Endoscopic microsurgical management of scars in the posterior commissure and interarytenoid region resulting in vocal cord pseudoparalysis

The author reports his treatment of scars in the interarytenoid region of the larynx and the surgical management of scars in the posterior commissure based on the endoextralaryngeal suture technique and the needle carrier he developed. After the examination by electromyography, the scars are separated endoscopically. To prevent recurrent scarring and adhesions, two procedures are applied to the posterior commissure. When the size of the scars does not exceed 5 mm, both vocal cords are lateralized temporarily once the scars have been separated. In this way, the surfaces of the scars do not touch, thus preventing adhesion. When the scars are larger than 5 mm but less than 10 mm, a soft silicon stent replicating the shape of the lumen is fixed between the scars in the lumen of the larynx using the author’s technique and suture device. The laterofixing sutures and silicon stent are removed in the fourth postoperative week. As a result of the operation, the lumen of the larynx has been found to be of adequate width and suitable for normal breathing and sound formation. These procedures have been applied successfully in 12 out of 13 patients. Received: 26 September 1998 / Accepted: 7 April 1999     

Reverse shoulder arthroplasty for non-traumatic problems

Reverse shoulder arthroplasty (RSA) was developed by Grammont to address cuff tear arthropathy (CTA) in the elderly. RSA facilitates centring of the humeral head within the glenoid, such that deltoid function is maintained. CTA remains the main indication for RSA but observed improvements in postoperative outcomes have driven an expansion of indications. This review explores the broadening role of RSA, with emphasis on non-traumatic indications. In addition, the biomechanical principles, evolution of reverse polarity prostheses and complications are discussed.