylosis. The age, gender, laterality and etiology were the factors taken into consideration. Results: A total of 277 cases spanning over the age range of 2 months to 98 years met our inclusion criteria, out of which 179 were males, and 98 were females with a male to female ratio being 1.82:1. In terms of laterality, 182 patients had left sided, and 95 had right sided vocal cord palsy. Majority of the cases were found to be in the fourth and fifth decades. The most common etiology was idiopathic 136 (49.1%). The incidence of various other etiologies were surgical trauma 60 (21.6%), nonsurgical trauma 10 (3.7%), nonlaryngeal malignancy 36 (12.9%), central/ neurological 17 (6.1%), postradiation 1 (0.3%), and other benign lesions 17 (6.1%). Among the surgical causes, the incidence of nonthyroidectomy surgeries (58.3%) was more than that of thyroidectomy (41.6%). Thyroidectomy was the single most common surgical cause for unilateral vocal cord palsy, followed by other nonthyroid neck surgeries (20%) and anterior cervical decompression (18.3%). Conclusion: The most common cause for unilateral vocal cord palsy is idiopathic. Nevertheless it is still an important sign of various underlying diseases. A thorough evaluation which must necessarily include a computerized tomographic scan from base of the skull to upper mediastinum is essential before labeling a case as idiopathic; hence, also the need for extended follow-up of the cases to avoid misdiagnosis of any underlying subclinical malignancy.
Introduction Amyloidosis is brought about by intracellular and/or extracellular accumulation of insoluble abnormal amyloid fibrils that alters the normal function of the tissues. Localized laryngeal amyloidosis is a rare disease which lacks long-term follow-up studies. It is prone to recurrence; hence meticulous excision is required. We are doing this study to analyse clinical features of primary laryngeal amyloidosis, the subsites commonly found in, and the effectiveness of CO2 laser as treatment modality. Materials and Methods It is a retrospective study of 13 patients diagnosed as Primary Laryngeal Amyloidosis in between 2005 to 2018, where clinical features, histologic and immuno-histochemical patterns of the patients were evaluated. Systemic amyloidosis was ruled out by the non-appearance of Bence-Jones proteins in urine and serum electrophoresis examination. Systemic workups were pursued during the follow-up. The patients were followed up 3 monthly for the first year, then 6 monthly after that, for 3 years. The last patient who underwent the surgery was in the 2018 and had just finished his 2nd follow up, while the rest have been followed up for 3 years. Results Hoarseness was the most common complaint in all the patients. The subsites most common for amyloid deposition were seen in the true vocal cords followed by supraglottis, anterior commissure, ventricle and the subglottis. Microscopically, the amyloid was deposited within the submucosa surrounded by lymphoplamocytic infiltration. All cases were treated with microlaryngoscopic CO2 Laser excision. With the exception of one patient, the rest had no recurrence. Conclusion Primary Laryngeal Amyloidosis is an uncommon benign disease that has a predisposition for recurrence. With use of CO2 laser as the primary treatment modality, the percentage of recurrence has drastically reduced. Systemic involvement should be ruled out. A frequent follow-up of the patients is desirable for early detection of recurrences. Laser is a novel treatment of laryngeal amyloidosis.
Neocord formation after Type III cordectomy is insufficient for complete glottic closure due to scarring and soft tissue deficit. This study evaluates the role of autologous fat injection (AFI) in phonosurgical management of patients who have previously undergone Type III cordectomy for early glottic cancer. Data was collected from hospital records of patients who underwent AFI after previously undergoing Type III cordectomy. A minimum duration of 6 months post-cordectomy was maintained before fat injection. Trans-oral injection was performed at a single site. Pre-operative voice evaluation was done using VHI, GRBAS scale and MDVP software. Post-operative evaluation was done at 6 weeks. 21 out of 62 post-Type III cordectomy patients chose to undergo fat augmentation and were included in the study. A comparison of pre-operative and 6 months post-operative AFI voice analysis showed a significant improvement in VHI, all parameters of GRBAS scale, and improvement in Jitter, Shimmer, SPI and NHR. There was a decrease in fundamental frequency but this was not statistically significant. AFI is an effective procedure for surgical voice rehabilitation of patients who have undergone Type III cordectomy for early laryngeal cancer.
Background: Laryngeal and hypopharyngeal cancers are commonly diagnosed by histopathological examination of a punch biopsy specimen from the lesion. The histopathological report of the punch biopsy specimen in certain cases is inconclusive, most commonly in cases of endophytic growths. Objective: To evaluate the efficacy of trucut biopsy as a diagnostic procedure in such cases of laryngeal and hypopharyngeal growth which are clinically malignant but histopathology report by punch biopsy is inconclusive. Materials and Methods: Seven cases with clinical suspicion of laryngeal or hypopharyngeal malignancies but with inconclusive histopathological examination on punch biopsy were included. Trucut biopsy was performed in them. 6 out of the 7 trucut biopsies were found to be malignancies on histopathological examination. Conclusion: Trucut biopsy is promising diagnostic tool in laryngeal and hypopharyngeal malignancies especially in those cases where there is strong suspicion of malignancy and the punch biopsy does is inconclusive.
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