Reconstruction of the anterior face of the base of the skull using coral grafts

Following experimental investigations on animals, small coral grafts have been utilized on patients since 1985 to fill in burr holes (42 patients). This first clinical experimental step has been satisfactory. Therefore, blocks of corals have since then been used as bone graft substitutes for anterior skull basis reconstruction (12 patients). Cheap and easily sterilized, coral implants have the advantage of being inert (99% of calcium carbonate), biodegradable and well reossified. They shorten surgical procedures by avoiding the use of iliac and/or costal grafts. No infectious complications have been noted.     

Myomucosal shunt following total laryngectomy: a report of 31 cases

An original technique of voice rehabilitation following total laryngectomy based on the concept of a myomuscosal unit was originally described by Strome. Thirty-one cases of myomucosal shunts (MMS) are analyzed in the present report. The 14 initial cases failed because of a lack clinical and surgical experience and insufficient selection of the patients. Among the last 17 cases, 1 was lost to follow-up, 1 had an insufficient follow-up, and 2 patients refused to speak with the MMS instead of a patent shunt; 5 of the remaining patients had voices evaluated as excellent, 7 had voices interpreted as good and only 1 patient had a voice evaluated as poor. Aspiration was not a problem. Eleven patients were found to stenose their shunt, but fistula were recalibrated successfully. The MMs can be used safely in oncological surgery and only 1 of 31 deaths in our total experience was due to a local recurrence. These findings show that the MMS is a reliable procedure for voice restoration following total laryngectomy; a prosthesis is not required and there are currently no oncological limits to the procedure. However, a very close follow-up of the patients is required after surgery.     

Madreporic coral: a new bone graft substitute for cranial surgery

Since 1985, the authors have been using madreporic coral fragments (genera Porites) as a bone graft substitute. Of the 167 coral grafts implanted, 150 were coral "corks" used to obliterate burr holes (diameter 10 mm), five were large implants (length 20 to 40 mm) to repair skull defects, and 12 were coral blocks to reconstruct the floor of the anterior cranial fossa. Previous experimental studies suggested that coral grafts would be well tolerated and become partially reossified as the calcific skeleton was resorbed. The authors describe their experience and detail the main biological properties of these materials, which appear to be very promising for use in cranial reconstructive surgery.     

Endoscopic cordectomy. a proposal for a classification by the Working Committee, European Laryngological Society

The European Laryngological Society is proposing a classification of different laryngeal endoscopic cordectomies in order to ensure better definitions of postoperative results. We chose to keep the word “cordectomy” even for partial resections because it is the term most often used in the surgical literature. The classification comprises eight types of cordectomies: a subepithelial cordectomy (type I), which is resection of the epithelium; a subligamental cordectomy (type II), which is a resection of the epithelium, Reinke’s space and vocal ligament; transmuscular cordectomy (type III), which proceeds through the vocalis muscle; total cordectomy (type IV); extended cordectomy, which encompasses the contralateral vocal fold and the anterior commissure (type Va); extended cordectomy, which includes the arytenoid (type Vb); extended cordectomy, which encompasses the subglottis (type Vc); and extended cordectomy, which includes the ventricle (type Vd). Indications for performing those cordectomies may vary from surgeon to surgeon. The operations are classified according to the surgical approach used and the degree of resection in order to facilitate use of the classification in daily practice. Each surgical procedure ensures that a specimen is available for histopathological examination. Received: 29 December 1998 / Accepted: 2 July 1999     

Idiopathic sub-glottal stenosis in the adult

Idiopathic subglottic stenosis is a rare condition. The records of five patients with idiopathic subglottic stenosis treated between 1989 and 1998 were reviewed. All were female and had similar clinical and histopathologic features. Endoscopic dilatation or/and radial CO2 laser and dilatation were successful in maintaining the airway of all five patients without tracheotomy. The pathogenesis of idiopathic subglottic stenosis is strictly speculative, for this reason we advocate a conservative approach.     

T1 squamous cell carcinoma of the arytenoid.

Twenty-two cases of early squamous cell carcinoma of the arytenoid cartilage staged as T1 according to the 1983 American Joint Committee for Cancer Staging Classification system were reviewed. Eighteen percent of the patients showed no symptoms. In the remaining 82%, the main presenting symptom was pain in the form of sore throat, odynophagia, or otalgia. Radiotherapy and partial laryngeal surgery were the options retained for the treatment of the larynx. A "watch and wait" policy or preventive treatment of the ipsilateral jugulocarotid lymph nodes were the treatment options retained for the neck. Significant differences were noted in terms of local and nodal recurrence between the two programs. Results indicate that partial laryngeal surgery with total arytenoidectomy and preventive treatment of the neck appear to be advisable for this particular type of primary lesion.     

Objective acoustic and aerodynamic measures of breathiness in paralytic dysphonia

This study was designed to determine which objective acoustic or aerodynamic parameters allowed a homogeneous group of patients with unilateral vocal fold paralysis (UVFP) to be distinguished from an age-matched and smoking-matched control group and to search for linear correlations between the objective parameters and the subjective breathiness ratings. Eight patients with recent-onset UVFP and 12 controls were prospectively studied. The acoustic parameters measured for the vowel /a/ at a comfortable frequency and intensity were: jitter, shimmer, harmonics-to-noise ratio, cepstral peak prominence, the difference between the levels of the first two harmonics and the relative energy above 6 kHz. Aerodynamic parameters included the mean flow rate during a sustained /a/ and intraoral pressure during the production of the phoneme /pi/. The long-term average spectrum was calculated for 40 s of text, and the relative average energies in four frequency bands were compared. Six judges rated a mid-/a/ sample using a five-parameter scale with four levels of severity. Nonparametric statistical analysis revealed significant differences ( P<.05) between the UVFP group and the control group for 14 of the 19 parameters studied. Correlations between the objective parameters and perceived breathiness differed in the two groups. Correlations were not always as expected as based on previous literature reports. These measurements provided an objective qualification of voice in patients with UVFP and successfully distinguished them from the normal controls. The objective acoustic and aerodynamic measurements had generally low linear correlations with breathiness ratings in the control group. Higher correlations were seen in the UVFP group, in which breathiness was best correlated with airflow measurements.