PubMed Health⌕ Search

Biomedical subjects

Stéphane Hans

Publications and source records attributed to Stéphane Hans.

At least 19 recordsLinked to original sources
PubMed2006

[Organ preservation surgery in pharyngolaryngeal cancer].

Organ preservation surgery is a reasonable name for these types of techniques because it accurately describes the postoperative outcome, which is preservation of the quintessential laryngeal functions: swallowing, respiration without a permanent stoma and speech. In response to the common use of total laryngectomy, the non-surgical approaches have often been referred to as organ preservation strategies. In many institutions, it appears that there are organ preservation strategies and then there is surgery. In our opinion there are both non surgical organ preservation strategies and surgical organ preservation strategies. The key is that in both approaches the goal is to spare the functions of the larynx. In both, the work-ups are very important to analyse 3-dimensional extent of the lesion by nasofibroscopy (laryngeal mobilities), endoscopy and radiology. Organ preservation surgical approach allowed to save the use of radiotherapy for the management of various metachronous second primary tumours.

Chemotherapy, Adjuvant↗
PubMed2006

Vocal tract area function for vowels using three-dimensional magnetic resonance imaging. A preliminary study.

OBJECTIVE: To assess whether magnetic resonance imaging (MRI) allows the vocal tract (VT) area function to be determined for a normal male speaker. METHOD: VT shapes were acquired using MRI during sustained production of French points vowels: /i/, /a/, /u/. Cross-sectional areas were measured from a series of planes spaced at intervals of 1 cm along the length of the VT and were used as input in a previously described VT model to simulate the vowels. The first three formant frequencies, F1, F2, and F3, computed from the MRI-measured VT model were compared with subject's natural formant frequencies. RESULTS: Including piriform sinuses, calculated formants differed from measured formants F1, F2, and F3, respectively, for /i/ by -3.5%, +7.7%, and +27.5%; for /a/ by +11% +19.5%, and -4.3%; and for /u/ by +.9%, +23.4%, and +9.6%. Excluding piriform sinuses, calculated formants differed from measured formants F1, F2, and F3, respectively, for /i/ by -3.5%, +12%, and +28%, and for /u/ by +10.1%, +26.8%, and +13.7% The piriform sinuses were not visualized for /a/ on MRI. CONCLUSIONS: MRI is a noninvasive technique that allows VT imaging and determination of VT area function for a normal male speaker. Several possible sources of discrepancies are as follows: variability of the articulation, difficulties in assessment of VT wall boundaries, role of the piriform sinuses, and VT length.

Adult↗
PubMed2006

Prognostic value of tumor-infiltrating CD4+ T-cell subpopulations in head and neck cancers.

PURPOSE: CD4(+) T cells play a central role in initiating and maintaining anticancer immune responses. However, regulatory CD4(+)CD25(+) T cells which express Foxp3 have also been shown to inhibit antitumor effector T cells. In view of these heterogeneous CD4(+) T-cell populations, this study was designed to determine the prognostic value of various tumor-infiltrating CD4(+) T-cell populations in head and neck squamous cell carcinoma. EXPERIMENTAL DESIGN: Eighty-four newly diagnosed untreated patients with histologically proven primary head and neck squamous cell carcinoma were included in this study. Double or triple immunofluorescence staining was done to assess and quantify the activated CD4(+)CD69(+) T cells, regulatory CD4(+)Foxp3(+) T cells, and mixed CD4(+)CD25(+) T cells comprising both activated and regulatory T cells. RESULTS: On univariate analysis, high levels of tumor-infiltrating CD4(+)CD69(+) T cells were correlated with both better locoregional control (P = 0.01) and longer survival (P = 0.01). Infiltration by regulatory Foxp3(+)CD4(+) T cells was positively associated with a better locoregional control of the tumor. Multivariate analysis showed that the only significant prognostic factors related to locoregional control were T stage (P = 0.02) and CD4(+)Foxp3(+) T-cell infiltration of the tumor (P = 0.02). In the Cox multivariate analysis, only two variables influenced overall survival probability: T stage (P = 0.036) and CD4(+)CD69(+) T-cell infiltration (P = 0.017). CONCLUSION: This study shows that tumor-infiltrating activated CD4(+)CD69(+) T cells are associated with a good prognosis in head and neck squamous cell carcinoma. In addition, regulatory Foxp3(+)CD4(+) T cells are positively correlated with locoregional control may be through down-regulation of harmful inflammatory reaction, which could favor tumor progression.

Antigens, CD↗
PubMed2006

Early-stage glottic cancer: oncological results and margins in laser cordectomy.

OBJECTIVES: To assess local control of early-stage glottic cancer by laser cordectomy in comparison with previously published external partial laryngectomy series and to determine the relevance of histological margins in glottic cancers excised with laser cordectomy. DESIGN: Retrospective review of laser cordectomy for carcinoma in situ (Tis) and stage T1 glottic cancer from January 1991 to January 2004. SETTING: University hospital. PATIENTS: Fifty-two patients with Tis or T1 glottic cancer. INTERVENTION: Endoscopic laser cordectomy, classified using the system proposed by the European Laryngeal Society Working Committee. MAIN OUTCOME MEASURES: Local control after initial surgery and after salvage compared with a published historical control group, according to the type of cordectomy performed and the histological margins of the removed specimen. RESULTS: Sixteen patients with Tis, 30 with T1a tumors, and 6 with T1b tumors were followed up for an average of 38 months. Type I cordectomy was the most common procedure used to treat Tis, and type II and type III were the most common for treating T1a and T1b tumors. Of 6 recurrences, 4 were treated with laser cordectomy and 2 were treated with external partial laryngectomy. The rate of laryngeal preservation was 100%. There were 3 recurrences despite histologically clear margins. Three (17%) of 18 patients with suspicious margins developed recurrences. The rate of local control with single intervention (46 [89%] of 52) was lower than with partial external laryngectomy. However, 46 (89%) of 52 patients ultimately had less tissue removed by laser than would have been removed by external partial laryngectomy. CONCLUSIONS: Laser cordectomy provides excellent local control and laryngeal preservation. Close follow-up of patients with positive or suspicious margins is an alternative to further routine treatment.

Adult↗
PubMed2006

Preservation of the marginal mandibular branch of the facial nerve using a plexus block nerve stimulator.

Preserving the marginal mandibular branch of the facial nerve is essential in submandibular neck dissection to avert disfiguring complications. Despite the high incidence of postoperative palsy, old-fashioned techniques of nerve identification remain widespread. The use of disposable plexus block nerve stimulators as a safe and accurate method to localize the nerve intraoperatively is suggested herein. Such devices are significantly more affordable and user-friendly than larger facial nerve monitoring devices, which are rather favored for those procedures more extensively jeopardizing the branches of the facial nerve. In this report, disposable stimulators led to successful identification of the nerve in 100% of 25 patients between 2003 and 2005, with no postoperative paralysis. In addition, stimulation devices are constantly gaining in reliability and safety, and the number of surgical fields supporting their use is expanding. Therefore, their routine use for surgery on the submandibular area is recommended by the authors.

Disposable Equipment↗
PubMed2005

Fundamental frequency histograms measured by electroglottography during speech: a pilot study for standardization.

This study was designed to develop a database for the electroglottographic measurement of fundamental frequency (Fo) in normal subjects in running speech, for reference in the diagnosis and follow-up of dysphonic patients. A prospective pilot study included 20 healthy male volunteers without laryngeal disorder. Electroglottographic recordings of speaking Fo during connected speech (French) were obtained from two texts with different prosodic content. Fo histograms were sensitive to the variation of speaking Fo between both texts. Graphic representation of the range and distribution of the Fo of the speaker were designed as normalized Fo histograms with plot lines at 5th and 95th percentiles. Less than 5% variability of Fo histograms was recorded when recording more than 15 subjects. This pilot study designed a graphic display of standardized electroglottographic Fo measurements during the physiological condition of connected speech. As the degree of Fo variability depends on the phonetic contents of the text and on the language spoken, a separate histogram for normal subjects needs to be developed in each country or at least for each voice laboratory, with a standard, previously chosen text.

Adult↗
PubMed2005

Transoral lateral oropharyngectomy for squamous cell carcinoma of the tonsillar region: II. An analysis of the incidence, related variables, and consequences of local recurrence.

OBJECTIVES: To determine the incidence of local and regional failure, distant metastasis, and overall survival following transoral lateral oropharyngectomy (TLO) and to determine factors associated with local recurrence. DESIGN: Retrospective case series throughout 20 years; mean follow-up of 10 years. SETTING: Academic center. PATIENTS: A total of 166 previously untreated patients with squamous cell carcinoma of the tonsil. INTERVENTIONS: A total of 131 (81.9%) of the 166 patients received preoperative induction chemotherapy. Fifty-one patients (30.7%) underwent postoperative radiation therapy. MAIN OUTCOME MEASURES: Local and regional recurrence, distant metastasis, second primary tumors, and survival. RESULTS: The 1- and 5-year Kaplan-Meier local control estimates were 91.2% and 82.1%, respectively. The 1- and 5-year Kaplan-Meier local control estimates were 98.3% and 89.0% for T1, 88.9% and 81.7% for T2, and 78.9% and 62.7% for T3 lesions, respectively (P = .02). In univariate analysis, 7 variables were significantly associated with an increased risk of local failure: increasing T classification; positive margins of resection; poor clinical response to induction chemotherapy; tumor spread to the posterior pillar, posterior pharyngeal wall, and contralateral soft palate; and invasion of the junction between the tonsil and soft palate. In a logistic regression model, spread to the posterior pillar was the only variable statistically associated with local failure (P = .02). The 1-, 3-, and 5-year Kaplan-Meier survival estimates were 87.9%, 67.2%, and 57.7%, respectively. The Kaplan-Meier survival estimate was significantly reduced (P = .009) in patients with local failure. CONCLUSIONS: Selected tonsillar squamous cell carcinoma can be managed with TLO with local control comparable to radiotherapy. Patient selection is critical and TLO is best suited for patients with anterior T1 to T2 squamous cell carcinoma of the tonsil, without posterior anatomic spread.

Adult↗
PubMed2005

Laryngeal aerodynamics after vocal fold augmentation with autologous fat vs thyroplasty in the same patient.

OBJECTIVE: To analyze laryngeal aerodynamics in the same patient in 4 different circumstances: before the onset of unilateral vocal fold paralysis (UVFP), after the onset of UVFP, and after 2 types of surgical vocal fold medialization techniques to compare the results of surgery with the measurements made in that same patient when his larynx was healthy (before paralysis). DESIGN: Prospective self-paired study of 1 male patient. Measurements were taken before iatrogenic UVFP (of the patient's healthy larynx), 1 week after the onset of iatrogenic UVFP (thoracic surgery), 3 days after vocal fold medialization with autologous fat, and 2 months after polytetrafluoroethylene thyroplasty. SETTING: University hospital. MAIN OUTCOME MEASURE: Phonatory airflow and intraoral pressure. RESULTS: Airflow and intraoral pressure increased after the onset of UVFP. Airflow decreased to preparalytic values after both types of vocal fold medialization. Intraoral pressure decreased after fat injection but increased after thyroplasty, despite the favorable effects of this treatment on laryngeal resistance and vocal efficiency compared with preparalytic values. CONCLUSIONS: Our study demonstrates the variability of intraoral pressure as an indirect measure of subglottal pressure after vocal fold medialization in UVFP, due to as yet unknown factors. Phonatory airflow, laryngeal resistance, and vocal efficiency seem to be more reliable indicators of aerodynamic results after vocal fold medialization.

Adipose Tissue↗
PubMed2005

Thyroplasty type I with Montgomery implant among native French language speakers with unilateral laryngeal nerve paralysis.

OBJECTIVE: To document the long-term results achieved with the Montgomery implant in 96 French speakers with a unilateral laryngeal nerve paralysis (ULNP). STUDY DESIGN: Retrospective series, inception cohort of 96 patients. METHODS: Data regarding morbidity and functional results were obtained at regular visits to our clinic. All patients were followed for a minimum of 6 months or until death. Forty-two patients had a minimum of 12 months of follow-up. Early in the study, 36 patients were prospectively recorded under similar conditions before placement of the Montgomery implant and at 1, 3, 6, and 12 months postoperatively. RESULTS: None of the 96 patients died in the immediate postoperative period. The perioperative course was unremarkable in 94.8% of cases. Perioperative problems included failure to obtain a satisfactory phonatory result in three patients, difficulty to stabilize the implant posteriorly in one patient, and fracture of the inferior rim of the thyroid cartilage window in another patient. The primary immediate postoperative problem (within the first postoperative month) was laryngeal dyspnea, noted in four patients. According to the patient's subjective assessment, speech and voice was always improved in the immediate postoperative period. However, three patients had secondary degradation of speech and voice. Revision surgery under local anesthesia resulted in a 97.9% ultimate speech and voice success rate. According to the patient's subjective assessment, adequate swallowing in the immediate postoperative period was achieved in 94.2% of cases that had swallowing problems preoperatively. A significant statistical increase in the duration parameters (phonation time, phrase grouping, speech rate) together with a statistical significant decrease in both the jitter and shimmer values was noted when comparing the preoperative and the postoperative values at 1 month. Analysis of the evolution of the speech and voice parameters at 1, 3, 6, and 12 months postoperatively showed a significant decrease in the fundamental frequency and noise-to-harmonic ratio values but did not demonstrate any significant differences for the other speech and voice parameters. CONCLUSIONS: From the reported data, we conclude that the type I thyroplasty with Montgomery implant insertion is a safe and reproducible method to treat ULNP. Furthermore, this system achieves very good and stable phonatory results. Finally, the use of this technique and implant system appears safe in patients from various cultures with ULNP from a variety of causes and severe comorbidity. Over the past decade at our department, this procedure progressively replaced the use of the intracordal injection of autologous fat injection that was initially advocated in patients with ULNP.

Adult↗
PubMed2005

Dilatation for assisted ventilation-induced laryngotracheal stenosis.

OBJECTIVE: To assess the long-term results of dilatation and our experience with dilatation for assisted ventilation-induced laryngotracheal stenosis. DESIGN: A retrospective study of 32 patients primarily treated with dilatation for assisted ventilation-induced laryngotracheal stenosis between 1977 and 2002. SETTING: A tertiary care center and university teaching hospital. PATIENTS: There were 19 men and 13 women aged 15 to 76 years. The stenosis was cicatricial with some inflammatory process in 27 patients and completely mature in 5 patients. The stenosis involved the cricoid and the trachea in four patients. In 28 patients, the stenosis involved only the trachea. METHODS: Dilatation was performed with serially sized rigid bronchoscopes. Endoscopic laser vaporization was never performed in this series. Six patients were treated with only one dilatation. The 26 remaining patients were treated with successively 2 to 10 dilatations (mean, 3.3 dilatations). The dilatation success rate was analyzed using the Kaplan-Meier method. RESULTS: Median duration of follow-up was 1.8 years. Mortality rate was 9.4%. The overall failure rate was 71.8%. Twenty patients presented with recurrent stenosis. The treatment of recurrent stenosis consisted of tracheal resection with end-to-end anastomosis (11 patients, 55%), cricotracheal anastomosis (5 patients, 25%), tracheal endoprosthesis (2 patients, 10%), and tracheotomy (1 patient, 5%). All patients who underwent tracheal or cricotracheal anastomosis were successfully treated. None of the variables under analysis (sex, age, medical history, cause for intubation, intubation type and duration, delay from initial injury, degree of stenosis, length of trachea involved, number of dilatations) were statistically related to the incidence of complications and the success rate of dilatations. CONCLUSIONS: We do not recommend dilatation technique as the sole treatment for assisted ventilation-induced laryngotracheal stenosis. This technique is helpful in case of emergency to restore an airway and useful for the assessment of stenosis.

Adolescent↗
PubMed2005

Supracricoid hemilaryngopharyngectomy in patients with invasive squamous cell carcinoma of the pyriform sinus. Part I: Technique, complications, and long-term functional outcome.

On the basis of a retrospective review of an inception cohort of 135 patients, with an isolated, previously untreated, moderately differentiated to well-differentiated invasive squamous cell carcinoma of the pyriform sinus and a minimum of 3 years of follow-up, consecutively managed with a supracricoid hemilaryngopharyngectomy (SCHLP) at a single tertiary referral care center and locally controlled, the authors review in detail the surgical technique, highlight the potential technical pitfalls, and document the complications and long-term functional outcome. The overall postoperative mortality rate was 3.7%. The overall mortality rate directly related to the SCHLP was 1.5%. A significant surgical complication directly related to SCHLP completion was noted in 9.6% of cases. The mean lengths of time to removal of the tracheotomy and feeding tubes were 9 and 19 days, respectively. The mean duration of hospitalization was 25 days. Normal swallowing without aspiration by the first postoperative month was noted in 64.6% of patients. Temporary grade 1-2 aspiration and grade 3 aspiration were noted in 26.9% and 8.5% of patients, respectively. Overall, in our series, successful oral alimentation without gastrostomy or completion total laryngectomy was achieved in 91.9% of patients by the first postoperative year, and the incidences of permanent gastrostomy, completion total laryngectomy, and aspiration-related death were 0.7%, 1.5%, and 0.7%, respectively. A significant late complication related to the use of postoperative radiotherapy was noted in 26.5% of cases. From a functional point of view, such results suggest that SCHLP should be integrated among the various conservation treatment options available to patients with selected invasive squamous cell carcinoma of the pyriform sinus.

Adult↗
PubMed2005

Supracricoid hemilaryngopharyngectomy in patients with invasive squamous cell carcinoma of the pyriform sinus. Part II: Incidence and consequences of local recurrence.

Supracricoid hemilaryngopharyngectomy (SCHLP) was performed in 147 patients over a 19-year period for previously untreated invasive squamous cell carcinoma of the pyriform sinus. With a minimum of 3 years' follow-up, the current retrospective series was designed to document the incidence, risk factors, and consequences of local recurrence following SCHLP. Before operation, 97.4% of patients had an induction chemotherapy regimen. A complete clinical response and a complete histologic regression were noted in 21.7% and 16.8% of patients, respectively. A significant statistical relationship (p = .0001) was noted between complete clinical response and complete histologic regression. Postoperative radiotherapy was used in 49.8% of patients. The overall local recurrence rate was 8.2%. The 5-year actuarial (Kaplan-Meier life-table method) local control estimate was 90.4%. As a function of T stage, the 5-year actuarial local control estimates were 96.2%, 91.1%, 92.9%, and 62.6% in patients with tumors classified as T1, T2, T3, and T4a, respectively. On univariate analysis, the overall local recurrence rate varied significantly, from 5.3% to 55.6% if the apex of the pyriform sinus was invaded (p = .02), 6.9% to 18.7% if the posterior pharyngeal wall was invaded (p = .03), and 6.3% to 60% if the margins of resection were positive (p = .02). In a stepwise regression model, positive margins of resection (odds ratio, 8.4; 95% confidence interval, 2.2 to 32.2; p = .002) and invasion of the apex of the pyriform sinus (odds ratio, 6.1; 95% confidence interval, 1.1 to 33.3; p = .04) were the variables statistically associated with an increased risk of local recurrence. Local recurrence resulted in a statistically significant increased risk of nodal recurrence (p = .005) and death (p < .004). The overall laryngeal preservation rate was 91.2%. From an oncological perspective, these results suggest that SCHLP should become a major tool in the armamentarium of the head and neck surgeon and should be integrated into future trials aimed at organ preservation in patients with invasive squamous cell carcinoma of the pyriform sinus.

Adult↗
PubMed2005

Frontolateral vertical partial laryngectomy without tracheotomy for invasive squamous cell carcinoma of the true vocal cord: a 25-year experience.

On the basis of an inception cohort of 270 patients with a previously untreated invasive squamous cell carcinoma of the true vocal cord (232 T N0M0, 35 T2N0M0, and 3 T3N0M0) and a minimum of 3 years of follow-up, the authors analyze the oncological and functional outcomes following frontolateral vertical partial laryngectomy without tracheotomy. The 5-year Kaplan-Meier actuarial survival estimate ranged from 83.1% for T1 tumors to 67.2% for T2 tumors (p = .005). On univariate analysis, a significant statistical relationship was noted between reduced survival and the following variables: increased age, increased Charlson comorbidity index score over grade 0, increased tobacco intake, increased alcohol intake, increased T stage, local failure, nodal failure, and development of a metachronous second primary cancer. The hospital mortality rate was 0.4%. A significant postoperative surgical complication was noted in 49 patients (18.1%). The predominant significant surgical complication was wound infection (19 patients; 7%), followed by seroma and major subcutaneous emphysema. No significant statistical relationship was noted in a comparison of each, significant postoperative complication (including postoperative death) with the variables under analysis. The incidence of secondary tracheotomy was 0.4%. The incidence of completion laryngectomy due to functional problems was 0%. The 5-year Kaplan-Meier actuarial local control estimate was 91% for T1 tumors and 68.7% for T2 tumors (p <.0001). Within the T1 tumors, the 5-year Kaplan-Meier actuarial local control estimate ranged from 96.2% for tumors without anterior commissure involvement to 74.7% for tumors with anterior commissure involvement (p = .0002). On univariate analysis, a significant statistical relationship was noted between an increase in local recurrence and the following variables: increased T stage, anterior commissure involvement, and pathological margin involvement. The overall disease control rate and laryngeal preservation rate were 92.9% and 93.3%, respectively.

Age Factors↗
PubMed2004

Variability of electroglottographic glottal closed quotients: necessity of standardization to obtain normative values.

OBJECTIVE: To demonstrate the variability of electroglottographic measurements of the glottal closed quotient (GCQ) in normal subjects by the calculation method used, fundamental frequency, and intensity. DESIGN: Prospective study. SETTING: Tertiary university-based referral center. SUBJECTS: Twenty healthy male volunteers without laryngeal disorder. Three successive sustained productions of the vowel /a/ were performed by each subject. Electroglottographic recordings of GCQ were obtained using the criterion level method, which defines an approximate duration of glottal closure and opening. Glottal closed quotient values were calculated based on criterion levels ranging from 10% to 40%. MAIN OUTCOME MEASURES: The extent of correlation between GCQ variation and the mean fundamental frequency and intensity. RESULTS: As the criterion level increased, a decrease in the mean GCQ was recorded, which was significant with a 10% criterion level increase, up to a critical level of 25%. A significant positive correlation was found between GCQ and the variables of fundamental frequency and intensity. CONCLUSIONS: This study demonstrated significant effects of the criterion level used, fundamental frequency, and intensity in the determination of normative values of GCQ. Normative values can only be assessed through the standardization of one criterion level reached by consensus.

Adult↗
PubMed2004

Local control after supracricoid partial laryngectomy for "advanced" endolaryngeal squamous cell carcinoma classified as T3.

OBJECTIVES: To determine the incidence of local control in patients with "advanced" moderately to well-differentiated endolaryngeal invasive squamous cell carcinoma classified as T3, treated with a supracricoid partial laryngectomy; to identify any statistical relationship; and to analyze the consequences of local recurrence. DESIGN: Retrospective nonrandomized case series. SETTING: A tertiary referral care center and university teaching hospital. PATIENTS: An inception cohort of 118 patients. Tumor stage was T3 N0 M0 in 90 patients, T3 N1 M0 in 21 patients, T3 N2 M0 in 5 patients, and T3 N3 M0 in 2 patients. INTERVENTIONS: All patients underwent supracricoid partial laryngectomy. A platin-based induction chemotherapy regimen was used in 100 patients. Postoperative radiotherapy was used for 24 patients. MAIN OUTCOME MEASURES: Local recurrence, nodal recurrence, distant metastasis, and survival; univariate and multivariate analysis of local recurrence. RESULTS: Nine patients developed a local recurrence. The 1-, 3-, and 5-year actuarial local control estimates were 97.3%, 93.5%, and 91.4%, respectively. In a stepwise regression model, the presence of positive margins of resection was the only variable that statistically increased the risk of local recurrence (P =.008). Local recurrence resulted in a significant increase in nodal recurrence (P<.001) and distant metastasis (P<.001) and a significant decrease in survival (P =.03). An overall 89.8% laryngeal preservation rate and 98.3% local control rate were achieved. CONCLUSION: Supracricoid partial laryngectomies should be considered when an organ preservation strategy is discussed in patients with advanced endolaryngeal squamous cell carcinoma classified as T3.

Actuarial Analysis↗
PubMed2003

[Unilateral laryngeal paralyses: epidemiological data and therapeutic progress].

OBJECTIVES: Analysis of the epidemiology and progress in treatment of unilateral laryngeal nerve paralysis. METHOD: A retrospective study in a cohort of 325 patients (1989-2001) with unilateral laryngeal nerve paralysis. RESULTS: The sex ratio was 1:2. Age varied from 16 to 98 years (mean age: 55 years). Symptoms included dysphonia in 321 patients, swallowing impairment in 126 patients and dyspnea on exertion in 3 patients. Etiologies were post-surgical (243 patients) predominantly thyroid and thoraco-mediastinal surgery, idiopathic (39 patients), tumoral (28 patients), non-surgical traumatism (8 patients) and medical causes (7 patients). The paralysis was globally related to a neoplastic disease in 50% of cases. Analysis of the evolution of the etiologies over time revealed an increase in the post surgical causes and paralysis related to a neoplastic diseases. Spontaneous recovery of unilateral laryngeal nerve paralysis occurred in 23% of patients. Surgical rehabilitation was performed in 44% of patients (thyroplasty under local anesthesia in 55 patients and intracardal injection under general anesthesia in 88 patients). The analysis of the evolution of treatment modalities showed: an increasing number of patients undergoing surgical rehabilitation, an increasing number of patients undergoing surgery under local anesthesia (thyroplasty) and an increasing number of patients refusing any surgical rehabilitation. CONCLUSION: Analysis of the data underlined the changes in the distribution of the etiologies and treatments of unilateral laryngeal nerve paralysis.

Academic Medical Centers↗
PubMed2003

Intracordal injection of autologous fat in patients with unilateral laryngeal nerve paralysis: long-term results from the patient's perspective.

OBJECTIVE: Based on 80 patients with a previously nonsurgically treated unilateral laryngeal nerve paralysis (ULNP) and according to the patient's self-assessment, the authors document the long-term results achieved with the intracordal injection of autologous fat. STUDY DESIGN: Retrospective series, inception cohort. METHODS: Kaplan-Meier actuarial life table method and univariate analysis. RESULTS: None of the 80 patients died in the immediate postoperative period. Morbidity included hematoma at the donor site (in three patients), development of an intracordal cyst at the injection site (in three patients), fat extrusion at the injection site (in one patient), and temporary tracheotomy (in one patient). The initial and ultimate overall success rates were 96.2% and 77.2%, respectively. In univariate analysis, none of the variables under analysis (gender, age, associated neurological lesions, associated pneumonectomy, associated neoplasia, cause of the ULNP, side of the ULNP, nerve involved, delay between the onset of the ULNP and the intracordal injection, severity of the symptoms, mode of harvesting the autologous fat, and surgeon who performed the injection) was statistically related to the ultimate outcome after the intracordal injection of autologous fat. Among the group of 45 patients in whom the intracordal injection was initially considered to be successful with no further recovery of motion of the true vocal cord and a minimum survival of 12 months, the ultimate overall success rate was 62.2%, and the 3-month, 6-month, and 12-month Kaplan-Meier actuarial estimates for success were 91.1%, 72.8%, and 63.1%, respectively. CONCLUSIONS: In the present study, data confirm that the intracordal injection of autologous fat is a useful and safe procedure in patients with ULNP. However, the impossibility of exactly predicting the amount of resorption of the injected fat and the lack of predictability of the duration of the results, together with the good and stable results achieved at the authors' department with the medialization thyroplasty led the authors to reduce its current use.

Adipose Tissue↗