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Michael M Johns - One of the best experts on this subject based on the ideXlab platform.
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vocal outcome measures after bilateral posterior Cricoarytenoid Muscle botulinum toxin injections for abductor spasmodic dysphonia
Otolaryngology-Head and Neck Surgery, 2008Co-Authors: Adam M Klein, Benjamin C Stong, Justin C Wise, John M Delgaudio, Edie R Hapner, Michael M JohnsAbstract:Objective To review vocal outcome measures, using the Voice Related Quality of Life (VRQOL) index, after simultaneous bilateral posterior Cricoarytenoid Muscle botulinum toxin injections. Study Design Case series. Setting Tertiary care academic clinic. Subjects and Methods Fourteen subjects with abductor spasmodic dysphonia received 37 simultaneous bilateral posterior Cricoarytenoid Muscle botulinum toxin injections for isolated abductor spasmodic dysphonia (ABSD) over a 16-month period. Main Outcome Measures VRQOL index. Results Of the 37 injections, 33 of 37 (89%) resulted in improvement. Three injections resulted in no improvement, and one injection resulted in a worse VRQOL. The overall VRQOL mean improvement was 19.8 (range 5-53), with an average pre/postinjection VRQOL interval of 36 days (range 21-45 days). Conclusions Simultaneous bilateral posterior Cricoarytenoid Muscle botulinum injections result in a statistically significant improvement in VRQOL index scores for a high percentage of ABSD patients, thus improving patient quality of life.
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Safety of simultaneous bilateral botulinum toxin injections for abductor spasmodic dysphonia
Archives of otolaryngology--head & neck surgery, 2005Co-Authors: Benjamin C Stong, John M Delgaudio, Edie R Hapner, Michael M JohnsAbstract:Objective To review the safety of simultaneous bilateral posterior Cricoarytenoid Muscle botulinum toxin injections. Design Retrospective case series review. Setting Tertiary care academic clinic. Patients Twenty-one patients with abductor spasmodic dysphonia. Interventions Patients received 100 simultaneous bilateral posterior Cricoarytenoid Muscle botulinum toxin injections for isolated abductor spasmodic dysphonia over a 6-year period. Main Outcome Measures Major and minor complications, injection dosing, and demographics. Results The total bilateral botulinum toxin injection dose per session ranged from 2.50 to 7.50 U, and the average total bilateral dose per patient was 4.70 U. There were no major complications, and minor complications were self-limited. There was a 5% incidence of significant dyspnea and a 2% incidence of dysphagia, and all patients were treated conservatively. The average doses at which dyspnea and dysphagia occurred were 4.97 and 5.56 U, respectively. Conclusions This case series demonstrates that simultaneous bilateral posterior Cricoarytenoid Muscle botulinum toxin injection is safe up to the highest doses reported. Complications with this approach are consistent with those previously reported using other methods. Prospective studies on vocal outcome measures are needed for simultaneous bilateral posterior Cricoarytenoid Muscle botulinum toxin injections to evaluate the efficacy of this technique.
Benjamin C Stong - One of the best experts on this subject based on the ideXlab platform.
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ORIGINAL ARTICLE Safety of Simultaneous Bilateral Botulinum Toxin Injections for Abductor Spasmodic Dysphonia
2014Co-Authors: Benjamin C Stong, Md John, M. Delgaudio, Md Edie, R. Hapner, Phd Michael M. JohnsAbstract:Objective: To review the safety of simultaneous bilat-eral posterior Cricoarytenoid Muscle botulinum toxin injections. Design: Retrospective case series review. Setting: Tertiary care academic clinic. Patients: Twenty-one patients with abductor spas-modic dysphonia. Interventions: Patients received 100 simultaneous bi-lateral posterior Cricoarytenoid Muscle botulinum toxin injections for isolated abductor spasmodic dysphonia over a 6-year period. Main Outcome Measures: Major and minor compli-cations, injection dosing, and demographics. Results:The total bilateral botulinum toxin injection dose per session ranged from 2.50 to 7.50 U, and the average total bilateral dose per patient was 4.70 U. There were no major complications, and minor complications were self-limited. There was a 5 % incidence of significant dys-pnea and a 2 % incidence of dysphagia, and all patients were treated conservatively. The average doses at which dyspnea and dysphagia occurred were 4.97 and 5.56 U, respectively. Conclusions: This case series demonstrates that simul-taneous bilateral posterior Cricoarytenoid Muscle botu-linum toxin injection is safe up to the highest doses reported. Complications with this approach are consis-tent with those previously reported using other meth-ods. Prospective studies on vocal outcome measures are needed for simultaneous bilateral posterior cricoaryte-noid Muscle botulinum toxin injections to evaluate the efficacy of this technique
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vocal outcome measures after bilateral posterior Cricoarytenoid Muscle botulinum toxin injections for abductor spasmodic dysphonia
Otolaryngology-Head and Neck Surgery, 2008Co-Authors: Adam M Klein, Benjamin C Stong, Justin C Wise, John M Delgaudio, Edie R Hapner, Michael M JohnsAbstract:Objective To review vocal outcome measures, using the Voice Related Quality of Life (VRQOL) index, after simultaneous bilateral posterior Cricoarytenoid Muscle botulinum toxin injections. Study Design Case series. Setting Tertiary care academic clinic. Subjects and Methods Fourteen subjects with abductor spasmodic dysphonia received 37 simultaneous bilateral posterior Cricoarytenoid Muscle botulinum toxin injections for isolated abductor spasmodic dysphonia (ABSD) over a 16-month period. Main Outcome Measures VRQOL index. Results Of the 37 injections, 33 of 37 (89%) resulted in improvement. Three injections resulted in no improvement, and one injection resulted in a worse VRQOL. The overall VRQOL mean improvement was 19.8 (range 5-53), with an average pre/postinjection VRQOL interval of 36 days (range 21-45 days). Conclusions Simultaneous bilateral posterior Cricoarytenoid Muscle botulinum injections result in a statistically significant improvement in VRQOL index scores for a high percentage of ABSD patients, thus improving patient quality of life.
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Safety of simultaneous bilateral botulinum toxin injections for abductor spasmodic dysphonia
Archives of otolaryngology--head & neck surgery, 2005Co-Authors: Benjamin C Stong, John M Delgaudio, Edie R Hapner, Michael M JohnsAbstract:Objective To review the safety of simultaneous bilateral posterior Cricoarytenoid Muscle botulinum toxin injections. Design Retrospective case series review. Setting Tertiary care academic clinic. Patients Twenty-one patients with abductor spasmodic dysphonia. Interventions Patients received 100 simultaneous bilateral posterior Cricoarytenoid Muscle botulinum toxin injections for isolated abductor spasmodic dysphonia over a 6-year period. Main Outcome Measures Major and minor complications, injection dosing, and demographics. Results The total bilateral botulinum toxin injection dose per session ranged from 2.50 to 7.50 U, and the average total bilateral dose per patient was 4.70 U. There were no major complications, and minor complications were self-limited. There was a 5% incidence of significant dyspnea and a 2% incidence of dysphagia, and all patients were treated conservatively. The average doses at which dyspnea and dysphagia occurred were 4.97 and 5.56 U, respectively. Conclusions This case series demonstrates that simultaneous bilateral posterior Cricoarytenoid Muscle botulinum toxin injection is safe up to the highest doses reported. Complications with this approach are consistent with those previously reported using other methods. Prospective studies on vocal outcome measures are needed for simultaneous bilateral posterior Cricoarytenoid Muscle botulinum toxin injections to evaluate the efficacy of this technique.
Mamoru Suzuki - One of the best experts on this subject based on the ideXlab platform.
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combination of direct pull of lateral Cricoarytenoid Muscle and thyroplasty type i for severe unilateral vocal cord paralysis
Nippon Jibiinkoka Gakkai Kaiho, 2006Co-Authors: Hidenori Kanebayashi, Ryoji Tokashiki, Hiroyuki Hiramatsu, Mamoru SuzukiAbstract:外側輪状披裂筋牽引術(lateral Cricoarytenoid Muscle pull:以下LCA-Pull)と甲状軟骨形成術I型(以下I型)を併用した片側性喉頭麻痺5症例についてその効果を検討した.当科では2000年より片側性喉頭麻痺に対しLCA-Pullを行ってきたが,当初はその効果を判断するために高度嗄声例に対してもあえて単独で対応してきた.その結果は最長発声持続時間(MPT)10秒以上を「改善」としたところ75%の改善率であったが,改善例の中にも聴覚印象的には不満足な症例があった.この結果をふまえ我々は2004年6月以降,高度嗄声を呈した症例に対してはLCA-PullとI型とを併用する方針とした.2004年10月から2005年3月までの6ヵ月間に両術式を併用した症例は5例で,4例は一期的に両術式を行い,残り1例は2004年10月以前にLCA-Pullを施行し,上記期間内にI型を追加した.これら5症例に対しMPT,発声時平均呼気流率(MFR),GRBASを用いた聴覚印象による評価を行い,全例正常音声と判断できるレベルまで改善した.LCA-PullとI型の併用は甲状軟骨板を経由した同一術野での手術であり,両術式を併用する必要のある高度嗄声症例に対し有用である.
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direct pull of lateral Cricoarytenoid Muscle for unilateral vocal cord paralysis
Acta Oto-laryngologica, 2005Co-Authors: Ryoji Tokashiki, Hiroyuki Hiramatsu, Hiroya Yamaguchi, Rei Motohashi, Kiyoaki Tsukahara, Mamoru SuzukiAbstract:Conclusion. Lateral Cricoarytenoid Muscle-pull surgery (LCA pull) is a safe and effective method for the treatment of unilateral vocal cord paralysis. Objective. To evaluate the results of an improved method of LCA pull for unilateral vocal cord paralysis. Material and methods. Thirteen patients with unilateral vocal cord paralysis underwent LCA pull between April 2003 and January 2004. A small window was made in the posterior lower part of the thyroid cartilage and 2–3 mm in a cranial direction to the lower edge of the thyroid cartilage. The inner perichondrium was carefully removed to expose the LCA Muscle. A 4-0 nylon suture placed through the LCA Muscle was pulled to adduct the arytenoid and was tied to the anterior lower part of the thyroid cartilage. All cases were treated by LCA pull alone. In all cases, the maximum phonation time was measured and an auditory evaluation was performed using the grade, roughness, breathiness, asthenia and strain scale. The airflow rate was measured in five cases. Res...
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a case of high pitched diplophonia that resolved after a direct pull of the lateral Cricoarytenoid Muscle
Acta Oto-laryngologica, 2005Co-Authors: Kiyoaki Tsukahara, Ryoji Tokashiki, Hiroyuki Hiramatsu, Mamoru SuzukiAbstract:Various approaches have been employed for the surgical treatment of unilateral vocal cord paralysis. Recently, we performed a direct pull of the lateral Cricoarytenoid Muscle in a case of high-pitched diplophonia with little difference between the right and left vocal cord levels and obtained favorable results. The patient was a 66-year-old male who consulted our hospital with chief complaints of husky voice and abnormal sensation in the pharyngolaryngeal region. Cerebellum/brainstem inflammation was diagnosed in February 2002 and appropriate treatment was instituted. Despite an improvement in the patient's systemic condition, right vocal cord paralysis remained. Although there were no abnormalities in the vocal range for ordinary speech, diplophonia was noted at high pitches, and synchronization could not be observed using stroboscopy. Therefore, the patient was operated on in October 2002. The high-pitched diplophonia disappeared and stroboscopy revealed favorable mucosal waves at high pitches. Thus, di...
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A case of high-pitched diplophonia that resolved after a direct pull of the lateral Cricoarytenoid Muscle
Acta oto-laryngologica, 2005Co-Authors: Kiyoaki Tsukahara, Ryoji Tokashiki, Hiroyuki Hiramatsu, Mamoru SuzukiAbstract:Various approaches have been employed for the surgical treatment of unilateral vocal cord paralysis. Recently, we performed a direct pull of the lateral Cricoarytenoid Muscle in a case of high-pitched diplophonia with little difference between the right and left vocal cord levels and obtained favorable results. The patient was a 66-year-old male who consulted our hospital with chief complaints of husky voice and abnormal sensation in the pharyngolaryngeal region. Cerebellum/brainstem inflammation was diagnosed in February 2002 and appropriate treatment was instituted. Despite an improvement in the patient's systemic condition, right vocal cord paralysis remained. Although there were no abnormalities in the vocal range for ordinary speech, diplophonia was noted at high pitches, and synchronization could not be observed using stroboscopy. Therefore, the patient was operated on in October 2002. The high-pitched diplophonia disappeared and stroboscopy revealed favorable mucosal waves at high pitches. Thus, direct pulling of the lateral Cricoarytenoid Muscle appears to be a useful procedure, even in a case of mild unilateral vocal cord paralysis.
Ira Sanders - One of the best experts on this subject based on the ideXlab platform.
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Reanimation of the paralyzed human larynx with an implantable electrical stimulation device.
The Laryngoscope, 2003Co-Authors: David L. Zealear, Mark S Courey, James L. Netterville, Cheryl R. Billante, Ira Sanders, George S. Goding, Randal C. Paniello, Garrett D. Herzon, Wolf J. Mann, Hasse EjnellAbstract:Objectives/Hypothesis Electrical stimulation of the posterior Cricoarytenoid Muscle, when paced with inspiration, offers a physiological approach to restore ventilation in bilateral laryngeal paralysis without any of the disadvantages associated with conventional treatment. Study Design A prospective study of six patients. Methods The patients were successfully implanted with an Itrel II stimulator (Medtronic, Inc). In postoperative sessions, stimulated vocal fold abduction, patient ventilation, and voice were assessed and compared with preoperative values. Results The optimum stimulus paradigm was a 1- to 2-second train of 1-millisecond pulses delivered at a frequency of 30 to 40 Hz and amplitude of 2 to 7 V. Posterior Cricoarytenoid stimulation produced a large dynamic abduction (3.5–7 mm) in three patients and moderate abduction (3 mm) in a fourth patient. The fifth patient showed a large but delayed response of 4 mm to stimulation with some lateralization of the vocal fold. In the sixth patient, stimulated abduction was noted on device implantation but was lost postoperatively. All five patients with stimulated abduction postoperatively met the ventilatory criteria for decannulation, and three patients subsequently had decannulation. Long-term stimulation of the posterior Cricoarytenoid Muscle had no appreciable effect on voice quality. Conclusions Electrical stimulation of the posterior Cricoarytenoid Muscle shows potential as an improved therapy for bilateral vocal fold paralysis.
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Axons Enter the Human Posterior Cricoarytenoid Muscle From the Superior Direction
Archives of otolaryngology--head & neck surgery, 1995Co-Authors: Ira Sanders, Hugh F. BillerAbstract:Objective: To examine the possibility that axons from the superior laryngeal nerve travel inferiorly through connections between the recurrent and the superior laryngeal nerves within the interarytenoid Muscle to innervate intrinsic laryngeal Muscles. Materials: The branch point from the recurrent laryngeal nerve to the posterior Cricoarytenoid Muscle was excised from five human larynges. Methods: The section of nerve was first microdissected to remove the epineurium. Then, the specimen was incubated at 37°C in a 1% collagenase solution, which was alternated with 0.4% chymopapain or 0.25% trypsin. Finally, the specimen was stained with 1% toluidine blue. Results: In all five specimens, axons could be seen entering the nerve branch to the posterior Cricoarytenoid Muscle from the superior direction. In one specimen, about one third of the axons entering the Muscle could be identified as arising from the superior direction. In two cases, the superior axons could be traced back to the recurrent laryngeal nerve branch to the interarytenoid Muscle. Conclusions: These results suggest that axons from the superior laryngeal nerve connect with the recurrent laryngeal nerve in the area of the interarytenoid Muscle. Furthermore, these axons travel inferiorly to innervate the posterior Cricoarytenoid Muscle. (Arch Otolaryngol Head Neck Surg. 1995;121:754-757)
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Arytenoid motion evoked by regional electrical stimulation of the canine posterior Cricoarytenoid Muscle
The Laryngoscope, 1994Co-Authors: Ira Sanders, Frank Rao, Hugh F. BillerAbstract:Anatomical studies have demonstrated that the posterior Cricoarytenoid Muscle in the dog is composed of three bellies. These bellies are termed vertical, oblique, and horizontal on the basis of their orientation. The purpose of this study was to show whether each of these bellies can move the vocal fold in different ways. Ten anesthetized dogs underwent laryngectomies while paralyzed with curare. The posterior Cricoarytenoid Muscles were then exposed by dissecting the overlying esophageal mucosa. Electrical stimulation was applied to each belly, and the motion of the arytenoid cartilage was measured. Because the oblique belly overlies the vertical belly, they were usually stimulated together. It was found that the vertical and oblique bellies rock the arytenoid backwards while sliding it laterally, thus causing a maximal dilation of the airway. The horizontal belly caused a swiveling motion of the arytenoid. It is proposed that the vertical and oblique bellies normally cause vocal fold abduction during respiration, while the horizontal belly primarily is used to adjust finely the position of the vocal process during phonation. Because the human posterior Cricoarytenoid is also composed of separate bellies it, too, may have distinct functions.
Michael W. Vannier - One of the best experts on this subject based on the ideXlab platform.
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Anatomic considerations in botulinum toxin type A therapy for spasmodic dysphonia.
The Laryngoscope, 1994Co-Authors: P F Castellanos, G A Gates, G Esselman, F. Song, Michael W. VannierAbstract:Chemodenervation by injection of botulinum toxin type A into the vocal fold(s) has become the preferred treatment for patients with adductor spasmodic dysphonia. Injection may be done either perorally or transcutaneously; each method has its advocates and advantages. The authors have used the transcutaneous transcricothyroid membrane route exclusively with satisfactory results in more than 50 patients. Temporary breathliness and aspiration are common. The preferred injection site should be as close as possible to the motor end plates of the affected Muscle. The thyroarytenoid Muscle end plates are distributed throughout the Muscle, whereas in the lateral Cricoarytenoid Muscle they are located in band in the center of the Muscle. The transcutaneous injection site is below and posterior to the midpoint of the vibrating vocal fold as visualized by indirect laryngoscopy. The proximity of this site to the lateral Cricoarytenoid Muscle suggests that postinjection breathiness and aspiration may be related to spread of botulinum toxin type A to the lateral Cricoarytenoid Muscle. However, it is likely that thyroarytenoid Muscle paresis is mainly responsible for this side effect and that the rapid clearing of the breathy dysphonia in the face of prolonged relief of spasmodic dysphonia symptoms suggests the action of an adaptive neural response, such as axonal sprouting. Further research of this subject is warranted.