Vyas M.N. Prasad

Singapore Medical Specialist Centre · Otolaryngology-Head and Neck Surgery

A thesis submitted in fulfillment of the requirements for the degree of MSc in Surgical Science and the Diploma of Imperial College

The carbon dioxide laser has established itself over the last half-century as the most established laser for transoral endolaryngeal surgery. It is versatile and is used in both benign and oncological cases with the possibility of being utilised in the office and operating theatre using both fibre delivery systems and straight beam technology. Sinc...

Introduction: Atypical mycobacterial disease in otolaryngology is well described and relatively common in the pediatric setting. Adult disease, especially in an otherwise healthy patient with no obvious soil- or water-borne source, is rare. We present an interesting case and discuss the lessons learned in her management. Method: A 45-year-old woman...

Introduction Various devices have been used to cut and remove tissue in endonasal surgery. Our aim is to present our experience in using a powered energy ligating and sealing device that is used regularly in laparoscopic surgery for the removal of two intra-nasal lesions. Methods We present two cases of an intranasal solitary mass. The first case w...

Introduction Flexible platforms for TORS have been utilised for over five years. The aim of this review is to provide a thorough appraisal of the impact of flexible robotic systems in head and neck surgery and laryngology, the advantages and disadvantages compared to other systems, cost and benefits as well as future prospects in the development of...

Session Description: This panel presentation comprehensively reviews evaluation and management of vocal fold leukoplakia. Updated from prior years, this iteration will explore management strategies through focus on a case-based approach. Though white vocal fold lesions are common, management remains challenging—doing too little may allow precancero...

Objective This state-of-the-art article reviews the epidemiology, diagnosis, and management of vocal fold leukoplakia, with focus on recent advances. It focuses on the clinical challenges that otolaryngologists face balancing both oncological efficacy and functional outcomes in leukoplakia and presents the current philosophies and techniques to con...

Neurolaryngology as a subspecialty of laryngology has developed considerably in the last four decades with more laryngologists, neurologists, speech and swallow therapists, and neurophysiologists taking interest in the field. The North American and Japanese laryngology societies have increasingly focused on conditions which are mainly concerned wit...

Vocal fold immobility can be either unilateral or bilateral and partial or complete. The aim of this chapter is to discuss the management of unilateral paresis using medialization thyroplasty with or without arytenoid adduction as a means of treating neurogenic causes as opposed to mechanical fixation. Medialization thyroplasty is an open surgical...

Fresh perspectives on the basic science, diagnostics and treatment options in Neurolaryngology Volume 85 in the series 'Advances in Oto-Rhino-Laryngology' contains a combination of our current understanding of neurolaryngological anatomy, physiology, pathology and management options. The content of 'Advances in Neurolaryngology' is divided into fou...

Objectives: Voice feminization surgery for transsexual males to females (MtFs) primarily involves raising the pitch, which requires either an increase in the tension of the vocal fold, reduction in its mass, or shortening of the vibratory segment. Wendler glottoplasty is a procedure performed transorally and endoscopically. It involves the iatrogen...

Objectives: Intrathyroidal parathyroid adenomas, albeit rare, are well documented in the literature. Despite this, surgeons continue to have challenging situations when exploration after radio isotope imaging can result in not identifying these tumors within the substance of the thyroid gland. Methods: We present an interesting case of a 51-year-ol...

Objectives: Postauricular pain is a common presentation seen in the otolaryngology clinic. Methods: We present the case of a 71-year-old man with a significant smoking history who was first seen in the ear, nose, and throat clinic with postauricular pain. Results: With subsequent longitudinal follow-up, this case was eventually revealed to be metas...

Objectives: Ear canal stenoses and false fundi from chronic scarring are difficult to treat in the Asian population, in whom canal diameter is generally smaller than in normal subjects. Several therapeutic options exist but many require canalplasty, complete excision of the scar, and skin grafting. We present a novel method to ablate the scar tissu...

Session Description: This panel presentation comprehensively reviews evaluation and management of laryngeal leukoplakia. Updated from prior years, this iteration will explore management strategies through focus on a case-based approach. Although “white vocal fold lesions” are common, management remains challenging: Doing “too little” may allow prec...

Objectives: To report a case of metastatic cervical cancer in a 50-year-old woman with a sole presentation of neck fullness and ache after close 2-year posttreatment follow-up, and review the literature. Methods: A case report and review of the literature on isolated bony metastases to the neck from cervical cancer were performed. Results: A 50-yea...

Session Description: This session will review exciting new developments in robotic laryngeal surgery as we review the current state of the art in robotic laryngeal surgery and see where the field is going. Transoral robotic surgery has been an increasingly used part of otolaryngologic practice, particularly for lesions of the oropharynx, and new ro...

Objectives: To describe a single-center experience with laser subtotal arytenoidectomy for bilateral vocal fold immobility. Methods: A retrospective review of a single-center, single surgeon’s experience on the “Remacle” subtotal CO2 laser arytenoidectomy was performed. Results: Five patients underwent subtotal arytenoidectomy using the CO2 laser o...

Session Description: This session comprehensively reviews the evaluation and management of laryngeal leukoplakia. Updated from prior years, this iteration will explore management strategies through focus on a case-based approach. Although “white vocal fold lesions” are common, management remains challenging—doing “too little” may allow precancerous...

Objectives: The surgical management of anterior glottic webs includes both open and closed approaches, both of which do not guarantee complete resolution of the web on all occasions. We present our experience in 11 patients between 2012 and 2015, including using the Lichtenberger endoscopic approach. Methods: We used the Lumenis CO2 laser using the...

Objectives: (1) To present an unusual pulsatile left-sided oropharyngeal mass in a 78-year-old female patient who presented with a history of globus of 1-month's duration, which on contrast computed tomography (CT) imaging was found to be a medialized common carotid artery giving the impression of a pseudotumor. (2) To review the current literature...

Session Description: This panel presentation comprehensively reviews evaluation and management of laryngeal leukoplakia. Updated from prior years, this iteration will explore management strategies through focus on a case-based approach. Although white vocal fold lesions are common, management remains challenging: doing too little may allow precance...

Objectives: To assess the voice outcomes in patients treated for benign laryngeal lesions using CO2 laser as a phonosurgical tool. Methods: A retrospective review over 2 years at a tertiary adult hospital with a single-surgeon, single-speech pathology team. Subjective and objective voice instruments were used including the Grade, Roughness, Breathi...

This presentation will review exciting new developments in robotic laryngeal surgery as we review the current state-of-the-art in robotic laryngeal surgery and see where the field is going. Transoral robotic surgery has been an increasingly used part of otolaryngologic practice, particularly for lesions of the oropharynx, and new robotic platforms...

The purpose of this case series is to present the first four cases utilizing micro-phonosurgical instrumentation designed specifically for use with a semi-flexible ‘robotic’ system—the Medrobotics Flex system and to evaluate the accessibility and feasibility of this platform in the context of transoral robotic surgery (TORS) for laryngeal surgery. Met...

The article 'Laser-assisted surgery of the upper aero-digestive tract: a clarification of nomenclature. A consensus statement of the European Laryngological Society,' written by Marc Remacle, Christoph Arens, Mostafa Badr Eldin, Guillermo Campos, Carlos Chiesa Estomba, Pavel Dulguerov, Ivana Fiz, Anastasios Hantzakos, Jerôme Keghian, Francesco Mora...

INTRODUCTION The aim of this study was to analyse the extent laryngeal ossification affected the identification of foreign bodies on soft-tissue neck radiographs and its impact on the management of foreign bodies in the throat. METHODS All patients presenting to the emergency department with a history suggestive of a foreign body in the throat were...

INTRODUCTION In this study, we aimed to share our experience of subtotal laser arytenoidectomy (according to Remacle) for bilateral vocal fold immobility in an adult tertiary hospital in Singapore. METHODS This was a retrospective case series of five adult patients (four female, one male) aged 57–82 years, who over the last 18 months, underwent sur...

Acronyms and abbreviations are frequently used in otorhinolaryngology and other medical specialties. CO2 laser-assisted transoral surgery of the pharynx, the larynx and the upper airway is a family of commonly performed surgical procedures termed transoral laser microsurgery (TLM). The abbreviation TLM can be confusing because of alternative modes...

Development of a novel computerized acoustic assessment. (Presentation) American Academy of Otolaryngology Annual ENT Expo, Chicago, USA, 2017.

Objective: To highlight upper airway inflammation of no known cause besides high air pollution levels. Methods: A retrospective case series covering 12 months from July 2015 to July 2016. Results: In the Indonesian islands surrounding the Malaysian archipelago, forest fires, either intentional or accidental, have recently contributed to alarmingly...

Objectives: To compare a novel computer acoustical software’s (A4S) analysis of laryngectomized valved speech (laryngectomy voice analysis) with that of a team of speech pathologists using the Impression, Intelligibility, Noise, Fluency and Voicing (IINFVo) scale. Methods: This is a prospective single-center observational study over 12 months. A to...

Objectives: To describe experiences of using various lasers in the treatment for benign laryngeal lesions. Methods: A 10-year retrospective review was conducted. Results: Over the past decade, lasers have been used for a variety of lesions in the adult and pediatric population for benign laryngeal lesions. We present our experiences using several l...

Objectives: Melioidosis is a potentially deadly disease caused by the gram-negative saprophyte Burkholderia pseudomallei. It is still an unfamiliar infection in most countries, especially in developed countries. Melioidosis is endemic in Southeast Asia and Northern Australia, but recent case reports show that it is spreading beyond the known endemi...

DOI: 10.1177/0194599817717236 Objective: The aim of this study was to analyze the extent to which laryngeal ossification affects the identification of foreign bodies in soft-tissue neck radiographs and their impact on the management of foreign bodies in the pharynx and cervical esophagus. Methods: All adult patients presenting to the emergency depa...

This miniseminar comprehensively reviews the evaluation and management of laryngeal leukoplakia. Although “white vocal fold lesions” are common, management remains challenging—doing “too little” may allow precancerous lesions to progress, while doing “too much” may create unnecessary dysphonia. Using cases, panel discussion, and the encompassing of...

Objective: To determine the etiology and subsequent management of patients with unilateral vocal fold immobility (UVFI) and compare our results with other such studies. Study design: Retrospective case series of all patients treated for UVFI at one single tertiary referral centre between 2010 and 2014. Methods: The medical records of 161 patients o...

Head and Neck Melioidosis: Experience of a Singaporean Center Noushin Mehran, MD, MS, Rebecca Heywood, MBBCh, FRCS, ,Vyas M.N. Prasad, MBBCh, MSc, FRCS; Objectives: Melioidosis is a potentially deadly disease caused by the gram-negative saprophyte Burkholderia pseudomallei. It is still an unfamiliar infection in most countries, especially in dev...

Introduction Soft tissue neck radiographs (i.e. neck X-rays) are a common investigation used in the diagnosis of pharyngeal and upper esophageal foreign bodies. Identification of foreign bodies in radiographs may be impeded by various radiographic shadows. Aim The aim of this study was to analyse the extent laryngeal ossification affected the iden...

Introduction Transoral robotic surgery (TORS) has over the last decade become an integral part of minimally invasive surgery in the head and neck. Over this period, ENT surgeons have adapted the da Vinci robotic system to fulfill unmet needs for access in the oropharynx and tongue base primarily. The larynx has however been more difficult to access...

The use of lasers in the larynx has been well described over the last forty years. However, there is still controversy and uncertainty of the safety and versatility of lasers in microphonosurgical work. We present an instructional course on the utility of lasers in benign laryngeal surgery with several case based discussions and participation from...

Aim: To investigate the associations between hearing loss and prevalent and incident mild cognitive impairment (MCI) and dementia. Methods: Cross-sectional and longitudinal analyses of baseline and follow up data were performed in a population-based cohort of 2599 adults aged ≥55. The baseline sample included 1515 cognitively normal subjects who w...

Setting up a voice clinic has its own challenges depending on the economic, cultural and political forces that govern healthcare. Singapore is a multi-cultural island nation with a population of nearly 6 million people living in close proximity. There are many languages and dialects which are spoken regularly although Mandarin, Malay, Tamil and Eng...

Panel Discussion - Difficult cases in Phonosurgery Chair: Professor Jean Abitbol Moderator: Professor Marc Remacle Panellists: Mohammed Almohizea, V Djukic, Anastasios Hantzakos, Nupur Nerurkar, Vyas Prasad

Optic Neuropathy and Visual Loss due to Posterior Ethmoidal Mucocele

Bilateral vocal fold immobility (BVFI) has several aetiologies. Vocal fold paralysis affecting both folds due to recurrent laryngeal nerve (RLN) injury is the commonest cause for bilateral vocal fold immobility syndrome. Other causes include ankylosis resulting in joint arthrodesis. Patients present paradoxically with a breathy voice that improves...

Vocal fold immobility is a restriction of movement of the vocal folds either by a neuropathic or mechanical cause. Over the past few decades, there has been a shift in the etiology of unilat- eral vocal fold immobility (UVFI) from extralaryngeal malig- nancies to nonthyroid surgical procedures. We present a retrospective review of 161 patients diag...

Type I medialization thyroplasty (MT) was introduced by Isshiki more than 40 years ago. It is one of the most widely used surgical options to correct glottic insufficiency. Intraoperatively, the surgeon relies solely on perceptual subjective measures to help to achieve an optimal glottic closure by bringing the affected vocal fold closer to the mid...

Type I medialization thryoplasty (MT) was introduced by Isshiki more than 40 years ago. It is one of the most widely used surgical options to correct glottic insufficiency. Intraoperatively, the surgeon relies solely on perceptual subjective measures to help to achieve an optimal glottic closure by bringing the affected vocal fold closer to the mid...

Fungus ball is defined as the non-invasive accumulation of dense fungal concrements in a solitary sinus. Bone, blood vessels, and sinus mucosa are free of fungal elements. It is usually encountered in immunocompetent individuals with a female preponderance. It can involve the maxillary or the sphenoid sinuses. The authors aim to report the clinical...

Forest fires either intentional or accidental mainly in the Indonesian islands surrounding the Malaysian archipelago have recently contributed to alarmingly high air pollution levels causing a variety of problems both socio-economic and more importantly to the health of neighbouring populations. Over the period of early June to the end of Novemb...

Vocal fold immobility is a restriction of movement of the vocal folds either by a neuropathic or mechanical cause. Over the past few decades, there has been a shift in the aetiology of unilateral vocal fold immobility (UVFI) from extra-laryngeal malignancies to non-thyroid surgical procedures. We present a retrospective review of a 161 patients ove...

Transoral robotic surgery (TORS) has steadily developed into a highly specialised area in head and neck surgery with applications predominantly in the oropharynx and tongue base. The larynx has however been a more challenging area using the current robotic technology available. We present three cases using a novel system recently developed to facil...

Type I Medialization Thryoplasty (MT) was introduced by Isshiki more than 40 years ago. It is one of the most widely used surgical options to correct Glottic insufficiency. Intraoperatively, the surgeon relies solely on perceptual subjective measures to help to achieve an optimal glottic closure by bringing the affected vocal fold closer to the mid...

Objectives: 1. Understand the challenges related to hearing health and cognitive decline in seniors facing a small country that has undergone rapid development over the last 50 years. 2. Identify ways that may start to address these through education and research. Introduction: The burden of dementia continues to rise worldwide. Hearing loss has be...

Hearing loss and cognitive decline in Singapore: status quo of an island nation - Volume 130 Issue S3 - Rebecca Heywood, Priyanka Vankayalapati, Dona Jayakody, Rob Eikelboom, Gary Lee, Jiaying Liu, Vyas Prasad, Euan Murugasu, Marcus Atlas

Type I medialization thyroplasty (MT) was introduced by Isshiki more than 40 years ago. It is one of the most widely used surgical options to correct glottic insufficiency. Intraoperatively, the surgeon relies solely on perceptual subjective measures to help to achieve an optimal glottic closure by bringing the affected vocal fold closer to the mid...

Objective: Retrospective study on autologous fat injection for minor velopharyngeal insufficiency correction. Methodology: We report our experience regarding autologous fat injection for the correction of minor velopharyngeal insufficiency. Our indications includes: gaps from short velum, complement of surgical repairing of anatomical velopharyngea...

The da Vinci robotic system in Head and Neck Surgery. Intuitive Surgical Inc. (Sunnyvale, Ca, USA) extended the use of the da Vinci robot to head and neck surgery in 2005 following the previous use in urological, gynecological and cardiothoracic surgery. It then gained wide popularity throughout the globe. Our aim is to describe the da Vinci Robot...

Transoral robotic surgery for base of tongue neoplasms I. Sayin, R. Fakhoury, V. M. N Prasad, M. Remacle and G. Lawson Department of Otolaryngology – Head and Neck Surgery, CHU Dinant Godinne, 5530 Yvoir, Belgium Key-words. Transoral robotic surgery; base of tongue; unknown primary; benign; malignant; neoplasm Abstract. Transoral robotic surgery fo...

Functional outcomes after transoral robotic surgery for squamous cell carcinoma of the oropharynx. Over the past decade, the development of transoral robotic surgery (TORS) brought a new opportunity in the treatment of early T-stage oropharyngeal squamous cell carcinoma (OPSCC). The objective of this study is to review the functional outcomes after...

A frequently cited criticism of robotic surgery is the cumbersome nature of setting up the robotic system in operating theatres. This misconception has led many to steer away from developing this new technology even if it likely that it possesses advantages over traditional surgical approaches to the head and neck. Over the last 8 years we have de...

Nous présentons notre expérience du traitement des synéchies antérieures au cours des quatre dernières années avec l'utilisation du stent LACS (Laryngeal Anterior Commissure Stent) . Le LACS ( Boston Medical, USA) est une membrane en silastique de 0.4 mm d'épaisseur avec un renforcement tubulaire pour le passage d'un fil de type monofilament non re...

Voice rehabilitation after transoral laser microsurgery to the larynx is challenging. We wait at least 6 months before surgical intervention. Only a few patients after total or extended cordectomy requested voice restoration. Subjective perception of voice using the Voice Handicap Index in medialization thyroplasty was significantly better. Mediali...

The primary objective of this paper is to report our first cases of an ongoing prospective study for assessing the safety and performance of the Medrobotics Flex System for access and visualization of the larynx and the vocal folds when used for transoral surgical treatments.

Head and neck surgery can be fraught with difficulties in accessing the pharynx and larynx. Minimally invasive surgery has developed with the recent advances in technology. Currently, we have a variety of high-definition multichannel videoendoscopes and robots in our armamentarium. We present our experience in a new robotic surgical system-'The Med...

Dear Editor, We are writing to convey our sentiments with reference to the article by Schuler et al.1 Although we agree that the authors are possibly the first to have performed transoral robotic surgery on a T2 squamous carcinoma of the oropharynx using the Flex System (Medrobotics Corp., Raynham, MA) as described in their article published in you...

Objective: Retrospective study on autologous fat injection for minor velopharyngeal insufficiency correction. Methodology: We report our experience regarding autologous fat injection for the correction of minor velopharyngeal insufficiency. Our indications includes: gaps from short velum, complement of surgical repairing of anatomical velopharyngea...

DOI. 10.1017/S0022215114001108 Lingual nerve ancient schwannoma – removal with nerve preservation J Baldy, V Prasad, M Dilkes St Bartholomew’s Hospital, London Introduction Schwannomas are infrequent encapsulated neoplasms derived from neural crest cells. Ancient schwannomas are a variant of these which present with degenerative changes and nuclear...

Objective: To assess subjective preference using three nasal hygiene systems: Stérimar Original(®), Emcur(®) and Sinus Rinse™. Design: We used a prospective, single-blind, randomised, crossover study to compare three nasal hygiene systems: Stérimar Original, Emcur and Sinus Rinse. Subjects: Eighteen adult volunteers were recruited and were ask...