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Cancer
Published in Jahangir Moini, Matthew Adams, Anthony LoGalbo, Complications of Diabetes Mellitus, 2022
Jahangir Moini, Matthew Adams, Anthony LoGalbo
Papillary carcinoma often is detected as a painless mass, with enlargement of the cervical lymph nodes. However, some patients may complain about neck pain, hoarseness, and dysphagia. Patients have also nodal metastases in the lateral neck. Follicular thyroid carcinoma is often a painless tumor, from less than 1 cm in diameter up to several centimeters. Large tumors cause dyspnea or dysphagia, and throat or neck soreness and pain. There may be unintended weight loss and night sweats. Cervical lymph node enlargement at diagnosis is not common. Sometimes, the first symptom is metastasis that can be signified by a lung nodule or a bone fracture. If a metastasis is diagnosed as being from the thyroid, a neck examination will usually reveal a thyroid mass. In certain cases, findings of bone metastases prompt reexamination of an earlier resected thyroid mass that was believed to be an adenoma. There are also rare cases of functional follicular thyroid carcinoma related to hyperthyroidism. The majority of MTCs are painless. Extensive localized tumor growth causes upper airway obstruction plus dysphagia. With metastases, some patients experience flushing and severe diarrhea because of high circulating calcitonin levels and other products that result from the tumor. Patients may present with a firm neck mass that is fixed in one location. The tumor is widely infiltrative. Hoarseness, breathing problems, dysphagia, and pain are common symptoms, as well as dyspnea and vocal cord paralysis. Approximately 35% of patients initially present with distant metastasis to the lungs and bones.
Impairment of functions of the nervous system
Published in Ramar Sabapathi Vinayagam, Integrated Evaluation of Disability, 2019
Aphonia is a loss of voice due to an organic or functional disturbance of the vocal organs. Laryngectomy/paralysis of vocal cord, and so on, may cause aphonia. The vocal cord paralysis may be unilateral (or) bilateral, and it may be in abduction (or) adduction. The bilateral vocal cord paralysis in abduction produces aphonia. The unilateral vocal cord paralysis in abduction may produce dysphonia. Dysphonia may also be due to tracheostomy. Both unilateral and bilateral paralysis in abduction has a potential risk of aspiration. The bilateral vocal cord paralysis in adduction is an acute emergency mainly with respiratory compromise demanding tracheostomy. The unilateral vocal cord paralysis in adduction produces mostly respiratory insufficiency.
Phonosurgery
Published in John C Watkinson, Raymond W Clarke, Terry M Jones, Vinidh Paleri, Nicholas White, Tim Woolford, Head & Neck Surgery Plastic Surgery, 2018
Muscle nerve pedicle reinnervation has also been described using a block of omohyoid with its branch from the ansa cervicalis, although some surgeons are now combining neural anastomosis with laryngeal framework surgery as it appears that neural anastomosis alone does not give a good result in a lateralized cord. In the author’s opinion, there is currently no convincing clinical or scientific evidence that the reinnervation techniques give better or equal results to either injection, medialization or laryngeal framework surgery in the management of a unilateral vocal cord paralysis. Table 67.1 shows the advantages and disadvantages of the most common procedures currently used for the rehabilitation of a patient with a unilateral vocal cord paralysis.
Surgical Outcomes and Efficacy of Isthmusectomy in Single Isthmic Papillary Thyroid Carcinoma: A Preliminary Retrospective Study
Published in Journal of Investigative Surgery, 2021
Hee Won Seo, Chang Myeon Song, Yong Bae Ji, Jin Hyeok Jeong, Hye Ryoung Koo, Kyung Tae
Postoperative hematoma occurred in 3 patients (4.3%) of the total thyroidectomy group and 1 patient (2.5%) of the lobectomy group. Unilateral vocal cord paralysis occurred in 4 patients (5.7%) and 1 patient (2.5%) of the total thyroidectomy and lobectomy groups, respectively. All vocal cord paralysis was temporary and returned to normal within 3 months postoperatively. Postoperative hypoparathyroidism was observed in 33 patients (47.1%) of the total thyroidectomy group, two of whom showed permanent dysfunction; the rate of occurrence in the total thyroidectomy group was significantly higher than that in the lobectomy (5%) and isthmusectomy (9.1%) groups. Recurrence was not different among the three groups (p = 1.000) (Table 2). Recurrences occurred in 2 patients, 1 patient each in the total thyroidectomy and lobectomy groups.
A spontaneous partially thrombosed ductal aneurysm presenting with left recurrent laryngeal nerve palsy
Published in Acta Oto-Laryngologica Case Reports, 2020
Abhilasha Goswami, Anandita Das
Vocal cord paralysis – definition and anatomy: The vocal cords, more often called the vocal folds due to its resemblance to folds of tissue, are located in a subsite of the larynx called the glottis. The glottis comprises of the true vocal cords, the anterior commissure, and the posterior commissure. Histologically, the vocal cords are composed of five layers. From superficial to deep, these layers are – 1) stratified squamous non-keratinizing epithelium, 2) superficial layer of the lamina propria (Rienke’s space), 3) intermediate layer of lamina propria, 4) deep layer of lamina propria, and 5) vocalis muscle. The movement of the vocal cords is controlled by the intrinsic muscles of the larynx. The recurrent laryngeal nerve supplies all the intrinsic muscles of the larynx, except the cricothyroid, which is supplied by the internal division of the superior laryngeal nerve. Vocal cord paralysis is an inability to move the muscles of the vocal cords. It may be unilateral or bilateral. Paralysis of one vocal cord (unilateral vocal cord paralysis) can impair voice and sometimes swallowing. Paralysis of both vocal cords (bilateral vocal cord paralysis) can compromise the airway and breathing.
The assistance of coblation in arytenoidectomy for vocal cord paralysis
Published in Acta Oto-Laryngologica, 2019
Yuqiang Hu, Liangjun Cheng, Bing Liu, Hao Ming, Aimin Tian, Mei Ma
Surgery, neck trauma, or tumor compression may cause vocal cord paralysis. Noniatrogenic vocal cord paralysis is more often a result of lung, esophageal, or thyroid malignancy, while iatrogenic vocal cord paralysis is more commonly seen after thyroid surgery [1], especially after multiple surgeries [2]. Owing to limited abduction and normal adduction function of the vocal cords, the general speech function is acceptable, but inspiration difficulties may occur because of a stenotic glottis vocalis, and patients with severe paralysis may require a tracheotomy. Traditional treatment methods include laryngofissure and laryngoscopic CO2 laser surgery [3]; however, despite resolving the laryngeal obstruction, these methods result in greater tracheal intubation pain. Furthermore, activities of daily living are affected by the surgical outcomes. Because of regional limitations and issues with safety in the application of CO2 laser technologies, the diagnosis and treatment of bilateral vocal cord paralysis (BVCP) is still being explored, with the intent of finding a new method to treat BVCP. In recent years, with the continuous development of microsurgical technologies, micro-laryngoscopic coblation [4,5] has been widely used to treat ear, nose, and throat (ENT) diseases, and has been reported to have a faster recovery period with less surgical trauma [6]. Since January 2012, our department has used laryngoscopic coblation to treat 14 patients with BVCP; recovery was fast, and the patients had good outcome. In this manuscript, we report the feasibility, postoperative efficacies, and procedures of this method.