Soft Palate Injuries During Orotracheal Intubation With the Videolaryngoscope

Objective:

The videolaryngoscope has gained popularity for providing superior visualization in intubations. A rare complication of this technology is soft palate injury. Through a literature review and case series, we highlight the risks associated with the Glidescope and McGrath videolaryngoscopes and the management of soft palate injuries.

Method:

A case series of multi-institutional review of medical records was performed to identify patients with soft palate injuries from the videolaryngoscope. A literature review was also performed to analyze risk factors, mechanism of injury, complications, and management of palate injuries.

Results:

Of 9 cases, 3 resulted in soft palate perforations, which required primary closure. The remaining 6 patients sustained a soft palate laceration, which was treated conservatively. This injury commonly occurs when the intubator is focused on the video monitor and blindly inserts the Glidescope into the oropharynx. The rigid stylet used with the Glidescope increases the propensity for oropharyngeal injuries during blind insertions.

Conclusion:

Proper training, an awareness of this potential complication, and direct oral cavity visualization are recommended while inserting the videolaryngoscope. Repair is recommended for through-and-through perforations or if a large hanging flap is present. Antibiotics should be considered for lacerations greater than 1 to 2 cm.

http://aor.sagepub.com/cgi/content/abstract/0003489416678008v1?rss=1

Multivariate Analysis of Risk Factors in the Development of a Lower-Pitched Voice After Thyroidectomy

Objectives:

Thyroid surgeons frequently encounter outpatients with mobile vocal cords complaining of lower-pitched voices following thyroidectomy. This study investigated the clinical and pathological parameters affecting voice pitch following thyroid surgery.

Methods:

We analyzed the data of 393 patients with mobile vocal cords and who also underwent thyroid surgery. Speaking fundamental frequency (SFF) and fundamental frequency (F0) were compared before and after surgery.

Results:

Approximately 26.7% of patients had significantly lowered SFFs (SFF ≥ 12 Hz), and 30.2% exhibited significantly lower sustained vowel F0s (F0 ≥ 12 Hz) following thyroid surgery. On multivariate analysis, only gender: female remained a significant predictor of a clinically significant change in SFF following thyroid surgery (P < .001). Gender: female and extent of surgery: total remained significant predictors of a clinically significant change in F0 after surgery (P = .006 and P = .007, respectively).

Conclusions:

Appreciable proportions of patients experience lower-pitched voice and related vocal symptoms early after thyroid surgery. Such problems develop more frequently in females who underwent total thyroidectomy.

http://aor.sagepub.com/cgi/content/abstract/0003489416675875v1?rss=1

Diagnostic Challenges in a Case of IgG4-RD Affecting the Temporal Bone

Introduction:

Immunoglobulin G4–related disease (IgG4-RD) is a recently described fibroinflammatory condition with a characteristic histology. While IgG4-RD can affect a great variety of anatomical sites, it has been seldom described in the temporal bone.

Methods:

Herein, a case IgG4-RD occurring in the temporal bone of a 35-year-old woman is reported.

Discussion:

This case of IgG4-RD of the temporal bone proved a uniquely challenging diagnosis due to slightly atypical histology falling outside of "highly suggestive" criteria.

Conclusions:

We suggest that IgG4-RD remains a challenging diagnosis to reach despite increased awareness of the condition. We further suggest that clinicopathologic correlation remain the cornerstone of diagnosis as the spectrum of presentations of this newly described disease may be wider than previously anticipated.

http://aor.sagepub.com/cgi/content/abstract/0003489416678009v1?rss=1

Editorial on "Minimal Margin Extracapsular Dissection: A Viable Alternative Technique for Benign Parotid Lesions?"

http://aor.sagepub.com/cgi/reprint/0003489416676039v1?rss=1

Swallowing Quality of Life After Zona Incerta Deep Brain Stimulation

Objectives:

The management of Parkinson's disease (PD) has been improved, but management of signs like swallowing problems is still challenging. Deep brain stimulation (DBS) alleviates the cardinal motor symptoms and improves quality of life, but its effect on swallowing is not fully explored. The purpose of this study was to examine self-reported swallowing-specific quality of life before and after caudal zona incerta DBS (cZI DBS) in comparison with a control group.

Methods:

Nine PD patients (2 women and 7 men) completed the self-report Swallowing Quality of Life questionnaire (SWAL-QOL) before and 12 months after cZI DBS surgery. The postoperative data were compared to 9 controls. Median ages were 53 years (range, 40-70 years) for patients and 54 years (range, 42-72 years) for controls.

Results:

No significant differences were found between the pre- or postoperative scores. The SWAL-QOL total scores did not differ significantly between PD patients and controls. The PD patients reported significantly lower scores in the burden subscale and the symptom scale.

Conclusions:

Patients with PD selected for cZI DBS showed good self-reported swallowing-specific quality of life, in many aspects equal to controls. The cZI DBS did not negatively affect swallowing-specific quality of life in this study.

http://aor.sagepub.com/cgi/content/abstract/0003489416675874v1?rss=1

Book Review: Cases in Head and Neck Cancer: A Multidisciplinary Approach

http://aor.sagepub.com/cgi/reprint/0003489416678565v1?rss=1

Book Review: Laryngeal Physiology for the Surgeon and Clinician

http://aor.sagepub.com/cgi/reprint/0003489416675271v1?rss=1