Evaluación de la vía aérea mediante laringoscopia indirecta en pacientes con hipertrofia de la amígdala lingual

Introduction and objectivesPrevalence of the lingual tonsillar hypertrophy is unknown but it is believed that its presence is associated with the difficult airway. To investigate this, indirect laryngoscopy was performed on patients in the preoperative evaluation and this pathology was diagnosed. The relationship with difficulty of viewing the larynx, intubation and ventilation, under general anaesthesia and using direct laryngoscopy, was then studied.MethodsWe performed the demographic variable checks and tests for predicting difficult intubation (mouth opening, thyromental distance, cervical flexion-extension, neck thickness and Mallampati test), in the preoperative step on 300 patients who were going to be submitted to general anaesthesia. We then performed indirect laryngoscopy on them using a 70° rigid laryngoscope to ascertain the frequency of appearance of lingual tonsillar hypertrophy. Next, under general anaesthesia, we carried out direct laryngoscopy to verify whether there was difficulty in viewing the larynx and intubation and ventilation. We then investigated the association of demographic predictors of difficult intubation, including indirect laryngoscopy, with the presence of this condition.ResultsPrevalence of lingual tonsillar hypertrophy was 2%. No relationship between the appearance of this entity and the difficulty of viewing the larynx, intubation and ventilation was found. Only indirect laryngoscopy was linked to the appearance of this pathology.ConclusionsLingual tonsillar hypertrophy is a relatively frequent disorder, whose presence is not usually associated with difficult airway.     

Sensitivity to structure in the speech signal by children with speech sound disorder and reading disability

PurposeChildren with speech sound disorder (SSD) and reading disability (RD) have poor phonological awareness, a problem believed to arise largely from deficits in processing the sensory information in speech, specifically individual acoustic cues. However, such cues are details of acoustic structure. Recent theories suggest that listeners also need to be able to integrate those details to perceive linguistically relevant form. This study examined abilities of children with SSD, RD, and SSD + RD not only to process acoustic cues but also to recover linguistically relevant form from the speech signal.MethodTen- to 11-year-olds with SSD (n = 17), RD (n = 16), SSD + RD (n = 17), and Controls (n = 16) were tested to examine their sensitivity to (1) voice onset times (VOT); (2) spectral structure in fricative-vowel syllables; and (3) vocoded sentences.ResultsChildren in all groups performed similarly with VOT stimuli, but children with disorders showed delays on other tasks, although the specifics of their performance varied.ConclusionChildren with poor phonemic awareness not only lack sensitivity to acoustic details, but are also less able to recover linguistically relevant forms. This is contrary to one of the main current theories of the relation between spoken and written language development.Learning outcomes: Readers will be able to (1) understand the role speech perception plays in phonological awareness, (2) distinguish between segmental and global structure analysis of speech perception, (3) describe differences and similarities in speech perception among children with speech sound disorder and/or reading disability, and (4) recognize the importance of broadening clinical interventions to focus on recognizing structure at all levels of speech analysis.     

Influence of gender on the sensory organisation test and the limits of stability in healthy subjects

IntroductionThe sensory organization test and the limits of stability are the gold standard for dynamic posturography. It is postulated that these measurements vary depending on age, activity of the subject and musculoskeletal system, emotional condition or other factors. The aim of this study was to determine the influence of gender on the above-mentioned analyses.Material and methods70 healthy subjects (35 males and 35 females); mean age: 44.9 years. A clinical history was taken and a physical and otoneurological exploration was performed for each subject, along with a posturography study using the Neurocom SMART Balance Master platform model. The statistical study was carried out with the ANOVA test (p < 0.05).ResultsCondition 5 presented the lowest percentage of balance in both sexes (64.36%). The highest percentage of balance in males was in Condition 1 (p < 0.001) and the lowest in 3 (p = 0.030). There were no differences in the sensory analysis. The lowest employment of ankle strategy was in Condition 5 for both sexes (88.61%); women used the ankle strategy in Condition 4 more efficiently (p = 0.0129). There were also differences in the time of reaction towards the right (p = 0.022) and the mean (p = 0.011) (higher in females), and in the speed of movement backwards (p = 0.001) and towards the right (p = 0.04) (higher in males). In path length and directional control, there were no differences.ConclusionsGender differences should be taken into consideration for vestibular rehabilitation. Greater speed in conducting the tests does not lead to better balance control.     

Newborn hearing screening test with multiple auditory steady-state responses

IntroductionThe techniques most frequently used within a screening context (otoacoustic emissions and click auditory brainstem response) have well-known limitations in hearing loss detection.ObjectiveThis study examines the feasibility of a semi-automated multiple auditory steady-state responses (MSSR) system designed for neonatal hearing screening.MethodsA sample of 50 newborns without risk factors (well-babies) was tested within two weeks of birth. All had detectable auditory brainstem responses to clicks down to 40 dB nHL in both ears. Two amplitude modulated carrier tones of 500 and 2,000 Hz were mixed together and presented simultaneously. Each infant (and ear) was screened with the MSSR system; to simulate a hearing loss, a recording without stimulation was also obtained.ResultsMean auditory thresholds were 42.5 ± 7 dB HL at 500 Hz and 35.5 ± 6 dB HL at 2,000 Hz. The average duration of the MSSR recording was 2.6 ± 1.6 minutes for each tested ear and the overall duration of the screening procedure (including electrode fitting and infant preparation) was 17.8 ± 3.7 minutes. The diagnostic sensibility and the positive predictive values of the MSSR semi-automatic screening system was 100% and 96% respectively, with specificity of 96% and negative predictive values of 100%.ConclusionsAlthough the diagnostic efficiency of the semi-automated MSSR system was found adequate, further technological improvements are still necessary to facilitate its use in the context of universal newborn hearing screening program.     

Cinnamaldehyde is an effective anti-inflammatory agent for treatment of allergic rhinitis in a rat model

ObjectivesThe effect of cinnamaldehyde on the treatment of allergic rhinitis (AR) was investigated in rat model.MethodsTwenty-eight female Wistar albino rats were randomly divided into four groups: Group 1 (control) (C), Group 2 (AR with no treatment) (AR + NoTr), Group 3 (AR + Azelastine HCl) (AR + Aze), and Group 4 (AR + cinnamaldehyde) (AR + Cin). At day 21, AR + Aze rats were given an Azelastine HCl drop, and AR + Cin rats were given cinnamaldehyde intranasally. In all groups, allergic symptoms histopathological results were evaluated.ResultsThe AR + NoTr group showed the worst allergic symptoms, cilia loss and greater inflammation. In the AR + Aze and AR + Cin groups, allergic symptom scores were higher than those in the control group. However, between AR + Aze and AR + Cin groups, there were no significant differences in the allergic symptom scores Histopathological analysis revealed vascular congestion and an increase in goblet cell numbers in the AR + Cin group. However, AR + Cin rat nasal mucosa had less plasma cell infiltration compared with the AR + NoTr group. In rats from the AR + Aze group, analysis of the nasal mucosa revealed less eosinophil infiltration than that seen in the AR + NoTr group. A lower score for mast cell (MC) infiltration was observed in the nasal mucosa of rats treated with Azelastine HCl compared with cinnamaldehyde.ConclusionsIn this study we observed that both Azelastine HCl and cinnamaldehyde reduced allergic symptoms in an AR rat model. Cinnamaldehyde decreased vascular congestion as well as plasma cell, eosinophil, and inflammatory cell infiltration into the lamina propria.     

Sequential four-drug chemotherapy and intensity-modulated radiotherapy for larynx preservation in resectable advanced larynx and hypopharynx cancer: A pilot study

Objective

The value of additional use of cetuximab with the classical cisplatin, docetaxel and 5-fluorouracil regimen in larynx preservation remains unknown. This study was designed to resolve this issue and appraise its toxicity.

An investigation into hearing loss among patients of 50 years or older

Objects To investigate the extent of hearing loss in an elderly sample population to estimate hearing disorders among the age-equivalent population in China and to study primary clinical characteristic...     

What is the effectiveness of beta-glucan for treatment of acute otitis media?

IntroductionAs a supplement, beta–glucan has various therapeutic healing effects generated by the immune cells. It has been scientifically approved and proven to be a biological defense modifier. The aim of this study was to investigate the effects of beta–glucan on treatments administered in an acute otitis media modelObjectivesThis study investigated the effect of beta–glucan on the treatment of acute otitis media in an acute otitis media -induced animal model. Efficacy was evaluated both immunologically and histologically.MethodsThe study sample comprised 35 adult rats, randomly separated into 5 groups of 7: Group 1 (control), Group 2 (acute otitis media, no treatment), Group 3 (acute otitis media + antibiotic), Group 4 (acute otitis media + beta–glucan) and Group 5 (acute otitis media + beta–glucan + antibiotic). Analyses were made of the histopathology and immunology examination results in respect of thickening of the tympanic membrane, epithelium damage, inflammation, and sclerosis. In all groups the serum levels of TNF-α, IL-4, IL-6 and IL-1β were evaluated.ResultsAll serum cytokine levels were significantly lower in the beta–glucan and antibiotic-treated groups compared to the acute otitis media Group. Significant differences in tympanic membrane thickness, inflammation, epithelium damage, and sclerosis values were observed between the acute otitis media + antibiotic and acute otitis media + beta–glucan Groups. According to these parameters, the values in aute otitis media + antibiotic + beta–glucan Group were markedly lower than those of the other groups. There was a significant difference in the acute otitis media + antibiotic + beta–glucan Groups compared to acute otitis media Group (p < 0.001).ConclusionsBoth antibiotic and beta–glucan treatment reduced acute otitis media signs of inflammations in an acute otitis media-induced rat model, decreasing histological damage and cytokine levels. Co-administration of antibiotic and beta–glucan led to a significant reduction in tympanic membrane thickness, inflammation, and epithelium damage. Antibiotic + beta–glucan treatment resulted in a greater decrease in tympanic membrane thickness, inflammation, and epithelium damage than in the other groups. From these results, it can be suggested that beta–glucan, in combination with antibiotics may provide an alternative for the treatment of acute otitis media.     

ENDOCOCHLEAR POTENTIAL AND POTASSIUM CONCENTRATION RECORDING IN MINIPIG COCHLEA

Objective To record the endocochlear potential (EP) and calculate potassium concentration [K+] in Minipig cochleae. Methods We used multi-barreled electrodes to measure the EP and the potential, [K+].EP and potassium electrode recording were made in 9 cochleae from 5 minipigs to get normal EP values.Results The average EP value in the cochlea from the minipigs was 77.3 ± 14 mV. The average [K+] for the minipigs was 147.1 ± 13 mM. Conclusions The EP and potential, [K+] in minipigs are lower than in the human and rodents. This may be the reason why porcine ABR thresholds are slightly higher than humans and rodents.     

Otorhinolaryngologists’ personal treatment preferences (total laryngectomy or laryngeal preservation) when faced with advanced stage laryngeal cancer

ObjectiveTo analyse the treatment options that otorhinolaryngologists would consider if faced with advanced stage laryngeal cancer amenable to total laryngectomy or an organ preservation protocol.Material and methodsProspective study conducted in a French Teaching Hospital based on questionnaires filled in by 163 otorhinolaryngologists in 2012, studying the percentage chance of cure that they would be prepared to trade-off to preserve their larynx, defining the additional information that they would like to receive and identifying any statistical associations between these parameters and various medical and socioeconomic variables.ResultsA total of 42.3% of otorhinolaryngologists would not consider the slightest trade-off to preserve their larynx and preferred to undergo total laryngectomy. In the group of otorhinolaryngologists who would consider a larynx preservation protocol (57.6%), the percentage chance of cure that they would be willing to trade-off to preserve their larynx ranged between 5 to 100% (median: 15%) and 4.2% of them were willing to trade-off all chances of cure (100%) to avoid total laryngectomy. The percentage of otorhinolaryngologists who would not consider trading off the slightest chance of survival to preserve their larynx increased from 29.3 to 49.5% (P = 0.01) when they participated in multidisciplinary consultation meetings. In the group of otorhinolaryngologists who would consider a larynx preservation protocol, the median percentage survival trade-off that they would consider in order to preserve their larynx (i) decreased from 20 to 10% (P = 0.004) when they participated in multidisciplinary consultation meetings and (ii) increased regularly with their number of years of practice (P = 0.03) and their age (P = 0.025). Finally, 25.1% of otorhinolaryngologists wanted to receive additional information, although none of the variables analysed affected this desire for more information.ConclusionTreatment options considered by otorhinolaryngologists faced with advanced stage laryngeal cancer were almost equally divided between total laryngectomy and larynx preservation. Number of years of practice and regular participation in head and neck cancer multidisciplinary consultation meetings were variables that significantly influenced this choice.     

Protective effect of creatine on amikacin-induced ototoxicity

IntroductionAminoglycosides are widely known for their ototoxic side effects. Nevertheless, they are potent antibiotics used in the treatment of life-threatening conditions because of the current concern for antibiotic resistance. We hypothesized that creatine supplements which are believed to improve mitochondrial antioxidant defense system and maintain optimal energy homeostasis may improve the ototoxic side effects.ObjectiveThis study aimed to investigate the protective effects of creatine monohydrate against ototoxicity induced by amikacin in rats in an experimental animal model, using distortion product otoacoustic emissions and auditory brainstem response.MethodsTwenty healthy rats were assigned to four groups (5 rats in each): the control group, the creatine monohydrate group, the amikacin group and the amikacin + creatine monohydrate group. The creatine monohydrate group received creatine at a dose of 2 g/kg once daily via gastric gavage for 21 days. The amikacin group received amikacin at a dose of 600 mg/kg by intramuscular injections once daily for 21 days. The amikacin + creatine monohydrate group received intramuscular injections of amikacin (600 mg/kg) once daily for 21 days and creatine monohydrate (2 g/kg) once daily via gastric gavage for 21 days. The control group received nothing. The distortion product otoacoustic emissions and auditory brainstem response measurements were performed on all rats on days 0, 7, 21.ResultsRegarding auditory brainstem response values, a significant increase in the auditory threshold was observed in the amikacin group on day 21 (p <  0.001). The amikacin+creatine monohydrate group showed significantly lower levels of auditory brainstem response auditory thresholds on day 21 in comparison to the amikacin group (p <  0.001). Additionally, the control group and the amikacin+creatine monohydrate group did not differ significantly with respect to auditory brainstem response thresholds on treatment day 21 (p >  0.05). When we compare distortion product otoacoustic emissions values, there was no significant difference between the amikacin and amikacin+creatine monohydrate groups on day 7 (p >  0.05), However significantly greater distortion product otoacoustic emissions values were observed in the amikacin+creatine monohydrate group on day 21 compared to the amikacin group (p <  0.001).ConclusionOur findings demonstrate that creatine treatment protects against amikacin ototoxicity when given at a sufficient dose and for an adequate time period.     

The changes of endotracheal tube intracuff pressures after ear and head and neck surgery-related positions: a prospective observational study

IntroductionThe cuff of an endotracheal tube seals the airway to facilitate positive-pressure ventilation and reduce subglottic secretion aspiration. However, an increase or decrease in endotracheal tube intracuff pressure can lead to many morbidities.ObjectiveThe main purpose of this study is to investigate the effect of different head and neck positions on endotracheal tube intracuff pressure during ear and head and neck surgeries.MethodsA total of 90 patients undergoing elective right ear (Group 1: n = 30), left ear (Group 2: n = 30) or head and neck (Group 3: n = 30) surgery were involved in the study. A standardized general anesthetic was given and cuffed endotracheal tubes by the assistance of video laryngoscope were placed in all patients. The pilot balloon of each endotracheal tube was connected to the pressure transducer and standard invasive pressure monitoring was set to measure intracuff pressure values continuously. The first intracuff pressure value was adjusted to 18.4 mmHg (25 cm H₂O) at supine and neutral neck position. The patients then were given appropriate head and neck positions before related-surgery started. These positions were left rotation, right rotation and extension by under-shoulder pillow with left/right rotation for Groups 1, 2 and 3, respectively. The intracuff pressures were measured and noted after each position, at 15th, 30th, 60th, 90th minutes and before the extubation. If intracuff pressure deviated from the targeted value of 20–30 cm H₂O at anytime, it was set to 25 cm H₂O again.ResultsThe intracuff pressure values were increased from 25 to 26.73 (25–28.61) cm H₂O after left neck rotation (p = 0.009) and from 25 to 27.20 (25.52–28.67) cm H₂O after right neck rotation (p = 0.012) in Groups 1 and 2, respectively. In Group 3, intracuff pressure values at the neutral position, after extension by under-shoulder pillow and left or right rotation were 25, 29.41 (27.02–36.94) and 34.55 (28.43–37.31) cm H₂O, respectively. There were significant differences between the neutral position and extension by under-shoulder pillow (p < 0.001), and also between neutral position and rotation after extension (p < 0.001). However, there was no statistically significant increase of intracuff pressure between extension by under-shoulder pillow and neck rotation after extension positions (p = 0.033).ConclusionAccessing the continuous intracuff pressure value measurements before and during ear and head and neck surgeries is beneficial to avoid possible adverse effects/complications of surgical position-related pressure changes.     

OTOTOXIC MODEL OF OXALIPLATIN AND PROTECTION FROM NICOTINAMIDE ADENINE DINUCLEOTIDE

Oxaliplatin,an anticancer drug commonly used to treat colorectal cancer and other tumors,has a number of serious side effects,most notably neuropathy and ototoxicity.To gain insights into its ototoxic profile,oxaliplatin was applied to rat cochlear organ cultures.Consistent with it neurotoxic propensity,oxaliplatin selectively damaged nerve fibers at a very low dose 1μM.In contrast,the dose required to damage hair cells and spiral ganglion neurons was 50 fold higher(50μM).Oxailiplatin-induced cochlear lesions initially increased with dose,but unexpectedly decreased at very high doses.This non-linear dose response could be related to depressed oxaliplatin uptake via active transport mechanisms.Previous studies have demonstrated that axonal degeneration involves biologically active processes which can be greatly attenuated by nicotinamide adenine dinucleotide(NAD+).To determine if NAD+would protect spiral ganglion axons and the hair cells from oxaliplatin damage,cochlear cultures were treated with oxaliplatin alone at doses of 10μM or 50μM respectively as controls or combined with 20 mM NAD+.Treatment with 10μM oxaliplatin for 48 hours resulted in minor damage to auditory nerve fibers,but spared cochlear hair cells.However,when cochlear cultures were treated with 10μM oxaliplatin plus 20 mM NAD+,most auditory nerve fibers were intact.50μM oxaliplatin destroyed most of spiral ganglion neurons and cochlear hair cells with apoptotic characteristics of cell fragmentations.However,50μM oxaliplatin plus 20 mM NAD+treatment greatly reduced neuronal degenerations and hair cell missing.The results suggested that NAD+provides significant protection against oxaliplatin-induced neurotoxicity and ototoxicity,which may be due to its actions of antioxidant,antiapoptosis,and energy supply.     

“Post intubation Laryngeal injuries in a pediatric intensive care unit of tertiary hospital in India: A Fibreoptic endoscopic study”

Study objectivesTo identify acute laryngeal injuries among pediatric patients intubated for more than 48 hours, and to correlate these injuries with clinical variables.SettingPediatric Intensive Care Unit (PICU) of a tertiary level hospital in India.Patients and MethodsProspective, observational study. Thirty-four children meeting the inclusion and exclusion criteria were recruited into the study after obtaining informed consent from the parents. A bedside, flexible, fiberoptic laryngoscopy was done within the first 24 hours of extubation. Laryngeal injuries were documented and graded. Individual types of laryngeal injuries were correlated to the duration of intubation, size of the tube, the experience of the intubator and the patient's demographics. A repeat endoscopy was done in the outpatient department, 3-4 weeks after extubation, and findings noted.Results97% had acute laryngeal injury, of which 88% were significant. Erythema was the most common form of injury. Duration of intubation, with a mean of 4.5 days, showed a trend towards significance (p = 0.06) for association with subglottic narrowing. Laryngeal injuries were similar with both cuffed and uncuffed tubes. Age of the subject, size of the tube and skill level of the intubator did not correlate with the laryngeal injuries. 18% required intervention for post-extubation laryngeal lesions. Three (10%) children had post-extubation stridor, and of these, two needed surgical intervention (6%).ConclusionPost-extubation laryngeal injuries are not uncommon. Fiberoptic endoscopy is an inexpensive and cost-effective tool for bedside evaluation of post-intubation status in pediatric larynx. Early diagnosis of post-intubation laryngeal injuries in children can prevent long term sequelae. Hence, post-extubation fiberoptic laryngoscopy should be done routinely in pediatric population.     

Colgajos pediculados procedentes de la arteria esfenopalatina: estudio anatómico y quirúrgico

IntroductionLocal pedicle flaps based on the sphenopalatine artery make it possible to reconstruct large defects of the skull base (SB).Material and methodsFrom January 2008 to January 2013, 64 lesions with involvement of SB were analysed. These lesions were treated using endoscopic endonasal approach and required a pedicle flap based on the sphenopalatine artery. In addition, measurements and flexibility of the flaps were examined in 4 cadaveric nasal cavities.ResultsSurgical group. Sixty-four nasoseptal flaps (NSF) were used, in 4 cases associated with a middle turbinate flap (MTF), and in 1 case supplemented with an inferior turbinate flap (ITF). Five cerebrospinal fluid fistulas (8%) were noted. Among patients with initial lesions, 7% presented an anosmia. Cadaveric group. The length of the NSF varied between 5.2 cm and 7.7 cm and the width ranged from 3 cm to 4.5 cm. The ITF provided an anterior-posterior distance between 4.2 cm and 5 cm, with a width between 1.2 cm and 2.8 cm. The mean length of MTFs varied between 3.5 cm and 4.2 cm, with a width between 1.4 cm and 1.9 cm.ConclusionThe most versatile local flap for the reconstruction of skull base defects is the NSF, and flaps pedicled to the posterolateral nasal artery offer an excellent alternative.     

The effect of a chin-down maneuver after esophagectomy on oropharyngeal swallowing pressure measured using high-resolution manometry

ObjectiveTo elucidate the effects of a chin-down maneuver using high-resolution manometry (HRM) to measure pharyngeal swallowing pressure (SP) after esophagectomy.MethodsWe evaluated 9 of 16 patients who underwent esophagectomy featuring gastric tube reconstruction and three-field lymph node dissection (3FL) in our Department of Gastroenterological Surgery from September 2015 to June 2016. We compared all parameters of the neutral and chin-down positions using HRM to measure the maximum SP at the velopharynx, meso-hypopharynx, and upper esophageal sphincter (UES) and the duration of lowered SP at the UES, the distance from nostrils to the boundary between hypopharynx and UES and to derive SP and SP propagation curves at various distances from the nostrils.ResultsCompared to that at the neutral position, the maximum SP at the velopharynx was significantly lower in the chin-down position (p < 0.05); however, SP at the meso-hypopharynx and UES did not differ significantly. The duration of lowered SP at the UES was significantly prolonged in the chin-down position and the distance from nostrils to the boundary between hypopharynx and UES was significantly shortened representing the elevation of the larynx, respectively (p < 0.05, p < 0.01). On the SP propagation curve for males, the times to SP peaks at 13, 16, 17, and 18 cm from the nostrils were significantly prolonged (all p < 0.05) in the chin-down position.ConclusionChin-down positioning after esophagectomy/3FL may improve bolus passage by prolonging the duration of lowered SP at the UES, possibly by enhancing laryngeal elevation.     

Individualized treatment for allergic rhinitis based on key nasal clinical manifestations combined with histamine and leukotriene D4 levels

IntroductionThe types of allergic rhinitis are roughly classified based on the causative antigens, disease types, predilection time, and symptom severity.ObjectiveTo examine the clinical typing and individualized treatment approach for allergic rhinitis and to determine the optimal treatment method for this disease using various drug combination therapies.MethodsA total of 108 participants with allergic rhinitis were divided into three groups based on symptoms. Subsequently, each group was further categorized into four subgroups based on the medications received. The efficacy of the treatments was evaluated using the visual analog scale VAS scores of the total and individual nasal symptoms, decline index of the symptom score, histamine and leukotriene levels, and mRNA and protein expression levels of histamine 1 and cysteinyl leukotriene 1 receptors.ResultsLoratadine + mometasone furoate and loratadine + mometasone furoate + montelukast significantly improved the sneezing symptom and reduced the histamine levels compared with the other combination therapies (p < 0.05). Meanwhile, montelukast + mometasone furoate and montelukast + mometasone furoate + loratadine considerably improved the nasal obstruction symptom and decreased the leukotriene D4 levels compared with the other combination therapies (p < 0.05).ConclusionClinical symptom evaluation combined with experimental detection of histamine and leukotriene levels can be an objective and accurate method to clinically classify the allergic rhinitis types. Furthermore, individualized treatment based on allergic rhinitis classification can result in a good treatment efficacy.     

The AESOP robot system for video-assisted rigid endoscopic laryngosurgery

Surgeons may occasionally encounter difficulty in visualizing the whole larynx with a direct laryngoscope. In such cases, rigid endoscopic laryngosurgery using a direct laryngoscope is an optimal solution. Multidirectional examination of the larynx using rigid endoscopes during direct laryngoscopy, leads to better control and management of the ventricle, inferior surface of the vocal fold and subglottis, and the anterior commissure. Currently, 0 degrees , 30 degrees , 70 degrees and 120 degrees angled rigid telescopes are used worldwide. Our experience in telescopic endolaryngeal surgery provided us the opportunity to work with AESOP 3000 (automated endoscope system for optimal positioning), coupling a robotic arm to a rigid endolaryngeal telescope. The use of this device allows the surgeon to control the field of view and operate with both hands. A total of 20 patients presenting a laryngeal lesion were randomly selected and included in this study undergoing a robot-assisted procedure. Three of 20 patients presented a difficult laryngeal exposure with direct laryngoscopy due to a rigid, short neck (1 male, 1 female) and prominent teeth (1 male). We used Karl Storz Hopkins II long rigid endoscopes having 0 degrees , 30 degrees and 70 degrees direction of view, a Storz Xenon 300 cold light, a Storz Tricam SL camera, the Kleinsasser direct laryngoscope. The instruments we used are all commercially available for microlaryngeal surgery and included upward curved instruments in case of difficult laryngeal exposure. The operative equipment was the same for all procedures. We evaluated the acquisition of skills in controlling the AESOP 3000, the feasibility of a single surgeon performing procedures with this machine, and any advantages that it might offer to endolaryngeal surgery. The use of robotic devices improves the precision of surgical procedures, offering surgeons a more comfortable working position, particularly for longer procedures, and without an assistant to hold the camera.