Autologous Fat Augmentation in the Treatment of Unilateral Vocal Fold Paralysis - A 15-year Experience in a Single Institution

Autologous fat vocal fold augmentation is a widespread surgical procedure that aims to repair glottal incompetence in patients with unilateral vocal fold paralysis (UVFP). However, there are some concerns in the literature about the long-term results of this technique. At the ENT Department of the Zagreb University Hospital Centre, this technique has been in use for more than 15 years, and a retrospective medical chart review was conducted from June 2005 to November 2019. Overall, 78 patients with UVFP met the inclusion criteria for enrolment in the study. All patients underwent at least one preoperative and two postoperative voice assessments, one early (within 3 months from surgery) and one late (at least 1 year after surgery). All tested voice outcome parameters (maximum phonation time (MPT), jitter, shimmer, noise-to-harmonic ratio (NHR)) significantly improved after surgery, both early and late postoperatively (p<0.001). The reoperation rate was only 10.3% (8/78), with the majority of patients in our series experiencing long-term benefits from this surgical procedure. According to the results of our study, autologous fat vocal fold augmentation appears to be a highly useful and effective surgical technique with long-lasting results in the majority of patients suffering from UVFP.

Thyroidectomy-related Swallowing Difficulties: Review of the Literature

This study aims to provide insight into the etiology and frequency of swallowing complications that arise after thyroidectomy and to outline the available diagnostic procedures by revising the existing literature on this topic. We conducted a bibliographic search using the electronic database MEDLINE/PubMed to identify all relevant articles and 44 studies were included in the review out of a total of 218 published articles. Dysphagia after thyroid surgery is a common postoperative complication which, in the short- or long-term, significantly affects patient life quality. There is no standard diagnostic protocol for thyroidectomy-related swallowing impairment. Among the reviewed studies, 8 questionnaires and 12 instrumental diagnostic tools were used to identify swallowing difficulties related to thyroid surgery. The Swallowing Impairment Index (SIS-6) was the most-used questionnaire. Fiberoptic endoscopy is a standard diagnostic tool performed prior and after thyroid surgery, primarily to identify changes in vocal fold mobility. Although instrumental findings usually reveal non-specific alterations of swallowing; swallowing videofluoroscopy and esophageal manometry can be the most helpful tools in further management of thyroidectomy dysphagia. In patients with thyroidectomy-related swallowing difficulties and suspected laryngopharyngeal reflux, 24-hour MII-pH metry should be performed.

Thyroid metastasis from breast carcinoma resembling medullary thyroid carcinoma

We are reporting a case of a 42-yr-old female with a history of right breast carcinoma. She was surgically treated (breast quadrantectomy with axillary dissection) and receiving a third cycle of adjuvant chemotherapy when a feeling of a constant pressure in the front of the neck and lack of air occurred. Subsequent work-up revealed a node in the right thyroid lobe with enlarged paratracheal bilateral and right mid and lower jugular lymph nodes. Fine-needle aspiration cytology, repeated within a 20 days window and analyzed by two different cytologists, showed a medullary thyroid carcinoma with a cervical lymph nodes metastasis so the patient underwent total thyroidectomy with selective and paratracheal neck dissection. Histology and immunohistochemistry revealed the specimen to be metastasis of breast carcinoma. During regular follow-up of our patient, eighteen months after initial diagnosis, no new metastases were found. To our best knowledge, this is the first described case of a thyroid metastasis of breast carcinoma that was cytologically misdiagnosed as a medullary thyroid carcinoma.

Efficiency of radiofrequency assisted uvulopalatopharyngoplasty in the treatment of snoring

Snoring is an acoustic phenomenon, which is a consequence of vibrations of the soft tissue caused by partial obstruction of the upper breathing pathway while sleeping. It is estimated that 20% of men and 5% of women between 30 and 35 years of age snore and this rate increases to 50% of men and 30% of women over 60 years of age. The aim of this study was to evaluate the efficiency of radiofrequency assisted uvulopalatopharyngoplasty in the treatment of snoring by comparing snoring index and other polysomnography values before and after surgical treatment. The study included 22 patients (men 87% and women 13%), mean age 43.09 +/-9.6 (range, 28-67) years, treated for obstructive sleep apnea syndrome at University Department of ENT and Head and Neck Surgery, Sestre milosrdnice University Hospital Center, Zagreb, during a 2-year period. Snoring was evaluated by preoperative and postoperative polysomnography at Department of Psychophysiology, Vrapce Psychiatric Hospital, Zagreb. Results were analyzed using Wilcoxon test. Postoperative reduction of snoring was statistically significant (P = 0.00052). Snoring index was decreased in 83% of patients, yielding a mean reduction of 83%. In 50% of patients, reduction of snoring index was over 95%. These results confirm the high efficiency of the procedure in the treatment of patients suffering from snoring.

[Bloodless medicine]

The establishment of Czech Society of Bloodless Medicine, CSBM is a part of worldwide progress of medicine. The main mission of the society is the promotion, development and application of bloodless medicine in clinical practice and organisation of scientific symposias and congresses for continuous professional and scientific education of its members and other medical staff. Activities of CSBM included co-operation with scientific, educational and health organisations with the aim to improve professional and scientific work in the field of bloodless medicine.

[Intravenous treatment with iron in bloodless medicine]

Iron and iron plus a recombinant erythropoietin in bloodless medicine often offer a viable and safe alternative to the blood transfusion. But i.v. iron is often underutilised. This particularly applies to pre-operative anaemia which is present in 20% of patients admitted for surgery where iron deficiency is the major contributor. Treatment with i.v. iron, with or without recombinant erythropoietin, reduces the need for peri-operative transfusion.