Voice changes following cricothyroidotomy

Twenty-four patients underwent cricothyroidotomy at Guy's Hospital between 1977 and 1981. Of these, 13 died during admission or shortly after discharge as a result of their primary disease and three were unsuitable for further examination. The eight remaining patients were examined to assess the effect of cricothyroidotomy on the laryngeal function of voice production. Assessment was made both subjectively and objectively by laryngography. Objective findings were correlated with structural changes seen by indirect laryngoscopy. Six of the eight patients examined had both subjective and objective disturbance of voice production. We report our experience with the surgical procedure of cricothyroidotomy which, in addition to a high incidence of vocal disturbance, includes one case of subglottic stenosis secondary to granulation tissue.     

Laryngotracheal injury following cricothyroidotomy

Airway complications following elective cricothyroidotomy were reviewed in 48 adult cardiothoracic surgery patients. A 52% incidence of airway complications was found and manifested by failed or delayed decannulation, extensive subglottic granulation tissue, stenosis, vocal cord paralysis, and aspiration pneumonia. The most common cause for decannulation difficulty was subglottic stenosis (50%). Several risk factors were specifically identified, including a period of cricothyroid cannulation exceeding 30 days, the presence of diabetes, and advanced age. These findings suggest that airway sequelae following cricothyroidotomy in cardiothoracic surgery patients is higher than previously reported. Indications and risk factors for cricothyroidotomy are discussed.     

Vocal function following vertical hemilaryngectomy: a preliminary investigation

Seven consecutive male patients who received a vertical hemilaryngectomy were examined for vocal function employing video-stroboscopic, aerodynamic and acoustic measurement techniques. The results of this preliminary investigation suggest that with the group of patients studied, vocal quality was rated as "rough", "breathy" and "constricted". While large variability was noted between individuals, the general tendencies for the group included: (a) incomplete glottic closure; (b) supraglottic structures (ventricular folds, arytenoids) fulfilled or aided vibratory action of the remaining fold; (c) high average transglottal airflow; (d) reduced maximum phonation time; (e) high and more variable vocal frequency positioned near the top of the frequency range; (f) a lower, more variable, and restricted vocal intensity range, and (g) a reduced vocal fold diadochokinetic (vocal fold opening and closing action) rate. We are currently attempting to determine factors related to individual patient strategies for using either glottic or supraglottic valving during phonation.     

Passive versus active drainage following neck dissection: a non-randomised prospective study

Drainage is used following neck dissection to prevent the collection of fluid and aid healing. Active drains are thought to be more effective due to their ability to assist adherence of skin flaps and the minimisation of bacterial migration. There is controversy regarding the type of drain (active or passive) which should be used due to concerns about the potential for compromise of free flap pedicles with active drains. A prospective non-randomised study was undertaken to determine if there were any differences in neck healing following neck dissection between active and passive drains. A consecutive series of patients (the majority of whom had free flap reconstruction) were included over an 8 month period and were examined for delayed healing of the neck wound, flap loss, infection, haematoma and fistula. A total of 60 patients underwent 72 neck dissections during the study period (passive: 13, active: 47). The delayed healing rate in patients with passive drains was 54% compared with 6% for active drains (P < 0.001). This difference remained significant irrespective of surgeon grade, nodal status and whether or not a free flap was performed. There was no patient in whom the drain was thought to contribute to free flap loss. This non-randomised study has shown a significant difference in neck healing depending on the type of drain used following neck dissection. Despite the numerical differences between the groups the patients were relatively well matched for the parameters described. This difference in neck healing, combined with the lack of evidence for a contribution to flap loss, suggests active drains should be used following neck dissection in both free flap and non-free flap cases.     

Vocal function following hemilaryngectomy

Vocal function following hemilaryngectomy was investigated in 54 cases in which a superiorly based sternohyoid muscle flap was used for glottic reconstruction. Four types of material were employed for covering the muscle flap: hypopharyngeal mucosa, lip mucosa, thyroid perichondrium, and island cervical skin flap. The vocal function varied greatly from individual to individual; however, the following tendencies were observed in many cases: 1) the glottis did not close completely; 2) supraglottic structures (false fold, arytenoid region, and epiglottis) were hyperfunctional and vibrated instead of or together with the unaffected vocal fold; 3) vibrations of the laryngeal structures were irregular; 4) maximum phonation time was short; 5) mean airflow rate was high; 6) fundamental frequency and intensity ranges of phonation were limited; 7) the voice was rough, breathy, and/or strained; and 8) cases with poor vocal function were most frequent in the skin flap group and least frequent in the lip mucosa group.     

Immediate mobilization following fixation of mandible fractures: a prospective, randomized study

OBJECTIVES: To compare outcomes of open reduction and internal fixation of displaced mandible fractures followed by either immediate mobilization or 2 weeks of mandibular-maxillary fixation. STUDY DESIGN: A prospective, randomized, single-blinded study was performed. METHODS: The study was performed between January 1, 1997, and March 30, 2000. Inclusion criteria were displaced fractures between the mandibular angles, age greater than 16 years, and no involvement of the alveolus, ramus, condyles, or maxilla. All fractures were repaired by means of open reduction and internal fixation using 2.0-mm titanium plates secured either in transoral fashion or percutaneously. Data were collected at 6-week and 3- and 6-month postoperative examinations. Variables were assessed by a surgeon blinded to the history of immobilization and included pain, malunion or nonunion, occlusion, trismus, wound status, infection rates, dental hygiene, and weight loss. Twenty-nine consecutive patients were enrolled, 16 patients to immediate function and 13 patients to 2 weeks of mandibular-maxillary fixation. RESULTS: No statistically significant differences were found between groups for any of the variables. Immediate release and temporary immobilization showed mean weight loss of 10 and 8 pounds and trismus of 4.2 and 4.6 cm, respectively. One wound separation and one infection were seen in the immobilization population, and no wound separation or infection was seen in the immediate-release group. Dental hygiene was similar between the groups. No malunion or nonunion was noted in either group. CONCLUSIONS: In this prospective and randomized study, no significant differences were noted between the groups receiving either immediate release or 2 weeks of mandibular-maxillary fixation. The findings support the treatment of selective mandible fractures with 2.0-mm miniplates and immediate mobilization.     

Changes in salivary secretion and sense of taste following cochlear implantation: a prospective study

Conclusion: A set of methods for evaluating changes in salivary secretion and sense of taste following cochlear implantation (CI) was applied and tested. No association between implantation and objectively assessed sense of taste was found. However, a statistically significant decrease in non-stimulated salivary flow on the day after surgery was found. Objectives: To develop and test a research method describing the course of changes in salivary secretion and sense of taste following CI. Methods: This was a longitudinal study examining 13 patients undergoing CI at Odense University Hospital in 2012. Questionnaires, sialometry and gustatory testing were applied. Results: A general postoperative decrease in salivary secretion could not be found. However, a 29.9% mean reduction in non-stimulated salivary flow was observed when looking specifically at the visit the day after surgery (p = 0.001). When adjusting for perioperative administration of glycopyrrolate (p < 0.001) and atropine (p = 0.178), the former was highly associated with a 69.7% mean decrease in non-stimulated salivary flow at the visit the day after surgery. The third examination was still, independent of glycopyrrolate administration, borderline significantly associated with a 14.5% mean decrease (p = 0.054). We did not find any significant decrease in sense of taste following implantation.     

Endonasal dacryocystorhinostomy: a prospective study

Objective  The objectives of this study are to report the results of Endonasal Dacryocystorhinostomy (EnDCR) and the role of silicon intubation in EnDCR in Indian population. Study design  The authors conducted a prospective case series. Methods  290 patients underwent EnDCR between January 2002 and July 2007 — 240 cases without silicon intubation and 50 cases with silicon intubation. Patients were followed up for an average of 18.6 months in first group and 5.2 months in second group. Outcome was evaluated subjectively and objectively. Results  In EnDCR without silicon intubation, the procedure was successful in 93.3% of cases. In EnDCR with silicon intubation, the procedure was successful in 96% of cases. Conclusion  EnDCR is a safe procedure with good success rate and has potential advantages in chronic dacryocystitis cases. The use of silicon intubation in nasolacrimal pathway helps in maintaining the patency of rhinostomy.     

Myringoplasty: a prospective audit study

Seventy-three surgeons participated in a prospective audit of myringoplasty. They returned data on 1070 individual patients. Up to 12 months follow-up information was obtained. The mean number of myringoplasties performed per consultant in 1 year (1995) was 14.7 (95% confidence intervals (CI) 12.1 17.2). The main indication for performing the operation was to achieve an intact tympanic membrane. The mean graft take rate was 82.2%. When hearing improvement was the main indication for surgery it was improved in 67%. The use, or not, of an antibiotic had no significant influence on the graft take rate or the complication rate. Most complications reported were minor in nature.     

Post-myringotomy care: a prospective study

Children with tympanostomy tubes have always been considered somewhat handicapped in regard to swimming and bathing. Their parents had to maintain constant surveillance to prevent then from getting water in their ears. A prospective study involving more than 1,000 children was conducted between June 1981 and August 1982 on two groups of randomly selected patients to determine the prevalence of suppurative otitis media and its relationship to bathing and swimming. One group had to follow strict rules to prevent water entering the ear (bathing caps, earplugs) whereas the other group was allowed to bathe and swim without any precaution upon the condition of using a polymyxin B/gramicidin ear drop combination at bedtime on the day they swam. The study shows no increase in prevalence of suppurative otitis media in the "open canal" group as compared to the "closed canal" group. Furthermore, the monthly distribution of infections shows a relatively evan distribution throughout the year. This study implies that swimming and bathing are safe for the vast majority of children with tympanostomy tubes and thus simplifies enormously the post-myringotomy care for the child, the parents, and the physician.     

Vocal fold injury following endotracheal intubation

Vocal fold scarring results in the formation of fibrous tissue which disturbs the vibratory pattern of the fold during phonation. However, vocal fold scarring in humans is poorly understood because of the lack of clear case reports focusing on voice quality. The authors present a case of vocal fold scarring with changes in voice quality. At the time of injury the pedicle mucosa was cemented with fibrin glue. Phonation was inhibited for two weeks and tranilast (300 mg/day) was given for 3 months. Sixty-nine days later, perceptual evaluation showed a normal result and the phonation time became better, but the mucosal vibration was still lacking. Ninety-seven days later, mucosal vibration was finally restored. We suggest that characterization of vocal fold scarring in humans may be different from that in animals, and recommend that surgical management should be avoided for at least three months after injury.