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Table of Contents
ABSTRACTS
Year : 2019  |  Volume : 9  |  Issue : 1  |  Page : 32-42

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Date of Web Publication14-May-2020

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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2230-9748.284238

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How to cite this article:
. E-Posters. J Laryngol Voice 2019;9:32-42

How to cite this URL:
. E-Posters. J Laryngol Voice [serial online] 2019 [cited 2020 Jun 4];9:32-42. Available from: http://www.laryngologyandvoice.org/text.asp?2019/9/1/32/284238




   A rare case report of masquerading neck mass (ABS_001) (P-001) Top


Vineet Narula, Sumit Mrig, Sandeep Arora

Department of ENT, Max Smart Super Speciality Hospital, Saket, New Delhi, India

E-mail: narula.vineet@gmail.com

Objective: We report a rare case of spindle cell lipoma (SCL) of the neck extending into the larynx, which to the best of our knowledge is the first such case in the literature.

Introduction: SCL is an uncommon benign tumor of adipose tissue that is usually superficially located in the posterior neck, back, and shoulder region.

Case Report: We report a rare case of SCL of the lateral neck presenting with all features suggestive of a mixed pyolaryngocele having an external and an internal component traversing through the thyrohyoid membrane. The contrast-enhanced computed tomographic scan of the neck was suggestive of mixed pyolaryngocele. The tumor was excised by a transcervical approach, but the postoperative histopathology was found to be spindle cell lipoma. We report this case due to its atypical presentation and location.


   Ramsay–Hunt syndrome presenting true vocal cord paralysis (ABS_002) (P-002) Top


Carlos Luis Alfonso T. Hernandez, Jaypee M. Amable, Jose Carlo R. Villanueva

Department of Otorhinolaryngology-Head and Neck Surgery, University of the East – Ramon Magsaysay Memorial Medical Center, Inc., Quezon City, Philippines

E-mail: carlosthernandezmd@gmail.com

Objective:

  • To present an unusual case of Ramsay–Hunt syndrome initially presenting with vocal cord paralysis originally treated as stroke in an elderly hypertensive woman
  • To discuss the probable contributing factors leading to this unusual disease process.


Methods:

  • Design: Case report
  • Setting: Private tertiary, university hospital
  • Subject: One.


Results: A 62-year-old elderly, hypertensive woman presented with hoarseness associated with odynophagia, dysphagia, aspiration, left facial pain, and left facial paralysis of 3-day duration. The patient was initially treated as a case of stroke. However, the imaging study of the brain revealed a normal result. Videolaryngoscopy revealed left true vocal fold paralysis, with left arytenoid vesicular lesion. The patient was treated as a case of Ramsay–Hunt syndrome involving the trigeminal nerve, facial nerve, vagus nerve, glossopharyngeal nerve, and vestibulocochlear nerve and recovered with antiviral and oral corticosteroids.

Conclusion: The presentation of Ramsay–Hunt syndrome can be atypical and should not be disregarded merely on the basis of dysphagia. Consideration must be given to the possibility of multiple cranial nerve involvement, particularly when swallowing and airway protection are compromised. Swift diagnosis and treatment is crucial in the successful management of the disease.


   Adult glottic hemangioma: A case report (ABS_003) (P-003) Top


Lloyd Paolo Crizaldo, Archie Brian Ramos

Department of Otorhinolaryngology - Head and Neck Surgery, University of Santo Tomas Hospital, Manila, Philippines

E-mail: pao_lloydcrizaldo@yahoo.com.ph

Objectives: To present a rare case of adult glottic hemangioma in an adult female and the approach to diagnosis, management options, and its importance as a differential in patients presenting with hoarseness.

Materials and Methods: A 65-year-old female sought consult due to a 2-week history of hoarseness. Visualization through flexible laryngoscopy was done and showed a smooth, pedunculated, deep-colored mass from the ventricle at the anterior 1/3 of the right vocal cord partially obstructing the glottic opening. On direct suspension laryngoscopy, the pedunculated mass was noted to be paler looking, similar to the color of the surrounding mucosa. The patient underwent microlaryngeal excision of the pedunculated mass. Histopathology showed findings consistent with cavernous hemangioma.

Results: A laryngeal hemangioma, confined in the glottic area, in an adult female presenting as hoarseness, is a rare and noteworthy occurrence. It should be considered as an important differential in patients with a pedunculated glottic mass presenting with hoarseness.

Conclusion: Laryngeal hemangioma is a benign vascular tumor that is rarely seen in the adult population. There have been 16 reported cases of adult laryngeal hemangioma from 1979 to 2017. Among which, it is commonly documented among men and found at the supraglottic region. This will be the first reported case in the Philippines, second in Southeast Asia, and seventeenth in the world. Although rare, it is an important differential for vascular tumors in the glottis. Microlaryngeal excision using microscissors is a simple, safe, and effective technique in the management of glottic hemangioma, with favorable outcome.


   “Right Is Not Always Right”: A foreign body aspiration on the left main bronchus of a 6-year-old female (ABS_005) (P-005) Top


Aldrin Butz Bamba, John Hector Pagdanganan

Department of Otolaryngology- Head and Neck Surgery, Jose B. Lingad Memorial Regional Hospital, Pampanga, Philippines

E-mail: bambaaldrinbutz@gmail.com

Objectives: To present an atypical case of a foreign body aspiration of a 6-year-old girl and discuss the diagnostics and management dilemma on the location of the foreign body.

Materials and Methods:

  • Design: Case report
  • Setting: Tertiary government hospital
  • Patient: One.


Results: A 6-year-old girl accidentally swallowed a pebble when playing. Failed attempts to remove the aspirated pebble prompted consult. Radiographs were requested for confirmation and the foreign body was located on the right main bronchus. The patient was immediately brought to the operating room where a rigid bronchoscopy with foreign body extraction was planned. Insinuation of the bronchoscope to the right main bronchus was initially done, but did not find any pebble. To our surprise, the foreign body was lodge on the left main bronchus and was successfully extracted. Transient cyanosis and rapid decrease in oxygen saturation during extraction was overcome with the help of our anesthesiologist. The patient regained consciousness and was transfer to the regular ward.

Conclusion: Foreign body aspiration is less common than ingestion in children. If it happened, a prompt intervention must be done to extract the foreign body. A radiograph is an essential tool to confirm and locate the presence of the foreign body before subjecting the patient to definitive interventions. The incidence of foreign body in the tracheobronchial tree itself is less common, but how often does an inanimate object identified and confirmed on the right main bronchus will be relocated on the contralateral left main bronchus? This case report discusses our diagnostics and management dilemma.


   Supraglottic keratinous cyst in an elderly male presenting as dysphagia (ABS_006) (P-006) Top


P. Cathrine Miura, M. Jay Pee Amable, R. Jose Carlo Villanueva

University of the East - Ramon Magsaysay Memorial Medical Center, Inc., Quezon City, Philippines

E-mail: miura.cathrine@gmail.com

Objectives:

  • To present a case of keratinous cyst in an elderly male presenting with dysphagia
  • To present a rare case of keratinous cyst occurring in the aryepiglottic fold.


Materials and Methods:

  • Design: Case report
  • Setting: Tertiary private university hospital
  • Patient: One.


Results: A 63-year-old male presented with dysphagia wherein flexible nasopharyngolaryngoscopy was done and he was noted to have a left aryepiglottic fold mass. The patient underwent direct suspension microlaryngoscopy with excision of the left aryepiglottic fold mass. Histopathologic examination revealed a keratinous cyst.

Conclusion: By far, there are very few reported cases of a keratinous cyst found in the mucosa, let alone in the supraglottis. Dysphagia can entail many differential diagnoses, requiring proper investigation, which will also dictate the management. To the authors' knowledge, this is the first reported case of a keratinous cyst in the aryepiglottic fold.


   Posttubercular upper airway stenosis – A series of five cases (ABS_008) (P-007) Top


Rakesh Srivastava, Ashish Chandra, Issac M Macharia

Sushrut Institute of Plastic Surgery and Super Specialty Hospital Lucknow, Uttar Pradesh, India

E-mail: rakeshsrivastavaent@gmail.com

Introduction: Tuberculosis (TB) is a major health problem in India. It is transmitted through air droplets and lung being the most common organ to be affected. According to the WHO statistics of 2011, the estimated incidence of 2.2 million cases of TB in India out of global incidence of 9.6 million cases. The incidence of laryngeal TB is <1% of all tuberculosis.(2) Upper airway involvement from TB is becoming common in India. Healing of tubercular lesion in upper airway leads to stenosis.

Materials and Methods: A prospective study was done on patients visiting the outpatient department of a tertiary care hospital in North India. All the five cases presented with a combination of the following complaints: breathing difficulty, change in voice, and painful swallowing. The patients were evaluated by clinical examination, followed by flexible nasopharyngolaryngoscopy, blood investigations, radiological examination (X-ray chest/computed tomography scan neck and thorax or both), sputum microscopy/culture, and Mantoux test.

Case 1: A 21-year-old thin built male patient presented with difficulty in breathing for the past 3 months. He was treated for pulmonary TB and treatment concluded 3 months before presentation. Flexible laryngobronchoscopic examination in the operating room revealed upper tracheal stenosis (2nd/3rd ring) with two openings, multiple webs with inflammation, and fibrinous secretions.

Case 2: An 18-year-old male patient presented with severe breathing difficulty for the past 3 months. There was anterior glottis web and 2 mm of chink and also posterior glottic stenosis with immobile cricoarytenoid joint.

Case 3: A 38-year-old female patient presented with hoarseness of voice for 4 months and breathing sound during sleep. Airway assessment was done with a flexible scope and supraglottic and glottic narrowing with lumen of around 6 mm.

Case 4: A 24-year-old African male patient from Nairobi presented with tracheostomy. Suspension microlaryngoscopy examination under total intravenous anaesthesia showed anterior and posterior glottic stenosis.

Case 5: A 22-year-old male patient presented with change in voice, coughing, and painful swallowing for 3 months. Flexible laryngoscopy revealed thick postnasal secretions with partially destroyed epiglottis, ulcers over false cord, and aryepiglottic folds. Flexible nasopharyngolaryngoscopy after 2 months of anti tuberculous therapy showed partial bilateral postnasal stenosis and supraglottic stenosis (shortened aryepiglottic fold) and false cord stenosis with normal true vocal folds.

Discussion: The pathogenesis of upper airway stenosis secondary to TB is same as endobronchial (lower airway) stenosis. The bacilli involve mucosa, submucosa, and cartilage. The end result is fibrosis and stenosis of the airway. There are various barriers in the form of muscle and fat plane in the upper airway. The cartilage involvement is less common in upper airway.

Conclusion: There is a paucity of literature on glottic and supraglottic stenosis due to tuberculosis. Disease progression and its delayed effects on supraglottic airway have been exemplified in case five. Any patient with supraglottic or glottic stenosis of unknown cause should be investigated for tuberculosis.


   Juvenile laryngeal amyloidosis presenting as laryngeal papillomatosis: A case report (ABS_013) (P-010) Top


Mark Randell Quines1, William Lim1,2, John Silva1

1Department of Otorhinolaryngology, Head and Neck Surgery, University of Santo Tomas Hospital, Manila,2Department of Otorhinolaryngology, Head and Neck Surgery, St. Lukes Medical Center, Quezon City, Philippines

E-mail: randellquines@gmail.com

Objectives: To present a case of an uncommon laryngeal mass in a pediatric patient and to review the prevalence of laryngeal amyloidosis in the Philippines.

Design: Case report.

Setting: Private division of a tertiary hospital.

Patient: A 15-year-old male with laryngeal amyloidosis.

Case Summary: We present a case of a 15-year-old male who presented with 2 years of dysphonia. The patient was noted to have gradually worsening breathy and asthenic voice. Further examination revealed a papillomatous fleshy frond-like friable mass at the middle anterior area of the true vocal cords with normal movement of vocal cords and was initially diagnosed with laryngeal papillomatosis and underwent microlaryngeal surgery. A histologic examination was done, on the background of the history of the patient and consideration of papillomatosis, revealing respiratory mucosal tissue fragments with amorphous eosinophilic deposits and lymphoplasmacytic infiltrates. Congo red staining revealed apple-green birefringence on polarizing microscope and was compatible with amyloidosis. Further laboratories such as blood chemistries and radiologic imaging revealed normal results, ruling out systemic amyloidosis. No evidence of malignancy was noted.

The patient was not dyspneic on follow-up and had no recurrence of mass on 14 months of follow-up. Close follow-up was advised.

Conclusion: To this date, there is the only one documented case of amyloidosis out of the 3,493,766 reported cases in the Philippine Pediatric Society. Amyloidosis is a multisystem disease with a wide spectrum of clinical presentation. Deposition of amyloid in the larynx would present with dyspnea, hoarseness, and airway obstruction.


   Outcomes of transoral CO2 laser surgery for early glottic carcinoma: Experience at two private tertiary hospitals (ABS_014) (P-011) Top


William L. Lim1,2, Froilan Val Rafanan1,2, Cristine Celine Z. Pefianco1,2, Myron Jeffreu B. Uy1,2

1St. Luke's Medical Center, Quezon City,2St. Luke's Medical Center, Global City, Taguig, Philippines

E-mail: froilanrafananmd@gmail.com

Background: Early glottic squamous cell carcinoma (T1aN0, T1bN0, and T2N0) is one of the most curable malignancies of the head and neck. Cure and voice preservation can thus be achieved using a single modality treatment. Transoral laser microsurgery allows for resection of only the involved tissue and structures using narrow margins to spare uninvolved structures, thereby improving functional outcomes.

Methods: Medical records of patients were reviewed. All patients diagnosed with early glottic squamous cell carcinoma who underwent transoral CO2 laser microsurgery by a single surgeon in the two St. Luke's Medical Center hospitals from January 2000 to June 2018 were included. Age, sex, tumor staging, extent of resection, postoperative complications, radiotherapy done pre- or postsurgery, follow-up duration, and recurrence postresection were tabulated.

Results: From January 2000 to June 2018, 43 patients were diagnosed with early glottic squamous cell carcinoma. The median age of the included patients was 64 years (range of 42–92 years, mean of 63.14 years). Of the 43 patients, 39 (90.70%) were male and 4 (9.30%) were female. Majority of the patients (81.39%) were staged as T1a, followed by T2 (13.95%) and T1b (4.65%). Most patients (67.44%) underwent type III resection (transmuscular cordectomy), followed by type V resection (extended cordectomy, 18.60%) and type IV resection (total or complete cordectomy, 13.95%). No perioperative or postoperative complications were noted. The mean follow-up duration was 17.6 months (range of 12–94 months). Five (11.63%) patients developed recurrence within 3 years of resection, with 3 patients eventually undergoing total laryngectomy with neck dissection.

Conclusion: Transoral CO2 laser microsurgery is an effective technique for treating early glottic squamous cell carcinoma. Outcomes in this study were similar to previous studies.


   Management of laryngeal penetrating neck injury: A case report (ABS_015) (P-012) Top


Ruthlyn Pecolera, Rubiliza Onofre

East Avenue Medical Center, Quezon City, Philippines

E-mail: ruthlynpecolera@gmail.com

Objectives: This study aims to describe the presentation and the unconventional repair of the laryngeal structures, for a specific type of injury, in a patient who sustained a penetrating neck trauma in a Third World country in which plates and stents are not readily available.

Materials and Methods: A case report study was done in a Filipino male patient who had penetrating neck injury secondary to hacking wound in a tertiary government hospital. Medical record was used to collect information pertaining to the patient's clinical history.

Results: A 38-year-old conscious male patient came to the emergency room and presented with a hacking wound injury – laceration at the anterior neck that extended into the hypopharyngeal area, transecting the thyroid cartilage. Preemptive tracheostomy was performed by the general surgeon. Referral to the department of otorhinolaryngology was done due to the extensive hypopharyngeal injury. Neck exploration was performed to control the bleeders and confirm the initial findings. Reconstruction of the hypopharyngeal area, transected thyroid cartilage, and strap muscles were done via anastomosis using absorbable sutures. The technique utilized resulted to successful repair of the larynx.

Conclusion: Meticulous anastomosis via simple interrupted suturing using absorbable suture in the repairing of a Schaefer–Fuhrman classification Group 3 penetrating neck injury can provide prompt and appropriate treatment, thus proving good outcomes and less morbidity postinjury in this patient.


   A rare case of blue rubber bleb nevus syndrome (ABS_016) (P-013) Top


Shera Elefante

Department of ENT HNS, Southern Philippines Medical Center, Davao City, Philippines

E-mail: sheralimelefante@gmail.com

Objectives: This study aims to present a rare case of a blue rubber bleb nevus syndrome in a 35-year-old female who was initially diagnosed as pharyngitis. This is to highlight the importance of thorough history taking, physical examination, and proper management of head and neck tumors.

Materials and Methods:

  • Design: Case report
  • Setting: Clinical practice and tertiary government hospital
  • Patient: One.


Results: A 35-year-old female with iron-deficiency anemia who presented with globus sensation had multiple bluish soft, tender, and compressible nodules at both arms, back, and left leg. Flexible fiberoptic nasopharyngeal endoscopy revealed a smooth, wide-based, nonpulsatile, bluish mass at the left arytenoid partially obstructing the airway. Upper gastrointestinal endoscopy showed tonsillar and esophageal hemangioma, hiatal hernia, and erosive gastritis. Colonoscopy revealed internal hemorrhoids. Doppler ultrasound of lower extremities showed venous malformations on the left posterior proximal leg and medial malleolus. The patient was examined in Southern Philippines Medical Center where a multidisciplinary tumor board conference decided to manage the case conservatively with iron supplementation and frequent monitoring.

Conclusion: This is an interesting case of blue rubber bleb nevus syndrome, a rare disease manifested by distinctive cutaneous and gastrointestinal hemangiomatous lesions. The most common initial presentation is iron-deficiency anemia with multiple bluish cutaneous nodules. Rarely, laryngeal involvement is present. Early detection will prevent misdiagnosis and over usage of inappropriate tests. In this case, it is best to do conservative management if there is no immediate need for surgery, thus improving patient's quality of life and preventing further morbidity.


   Classical Hodgkin lymphoma of the thyroid: A case report (ABS_017) (P-014) Top


Nurhamizah Mahmud, Marina Mat Baki, Rohaizak Muhammad1

Departments of Otorhinolaryngology, Head and Neck Surgery and1Surgery, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia

E-mail: nurhamizahmm@gmail.com

Introduction: Classical Hodgkin lymphoma that primarily localized in the thyroid is extremely rare. Classical Hodgkin lymphoma of the thyroid accounts for 2% of all primary thyroid lymphoma patients and 2%–7% of all extranodal lymphomas.

Report: Here, we report a case of classical Hodgkin lymphoma of the thyroid with airway and esophageal obstruction. Radiological imaging (computed tomography scan) revealed aggressive thyroid tumor with airway infiltration and lung metastasis. Because cytological assessment was inconclusive, debulking thyroidectomy, frozen section, and tracheostomy were performed to obtain histopathological samples as well as to alleviate the severe airway obstruction. The frozen section report was suggestive of lymphoma; hence, complete excision was deferred. Histopathological assessment revealed the presence of Reed–Sternberg cells.

Conclusion: Relevant literatures for this rare clinical condition are reviewed and discussed. Although classical Hodgkin lymphoma of the thyroid is a rare entity, clinicians should consider it in the diagnosis of a thyroid mass.


   Interleukin 1β level in acquired laryngotracheal stenosis patients in University Kebangsaan Malaysia Medical Centre (ABS_018) (P-015) Top


A. Norazwani1,2, L. Yogeswaran3, A. Mawaddah1, M. H. Angela Ng3, M. Abdullah Sani1, Marina Mat Baki1

Departments of1Otolaryngology and3Tissue Engineering Centre, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia,2Department of Otolaryngology-Head and Neck Surgery, Kulliyah of Medicine, International Islamic University, Selangor, Malaysia

E-mail: norazwaniazwal@hotmail.com

Introduction: Acquired laryngotracheal stenosis (ALTS) remains one of the most challenging problems in otolaryngology. Interleukin-1 beta (IL-1β) has been identified as the main inflammatory mediator in the formation of ALTS and identifying its level early may help improve the outcome of patients with risk of developing ALTS.

Materials and Methods: This study involved 20 participants with ALTS (15 severe and 5 mild stenosis) and 5 healthy volunteers recruited from the ORL clinic of Universiti Kebangsaan Malaysia Medical Centre. The grade of stenosis was documented and blood samples were taken at four different time intervals of 6–12 weeks in which the IL-1β level was determined by performing ELISA tests. The IL-1β level was compared between (1) severe ALTS and healthy and (2) severe and mild ALTS using ANOVA. The trend of IL-1β level was compared with the severity of stenosis descriptively.

Results: Six female and nine male ALTS patients with an average age of 35.3 years were recruited. Severe ALTS patients before intervention showed significantly higher level of IL-1β compared to healthy volunteers (P = 0.05). Severe ALTS patients before intervention have higher IL-1β level compared to severe ALTS patients after interventions (P = 0.003). The mean of IL-1β of severe ALTS patients was higher than the mild ALTS patients throughout the study period. However, due to wide variation in IL-1β level of severe ALTS patients, the difference was found to be not statistically significant. The IL-1β level was also found to be reducing trend with the improvement of the Cotton Myer grading of stenosis for patients who underwent Open or endoscopic surgery who managed to be decannulated.

Conclusion: The present study demonstrated that the level IL-1β is associated with ALTS severity and is higher in the ALTS group than the healthy group. These findings may provide a baseline for further research in ALTS that may further help the management in treating and reducing the morbidity and mortality.


   Botox injection for adductor spasmodic dysphonia without EMG guidance (ABS_020) (P-016) Top


Gauri Kapre

Neeti Clinics, Nagpur, Maharashtra, India

E-mail: gauri.kapre@yahoo.com

Objective: Conventionally, botulinum toxin A injection into the vocal fold bilaterally under EMG control is the ideal treatment for adductor spasmodic dysphonia (ADSD). In a tier 2 city and a purely ear, nose, and throat setup, EMG might be difficult to arrange. We attempted to do Botox injective under flexible laryngoscopic view using the injection laryngoplasty technique to circumvent this limiting factor.

Materials and Methods: Three patients with clinically diagnosed ADSD underwent injection of Botox into the bilateral vocal folds under flexible laryngoscopic control rather than EMG control. The dose injected was 3.75 units of Botox in each vocal fold.

Results: All patients were relieved of their symptoms and had a spasm-free period of 7–8 months. The initial breathy voice period lasted for 4–6 days.

Conclusion: Treatment of ADSD by Botox injection can be done in a setup where laryngeal EMG is not available and the results are the same as traditional EMG-guided technique.


   Nuances in pediatric airway (ABS_021) (P-017) Top


Panchala V. L. N. Murthy1,2

1Department of ENT and Pediatric Airway, Rainbow Children's Hospital,2Department of ENT and Head and Neck Surgery, Star Hospitals, Hyderabad, Telangana, India

E-mail: drmurthyent@gmail.com

Objective: To discuss and highlight the nuances in pediatric airway.

Methodology: This was a retrospective study of 182 pediatric cases aged between 15 days and 12 years, who presented with stridor and respiratory distress and who underwent microlaryngobronchoscopy (MLB) by us from January 2016 to July 2019. All the patients were studied for the various clinical presentations, investigations, treatments, and sequelae.

Results: The cases included stridor and respiratory distress, who underwent MLB (142), aged between 15 days and 12 years. The findings of MLB include laryngomalacia (54), vocal cord palsy U/L and B/L (21), subglottic stenosis (SGS) congenital (7), SGS acquired (25), tracheal stenosis congenital (4), tracheal stenosis acquired (3), hemangioma SG, tracheal, tonsil, pyriform sinus (8), webs laryngeal (4), laryngeal cleft (4), epiglottic cleft (1), base tongue lesions (lingual thyroid and cystic lesions) (6), cystic hygroma (1), and surface tension (4).

Conclusion: Airway disorders are common in the pediatric population and will present with stridor, respiratory distress, and life-threatening episodes. Early recognition and management will prevent potential life-threatening events. Real-time visualization and assessment of airway dynamics with flexible laryngobronchoscopy and rigid scope remains the gold standard for diagnosis and management planning.


   Profile and treatment outcomes of laryngotracheal stenosis in a tertiary private hospital (ABS_023) (P-018) Top


William L. Lim, Myron Jeffrey B. Uy, Hycel S. More

St. Luke's Medical Center, Bonifacio Global City, Taguig, Philippines

E-mail: myron.uy@gmail.com

Objective: To describe the clinical profile and evaluate treatment outcomes of patients with laryngotracheal stenosis.

Background: Laryngotracheal stenosis is a complex airway problem. Tracheal resection with end-to-end anastomosis is considered the procedure of choice. An alternative to this open approach is endoscopic laser surgery with balloon dilatation.

Methods: Cross-sectional study.

Results: Twenty patients with laryngotracheal stenosis underwent 29 surgical procedures from July 2013 to July 2018. History of endotracheal intubation was reported in 18 out of 20 cases (90%). Among the 20 patients, 4 underwent cricotracheal resection and 16 (10 adult and 6 pediatric patients) underwent endoscopic surgery. Among these 16 patients, 10 underwent a single endoscopic procedure and 6 required multiple procedures at an average of 1.7 procedures per patient and an interval range of 2 weeks to 8 months. The overall rate of extubation or decannulation was 75%. Among those who underwent cricotracheal resection, the rate of extubation was 100%, with time of extubation ranging from 2 to 7 days. Among patients who underwent endoscopic surgery, the rate of decannulation was 69%, with time of decannulation ranging from 3 days to 1 year. Among pediatric patients, the rate of decannulation was 100%.

Conclusion: Laryngotracheal stenosis is most commonly due to intubation. Cricotracheal resection with end-to-end anastomosis is a safe and effective single-stage surgical procedure in managing laryngotracheal stenosis. Endoscopic laser surgery with balloon dilatation is also an effective yet minimally invasive surgical option, especially for the pediatric age group, though it may necessitate multiple procedures before decannulation.


   Voice workshop for teachers: Is it worth considering? (ABS_025) (P-019) Top


Yu Xuan Jenny Gan, Dharshini Manoharan

Allied Health/ Rehabilitation, Ng Teng Fong General Hospital, Singapore

E-mail: jenny_gan@nuhs.edu.sg

Objectives: Teachers have an increased risk for voice disorders, impacting on their personal and professional lives. Preventative strategies and early professional intervention have demonstrated benefits in mitigating voice disorders. However, multiple studies reported knowledge gaps among teachers pertaining to voice care and available avenues to seek professional help for dysphonia. This review investigates if a workshop targeted at improving voice care knowledge and voice use techniques is beneficial for teachers.

Methods: A literature review was completed using PubMed, EMBASE, speechBITE, ClinicalKey, Cochrane library, and University of Sydney Library. Studies reporting on voice care education programs and/or direct voice-training programs for teachers with/without dysphonia were included in the review. These programs were analyzed based on their effectiveness in improving self-reported voice symptoms and voice care knowledge.

Results: The included studies involved differing outcome measures and varying combinations of voice care education and/or voice training. This made direct comparison and meta-analysis difficult. There were limited studies that evaluate the effectiveness of these programs in the prevention of voice disorder. Nonetheless, descriptive analysis generally showed positive effects in self-reported voice symptoms and knowledge of voice care after voice care education and direct voice training. There was also evidence of positive outcomes being sustained for up to a year after intervention.

Conclusion: This review advocates for the implementation of training programs or workshops for teachers with a focus on voice care strategies and direct training of voice production techniques.


   Our experience of laryngeal laser surgery at Otorhinolaryngology Head and Neck Specialist Hospital, Yangon, Myanmar (ABS_026) (P-020) Top


Maung Maung Khaing, Chaw Su Hlaing

Department of Otorhinolaryngology - Head and Neck Surgery, ORL-HNS Specialist Hospital, University of Medicine (1), Yangon, Myanmar

E-mail: dr.cshlaing@gmail.com

Objective: The objective is to verify the outcome results of laryngeal laser surgery done at ORL-HNS Hospital, Yangon, Myanmar, and to share our experience of laser surgery.

Materials and Methods: All patients with laryngeal lesions who gave consent to undergo laser surgery were included. Thorough knowledge of microarchitecture anatomy of vocal folds and assessment of disease extend are very important for laser laryngeal surgery. Detailed preoperative assessment of larynx can foretell the outcome of surgery. Lingwave, voice handicap index score, videostroboscopy plays a crucial role for preoperative and postoperative outcome assessment.. To have favorable outcome, proper laser setting and instruments, surgeon's experience, and team work with anesthesiologists are necessary.

Results: Recently, the first case of laryngeal laser surgery was done on January 31, 2018, at ORL-HNS Specialist Hospital after 17th ASEAN ORL HNS Precongress Laser Workshop, Yangon, Myanmar. We have operated 66 cases of laryngeal diseases by laser. There are 24 cases of benign laryngeal lesions; 23 cases of recurrent laryngeal papilloma; 3 cases of laryngeal web; 12 cases of bilateral vocal cord palsy; and 4 cases of leukoplakia, cordal growth (T1), subglottic stenosis, and arytenoidectomy. About two-third of the cases are favorable outcome and one-third are unfavorable.

Conclusion: Laryngeal laser surgery is very effective and curative management of laryngeal lesion. It can significantly improve the morphology and the quality of phonation. Laser surgery can fulfill the patient's expectation of live free of tracheostomy tube after successful cordectomy. Now, we try to proceed the laser surgery on malignant laryngeal diseases.


   Isshiki thyroplasty Type II: An invaluable option for the management of adductor spasmodic dysphonia in a 27-year-old nonresponsive male to series of botulinum toxin treatment (ABS_030) (P-032) Top


Leighnette Geronimo, John Espina, Celso Ureta

Veterans Memorial Medical Center, Quezon City, Philippines

E-mail: leighgeronimomd@gmail.com

Objective:

  • To present the first successful local report of the patient diagnosed with spasmodic dysphonia who underwent Isshiki thyroplasty Type II
  • To discuss the clinical manifestation, surgical management, and postoperative outcome of the patient with spasmodic dysphonia using Isshiki thyroplasty Type II.


Methods:

  • Study Design: Case report
  • Setting: Tertiary hospital
  • Patient: One.


Results: A 27-year-old male preacher sought consult in our institution due to dysphonia characterized as shaky with involuntary phonatory breaks associated with sensation of strangulation and exhaustion after speaking long phrases. The patient consulted an ear, nose, and throat (ENT) specialist wherein he was managed as a case of spasmodic dysphonia and underwent repeated botulinum toxin injection, which provided temporary relief of symptoms of spasmodic dysphonia. Due to persistence of dysphonia, the patient sought consult in our institution. History, ENT, and neurological physical examination were normal and consistent with spasmodic dysphonia. The patient underwent Isshiki thyroplasty Type II under local anesthesia. The voice improved intra operatively. This was maintained up-to 5 months of follow up.

Conclusion: We presented a first successful local report of the patient diagnosed with spasmodic dysphonia who underwent Isshiki thyroplasty Type II after series of botulinum toxin injection. A patient with spasmodic dysphonia usually presents with progressive strained-strangled voice and experience breaks when speaking, temporarily relieve with botulinum injection. ENT and neurological examination are normal and VHI shows moderate disability. Isshiki thyroplasty Type II gives immediate and fairly permanent relief of symptoms of adductor spasmodic dysphonia.


   Spindle cell carcinoma of the base of the tongue: A rare entity (ABS_033) (P-021) Top


Dipak Nayak, Prerit Rao, J. Padmapriya1

Departments of ENT-HNS and1Pathology, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India

E-mail: drnent@gmail.com

Objectives: To report and discuss two rare cases of spindle cell carcinoma managed successfully.

Materials and Methods: A retrospective review of two patients of spindle cell carcinoma of the base tongue operated in the Department of ENT, Kasturba Medical College, Manipal. The case details are as follows.

Case 1: A 67-year-old male patient came with complaints of sticky sensation in his throat for 3 months not associated with throat pain, dysphagia, and change of voice. The rigid angled telescopic examination revealed a proliferative mass of 3 cm × 2 cm size in the midline involving BOT. Computed tomography showed a homogeneously enhancing lesion in the BOT and vallecula region measuring 2.8 cm × 2.5 cm × 2.8 cm.

Case 2: A 62-year-old male patient came with complaints of foreign body sensation in his throat for the last 2 years with no dysphagia, breathing difficulty, or voice change. On rigid telescopic examination, he was found to have proliferative growth in the vallecula and BOT. Computed tomography showed a homogeneously enhancing lesion in the BOT and vallecula region measuring 2.6 cm ×1.9 cm × 1.5 cm.

Results: Both the patients underwent KTP laser-assisted transoral excision of tumor and the resected margins were tumor free. Both of them received postoperative RT including the 1st one who received radiotherapy in an outside center.

Conclusion: Spindle cell carcinoma is rare, and a degree of suspicion is required especially in cases with unusual presentation as early diagnosis can lead to a better prognosis.


   A survival case of blunt traumatic complete laryngotracheal separation (ABS_034) (P-022) Top


J. Sitti Farhana, M. B. Marina, A. Mawaddah, M. Abdullah Sani

Department of Otorhinolaryngology, Head and Neck Surgery, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia

E-mail: farhana.joe217@gmail.com

Introduction: External laryngeal injury is rare and life-threatening, with over 75% patients d at the accident scene. A successful outcome is determined by early diagnosis, which requires an elevated level of suspicion. Securing the airway and early surgical repair for complex laryngotracheal (LT) injuries are the most important aspect of management for the best results of long-term airway patency and voice quality.

Case Presentation: We present a survival case of complete LT transection following blunt neck trauma, in which blind urgent intubation was performed upon worsening respiratory distress. LT injury was suspected after developing extensive subcutaneous emphysema following intubation. Computed tomography scan revealed tracheal disruption with extensive subcutaneous emphysema and malposition of endotracheal tube in anterior mediastinum. Emergency neck exploration and tracheostomy were performed on the same day, but LT reconstruction was performed after 3 days due to lack of expertise. He recovered well with normal voice, breathing, and swallowing.

Discussion: Complete transection of the cervical trachea secondary to blunt trauma is seen in 1% of blunt neck injuries. The diagnosis is challenging due to nonspecific signs and one-third of patients are asymptomatic for 24–48 h. A high index of suspicion for LT disruption is indicated by hoarseness, subcutaneous emphysema, and crepitus. The survival relies on proper airway management. Complications of LT injury is 17% for chronic airway obstruction and 25% for voice compromise. Early recognition and surgical intervention have resulted in a decrease in these complications.

Conclusion: LT injuries are considered a difficult clinical situation posing diagnostic and therapeutic challenges to clinicians. Awareness of this injury and its management is crucial to achieve a good outcome.


   Laryngeal actinomycosis: Clinical presentation, diagnosis, and management in a 43-year-old woman (ABS_035) (P-023) Top


Ralph Vincent Ti Yu, Milabelle Lingan

Jose R. Reyes Memorial Medical Center, Manila, Philippines

E-mail: ralphtiyu@gmail.com

Objectives:

  1. To describe a case of laryngeal actinomycosis and its clinical course
  2. To provide insights into its diagnostic and therapeutic management.


Materials and Methods:

  • Study Design: Case report
  • Setting: Tertiary government hospital
  • Patient: One.


Results: A 43-year-old female with a 2-year history of hoarseness, consulted due to dyspnea. Physical examination revealed edematous arytenoids and epiglottis with a fungating whitish mass from the left false vocal fold that was causing a ball valve effect and obstructing 90% of the airway. Tracheostomy and direct laryngoscopy with punch biopsy was done revealing actinomycosis. The patient was treated with a 3-month course of penicillin and was eventually decannulated with resolution of laryngeal lesion.

Conclusion: Laryngeal actinomycosis should always be a consideration in the differential diagnosis with or without the risk factors of the disease as seen in our patient. Diagnosis using histopathology with or without culture is advised. Prolonged antibiotic therapy combined with surgical excision is the mainstay of treatment of the disease.


   Case report: Upper airway manifestation in granulomatosis with polyangiitis (ABS_039) (P-024) Top


Dian Paramita Wulandari, Hesti Dyah Palupi

Department of ORL HNS, Sardjito Central Public Hospital, Yogyakarta, Indonesia

E-mail: hestitht@yahoo.com

Objectives: The objective of this study is to describe the upper airway pathology manifestation in a patient with granulomatosis with polyangiitis.

Materials and Methods: We follow a case with granulomatosis with polyangiitis with its complications of upper respiratory tract involvement.

Results: We present a case report of subglottic stenosis in a female patient diagnosed with granulomatosis with polyangiitis. The patient also had nasal septal perforation and nasal framework destruction. Antineutrophil cytoplasmic antibody test was positive and biopsy test showed necrotic vasculitis.

Conclusion: Upper airway manifestation of granulomatosis with polyangiitis occurs less frequently and as a result of chronic recurrent inflammation.


   Effectiveness of injection laryngoplasty transthyrohyoid approach in unilateral vocal fold palsy: A single-center experience (ABS_040) (P-025) Top


J. Sitti Farhana, A. Mawaddah, M. A. Ubaidah, M. Abdullah Sani, M. Mat Baki

Department of Otorhinolaryngology, Head and Neck Surgery, Universiti Kebangsaan Malaysia Medical Centre, Kuala Lumpur, Malaysia

E-mail: sittifarhana85@gmail.com

Objectives: Unilateral vocal fold paralysis (UVFP) is a distressing condition that affects quality of life resulting in psychological, social, emotional, and employment-related difficulties. The most common cause is iatrogenic injury to the nerve such as thyroidectomy. Injection laryngoplasty (IL) is one of the surgical options of UVFP. The advantages of IL include lower cost and morbidity as it can be done in clinic setting with minimal anesthetic requirements and avoidance of open surgical procedures. In this study, we evaluate the effectiveness and safety of office-based IL in treating patients with UVFP.

Materials and Methods: This is an observational study involving 12 patients (7 females and 5 males) with UVFP for 17 months duration from April 2018 to August 2019. The injection was given using transthyrohyoid approach under local anesthesia using hyaluronic acid (Juvederm UltraXC). Subjective and objective voice assessments were performed and compared at baseline, 1 month, and 3 months postintervention. Paired t-test was used to evaluate the improvement between baseline and the different time points. The correlation between objective parameters and Voice Handicap Index 10 (VHI-10) was done using Spearman's correlation.

Results: The UVFP patients with average age of 45.92 ± 14.08 years showed significant improvements after injection at 1 and 3 months for VHI-10 (P < 0.001, P < 0.001), jitter (P = 0.017, P = 0.010), shimmer (P = 0.007, P = 0.012), and mean phonation time (MPT) (P = 0.028, P = 0.013). Maximum voice intensity (P = 0.027) and noise-to-harmonic ratio (NHR) (P = 0.019) showed significant improvements after injection at 3 months. There was no significant difference for fundamental frequency (pitch) and between 1 and 3 months post-IL. Statistically significant moderate positive relationships were observed between VHI-10 and shimmer (rs = 0 .611, P < 0.001) and jitter (rs = 0.466, P = 0.004), while a significant moderate negative correlation was observed between VHI-10 and MPT (rs = −0.391, P = 0.018). No complications were observed in all patients.

Conclusion: Based on this small study, IL is effective and safe in treating glottic insufficiency.


   Outcomes of congenital upper airway pathologies at Universiti Kebangsaan Malaysia Medical Center: A 9-year review (ABS_047) (P-026) Top


I. Razak, A. Zara, B. S. Goh

Department of Otorhinolaryngology, Universiti Kebangsaan Malaysia Medical Center, Kuala Lumpur, Malaysia

Corresponding Author: B. S. Goh,

E-mail: irenegbs@yahoo.com

Objectives: The current study has attempted to determine the outcomes of congenital upper airway disorders in general.

Materials and Methods: A cross-sectional study was conducted to determine the risk factors and surgical outcomes of congenital airway pathologies at the Universiti Kebangsaan Malaysia Medical Center (UKMMC), a tertiary referral hospital in Kuala Lumpur, Malaysia. The case files of children diagnosed with congenital airway anomalies at UKMMC between 2009 and 2017 inclusive were obtained. These were reviewed in terms of sociodemography, diagnosis, as well as clinical outcomes.

Results: A total of 78 case notes were obtained for analysis. The patients were of an age range of 2 days to 7.2 years (median: 4.5 months; interquartile range: 9.8 months). In descending order, the most common diagnoses were laryngomalacia (n = 50; 64.1%), subglottic stenosis (n = 9; 11.5%), vallecular/subglottic cysts (n = 8; 10.3%), vocal cord palsy (n = 8, 10.3%), choanal stenosis (n = 6; 7.7%), and laryngeal/glottic webs (n = 3, 3.8%). In the 53 patients whom were diagnosed with laryngomalacia, 24 (45.3%) were treated conservatively and the rest were managed surgically. Among those who have been discharged, the median durations of follow-up were 2.5 and 2.0 years for the medical and surgical groups, respectively. Among the 78 patients, the outcomes were good: 50 (64%) patients resolved no more stridor, 22 (28%) were improved, and 6 (8%) were stable without deteriorating symptoms.

Conclusion: Congenital upper airway conditions have a good disease outcome. Surgery remains a safe and efficacious mode of treatment of congenital airway pathologies. Laryngomalacia is the common upper airway pathologies with good outcomes.


   The effectiveness of resonant voice therapy for school-aged children with vocal nodules: Preliminary results (ABS_048) (P-027) Top


Estella P. M. Ma, Yan-Chi Cheung, Jacky Lo1, Alice K.-Y. Siu1

Voice Research Lab, Faculty of Education, The University of Hong Kong,2Department of Otorhinolaryngology, Head and Neck Surgery, Tseung Kwan O Hospital, Hospital Authority, Hong Kong, China

E-mail: estella1@hku.hk

Objective: This study evaluated the effectiveness of resonant voice therapy for school-aged children with vocal nodules.

Methods: Twenty children aged between 6 and 10 years with vocal nodules were randomly assigned to three groups: treatment group, placebo group, and control group. Treatment group (n = 8) received six consecutive weekly sessions of vocal hygiene education with resonant voice therapy. Placebo group (n = 6) received six consecutive weekly therapy sessions on presentation skills and reading aloud skills. Control group (n = 6) did not receive any form of treatment. Outcomes were evaluated using acoustic voice analysis, auditory perceptual evaluation of voice quality, and voice-related quality of life questionnaire.

Results: Parents in all the three groups reported improvements in their children's voice-related quality of life, as indicated by the decrease in the voice handicap index total score at the posttreatment.

Conclusion: Improvements in perceptual overall severity were found in both the treatment group and the control group. Results will be discussed in relation to the possible placebo effect experienced by the participants.

Acknowledgments

This study was supported in part by a RGC General Research Fund, Project number: 17634416).


   Supraglottoplasty for severe laryngomalacia in a 3-month-old female child (ABS_057) (P-028) Top


Sachin Gandhi, Subash Bhatta

Department of Laryngology, Deenanath Mangeshkar Hospital, Pune, Maharashtra, India

E-mail: 2042subase@gmail.com

Objective: To present a case of severe laryngomalacia, operated at our center by transoral endoscopic supraglottoplasty.

Materials and Methods: A female child of age 3 months presented to us with a complaint of noisy breathing, failure to thrive, and chest retraction. She was diagnosed to have severe laryngomalacia after doing videolaryngoscopy. She was planned for supraglottoplasty under GA. Direct laryngoscopic visualization of the airway was done during the surgery; there were no associated airway anomalies. She underwent transoral endoscopic supraglottoplasty with the help of cold instruments and CO2 LASER.

Results: The patient tolerated the procedure well and was discharged from the hospital on the 6th POD; at discharge, her vitals were stable and there was decreased noisy breathing and chest retraction. The patient was followed up after 6 weeks and then 12 weeks; videolaryngoscopy was also done during the follow-up. There was no noisy breathing, the chest retraction was absent, and the patient was also gaining weight. Endoscopy revealed normal-looking aryepiglottic folds and decreased collapse of airway during inspiration.

Conclusion: Laryngomalacia is the most common congenital anomaly of the larynx. Mild cases and some of the moderate cases can be managed conservatively, but surgery is the only option of management for severe cases.


   Multiple functions of thyroid cartilage window (ABS_059) (P-029) Top


A. Athirah, M. A. Mohd Shariff, Masaany Binti Mansor,

Z. A. Zainal Abidin

Hospital Selayang, Ministry of Health Malaysia, Selangor, Malaysia

E-mail: masaanymansor@yahoo.com

The thyroid cartilage window was popularized by Isshiki in 1974 when he introduced to the world thyroplasty type 1. Since then, use of the thyroid cartilage window has been extended to a variety of laryngeal pathologies. We would like to discuss three cases of anterior cricoid split reconstructed with thyroid cartilage graft and the use of the thyroid cartilage window in obtaining diagnostic squamous cell carcinoma tissue for a case of laryngeal carcinoma.


   Management of laryngotracheal stenosis: A 10-year experience with tracheal T-tube (ABS_060) (P-030) Top


K. Naimah R, A. Athirah, Masaany Binti Mansor,

N. Gazali, Z. A. Zainal Abidin, S. H. Siti

E-mail: masaanymansor@yahoo.com

The necessity to tailor and individualize treatment for laryngotracheal stenosis based on patient characteristics has always been a great challenge. A retrospective study was done between September 2009 and September 2019 involving all laryngotracheal stenosis cases who underwent dilatation and stenting using the tracheal t tube. A total of 42 cases, both from the adult and pediatric age group, were included in this study. Age of onset, etiology, risk factors, operative technique, and complications plus outcome of these patients are discussed. We also describe our technique in endoscopically inserting a silicone tracheal t-tube yet maintaining good ventilation at all times throughout the procedure.


   Unilateral false cord nodule presenting as hoarseness in a young patient: A unique case report (ABS_061) (P-031) Top


Burhanuddin Salim1,2, Norain N. Muslim2, Vishnu Varatha2, Shashi Gopalan2

1Department of Otorhinolaryngology, University of Malaya, Kuala Lumpur,2Department of Otorhinolaryngology, Hospital Tengku Ampuan Rahimah, Selangor, Malaysia

E-mail: burhanuddin.salim@googlemail.com

Introduction: Vocal cord nodules are benign laryngeal lesions seen in professional voice users. They are usually bilateral and are thought to occur due to submucosal edema and hemorrhage, with a resultant fibrosis. False cord occurrences are very rare; hence, we report a unique case of unilateral right false cord nodule.

Case Report: A healthy 16-year-old female student presented with persistent hoarseness for 2 years without any history of voice abuse, trauma, infection, or endotracheal intubation. Endoscopic examination showed a mass occupying the right false cord. Subsequent direct laryngoscopy revealed a friable mass on the right false cord without any true cord involvement. Complete excision was done. Postoperatively, her symptoms completely resolved, and flexible endoscopic examination 7 months postoperative showed no recurrence. Histopathological examination revealed fragments of fibrocollagenous tissue covered by benign respiratory epithelium, favoring the diagnosis if a benign nodule.


   Anesthesia challenges in choanal atresia (ABS_062) (P-033) Top


Prachi Kelkar, Aarti Prabhune, Malathi Panchwagh, Prerana Mankad

Department of Anesthesiology, Deenanath Mangeshkar Hospital, Pune, Maharashtra, India

E-mail: shine89.115@rediffmail.com

Objectives: Perform safe anaesthesia in neonates with Choanal Atresia for endoscopic nasal dilatation with diode laser under GA.

Materials and Methods: We present two cases, one with bilateral and other with unilateral CA. Case 1 had bilateral CA with syndromic facial features. She had respiratory distress on day 1 of life. Nasogastric tube could not be passed. Two-dimensional echocardiography showed moderate pulmonary hypertension and was put on IV Sildenafil. Case 2 had unilateral CA with syndromic features. She presented on day 4 of life, with respiratory distress and delayed cry at birth. Both patients underwent endoscopic nasal dilatation with diode laser under GA.

We used sevoflurane for induction and oral airway for airway patency. Direct laryngoscopy and endotracheal tube (ETT) placement was done under succinylcholine. Portex tubes were used with soaked throat pack. Patients were maintained on O2 + air + sevoflurane. Postprocedure, transnasal stent (2.5 ETT) maintained airway patency. Both patients were gradually weaned and extubated in NICU. Both cases needed subsequent dilatation and were uneventful.

Results: Knowledge of anatomical variations with CA and skilled anesthesia practice can help in conduction of safe anesthesia for these children.

Conclusion: Anesthesia in CA can be challenging due to midface retraction syndromes, associated heart defects, prematurity, and anatomical variation of upper respiratory tract. Airway protection is necessary when lasers are used. The knowledge of associated syndrome with skilled and vigilant anaesthesia in such difficult airway cases can produce excellent results.


   Anesthetic management of high-risk laryngeal surgery with KTP laser under topical anesthesia with sedation (ABS_063) (P-034) Top


Swapna Naik, Sachin Gandhi, Nishant Rajadhyaksha

Deenanath Mangeshkar Hospital and Research Centre, Pune, Maharashtra, India

E-mail: swapnaik@gmail.com

Objective: We report successful management of a patient with multiple comorbidities posted for laryngeal surgery under topical anesthesia and sedation.

Materials and Methods: The patient was elderly obese male with ankylosis, hypertension, diabetes, obstructive sleep apnea, and cardiac dysrhythmia. He had restricted neck and jaw movements with reduced thyromental distance and interincisor gap predicting difficult airway. Breath holding time was <15 s denoting poor pulmonary reserve. Electrocardiography and echocardiogram revealed normal left ventricular ejection fraction with left ventricular hypertrophy. Anesthetic concerns were difficult intubation, possibility of cervical spine injury with suspension laryngoscopy, delayed recovery, and postoperative ventilation. Considering these risks, it was decided to conduct the procedure under topical anesthesia with sedation and the patient and relatives were counseled. Airway was prepared topically with nasal xylometazoline and 4% lignocaine and budecort nebulization. After preoxygenation in OT, dexmedetomidine bolus (1 mcg/kg) was given and continued as infusion (0.5 mcg/kg) with intratracheal xylocard (50 mg) and fentanyl. The lesion was excised with KTP laser.

Results: The patient was hemodynamically stable. To enable the patient to maintain his own airway and prevent cervical spine manipulation, we conducted the procedure under topical anesthesia and sedation in the upright position. Preoperative counseling enhanced patient cooperation. Topical anesthesia was the mainstay and dexmedetomidine provided procedural sedation and analgesia maintaining cardiorespiratory stability.

Conclusion: Accurate preoperative evaluation and optimal team coordination with judicious use of anesthetic agents enabled us to give a favorable patient outcome.


   Comparison of high-frequency jet ventilation and high-flow nasal oxygenation in microlaryngeal surgery (ABS_064) (P-035) Top


Rijuta Kashyapi, Pinky Kriplani, Aarti Prabhune

Deenanath Mangeshkar Hospital, Pune, Maharashtra, India

E-mail: rijutakashyapi@gmail.com

The duration of airway surgeries varies from less than half an hour to a few hours. High-flow nasal oxygenation (HFNO) and high-frequency jet ventilation (HFJV) are the established methods of maintaining oxygenation in these surgeries. We have compared maintenance of oxygenation, CO2 retention, and hemodynamic stability with HFJV and HFNO in microlaryngeal surgeries with a duration <30 min.

Methodology: Seventy patients (age 18–85 years) were randomly allocated to the two groups. Thorough preoperative evaluation and optimization was done and standard premedication was given. Preoxygenation with 100% oxygen was done to achieve almost complete denitrogenation. Total intravenous anesthesia was administered. Baseline and continuous intraoperative and immediate postoperative monitoring of heart rate (HR), mean arterial pressure (MAP), and oxygen saturation (SpO2) was done. End-tidal carbon dioxide (etCO2) monitoring was done immediately after induction of anesthesia and was resumed with an LMA at the end of the procedure after HFJV/HFNO was discontinued. The patients were ventilated till 40 mmHg etCO2 was achieved. After which, patients were reversed and shifted to the recovery room for postoperative care.

Results: The mean minimum SpO2 with HFNO was 98.49% and that with HFJV was 98.71% (statistically insignificant difference P = 0.513). The mean etCO2 values recorded at the end of the procedure in HFNO and HFJV were 50.77 mmHg and 38.49 mmHg, respectively (statistically significant difference P < 0.05). Time to normalize etCO2 to 40 mmHg was 3.78 min and 2.29 min in HFO and HFJV groups, respectively (statistically insignificant difference P = 0.058). There was no statistically significant difference in the MAP and HR of the two groups at any stage during the procedure.

Conclusion: With proper patient selection, sufficient denitrogenation, and appropriate monitoring, HFNO is as efficient as HFJV for the maintenance of oxygenation in microlaryngeal surgeries lasting up to 30 min.


   Rare case of sarcomatoid (spindle cell) carcinoma of larynx (ABS_066) (P-037) Top


Sachin Gandhi, Garima Bhola

Deenanath Mangeshkar Hospital and Research Centre, Pune, Maharashtra, India

E-mail: bholagarima6@gmail.com

Objective: To report one case of sarcomatoid (spindle cell) carcinoma of larynx.

Methodology: We searched for cases of sarcomatoid carcinoma of the larynx presented in our hospital. Four cases of sarcomatoid carcinoma of the larynx presented in our hospital from 2012 to date; the following is a case report of one such patient who presented to our institution. A 55-year-old male presented in August 2018 with a complaint of change in voice for 1 year. Videolaryngostroboscopy showed bilobed granuloma on the right arytenoid region. Routine blood investigations were normal. ML scopic CO2 laser-assisted biopsy was taken and sent for histopathology. CT neck was done. After 13 days, ML scopic CO2 laser-assisted excision of the lesion was done. Regular follow-up videolaryngostroboscopy was done to check recurrence.

Results: Excisional biopsy report was suggestive of sarcomatoid carcinoma of the right vocal cord. Laser right cordectomy Type Vb and right false vocal cord excision was done and the margins were found negative on histopathology. No evidence of recurrence was noted on follow-up scopy.

Conclusion: Sarcomatoid carcinoma of the larynx is a highly invasive and very uncommon variant of squamous cell carcinoma. Early carcinoma has a very good prognosis and good phonatory outcome.


   Evaluation of clinical use of videokymography in assessing voice disorders (ABS_065) (P-036) Top


Sachin Gandhi, Shivali Sharma

Deenanath Mangeshkar Hospital and Research Centre, Pune, Maharashtra, India

E-mail: drshivalisharma1987@gmail.com

Objective: To find diagnostic contribution of videokymography (VKG) in voice disorder assessment.

Methods: VKG was done on patients with age between 10 and 70 years in a 2-month duration using color high-speed video system with camera recorder and rigid laryngoscope after usual laryngoscopy and stroboscopy. The findings were recorded and analyzed for vibratory and symmetry pattern irregularities.

Results: VKG assesses all kinds of vocal cord vibrations which cause diplophonic, hoarse, breathy, and rough voice. Lateral propagation of mucosal waves, movements of upper as well as lower margins of vocal cords, glottal opening differences, left and right VC asymmetries, and phase differences can be seen easily.

Conclusion: VKG assesses voice disorders more accurately by studying the irregular and asymmetric vibration patterns of VC. It is a single-line high-speed imaging technique to be recommended in indecisive stroboscopic and laryngoscopic findings.






 

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