|Year : 2019 | Volume
| Issue : 1 | Page : 24-26
Abstracts accepted for presentation at the Frontiers in Laryngology, 1st-3rd November, Singapore:
Oral - Junior Consultant
|Date of Web Publication||14-May-2020|
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
. Abstracts accepted for presentation at the Frontiers in Laryngology, 1st-3rd November, Singapore:
Oral - Junior Consultant. J Laryngol Voice 2019;9:24-6
| Dilemma in the diagnosis and management of laryngotracheal cleft (ABS_009)|| |
Shruti Bansal, Arpit Sharma
Department of ENT, SRCC Children's Hospital, Mumbai, Maharashtra, India
Objective: To describe the dilemma in the diagnosis and management of laryngotracheal cleft (LC) cases.
Introduction: LC is a rare congenital malformation resulting in an abnormal communication between the esophagus and laryngotracheal complex. The estimated incidence of LC is 1/10,000–1/20,000 live births. These incidence rates may be underestimated due to difficulty in diagnosing minor forms and high mortality rate in severe forms. Five types of LC (Type 0 to Type 4) have been described based on downward extension of the cleft, which typically correlates with the severity of symptoms.
Materials and Methods: To discuss three cases of LC in age ranging from 2 to 18 months presenting with myriad of symptoms. All patients underwent airway assessment for diagnosis according to our hospital protocol and was managed according to the type of cleft.
Results: Two cases were diagnosed with Type 1 cleft which were managed conservatively. One patient had Type 3 cleft and underwent endolaryngeal repair.
Conclusion: Surgery should be performed as early as possible to avoid complications, except in Type 0 and Type 1 cases where conservative measures must first be attempted. Prognosis is variable depending on the severity of the LC and associated malformations. Early diagnosis and appropriate management help reduce mortality and morbidity.
| Clinical outcomes post-CO2 laser posterior cordotomy with anterior partial arytenoidectomy in bilateral vocal fold immobility: A retrospective case series review of 21 patients in a tertiary hospital|| |
William L. Lim, Tomas Joaquin C. Mendez
Department of Otolaryngology-Head and Neck Surgery,
St. Luke's Medical Center - Global City, Taguig, Philippines
- To analyze the etiologies of bilateral vocal fold immobility (BVFI) in a given population
- To measure the decannulation rate post-CO2 laser posterior cordotomy with anterior partial arytenoidectomy in BVFI
- To assess the efficacy of CO2 laser surgery in providing symptomatic relief in patients with BVFI
- To describe the postsurgical complications of CO2 laser surgery in patients with BVFI.
Materials and Methods: This was a 5-year descriptive and retrospective case series chart review of 21 patients with BVFI who underwent CO2 laser posterior cordotomy with anterior partial arytenoidectomy retrieved from the hospital records from 2010 to 2015 in a tertiary hospital in Bonifacio Global City, Taguig, Philippines.
Results: Of the 21 patients who underwent laser posterior cordotomy with anterior partial arytenoidectomy, all patients experienced significant improvement of symptoms with no need for an advanced airway. Sixteen patients underwent tracheostomy before surgery and all were successfully decannulated within 4 weeks postsurgery. Three patients experienced postoperative laryngeal granuloma formation, which resolved after being managed conservatively with steroids and proton-pump inhibitors. One patient experienced aspiration to liquids, which resolved 2 weeks after conservative therapy. All patients reported a good serviceable voice with return of normal swallowing function.
Conclusion: All patients with tracheotomies preoperatively were successfully decannulated with a good serviceable voice. Transient complications occurred in 19% of patients; however, the impact was minimal with spontaneous resolution of these complications. CO2 laser posterior cordotomy with anterior partial arytenoidectomy is, therefore, a safe procedure that is done for cases of BVFI.
| Dysphagia: An experience at our center (ABS_037)|| |
Department of Laryngology, Kokilaben Dhirubhai Ambani Hospital, Mumbai, Maharashtra, India
Introduction: Dysphagia is a difficult condition psychologically and physically. The main aim of dysphagia management is to provide the patient with proper nutrition and give him the psychological satisfaction of eating.
Aims: To study the spectrum of dysphagia with respect to symptoms, etiology, investigations, and treatment.
Materials and Methods: A retrospective, observational, cross-sectional study, over 1 year, was done in all the patients of dysphagia who underwent functional endoscopic evaluation of swallowing and were assessed on EAT 10 score and additional investigations if required were done. Management included either swallow therapy or surgical interventions.
Results: Twenty patients were included in the study (male: 11 and female: 9), of which 30% of the patients complained about dysphagia only to solids. The other symptoms were dysphagia to liquids, coughing, and choking after eating (70%). The average age was 55 years (range, 6–80 years). The etiology was neurological in 30%, postcoronary artery bypass graft (10%), postradiation or chemotherapy (15%), and 20% were miscellaneous (reflux esophagitis. fungal esophagitis, esophageal web, functional, vocal fold paralysis, and presbydysphagia). Intervention used was cricopharyngeal Botox, esophageal dilatation, injection laryngoplasty, and fundoplication. Four patients could not be weaned off the radiotherapy and required percutaneous endoscopic gastrostomy tube.
Conclusion: Main cause for dysphagia was neurological in this study. Follow-up, proper swallowing therapy, and interventions whenever needed definitely help in the management of dysphagia. A humanistic approach and whenever needed a bit of counseling also helps in getting a desired result.
| Intraoperative I-scan: Is it effective in determining margins for early glottic cancer (ABS_049)|| |
Sachin S. Gandhi, Dushyanth Ganesuni
Voice Clinic, Deenanath Mangeshkar Hospital, Pune, Maharashtra, India
Objectives: To determine whether use of intraoperative I-scan reduces the chance of obtaining a positive margin of resection in early glottic cancer when compared to standard transoral CO2 laser-assisted surgery.
Materials and Methods: Patients undergoing transoral CO2 laser surgery for early glottic cancer from July 2018 to June 2019 were included in our study. Preoperative I-scan was done under general anesthesia and margins of the lesion were clearly identified before giving the incisions with CO2 laser. Histopathology reports of patients in whom intraoperative I-scan is used were analyzed for margin positivity and compared with the retrospective data of patients from January 2013 to June 2018.
Results: None of the 18 patients who underwent ML scopy with preoperative I-scan had positive margins for malignancy, whereas 5% (1 out of 18) of patients had dysplastic changes in one of the margins. In patients in whom intraoperative I-scan is not used, 12% (23 out of 179) patients had margin positivity, 8% (15 out of 179) patients had dysplastic changes in the margins, and 8% (14 out of 179) patients had close margins ( tumor <1 cm).
Conclusion: Intraoperative I-scan is an important tool in determining the resection margin in early glottis cancer lesions.
| Transoral laser surgery for early glottic cancer: Our experience (ABS_050)|| |
Sachin S. Gandhi, Asheesh Dora Ghanpur
Department of Laryngology, Deenanath Mangeshkar Hospital and Research Centre, Pune, Maharashtra, India
Objective: This study aims to review oncologic and functional outcomes of transoral Laser Microlaryngoscopy (TLM) for the management of early glottic carcinoma at our institute.
Methodology: Patients with early glottic cancer managed by TLM from January 2011 to 2017 were included in the study. Medical records were analyzed to acquire data. The patients were followed up every 3 weeks till 3 months and for every 6 months till 3 years postoperatively. Voice analysis done after 3 months was compared to the preoperative voice analysis. Various parameters of stroboscopy were documented.
Results: One hundred and ninety-seven patients underwent TLM for the management of early glottic cancer between 2011 and 2017. Tumor-free margins were obtained after TLM in all 43 cases. For T1a, T1b, and T2 lesions, surgery obtained tumor-free margins in 89.5%, 77.8%, and 77.8% cases, respectively. Twenty-one patients were found to have a positive margin and two patients developed second primary and they underwent revision surgery. The overall local cure rate obtained by TLM was 92.4%. The overall 5-year survival rate was 98.5% and 3-year survival rate was 98.5%. Three patients died of other systemic diseases 3 years after TLM, giving a disease-specific 5-year survival rate of 100%.
Conclusion: TLM is a safe and effective treatment option for the management of early glottic cancer. Its outcomes are comparable to those of RT, and it has lesser cost, treatment duration, and morbidity.
| Long-term follow-up of patients of severe laryngomalacia after supraglottoplasty (ABS_051)|| |
Sachin Gandhi, Subash Bhatta
Department of Laryngology, Deenanath Mangeskar Hospital, Pune, Maharashtra, India
- To find out the present general status of the patients who have undergone supraglottoplasty in the past 5 years
- To find out the status of airway symptoms related to laryngomalacia in patients who have undergone supraglottoplasty in the past 5 years.
Methods and Methodology: It was a prospective study, in which all the patients with diagnosis of laryngomalacia who have undergone surgery in the last 5 years were short-listed and followed up. For follow-up details, a questionnaire was prepared and telephonic interview was taken. The various parameters were evaluated and analyzed.
Results: A total of 50 patients underwent supraglottoplasty, but only 44 met the criteria for inclusion and were included in the study. There were 24 males and 20 females, and the mean age of presentation was 27 days. Among these patients during follow-up, it was found that 86% had no stridor, 78% had appropriate weight for age, 81% had normal swallowing with no aspiration, and 91% had normal development as per age.
Conclusion: It can be concluded that surgery is the main modality of treatment for severe laryngomalacia. The success of surgery is determined not only by the resolution of stridor but also the improvement of overall general condition of the patients.
| Phonatory outcome in patients with transoral laser cordectomy for early glottic cancer (ABS_052)|| |
Sachin Gandhi, Shivali Sharma
Voice and Laser Clinic, Deenanath Mangeshkar Hospital and Research Centre, Pune, Maharashtra, India
Objective: To analyze voice production and voice outcome in patients 6 months posttransoral laser cordectomy for early glottic cancer.
Methods: Seventeen patients underwent transoral laser cordectomy, 9 had limited cordectomies (type I and type II), and 8 extended cordectomies (type III and type V). Multidimensional voice evaluations were performed 6 months after surgery.
Results: Phonatory outcome depends on glottic competence, which is modulated by remaining vocal cord (VC) musculature left after resection. Out of total 17 patients till date, 9 showed very less phonatory disturbance in type I cordectomy. Type III (2 out of 17) and V (2) showed significantly worse phonatory outcome as larger amount of VC musculature resection causes aerodynamic incompetence of glottic closure. VC-VC compensation was seen in type I cordectomy with VC-neo VC compensation in type II and III (maximum). There is increase in the fundamental frequency, jitter, shimmer and more hoarseness of voice with type V cordectomy as compared to type I. Also there is decrease in maximum phonatory time seen on increasing the muscular resection of the vocal cord. Voice handicap index (VHI) score is more for type III and V cordectomy. The total scores of voice parameters of asthenicity, strain, and voice handicap index improved in all patients after surgery. Patients with extended cordectomy showed higher breathiness and VHI total scores.
Conclusion: For having a good phonatory outcome comparable to normal voice, good amount of VC musculature has to be preserved along with ventricular folds and arytenoids.
| Arytenoid granuloma: A single-institution experience in the management of 62 cases (ABS_053)|| |
Voice Clinic, Deenanath Mangeshkar Hospital, Pune, Maharashtra, India
Objective: To review the management and its outcomes in arytenoid granuloma (AG) cases.
Materials and Methods: A retrospective observational study conducted at Deenanath Mangeshkar Hospital, Pune. Patients of AG managed between July 2012 and June 2019 were included. Age, sex, presenting complaints, history of intubation, reflux, and treatment details were collected. Diagnosis of AG was confirmed by videolaryngostroboscopy. Antireflux treatment, i.e., proton-pump inhibitor (PPI) and voice therapy details were collected for those patients managed conservatively. Transoral laser surgery (TOLS) with CO2 laser was the surgical method of choice for those failed conservative management, presenting with breathing difficulty and suspicious of malignancy in videolaryngostroboscopy. Response to conservative management and surgery were assessed.
Results: Sixty-two patients of AG were recruited. Fifty-three patients were male and nine were female. Fifty-four cases were conservatively managed for 6 months with 38 (70.4%) showed complete resolution of granuloma. Twenty-two (68.8%) patients out of 32 patients who were given PPI alone, 9 (75%) out of the 12 who received a combination of PPI with voice therapy, and 7 (70%) out of 10 who received voice therapy alone showed complete resolution of AG. TOLS was performed in 26 patients with 21 (81%) patients had complete resolution of granuloma. Recurrence was seen in 8 (21%) patients after conservative management and 5 (19%) cases among surgically treated cases. Recurrences were managed with PPI, surgery, and botulinum toxin accordingly.
Conclusion: Conservative treatment with PPI and voice therapy is the effective initial management in AG. TOLS has good results in certain indicated cases of AG.