Short-term treatment results for unilateral vocal fold palsy induced by mediastinal lesions.

Vocal fold paralysis (VFP) is a frequent complication of surgery of mediastinal structures. This study evaluated the characteristics and short-term treatment outcomes of injection laryngoplasty for unilateral VFP (UVFP) induced by mediastinal lesions. The enrolled patients (n = 60) underwent injection laryngoplasty once because of UVFP and were divided into two groups according to cause (group A, thyroidectomy and group B, mediastinal surgery). Voice analysis was performed preoperatively and at 1 month postoperatively. The glottal gap; the Grade, Roughness, Breathiness, Asthenia, and Strain scale; acoustic analysis; and aerodynamic results were measured. Group A and group B comprised eight and 52 patients, respectively. Group B patients were older than group A patients (P < 0.05). The injected volume in group B (0.91 ± 0.23 mL) was larger than that of group A (0.38 ± 0.17 mL; P = 0.022). Group B (13.35 ± 4.69 units) showed a larger glottal gap than group A (6.64 ± 4.05 units; P = 0.017), and the glottal gap decreased after the procedure. In both groups, most preoperative acoustic parameters except roughness improved after injection laryngoplasty. The preoperative maximum phonation time of group B (2.87 ± 1.11 seconds) was shorter than that of group A (7.04 ± 2.58 seconds), and it improved after injection. Mean airflow rate improved significantly after injection in both groups. Mediastinal lesion-induced UVFP is associated with a larger glottal gap than that caused by an injury induced by thyroidectomy. Despite large glottal gap, injection laryngoplasty improves voice outcomes in such types of UVFP.

Lee YS ，Kim YH ，Kwon M ，Ryu IS ，Jung GE ，Kim ST ，Roh JL ，Choi SH ，Kim SY ，Nam SY ... -  《-》

Influence of superior laryngeal nerve injury on glottal configuration/function of thyroidectomy-induced unilateral vocal fold paralysis.

Recurrent laryngeal nerve (RLN) injury may induce unilateral vocal fold paralysis (UVFP). During thyroidectomy, the most common cause of UVFP, the superior laryngeal nerve (SLN), is also at risk of injury. In the literature, the influence of SLN injury on glottal configuration and function in patients with UVFP remains controversial. The present study investigates SLN injury influence on glottal configuration and function in patients with UVFP after thyroidectomy. Prospective controlled study. Tertiary medical center. The SLN and RLN function of 34 patients with UVFP after thyroidectomy was determined by laryngeal electromyography. The subjects were dichotomized into the isolated RLN injury group (n = 26) or the concurrent SLN/RLN injury group (n = 8). We evaluated glottal angle and paralyzed vocal fold shape during inspiration, normalized glottal gap area, and glottal shape during phonation. The glottal function measurements included voice acoustic and aerodynamic analyses and the Voice Handicap Index. The aforementioned parameters of the RLN and concurrent SLN/RLN injury groups were compared. There were no statistical differences in glottal configuration such as glottal angle, paralyzed vocal fold shape, normalized glottal gap area, and glottal shape between the RLN and concurrent SLN/RLN injury groups. There were also no significant differences in other glottal function analyses including fundamental frequency, mean airflow rate, phonation quotient, maximal phonation time, and Voice Handicap Index. In the present study, we did not find any evidence that SLN injury could significantly influence the glottal configuration and function in patients with UVFP.

De Virgilio A ，Chang MH ，Jiang RS ，Wang CP ，Wu SH ，Liu SA ，Wang CC ... -  《-》

Laryngoplasty with hyaluronic acid in patients with unilateral vocal fold paralysis.

Augmentation of vocal fold with hyaluronic acid (Restylane; Q-Med AB, Uppsala, Sweden) is used as a therapeutic option for insufficient glottic closure in unilateral vocal fold paralysis (UVP). Analysis of the optimal glottic width, effectiveness (long-term voice improvement as a consequence of longevity of Restylane), and safety of this new method was made. In a prospective clinical cohort study, 19 consecutive patients with UVP who received vocal fold augmentation with hyaluronic acid (Restylane) were examined preoperatively; 6 weeks, 6, and 12 months postoperatively by laryngostroboscopy; and their voice was evaluated by subjective, objective, and self-assessment (Voice Handicap Index). In 11 of 19 (58%) patients, a subjectively and objectively acceptable voice quality was observed in a follow-up of 12 months. Eight of 19 (42%) patients had a considerable impairment of the voice after 6 weeks (range: 1-24 weeks). Therefore, another intervention (eg, injection laryngoplasty or thyroplasty) was recommended. An impairment of voice was mainly observed if the preoperative glottal gap during phonation was more than 1 mm. A long duration (up to 12 months) of acceptable quality of voice was achieved by augmentation with Restylane, if the glottal gap was 1 mm or less videolaryngostroboscopically during phonation. The authors recommend this therapy for temporary voice improvement and to augment vocal therapy, if spontaneous recovery of voice is likely. Long-term results remain to be seen.

Reiter R ，Brosch S 《-》

Types and timing of therapy for vocal fold paresis/paralysis after thyroidectomy: a systematic review and meta-analysis.

To perform a systematic literature review to evaluate the type and timing of therapy for vocal fold paresis/paralysis after thyroidectomy and develop a primary decision-making pathway. Meta-analysis. Four databases and one journal were searched using the key words of "thyroidectomy," "vocal cord paresis/paralysis," and "therapy." Study quality was evaluated using the Cochrane Collaboration's risk of bias tools. Data regarding type and timing of therapy were extracted from 39 articles. Odds ratios (ORs), relative risk (RR), 95% confidence interval, and heterogeneity were recorded. Logistic regression analysis was performed to determine the relationships between timing and OR/RR. Among the 13 studies investigating unilateral paresis/paralysis, five focused on early therapy (0-6 months). In these studies, the OR for clinical heterogeneity was significantly higher after neurolysis than after injection laryngoplasty and voice training (Q = 17.002, I(2) = 78%, P = 0.000), and the RR for heterogeneity was significantly higher after injection laryngoplasty at ≥12 months than <12 months (Q = 9.984, I(2) = 89.9%, P = 0.002). In the 26 studies that investigated bilateral paresis/paralysis, the OR for heterogeneity was significantly higher for bilateral posterior cordectomy than for endolaryngeal laterofixation (Q = 3.510, I(2) = 71.5%, P = 0.061) and laser arytenoidectomy with posterior cordectomy (Q = 2.90, I(2) = 65.6%, P = 0.088). For unilateral vocal fold paresis/paralysis after thyroidectomy, we recommend absorbable mass injection laryngoplasty, voice training, and neurolysis during the first 12 months but laryngeal reinnervation after 12 months. For bilateral vocal fold paresis/paralysis, we recommend early laterofixation and combined laser arytenoidectomy with posterior cordectomy after 12 months.

Chen X ，Wan P ，Yu Y ，Li M ，Xu Y ，Huang P ，Huang Z ... -  《-》

Laryngeal electromyography-guided hyaluronic acid vocal fold injection for unilateral vocal fold paralysis: a prospective long-term follow-up outcome report.

Wang CC ，Chang MH ，Jiang RS ，Lai HC ，De Virgilio A ，Wang CP ，Wu SH ，Liu SA ，Liang KL ... -  《-》