Background: Voice and swallowing impairments can impact on both quality of life and survival. Unilateral vocal fold paralysis (UVFP) as a result of distant metastasis can cause breathy voice and aspiration. The purpose of this study is to develop and evaluate a less invasive and effective alternative therapy for UVFP. Methods: This was a retrospective review of prospectively enrolled patients at a tertiary referral center in Taiwan. Among a cohort of 177 patients who received intracordal hyaluronate injections, 2 had UVFP from distant metastasis and met the inclusion criteria. Vocal cord motion was recorded by videostroboscopy, and the normalized glottal gap area was measured. Voice quality, defined by speech language pathologists, and swallowing status were compared, and immediate complications after the injection were investigated. Results: Two patients with UVFP with M1 lesions (both lung) accepted the procedure. The glottal gap area was significantly improved 1 month after in-office hyaluronate injection. Voice quality and aspiration were also improved. No immediate complications were noted in either patient. Conclusions: In-office intracordal hyaluronate injection is a safe and effective treatment for UVFP, providing a palliative method to help maintain the patient's voice and quality of life.
Background: Thyroid nodules are a common disease entity occurring in 5-10% of the general population and increasing with age. Their detection on ultrasonography ranges from 13% to 67%. Calcifications on ultrasound may occur in both benign and malignant diseases, but have been cited for increased risk of thyroid carcinoma. Objective: To determine the association of calcifications found on thyroid ultrasonography and the different types of calcifications with thyroid carcinoma. Method: Study Design: Retrospective Study Setting: Tertiary Private Hospital Participants: 126 patients with pre-operative thyroid or neck ultrasonography who subsequently underwent thyroidectomy (total or subtotal, with or without frozen section) were selected from a database covering a one-year period from January to December 2012. The presence and type of calcification on ultrasonography was correlated with the final histopathologic report for a diagnosis of thyroid carcinoma. Sensitivity, specificity, positive and negative predictive values were obtained. Results: 51 out of 126 studies (40%) were observed to have calcifications of any description, in both histologically benign (41%) and malignant (59%) nodules. Calcifications seen in malignancy arose from papillary carcinoma (86%). Follicular carcinoma and others (Plasmacytoma and Lymphoma) accounted for 7% each. The peripheral type of calcification was most prevalent accounting for 37% (11 out of 30). The sensitivity of detecting calcifications on ultrasonography is 58.82%, specificity 81.33%, positive predictive value 68.18% and negative predictive value 74.38%. Chi square test computed was 21.54 (P <0.05). Conclusion: There was an association between calcification found on ultrasonography and thyroid carcinoma and 86% of the calcifications were peripheral patterns, mostly found in papillary thyroid carcinomas. Ultrasonography alone is not sufficient in diagnosing thyroid carcinoma, but may increase the suspicion of malignancy depending on the type of calcification. Keywords: Thyroid carcinoma, papillary carcinoma, calcifications, ultrasonography
Objective: To describe the clinical profiles, interventions, and surgical outcomes of patients with advanced (grade III and IV) laryngotracheal stenosis prospectively seen over a 2-year period. Methods: Design: Prospective Case Series Setting: Tertiary Provincial Government Hospital Participants: Five (5) patients with advanced laryngotracheal stenosis confirmed by laryngoscopy and/or tracheoscopy. Results: Five (5) patients (4 males, 1 female), aged 23 to 31years (mean 27-years-old) diagnosed with advanced laryngotracheal stenosis between June 2016 to June 2018 were included in this series. Four resulted from prolonged intubation (14 - 60 days) while one had a prolonged tracheotomy (13 years). Presentations of stenosis included dyspnea on extubation attempt (n=3), failure to extubate (n=1) and failure to decannulate tracheotomy (n=1). Stenosis length was 3 cm in two, and 1.5 cm in three. Of the five (5) patients, three had grade IV stenosis while two had grade III stenosis based on the Cotton-Myer Classification System. Two of those with grade IV stenosis and both patients with grade III stenosis had undergone prolonged intubation. The stenosis involved the subglottis in three, and combined subglottic and tracheal stenosis in two. Prolonged intubation was present in all three with subglottic stenosis, and in one of the two with combined subglottic and tracheal stenosis. Two patients underwent open surgical approaches while three underwent endoscopic dilatation procedures. Four patients were successfully decannulated while one is still on tracheostomy. None of them had post-operative complications. Conclusion: Advanced laryngotracheal stenosis is a challenging entity that results from heterogenous causes. Categorizing stenosis and measuring stenosis length may help in treatment planning and predicting surgical outcome. Keywords: laryngotracheal stenosis; laryngotracheal reconstruction; tracheal resection anastomosis; subglottic stenosis; tracheal stenosis
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