MyMedR

A proposal for needle projections in transcutaneous injection laryngoplasty using three-dimensionally reconstructed CT scans

Nasir ZM, Azman M, Baki MM, Mohamed AS, Kew TY, Zaki FM

Surg Radiol Anat, 2021 Aug;43(8):1225-1233.

PMID: 33388863 DOI: 10.1007/s00276-020-02639-9

PURPOSE: This study aims to determine laryngeal dimension in relation to all three transcutaneous injection laryngoplasty (TIL) approaches (thyrohyoid, transthyroid and cricothyroid) using three-dimensionally reconstructed Computed Tomography (CT) scan and compare the measurements between sex, age group and ethnicity.

METHODS: CT scans of the neck of two hundred patients were analysed by two groups of raters. For thyrohyoid approach, mean distance from the superior border of the thyroid cartilage to the laryngeal cavity (THd) and mean angle from the superior border of the thyroid cartilage to mid-true cords (THa) were measured. For transthyroid approach, mean distance from mid-thyroid cartilage to mid-true cords (TTd) and Hounsfield unit (HU) at mid-thyroid cartilage (TTc) were measured. For cricothyroid approach, mean distance from the inferior border of the thyroid cartilage to the laryngeal cavity (CTd) and mean angle from the inferior border of the thyroid cartilage to mid-true cords (CTa) were measured.

RESULTS: There were statistically significant differences between males and females for all measurements except for CTa (p 0.05). There was a significant fair positive correlation between age and TTc (p = 0.0002). For all measurements obtained, there were moderate to excellent inter-group consistency and intra-rater reliability.

CONCLUSION: This study demonstrated a significant sex dimorphism that may influence the three TIL approaches except for needle angulation in the cricothyroid approach. The knowledge of laryngeal dimension is important to increase success in TIL procedure.

Matched MeSH terms: Vocal Cord Paralysis/surgery*

Fulltext Hoarseness of Voice in a Patient with Mitral Stenosis and Ortner's Syndrome

Mohamed AL, Zain MM

Malays J Med Sci, 2004 Jul;11(2):65-8.

PMID: 22973129 MyJurnal

Rheumatic mitral stenosis is prevalent in this part of the world and it gives rise to wide array of manifestations. However, hoarseness of voice secondary to recurrent laryngeal nerve paralysis (Ortner's syndrome) is an uncommon manifestation. This case illustrates an uncommon presentation in a common disease. A 29-year-old lady presented with a 2-year history of hoarseness of voice. Physical examination revealed a mid-diastolic murmur and left vocal cord paralysis. Echocardiography confirmed mitral stenosis with pulmonary hypertension. She underwent percutaneous mitral balloon valvotomy in 1991 with return of normal speech after a few months. The recurrent laryngeal nerve paralysis is mainly due to the compression by an enlarged pulmonary artery as initially thought. This complication is rarely seen nowadays due to greater awareness of the disease and earlier intervention. With the advent of percutaneous transvenous mitral valvotomy in the nineties, effective non-surgical intervention is plausible.

Matched MeSH terms: Vocal Cord Paralysis

A rare case of cervical hypoglossal nerve neurofibromas in a patient with type 1 neurofibromatosis

Lum SG, Baki MM, Yunus MRM

Braz J Otorhinolaryngol, 2021 Feb 25.

PMID: 33707119 DOI: 10.1016/j.bjorl.2021.01.006

BACKGROUND: Neurofibromas are benign peripheral nerve sheath tumours. Hypoglossal nerve neurofibromas in cervical region are relatively rare, bilateral occurrence is extremely rare.

METHODS: A 32-year-old man with type 1 neurofibromatosis presented with bilateral neck masses. Magnetic resonance imaging showed parapharyngeal masses consistent with neurogenic tumours, most likely neurofibromas.

RESULTS: Surgical exploration through lateral cervical approach revealed unexpected finding of the tumour that arose from the hypoglossal nerve. The tumour had totally engulfed the nerve with no normal nerve fascicles identifiable, thus resected in toto. In the postoperative course, the patient developed right hypoglossal palsy and vocal fold palsy treated with augmentation of the paralysed vocal fold with temporary injection material.

CONCLUSIONS: The authors described a patient with type 1 neurofibromatosis with neurofibroma originating from cervical part of hypoglossal nerve. This paper discussed this rare condition and the management on how to improve the treatment outcome.

Matched MeSH terms: Vocal Cord Paralysis

Fulltext Kashima operation: an endoscopic phonosurgery by laser for bilateral vocal cord palsy

Alamgir Chowdhury, M., Farid Hossain Chowdhury, Khaled Bin Shahabuddin, Tofazzal Hossain, A.B.M., Shaila Kabir

Borneo Journal of Medical Sciences, 2021;15(1):31-35.

MyJurnal

Complete or partial restriction of the vocal cords usually occurs due to cancer, neurologic causes or mechanical causes like huge neck mass, trauma to the neck, viral infection, and sometimes iatrogenic during surgery. Bilateral vocal cord palsy is a severe condition that can lead to significant problems in breathing, speaking, and swallowing. If any patient presents with stridor, it requires urgent surgical airway management followed by specific treatment. A case of viral bilateral abductor vocal cord palsy in a 41-year-old female is reported here. The patient presented with stridor, and immediate tracheostomy was done. The stridor developed first 3 months earlier followed by cold and fever for a week. The stridor worsened gradually and leads to a state of commencing immediate tracheostomy. There was no history of trauma to the neck or any neck surgery. All basic laboratory blood test was within the normal limit. The laryngoscopic examination showed both vocal cords were immobile and almost median position with a small gap at the posterior commissure. Chest and neck plain X-ray along with computed tomography scan of neck was normal which ruled out the other causes of bilateral vocal cord palsy. The patient subsequently underwent successful left posterior cordectomy by laser, and decannulation of tracheostomy was done, known as Kashima operation.

Matched MeSH terms: Vocal Cord Paralysis

Fulltext Reoperative thyroid surgery in hospital universiti sains malaysia

Tun M, Salekan K, Sain AH

Malays J Med Sci, 2003 Jan;10(1):86-9.

PMID: 23365506 MyJurnal

From 1996 to 2001, 393 thyroidectomies were performed and 25 (6.4%) patients underwent reoperative thyroid surgery at Hospital Universiti Sains Malaysia. All reoperated patients had undergone one prior thyroid operation. All were females with an average age of 39.1 years (18-61 years). The most frequent indication for reoperation was cancer in resected specimen of an originally misdiagnosed carcinoma treated by partial thyroid resection. Final histological diagnosis of 25 reoperations showed thyroid carcinoma in 22 (88%) cases and multinodular goiter in 3 cases. The overall interval between the initial and the reoperative procedures ranged from 3 weeks to 15 years. There was no post-operative mortality after reoperation. Post-operative complications were discovered in 5 patients, as 3 (12%) of whom had transient hypocalcaemia, one (4%) had wound breakdown and one (4%) had permanent recurrent laryngeal nerve palsy. Reoperative thyroid surgery is an uncommon operation with high complication rate.

Matched MeSH terms: Vocal Cord Paralysis

Fulltext Congenital bilateral vocal cord paralysis

Hasniah AL, Asiah K, Mariana D, Anida AR, Norzila MZ, Sahrir S

Med J Malaysia, 2006 Dec;61(5):626-9.

PMID: 17623966 MyJurnal

Congenital upper airway obstruction is a relatively rare but important cause of major respiratory problems in the neonatal period. Vocal cord paralysis is the second most common cause of congenital airway obstruction presenting with neonatal stridor. It is often the reason for the failure of neonates to wean from the respiratory support. A retrospective analysis of medical record review was conducted. There were seven paediatric patients diagnosed with bilateral vocal fold paralysis in the past three years, of which five were recently diagnosed. All patients underwent flexible with/without rigid bronchoscopes to confirm the diagnosis. This case series highlight our experience in managing the problem of bilateral vocal cord paralysis in the paediatric population, with particular emphasis on their clinical presentations, associated complications and both upper and lower airway abnormalities. The management options and outcome of these patients will also be discussed.

Matched MeSH terms: Vocal Cord Paralysis/congenital; Vocal Cord Paralysis/diagnosis*; Vocal Cord Paralysis/surgery

Fulltext Thoracic aortic aneurysm presenting as vocal cord paralysis

Norly, S., Noorizan, Y., Ros’aini, P.

International Medical Journal Malaysia, 2013;12(1):67-68.

MyJurnal

We present a case of 80-year-old man with two-year history of hoarseness of voice secondary to left vocal cord paralysis. CT scanning revealed a saccular thoracic aneurysm compressing the left recurrent laryngeal nerve. A review of literature on Ortner's or cardiovocal syndrome is presented.

Matched MeSH terms: Vocal Cord Paralysis

Fulltext Dual-tree complex wavelet packet transform for voice pathology analysis

Farah Nazlia Che Kassim, Muthusamy, Hariharan, Vijean, Vikneswaran, Zulkapli Abdullah, Rokiah Abdullah

Pertanika Journal of Science & Technology, 2020;28(3):839-858.

MyJurnal

Voice pathology analysis has been one of the useful tools in the diagnosis of the pathological voice, as the method is non-invasive, inexpensive, and can reduce the time required for the analysis. This paper investigates feature extraction based on the Dual-Tree Complex Wavelet Packet Transform (DT-CWPT) using energy and entropy measures tested with two classifiers, k-Nearest Neighbors (k-NN) and Support Vector Machine (SVM). Massachusetts Eye and Ear Infirmary (MEEI) voice disorders database and Saarbruecken Voice Database (SVD) were used. Five datasets of voice samples were used from these databases, including normal and abnormal samples, Cysts, Vocal Nodules, Polyp, and Paralysis vocal fold. To the best of the authors’ knowledge, very few studies were done on multiclass classifications using specific pathology database. File-based and frame-based investigation for two-class and multiclass were considered. In the two-class analysis using the DT-CWPT with entropies, the classification accuracy of 100% and 99.94% was achieved for MEEI and SVD database respectively. Meanwhile, the classification accuracy for multiclass analysis comprised of 99.48% for the MEEI database and 99.65% for SVD database. The experimental results using the proposed features provided promising accuracy to detect the presence of diseases in vocal fold.

Matched MeSH terms: Vocal Cord Paralysis

Fulltext Delayed complication of radiotherapy: laryngeal fibrosis and bilateral vocal cord immobility

Prepageran N, Raman R

Med J Malaysia, 2005 Aug;60(3):377-8.

PMID: 16379198

Radiotherapy is the accepted treatment for early laryngeal carcinomas with the advantage of voice preservation. It is however, not without complications. We report a case of bilateral vocal cord immobility 15 years after radiotherapy. This appears to be due to ankylosis of cricoarytenoid joint and fibrosis of the larynx.

Matched MeSH terms: Vocal Cord Paralysis/etiology*; Vocal Cord Paralysis/pathology*

Chemo-port insertion: A cause of vocal cord palsy

Alazzawi S, Hindi K, Malik A, Wee CA, Prepageran N

Laryngoscope, 2015 Nov;125(11):2551-2.

PMID: 26108861 DOI: 10.1002/lary.25422

We describe extremely rare cases of vocal cord palsy following surgical insertion of a chemo port. Our cohort consisted of patients with cancer who developed hoarseness immediately after central venous line placement for the administration of chemotherapy, with vocal cord palsy confirmed with flexible laryngoscopy. Given the timing, central venous line placement appears to be the most likely cause.

Matched MeSH terms: Vocal Cord Paralysis/etiology*

Fulltext Ultrasonic scissors-assisted 'open-book' thyroidectomy in massive goiter compressing airway and causing unilateral vocal cord paralysis

Irfan M, Yaroko AA, Soleh MN, Periasamy C

Med J Malaysia, 2013 Apr;68(2):183-5.

PMID: 23629575

A massive goiter may constrict the trachea resulting in shortness of breath. Recurrent laryngeal nerve compression may cause vocal cord paralysis. We highlight a case of a 62- year-old female with a 30 year history of an anterior neck swelling gradually increasing in size. She presented with acute symptoms of upper airway obstruction and voice changes. Emergency thyroidectomy was performed by dividing the middle part of the gland using ultrasonic scissors. The recovery was uneventful and the patient regained normal vocal cord function post operatively.

Matched MeSH terms: Vocal Cord Paralysis*

Laryngeal paralysis in organophosphorous poisoning

Indudharan R, Win MN, Noor AR

J Laryngol Otol, 1998 Jan;112(1):81-2.

PMID: 9538454

Organophosphorous poisoning causing isolated laryngeal paralysis has only been rarely reported before. We describe a case of difficult extubation in a patient with organophosphorous poisoning, the cause of which was found to be bilateral vocal fold palsy. This is a type of intermediate paralysis that recovers with time. Such a condition should be thought of as a cause of dyspnoea or difficult extubation in patients with organophosphorous poisoning.

Matched MeSH terms: Vocal Cord Paralysis/chemically induced*; Vocal Cord Paralysis/drug therapy

Vocal Fold Injury Following Intubation

Mohd Umbaik NA, Mohamad I, Nik Hassan NFH

J Craniofac Surg, 2020 10;31(7):2064-2065.

PMID: 32890162 DOI: 10.1097/SCS.0000000000006839

Matched MeSH terms: Vocal Cord Paralysis*

Fulltext A case of Hodgkin's disease presenting with recurrent laryngeal nerve palsy and tracheoesophageal fistula

Munshi A, Pandey MB, Kumar L, Karak AK, Mohanti BK

Med J Malaysia, 2006 Mar;61(1):97-9.

PMID: 16708743

Malignancy is the most common cause of tracheoesophageal fistulas. The malignancies commonly implicated in the development of tracheoesophageal fistulas are primary bronchial or esophageal carcinomas. Hodgkins disease rarely leads to such a fistula. We report a case of Hodgkin's disease with a tracheoesophageal fistula as well as a left recurrent nerve palsy at presentation. This presentation has no precedent in literature. The patient was treated with systemic chemotherapy and involved field radiotherapy. On follow up 1 year after the completion of treatment, he was clinically and radiologically disease free.

Matched MeSH terms: Vocal Cord Paralysis/diagnosis*; Vocal Cord Paralysis/physiopathology

Fulltext Hoarseness as the sole symptom of an impending thoracic aneurysm rupture?

Jaafar R, Mohamad I

Malays Fam Physician, 2014;9(1):25-7.

PMID: 25606294 MyJurnal

Unilateral vocal cord palsy secondary to thoracic aortic aneurysm is a rare occurrence. Direct compression of the enlarging thoracic aneurysm on the left recurrent laryngeal nerve causes neuronal injury of the nerve, which is manifested as hoarseness. We present a rare case of unilateral vocal cord palsy in a 60-year-old healthy gentleman caused by a large thoracic aortic aneurysm. This rare presentation, with a serious underlying pathology might be misdiagnosed or delayed. Therefore, it is important for us to have high index of suspicion in cases with a rare presentation such as this.

Matched MeSH terms: Vocal Cord Paralysis

Primary Squamous Cell Carcinoma of the Thyroid Gland

Ibrahim MI, Jusoh YR, Adam NN, Mohamad I

Iran J Otorhinolaryngol, 2018 Jan;30(96):65-68.

PMID: 29387667

Introduction: Primary squamous cell carcinoma (SCC) of the thyroid gland is one of the rarest types of all reported thyroid malignancies worldwide. It is very aggressive in nature and carries a poor prognosis. The surgical resection with adjuvant radiotherapy and chemotherapy is the most recommended treatment despite its poor reported outcome.

Case Report: A 74-year-old woman presented with a rapidly progressive neck swelling, with hoarseness and compressive symptoms. Physical examination revealed a multilobulated firm thyroid mass with unilateral vocal cord palsy. Histopathological findings confirmed the diagnosis of SCC while radiological investigations and panendoscopy findings ruled out the possibility of other primary tumors. A surgical intervention was performed; however, the patient eventually succumbed to death prior to undergoing an oncological treatment.

Conclusion: With no standard consensus to guide the management plan, SCC of the thyroid gland presents a great challenge for the managing team to come up with the best treatment option, due to its unfavorable rate of survival.

Matched MeSH terms: Vocal Cord Paralysis

Nonselective Laryngeal Reinnervation versus Type 1 Thyroplasty in Patients with Unilateral Vocal Fold Paralysis: A Single Tertiary Centre Experience

Ab Rani A, Azman M, Ubaidah MA, Mohamad Yunus MR, Sani A, Mat Baki M

J Voice, 2021 May;35(3):487-492.

PMID: 31732294 DOI: 10.1016/j.jvoice.2019.09.017

OBJECTIVE: This study compared the voice outcomes of selected patients with unilateral vocal fold palsy (UVFP) who underwent either nonselective laryngeal reinnervation (LR) or Type 1 thyroplasty (thyroplasty) in a Malaysian tertiary centre using multidimensional voice assessments.

PARTICIPANTS: The study included 16 patients with UVFP who underwent either LR (9 patients) or thyroplasty (7 patients) between 2015 and 2018 who fulfilled the inclusion criteria.

MAIN OUTCOME MEASURES: The outcomes were measured subjectively and objectively with: (1) voice handicap index-10 (VHI-10- Malay version); (2) auditory perceptual evaluation using the breathiness component of Grade, Roughness, Breathiness, Asthenia, Strain scale; (3) maximum phonation time (MPT); and (4) acoustic analysis (jitter%, shimmer%, and NHR) using OperaVOXTM. The outcomes were measured at baseline, 6 and 12-months postoperative. The comparison of outcomes between pre and postoperative of each group was evaluated using one-way ANOVA test. Mann-Whitney test was used to compare the outcomes between the two groups.

RESULTS: Comparison of each group at different time points showed significant improvement of VHI-10 and MPT of LR group between baseline and 12 months (P ≤ 0.05) whereas, the improvement in thyroplasty group was observed at all time points (P ≤ 0.05). When comparing between the two groups at 12 months, the VHI-10 and MPT was significantly better in the LR group than thyroplasty group with P = 0.004 and P = 0.001 respectively. Other outcome measures did not reveal significant difference between the two groups.

CONCLUSION: This observational study showed that LR may be better than thyroplasty in improving VHI-10 and MPT in selected patients with UVFP.

Matched MeSH terms: Vocal Cord Paralysis

Fulltext Experiences with teflon injections in unilateral adductor vocal cord paralysis

Lee SS

Med J Malaysia, 1990 Sep;45(3):239-43.

PMID: 2152086

Six of 16 patients presenting to the University Hospital Kuala Lumpur with unilateral recurrent laryngeal nerve paralysis were treated with teflon injection of the paralysed vocal cord. The results are presented and the role of surgical therapy, in particular teflon injection is reviewed.

Matched MeSH terms: Vocal Cord Paralysis/pathology; Vocal Cord Paralysis/therapy*

Vincristine-induced vocal cord palsy: case report and review of the literature

Latiff ZA, Kamal NA, Jahendran J, Alias H, Goh BS, Syed Zakaria SZ, et al.

J Pediatr Hematol Oncol, 2010 Jul;32(5):407-10.

PMID: 20505534 DOI: 10.1097/MPH.0b013e3181e01584

Vincristine-induced vocal cord paralysis is a rare but serious complication. We report 2 patients with acute lymphoblastic leukemia who developed progressive stridor during induction chemotherapy. There were no clinical features of peripheral or autonomic neuropathy. Flexible laryngoscopy confirmed the diagnosis of bilateral vocal cord palsy; interestingly, the nerve conduction test revealed axonal motor neuropathy involving the median and common peroneal nerves in both patients. The first patient required prolonged ventilatory support necessitating unilateral cordectomy before extubation, whereas the second only required supplemental oxygen therapy. There was resolution of stridor in the first patient after cordectomy and gradual clinical improvement in the second. These cases illustrate that a high index of suspicion of vincristine-induced vocal cord palsy with prompt otolaryngology consultation for laryngoscopy is required in the diagnostic evaluation of a patient who has received vincristine.

Matched MeSH terms: Vocal Cord Paralysis/chemically induced*; Vocal Cord Paralysis/drug therapy

Fulltext Bilateral vocal cord palsy post thyroidectomy: lessons learnt

Misron K, Balasubramanian A, Mohamad I, Hassan NF

BMJ Case Rep, 2014;2014.

PMID: 24663247 DOI: 10.1136/bcr-2013-201033

Bilateral vocal cord paralysis is a known possible complication following thyroid surgery. It owes to the close relationship between the recurrent laryngeal nerve and the thyroid gland. The most feared complication of bilateral vocal cord paralysis is airway compromise. We report the case of a 39-year-old woman who underwent total thyroidectomy for multinodular goitre. The surgery was uneventful. However she developed stridor in the recovery bay needing intubation. We postulate that the cause was attributed to bilateral vocal cord paresis due to the use of the intraoperative nerve monitoring (IONM) whose high setting throughout the surgery was overlooked. She made a complete recovery without the need of a tracheostomy. We share our lessons learnt from this case.

Matched MeSH terms: Vocal Cord Paralysis/etiology*

Displaying publications 1 - 20 of 32 in total