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Li R. Application of Ultrasound-Guided Cervical Plexus Block in Type I Thyroid Cartilage Laryngoplasty and Vocal Cord Medialization Surgery. EAR, NOSE & THROAT JOURNAL 2022:1455613221115114. [PMID: 35861187 DOI: 10.1177/01455613221115114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND Under the background that cervical plexus block (CPB) is often adopted for type I thyroid cartilage laryngoplasty (TCL) and vocal cord medialization (VCM), the present study sought to investigate whether ultrasound-guided CPB (USCPB) could improve the efficiency of type I TCL and VCM. METHODS Patients with TCL were enrolled and subjected to deep and superficial USCPBs. Intravenous dexmedetomidine pumping was used to assist the painless sedation and ensure the patients to be awake for phonation during surgery. Blood pressure, electrocardiogram, heart rate (HR), and blood oxygen saturation (SpO2) of patients were recorded. The complications, like local anesthetic toxicity and total spinal anesthesia, were monitored. RESULTS All patients underwent CPB without infiltration anesthesia and complication. The use of Sufentanil at the dose of 5-10 μg was reported in 2 of 15 patients. No Horner syndrome was discovered in patients after anesthesia, and total intravenous anesthesia with intravenous pumping of dexmedetomidine was effective. During surgery, HR, diastolic blood pressure and mean blood pressure were barely changed, but systolic blood pressure was decreased. CONCLUSION Ultrasound-guided CPB with the intravenous dexmedetomidine pumping is a safe anesthesia method for patients during TCL.
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Affiliation(s)
- Ronggang Li
- Department of Anesthesiology, Shengli Clinical Medical College of Fujian Medical University, Fuzhou, China
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Yamauchi T, Kanazawa T, Hasegawa T, Kurakami K, Konomi U, Hirosaki M, Komazawa D, Nozawa M, Takahashi S, Watanabe Y. Long‐term results and safety of fibroblast growth factor injection for unilateral vocal fold paralysis. Laryngoscope Investig Otolaryngol 2022; 7:799-806. [PMID: 35734070 PMCID: PMC9194994 DOI: 10.1002/lio2.806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2022] [Revised: 03/16/2022] [Accepted: 04/01/2022] [Indexed: 11/29/2022] Open
Abstract
Objectives Treatments for unilateral vocal fold paralysis (UVFP) include conservative voice rehabilitation, vocal fold injection, and laryngeal framework surgery. We proposed basic fibroblast growth factor (bFGF) injection as a potential novel treatment for UVFP and have reported the short‐term results. In this study, we present the long‐term results and safety of vocal fold bFGF injection as a treatment for UVFP. Methods This retrospective study included 42 patients (25 males and 17 females) with UVFP who were administered a local injection of bFGF. The injection regimen involved injecting FGF (0.5 μg/ml in 0.5 ml per side) into the bilateral vocal folds using a 23‐gauge injection needle. Phonological outcomes were evaluated 6 months and 12 months after the injection. Results Overall, 26 patients received a single injection of bFGF, six patients received an additional injection, and 10 patients received the additional framework surgery. Maximum phonation time, mean flow rate, pitch range, jitter and shimmer percentages, the total GRBAS (grade, roughness, breathiness, asthenia, strain) score, and voice handicap index scores improved significantly in the long term. In patients who received the additional injection or framework surgery, the effects of bFGF injection were temporary, but did not interfere with the performance of the framework surgery. Conclusion In total, 42 patients who underwent vocal fold bFGF injections were reviewed. The bFGF injections were effective and safe in the long‐term results for UVFP in the selected cases. Some patients with severe symptoms benefited from the additional framework surgery but not the additional bFGF injection.
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Affiliation(s)
- Tomohiko Yamauchi
- Division of Laryngeal Surgery, Department of Otolaryngology‐Head and Neck Surgery Jichi Medical University Shimotsuke Japan
| | - Takeharu Kanazawa
- Division of Laryngeal Surgery, Department of Otolaryngology‐Head and Neck Surgery Jichi Medical University Shimotsuke Japan
- Tokyo Voice Center International University of Health and Welfare Tokyo Japan
| | - Tomohiro Hasegawa
- Tokyo Voice Center International University of Health and Welfare Tokyo Japan
| | - Kazuya Kurakami
- Tokyo Voice Center International University of Health and Welfare Tokyo Japan
- Department of Otolaryngology Head and Neck Surgery, Faculty of Medicine Yamagata University Yamagata Japan
| | - Ujimoto Konomi
- Tokyo Voice Center International University of Health and Welfare Tokyo Japan
- Voice and Dizziness Clinic Futakotamagawa Otolaryngology Tokyo Japan
| | - Mayu Hirosaki
- Tokyo Voice Center International University of Health and Welfare Tokyo Japan
| | - Daigo Komazawa
- Tokyo Voice Center International University of Health and Welfare Tokyo Japan
- AKASAKA Voice Health Center Tokyo Japan
| | - Miki Nozawa
- Division of Laryngeal Surgery, Department of Otolaryngology‐Head and Neck Surgery Jichi Medical University Shimotsuke Japan
| | - Satoka Takahashi
- Division of Laryngeal Surgery, Department of Otolaryngology‐Head and Neck Surgery Jichi Medical University Shimotsuke Japan
| | - Yusuke Watanabe
- Tokyo Voice Center International University of Health and Welfare Tokyo Japan
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Mohammad Shehata I, Elhassan A, Zaman B, Viswanath O. Challenge of Lung Isolation in Patients with Vocal Cord Implants. Anesth Pain Med 2022; 12:e123370. [PMID: 35433377 PMCID: PMC8995872 DOI: 10.5812/aapm.123370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 02/20/2022] [Indexed: 12/05/2022] Open
Abstract
Glottic closure insufficiency increases the risk of aspiration and pneumonia, particularly in the elderly. Medialization thyroplasty is an open surgical procedure for treating glottic incompetency by approximating both vocal folds. The vocal fold medialization is achieved by inserting an implant to bring the nonmobile fold to the unaffected side. Lung isolation in patients with vocal cord implantation poses a unique challenge. Understanding the risks of different modalities of lung isolation and their impacts on the vocal cord implant is crucial to implementing a specifically tailored plan. Preoperative bronchoscopy, intraoperative video laryngoscopy, and bronchoscopy are ideal methods for assessing the vocal fold implants and guiding the lung isolation technique. Bronchial blocker through a single-lumen endotracheal tube may be the preferred choice to avoid the injury of the stretched vocal cords and dislodgement of the implant by a larger diameter double-lumen tube.
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Affiliation(s)
- Islam Mohammad Shehata
- Department of Anesthesiology, Ain Sham University, Cairo, Egypt
- Corresponding Author: Department of Anesthesiology, Ain Sham University, Cairo, Egypt.
| | - Amir Elhassan
- Community Memorial Hospital Center, Ventura, California, USA
| | - Behrooz Zaman
- Pain Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran
- Corresponding Author: Pain Research Center, Department of Anesthesiology and Pain Medicine, Iran University of Medical Sciences, Tehran, Iran.
| | - Omar Viswanath
- Department of Anesthesiology, Louisiana State University Health Shreveport, Shreveport, Los Angeles, USA
- Valley Anesthesiology and Pain Consultants, Envision Physician Services, Phoenix, Arizona, USA
- Department of Anesthesiology, University of Arizona College of Medicine, Phoenix, Arizona, USA
- Department of Anesthesiology, Creighton University School of Medicine, Omaha, Nebraska, USA
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Wilson A, Kimball EE, Sayce L, Luo H, Khosla SM, Rousseau B. Medialization Laryngoplasty: A Review for Speech-Language Pathologists. JOURNAL OF SPEECH, LANGUAGE, AND HEARING RESEARCH : JSLHR 2021; 64:481-490. [PMID: 33524276 PMCID: PMC8632480 DOI: 10.1044/2020_jslhr-20-00344] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 09/18/2020] [Accepted: 11/17/2020] [Indexed: 05/26/2023]
Abstract
Purpose The purpose of this study is to familiarize speech-language-pathologists with the current state of the science regarding medialization laryngoplasty in the treatment of voice disorders, with emphasis on current evidence-based practice, voice outcomes, and future directions for research. Method A literature review was performed in PubMed and Embase using the keywords vocal fold/cord and laryngoplasty, thyroplasty, augmentation, or laryngeal framework. Articles published between 2010 and 2020 were reviewed for data about clinical applications, technical approach, voice-related outcomes, and basic science or clinical innovations with the potential to improve patient care. A synthesis of data was performed from articles meeting the outlined search criteria. Conclusions As key members in the multidisciplinary care of voice disorders, speech-language pathologists need to be informed of current research in medialization laryngoplasty, a procedure commonly used for patients with glottic insufficiency. Advances in anesthetic technique, office-based procedures, and the development of materials with increased bio-tolerability over the past decade have led to innovations in treatment and improved patient outcomes. Recent applications of computational and bioengineering approaches have the potential to provide new directions in the refinement of currently available techniques and the improvement of patient-based treatment outcomes.
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Affiliation(s)
- Azure Wilson
- Department of Communication Science and Disorders, University of Pittsburgh, Pittsburgh, PA
| | - Emily E. Kimball
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, TN
| | - Lea Sayce
- Department of Communication Science and Disorders, University of Pittsburgh, Pittsburgh, PA
| | - Haoxiang Luo
- Department of Otolaryngology, Vanderbilt University Medical Center, Nashville, TN
| | - Sid M. Khosla
- Department of Otolaryngology Head and Neck Surgery, University of Cincinnati College of Medicine, OH
- Neurosensory Disorder Center at UC Gardner Neuroscience Institute, Cincinnati, OH
| | - Bernard Rousseau
- Department of Communication Science and Disorders, University of Pittsburgh, Pittsburgh, PA
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Abstract
Common complaints of patients who have received thyroidectomy include dysphonia (voice dysfunction) and dysphagia (difficulty swallowing). One cause of these surgical outcomes is recurrent laryngeal nerve paralysis. Many studies have discussed the effectiveness of speech therapy (e.g., voice therapy and dysphagia therapy) for improving dysphonia and dysphagia, but not specifically in patients who have received thyroidectomy. Therefore, the aim of this paper was to discuss issues regarding speech therapy such as voice therapy and dysphagia for patients after thyroidectomy. Another aim was to review the literature on speech therapy for patients with recurrent laryngeal nerve paralysis after thyroidectomy. Databases used for the literature review in this study included, PubMed, MEDLINE, Academic Search Primer, ERIC, CINAHL Plus, and EBSCO. The articles retrieved by database searches were classified and screened for relevance by using EndNote. Of the 936 articles retrieved, 18 discussed "voice assessment and thyroidectomy", 3 discussed "voice therapy and thyroidectomy", and 11 discussed "surgical interventions for voice restoration after thyroidectomy". Only 3 studies discussed topics related to "swallowing function assessment/treatment and thyroidectomy". Although many studies have investigated voice changes and assessment methods in thyroidectomy patients, few recent studies have investigated speech therapy after thyroidectomy. Additionally, some studies have addressed dysphagia after thyroidectomy, but few have discussed assessment and treatment of dysphagia after thyroidectomy.
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Affiliation(s)
- Wing-Hei Viola Yu
- Department of Otolaryngology-Head and Neck Surgery, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan
| | - Che-Wei Wu
- Department of Otolaryngology-Head and Neck Surgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Otolaryngology-Head and Neck Surgery, Kaohsiung Municipal Siaogang Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan
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Kanazawa T, Kurakami K, Kashima K, Konomi U, Komazawa D, Nakamura K, Matsushima K, Akagi Y, Misawa K, Nishino H, Watanabe Y. Injection of basic fibroblast growth factor for unilateral vocal cord paralysis . Acta Otolaryngol 2017; 137:962-967. [PMID: 28434284 DOI: 10.1080/00016489.2017.1314550] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Unilateral vocal cord paralysis (UVCP) not only induces severe dysphonia, but aspiration as well. Although laryngeal framework surgery is usually performed to treat this condition, the procedure is not tolerated by some patients. In the previous study, basic fibroblast growth factor (bFGF) injections for vocal cord scarring and sulcus have been reported to provide favorable outcomes while being minimally invasive. In this study, the authors retrospectively investigated phonological outcomes after bFGF injection in patients with UVCP. METHODS This study was registered in University hospital Medical Information Network - Clinical Trials Registry (UMIN000019347). Nineteen patients with unilateral cord paralysis were treated with bFGF injection. The treatment regimen involved a single injection of 50 μg of bFGF into the muscle layer. More than six months after the injection, aerodynamic and acoustic outcomes were examined. RESULTS The voice handicap index, maximum phonation time, mean airflow rate, and pitch range improved significantly after injection of bFGF. No sex-related differences were observed in any phonological parameter. CONCLUSION bFGF injection, an easy method and suitable as an office procedure, significantly improved the hoarseness caused by UVCP. It is expected to be widely adopted and effective adjunctive drugs, and procedures are anticipated to be developed.
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Affiliation(s)
- Takeharu Kanazawa
- Tokyo Voice Center, International University of Health and Welfare, Tokyo, Japan
- Department of Otolaryngology-Head and Neck Surgery, Jichi Medical University, School of Medicine, Shimotsuke, Japan
| | - Kazuya Kurakami
- Tokyo Voice Center, International University of Health and Welfare, Tokyo, Japan
- Department of Otolaryngology-Head and Neck Surgery, Yamagata University, Faculty of Medicine, Yamagata, Japan
| | - Kazutaka Kashima
- Tokyo Voice Center, International University of Health and Welfare, Tokyo, Japan
- Department of Otolaryngology-Head and Neck Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Ujimoto Konomi
- Tokyo Voice Center, International University of Health and Welfare, Tokyo, Japan
- Department of Otolaryngology-Head and Neck Surgery, Tokyo Medical University, Tokyo, Japan
| | - Daigo Komazawa
- Tokyo Voice Center, International University of Health and Welfare, Tokyo, Japan
| | - Kazuhiro Nakamura
- Tokyo Voice Center, International University of Health and Welfare, Tokyo, Japan
- Department of Otolaryngology-Head and Neck Surgery, Tokyo Medical University, Tokyo, Japan
| | - Koji Matsushima
- Tokyo Voice Center, International University of Health and Welfare, Tokyo, Japan
- Department of Otolaryngology-Head and Neck Surgery, Toho University Omori Medical Center, Tokyo, Japan
| | - Yusuke Akagi
- Tokyo Voice Center, International University of Health and Welfare, Tokyo, Japan
- Department of Otolaryngology, Okayama Medical Center, Okayama, Japan
| | - Kiyoshi Misawa
- Department of Otolaryngology-Head and Neck Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan
| | - Hiroshi Nishino
- Department of Otolaryngology-Head and Neck Surgery, Jichi Medical University, School of Medicine, Shimotsuke, Japan
| | - Yusuke Watanabe
- Tokyo Voice Center, International University of Health and Welfare, Tokyo, Japan
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Saadeh CK, Rosero EB, Joshi GP, Ozayar E, Mau T. Reducing sedation time for thyroplasty with arytenoid adduction with sequential anesthetic technique. Laryngoscope 2017; 127:2813-2817. [DOI: 10.1002/lary.26743] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2017] [Accepted: 05/22/2017] [Indexed: 11/06/2022]
Affiliation(s)
- Charles K. Saadeh
- Clinical Center for Voice Care, Department of Otolaryngology-Head and Neck Surgery
| | - Eric B. Rosero
- Department of Anesthesiology and Pain Management; University of Texas Southwestern Medical Center; Dallas Texas U.S.A
| | - Girish P. Joshi
- Department of Anesthesiology and Pain Management; University of Texas Southwestern Medical Center; Dallas Texas U.S.A
| | - Esra Ozayar
- Department of Anesthesiology and Pain Management; University of Texas Southwestern Medical Center; Dallas Texas U.S.A
| | - Ted Mau
- Clinical Center for Voice Care, Department of Otolaryngology-Head and Neck Surgery
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Fukuhara T, Morisaki T, Kataoka H, Miyake N, Taira K, Koyama S, Fujiwara K, Kitano H, Takeuchi H. Modifications to the Fenestration Approach for Arytenoid Adduction Under Local Anesthesia. J Voice 2016; 31:490-494. [PMID: 27916331 DOI: 10.1016/j.jvoice.2016.10.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2016] [Revised: 10/21/2016] [Accepted: 10/26/2016] [Indexed: 11/18/2022]
Abstract
OBJECTIVE We modified the fenestration approach for arytenoid adduction to make it easier to perform the surgery. The aim of this study was to evaluate the usefulness of our modifications, which included (1) use of an Alexis wound retractor (Applied Medical) to secure the surgical field through a small incision, and (2) use of a 12-mm, 1/2 R, insert-molded taper needle with 3-0 nylon suture to prevent damage to the arytenoid cartilage. STUDY DESIGN This is a retrospective non-randomized observational cross-sectional study. METHODS We compared the operative time and skin incision length between the conventional fenestration approach and our modified procedure, and verified the improvement of patients' voice by our procedure. RESULTS Seven patients underwent the conventional fenestration approach for arytenoid adduction with type I thyroplasty, whereas nine patients underwent our modified fenestration approach for arytenoid adduction with type I thyroplasty. The skin incision length with our modifications (median, 3.0 cm; interquartile range [IQR], 3.0-4.0) was significantly shorter than with the conventional procedure (median, 5.0 cm; IQR, 4.3-5.8) (P = 0.001). The operative time with our modifications (median, 95 minutes; IQR, 90-100) was significantly shorter than without our modifications (median, 115; IQR, 100-130) (P = 0.035). All patients who underwent our modified fenestration approach for arytenoid adduction had maximum phonation time greater than 11 seconds after surgery. CONCLUSIONS Our two distinctive modifications reduced the operative time and skin incision length for the fenestration approach, which improved the procedure by making it less invasive.
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Affiliation(s)
- Takahiro Fukuhara
- Department of Otolaryngology-Head and Neck Surgery, Tottori University Faculty of Medicine, Yonago, Japan.
| | - Tsuyoshi Morisaki
- Center for Head and Neck Surgery, Kusatsu General Hospital, Kusatsu, Japan
| | - Hideyuki Kataoka
- Division of Medical Education, Department of Social Medicine, Tottori University Faculty of Medicine, Yonago, Japan
| | - Naritomo Miyake
- Department of Otolaryngology-Head and Neck Surgery, Tottori University Faculty of Medicine, Yonago, Japan
| | - Kenkichiro Taira
- Department of Otolaryngology-Head and Neck Surgery, Tottori University Faculty of Medicine, Yonago, Japan
| | - Satoshi Koyama
- Department of Otolaryngology-Head and Neck Surgery, Tottori University Faculty of Medicine, Yonago, Japan
| | - Kazunori Fujiwara
- Department of Otolaryngology-Head and Neck Surgery, Tottori University Faculty of Medicine, Yonago, Japan
| | - Hiroya Kitano
- Department of Otolaryngology-Head and Neck Surgery, Tottori University Faculty of Medicine, Yonago, Japan
| | - Hiromi Takeuchi
- Department of Otolaryngology-Head and Neck Surgery, Tottori University Faculty of Medicine, Yonago, Japan
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Rosero EB, Ozayar E, Mau T, Joshi GP. A sequential anesthesia technique for surgical repair of unilateral vocal fold paralysis. J Anesth 2016; 30:1078-1081. [PMID: 27522215 DOI: 10.1007/s00540-016-2231-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 08/02/2016] [Indexed: 11/30/2022]
Abstract
Thyroplasty with arytenoid adduction, a combined procedure for treatment of unilateral vocal fold paralysis, is typically performed under local anesthesia with sedation to allow for intraoperative voice assessment. However, the need for patient immobility and suppression of laryngeal responses to surgical manipulation can make sedation-analgesia challenging. We describe our first 26 consecutive cases undergoing thyroplasty and arytenoid adduction with a standardized technique consisting of a combination of general anesthesia with tracheal intubation followed by sedation-analgesia. Most patients (69 %) were women, with age of 53 ± 15 years (mean ± SD). Neck surgery was the cause of vocal fold paralysis in 50 % of patients. Initially, general anesthesia was maintained with desflurane and remifentanil with dexmedetomidine added just before tracheal extubation. During the sedation-analgesia phase, patients received infusions of remifentanil and dexmedetomidine. Duration of general anesthesia and sedation-analgesia phases was 162 ± 68.2 and 79 ± 18.3 min, respectively. Mean (SD) wake-up time was 8.0 ± 4.0 min after desflurane discontinuation. Extubation occurred without coughing, bucking, or agitation in 96 % of patients. All the patients were able to phonate appropriately and remained comfortable after emergence. This technique allowed improved surgical conditions with reduced patient discomfort and may be advantageous for other laryngeal and neck surgeries in which intraoperative patient feedback is required.
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Affiliation(s)
- Eric B Rosero
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, TX, USA.
| | - Esra Ozayar
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Ted Mau
- Department of Otolaryngology-Head and Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Girish P Joshi
- Department of Anesthesiology and Pain Management, University of Texas Southwestern Medical Center, Dallas, TX, USA
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Zapater E, Oishi N, Hernández R, Basterra J. Medialization thyroplasty under intubation anesthesia to restore the voice after cordectomy. Laryngoscope 2015; 126:1404-7. [DOI: 10.1002/lary.25600] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/29/2015] [Indexed: 11/11/2022]
Affiliation(s)
- Enrique Zapater
- ENT Department; University General Hospital, Valencia Medical School; Valencia Spain
| | - Natsuki Oishi
- ENT Department; University General Hospital, Valencia Medical School; Valencia Spain
| | - Rosa Hernández
- ENT Department; University General Hospital, Valencia Medical School; Valencia Spain
| | - Jorge Basterra
- ENT Department; University General Hospital, Valencia Medical School; Valencia Spain
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Oishi N, Herrero R, Martin A, Basterra J, Zapater E. Is testing the voice under sedation reliable in medialization thyroplasty? LOGOP PHONIATR VOCO 2015; 41:149-53. [DOI: 10.3109/14015439.2015.1054306] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
| | | | - Ana Martin
- Department of Anesthesiology, University General Hospital, Valencia, Spain
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