The evaluation of benign glottic lesions: rigid telescopic stroboscopy versus suspension microlaryngoscopy.
ABSTRACT Rigid telescopic strobo-video-laryngoscopy (RTS) is a primary clinical assessment methodology in the office evaluation of benign glottic lesions. However, diagnostic observations can be made only at the time of suspension microlaryngoscopy (SML). The records of 100 consecutive patients undergoing microlaryngoscopy for benign glottic lesions were retrospectively reviewed. Nine of 100 patients were found to have additional glottic lesions during SML. Sixteen additional lesions were noted in these nine patients. Fifteen of 16 lesions were sulci and/or mucosal bridges. Forty-five percent (4/9) of the patients with additional lesions underwent a management change intraoperatively. Three patients underwent additional surgical dissection, and one underwent less dissection than was planned. The discrepancy in diagnosis between rigid telescopic strobo-video-laryngoscopy and suspension microlaryngoscopy highlights certain key points: (1) During office endoscopy, tangential views of the medial surface of the glottis limit the diagnostic sensitivity. (2) Sulci and mucosal bridges are most subject to this limitation. (3) Informed consent should address the potential need for a change in intraoperative management. It is advisable to discuss the possibility for dissection in both vocal folds, even if a unilateral lesion is observed in the office. (4) Microlaryngoscopy is the final diagnostic step in the evaluation of glottic pathology. Meticulous inspection and palpation of the glottis are recommended during SML.
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ABSTRACT: Optical coherence tomography (OCT) can provide high-resolution ( approximately 10-15 microm/pixel) images of vocal fold microanatomy, as demonstrated previously. We explored physiologically triggered Fourier-domain OCT for imaging vocal folds during phonation. The goal is to visualize dynamic histological cross sections and four-dimensional data sets where multiple planes are displayed in synchronized motion. If feasible, this approach could be a useful research tool and spur development of new clinical instrumentation. A Fourier-domain, triggered OCT system was created and tested in experiments on excised calf larynges to obtain preliminary observations and characterize important factors affecting image quality. Larynges were imaged during phonation driven by warm, humidified air. A subglottal pressure signal was used to synchronize the OCT system with the phonatory cycle. Image sequences were recorded as functions of anatomical location or subglottal pressure. Implant materials were also imaged during vibration, both in isolation and after injection into a vocal fold. Oscillations of epithelium and lamina propria were observed, and parameters such as shape, amplitude, and velocity of the vocal fold mucosal waves were found to be measurable. Ripples of mucosal wave as small as 100 microm in vertical height were clearly visible. Internal strain was also observed in normal and implanted vocal folds. Four-dimensional OCT of the vocal fold may help to more directly relate biomechanics to anatomy and disease. It may also be useful for assaying the functional rheology of implants in the context of real tissue. With further development, this technology has potential for clinical endoscopic application.The Laryngoscope 07/2010; 120(7):1354-62. DOI:10.1002/lary.20938 · 2.03 Impact Factor
- Journal of the American Dietetic Association 09/2011; 111(9). DOI:10.1016/j.jada.2011.06.215 · 3.92 Impact Factor
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ABSTRACT: The management of voice disorders requires a close collaboration between the throat surgeon and the speech therapy team. The diagnosis of cordal lesions is essential to an accurate therapy. Stroboscopy contributes functional information which is useful to decide between microsurgery, vocal reeducation or a combined treatment. We have reviewed our phonomicrosurgery cases for the past five years and analyzed the correlation between preoperative diagnosis obtained by stroboscopy and intraoperative findings. In 90% of cases there exists a relation between both diagnoses. We consider stroboscopy as an essential means of evaluation to establish an adequate management and guidance for surgical treatment.Acta Otorrinolaringológica Española 03/2010; 61(2). DOI:10.1016/j.otorri.2009.10.010