Objectives. To review surgical techniques used in the treatment of laryngoceles over the last two decades and point out developments and trends.Materials and Methods. PubMed, the Cochrane Library, and the JBI Library of Systematic Reviews were searched using the term “laryngocele.” Demographic data, type of laryngocele, presence of a laryngopyocele, type of treatment and need for a tracheotomy were assessed.Results. Overall, data on 86 patients were analyzed, culled from 50 articles, of which 41 were case reports and 9 were case series. No single systematic review or meta-analysis or randomized controlled trial has been published on the topic. Altogether, 71 laryngoceles in 63 patients met the criteria for further analysis focusing on surgical treatment. An external approach was selected in 25/29 (86.2%) cases of combined laryngoceles. Microlaryngoscopic resection using a CO2laser was performed in three cases and endoscopic robotic surgery in one case. The majority of patients with an internal laryngocele, 31/42 (73.8%), were treated using the microlaryngoscopy approach.Conclusions. Microlaryngoscopy involving the use of a CO2laser has become the main therapeutic procedure for the treatment of internal laryngoceles during the past 20 years. An external approach still remains the main therapeutic approach for the treatment of combined laryngoceles.
12 September 2019 in European Archives of Oto-Rhino-Laryngology
The present study evaluated whether drug-induced sleep endoscopy (DISE) helps identify the site of obstruction in patients with obstructive sleep apnoea (OSA). A total of 51 consecutive patients with polysomnography-confirmed OSA were enrolled in this prospective study. The presumed site of obstruction was determined according to history, otorhinolaryngologic examination, and polysomnography and a therapeutic plan designed before DISE. In 11 patients with severe OSA and/or previously failed continuous positive airway pressure (CPAP) treatment, DISE with simultaneous CPAP was performed. Multilevel collapse was noted in 49 patients (96.1%). The most frequent multilevel collapse was palatal, oropharyngeal, and tongue base collapse (, 33.3%), followed by palatal and oropharyngeal collapse (, 23.5%). Pathology of the larynx (epiglottis) was observed in 16 patients (31.4%). The laryngeal obstruction as a reason for intolerance of CPAP was observed in 3/11 (27.3%) patients. After DISE, the surgical plan was changed in 31 patients (60.8%). The results indicate that DISE helps identify the site of obstruction in the upper airways in patients with OSA more accurately and that the larynx plays an important role in OSA.
17 June 2011 in Graefe's Archive for Clinical and Experimental Ophthalmology
Background To compare the success rate of monocanalicular intubation (MCI) compared with bicanalicular silicone intubation (BCI) in congenital nasolacrimal duct obstruction (CNLDO) in infants and toddlers. Methods In a prospective, nonrandomized, comparative study, MCI (n = 35 eyes) through the inferior canaliculus or BCI (n = 35 eyes) were performed under general anaesthesia in children aged 10 to 36 months with CNLDO. The tubes were removed 3–4 months after tube placement, and the children were followed up for 6 months after the removal of tubes. Therapeutic success was defined as the fluorescein dye disappearance test grade 0–1, corresponding with a complete resolution of previous symptoms. Partial success was defined as improvement with some residual symptoms. Results Complete and partial improvement was achieved in 31/35 (88.57%) in the BCI group and 34/35 (97.14%) in the MCI group. The difference between the two groups was not significant (p = 0.584). Complications occurred in both groups. Dislodgement of the tube and premature removal was observed in four BCI cases, and loss of the tube was observed twice in the MCI group. Canalicular slitting was observed in five eyes in the BCI group. Granuloma pyogenicum observed in 2 cases with MCI revealed a few weeks after the tube removal. Corneal erosion in the inferior medial quadrant was observed in one MCI eye and revealed in a few days after the local treatment without tube removal. Conclusions Both MCI and the BCI are effective methods for treating CNLDO. MCI has the advantage of a lower incidence of canalicular slit and easy placement.