Iatrogenic Laryngeal Lipoma: Rare Complication after Fat Injection Due to Increased Vocal Fold

Centrifuged autologous fat injection is a safe, feasible and effective phonosurgical technique for the treatment of chordal paralysis and its use dates back to 1991. This procedure allows to correct glottic incompetence by medialization of one or both vocal cords. Expecting fat resorption, which occurs postoperatively, the surgeon injects at least 30-40% more fat than needed to achieve glottic closure. The procedure is minimally invasive, with minimal morbidity and complications. In this article, we present a rare case of iatrogenic lipoma secondary to excessive lipoinjection due to the increase of the vocal cords, causing severe dysphonia.

Unilateral Vocal Fold Paralysis With Large Posterior Glottic Gap: Is Arytenoid Procedure Necessary?

Objectives: For unilateral vocal fold paralysis (UVFP) with large posterior glottic gap medialization laryngoplasty (ML) + arytenoid adduction (AA), ML + adduction arytenopexy (AApexy), and ML alone using prosthesis with posterior extension are possible solutions. This study was carried out to elucidate the controversy among these solution options. Methods: Retrospective cohort. Tertiary referral center. One hundred forty patients with UVFP with large posterior glottic gap. Group 1 had 30 patients with ML + AA; Group 2 had 25 patients with ML + AApexy; Group 3 had 29 patients with ML using Isshiki prosthesis; Group 4 had 26 patients with ML using Montgomery prosthesis; Group 5 had 30 patients with ML using prosthesis with large posterior extension. Glottic closure using videolaryngostroboscopy, GRBAS, VHI-30, EAT-10, acoustic and aerodynamic analysis was carried out pre- and 1-year-postoperatively. Results: Preoperatively there was no significant difference in any parameters studied among all study groups ( P > .05). Except F0, speaking F0 and EAT-10, all other parameters in acoustic and aerodynamic analysis, glottic closure, GRBAS, and VHI-30 scores were significantly better postoperatively in Groups 1 and 2 compared to Groups 3 to 5 ( P < .05). Conclusions: In patients with UVFP and large posterior glottic gap, ML + AA and ML + AApexy seem to do better subjectively and objectively, acoustically and aerodynamically, when compared to ML using prosthesis with and without large posterior extension. ML alone does not appear to close posterior glottic gap. Therefore, it is a better and more reasonable option to perform arytenoid procedure when there is large posterior glottic gap in UVFP.

Use of 532 nm Potassium Titanyl Phosphate Laser on Vocal Fold Scars Under Topical Anesthesia: A Pilot Study

Objective: This pilot study aims to evaluate the efficacy of 532 nm potassium titanyl phosphate (KTP) laser under topical anesthesia in patients with vocal fold scars. Methods: A series of 18 patients with vocal fold scars of varying degrees were treated. The KTP laser was used under local anesthesia in the outpatient clinic. It was set to deliver 6 W of power using a continuous output mode. Close-to-contact mode was used for laser irradiation, and contact mode was used for ablation and excision of the lesions. Some of the patients received laser scar ablation on both vocal folds; the scarred vocal fold on one side and the hypertrophic vocal fold on the other. Parameters include glottic closure, amplitude, and mucosal wave pattern were measured using laryngeal stroboscopic examination. Aerodynamic and voice evaluations were carried out using maximum phonation time (MPT), jitter, shimmer, Voice Handicap Index questionnaire (VHI-30), and GRBAS scale. Results: In total, 21 surgeries were performed on 18 patients. Glottic closure, amplitude, and mucosal wave pattern showed improvement 2 months postoperatively ( P < .05). There was significant improvement in the postoperative scores for VHI-30, VHI-emotional sub-scale, VHI-physical sub-scale, and GRBAS ( P < .05). There was no significant difference in the MPT and VHI-functional sub-scale before and after the operation ( P > .05). Re-adhesion of the anterior commissure was observed in 2 patients with Type III scars. Conclusion: The 532 nm KTP laser is an effective tool for the treatment of vocal fold scars. Further research is required to determine if serial laser applications could improve outcomes for this challenging condition. Level of Evidence: Level IV

Comparison between Conventional Microdissection and CO2 Laser in the Treatment of Vocal Cord Polyp

Background: Vocal cord polyp usually arises from the epithelium and the lamina propria. Minimally invasive dissection procedures are employed to treat these vocal cord polyp for an effective outcome. Two types of microsurgical techniques were developed gradually and practiced namely, the conventional laryngeal microsurgery, which involves the use of cold instruments and the laryngeal laser micro-surgery. Objective: To compare the conventional cold dissection and CO2 laser methods in treatment of vocal cord polyp. Methods: A randomized prospective study was conducted at the Department of Otolayngology- Head & Neck Surgery, at Bangabondhu Sheikh Muzib Medical University (BSMMU) between July 2017 and June 2019. A total of 60 cases were studied on the following parameters: a. Visual analysis on stroboscopy b. Voice analysis –GRBAS (grade, roughness, breathiness, asthenia, strain) indices c. Duration of surgery d. Peroperative bleeding. Results: During first postoperative assessment, both groups had the normal symmetrical waves, while 50% of cases still had aperiodicity but all patients had the near normal periodicity in the second postoperative assessment. Regarding glottic closure, during preoperative assessment, almost all patients had incomplete glottic closure due to mass lesion as polyps. During first postoperative assessment, glottic closure was found to be better in group B (83% of cases) than group A (76% of cases), while during second postoperative assessment, all patients of both groups had around 95% glottic closure. The mean duration oflaser technique (7.1 ± 1.1 minutes) was less than the conventional technique time (15.6 ± 1.9 minutes), also mean of operative bleeding of laser technique (zero pack) is less than the conventional two(2 packs). Conclusion: There is no significant difference between both groups in all parameters except operative time and bleeding, as laser technique has less time and clear field. Bangladesh J Otorhinolaryngol; April 2021; 27(1): 17-24

Glottal Closure in Women with No Voice Complaints or Laryngeal Disorders

Introduction The understanding of normal vocal production is essential to guide any voice professional as it is fundamental to understand the effects of the posterior glottal gap on the vocal quality. Objective The aim of the present study was to verify the association between glottic closure, acoustic parameters, and some characteristics of the videolaryngostroboscopy of young women without vocal complaints nor laryngeal disorders. Methods This is a cross-sectional study with 56 women between 20 and 30 years old who underwent videolaryngostroboscopy. The acoustic parameters of the vowel /a:/ were analyzed using the Praat software, Release 4.6.10 (Paul Boersman and David Weenik, Amsterdam, Netherlands). Statistical Analysis The chi-squared, Fischer, and Kruskall-Wallis tests were applied, with 5% significance. Results Significant occurrence of posterior glottal gap (85.71%, p < 0.001), of normal vocal folds vibration amplitude (82.14%, p < 0.001), and of absence of significant constriction of the laryngeal vestibule (98.21%, p < 0.001); no significant association of the glottic closure with the vocal acoustic parameters; no significant association of glottic closure, vocal folds vibration amplitude, and constriction of the laryngeal vestibule. Conclusion There was a predominance of posterior glottal gap, normal vocal folds vibration amplitude, and absence of laryngeal vestibule constriction, and no relation with the acoustic parameters, suggesting that the posterior glottal gap did not generate impact on the vocal production of the young adult women studied.