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Alveolar soft part sarcoma (ASPS) is a rare malignant neoplasm that tends to occur in the deep soft tissues of both adults and children. ASPS has a progressive clinical course that is unfortunately characterised by late metastases and an overall poor prognosis. Although the tumour has been reported in a wide range of anatomic sites, few cases of primary laryngeal ASPS are reported in the literature. Here, we report the case of a 24-year-old man with no significant medical history who presented with progressive mild dysphonia and hoarseness. Imaging studies revealed a well-circumscribed, partially cystic submucosal mass with involvement of the right vocal fold and other local structures, and the patient was referred for surgical excision. Morphological and immunohistochemical examination of the excised lesion revealed ASPS. The findings of this case are compared with those of seven additional cases of primary laryngeal ASPS, which were found following literature review.

El presente artículo presenta la evaluación y rehabilitación vocal en un caso de parálisis laríngea unilateral; se comparan parámetros vocales objetivos pre y postratamiento y se aplican estrategias y actividades de intervención, basadas en los principios de aprendizaje sensoriomotor. Método: Paciente masculino de 69 años con diagnóstico de parálisis de pliegue vocal derecho en posición paramediana. Se realiza evaluación pre y post rehabilitación vocal, incluyendo parámetros objetivos a nivel acústico, electroglotografíco, videoestroboscopico. El plan de tratamiento incluyó 5 sesiones de intervención. Resultados: cambios objetivos en tiempo máximo de fonación, cualidades acústicas de la voz, parámetros acústicos (de frecuencia, perturbación, relación armónico- ruido y características espectrales a largo plazo), grado de aducción de los pliegues vocales y competencia glótica. Adherencia del tratamiento a los contextos reales de desempeño del paciente, permitiéndole un habla espontánea con audibilidad, naturalidad e inteligibilidad; interacciones comunicativas efectivas con familia, amigos y compañeros de trabajo. Conclusión: La parálisis de pliegue vocal unilateral es una deficiencia donde el tratamiento terapéutico se convierte en el principal recurso para fortalecer la calidad de vida del paciente con este diagnóstico; los principios de aprendizaje sensorio-motor fueron un aspecto esencial para los cambios reportados en la voz del paciente

OBJECTIVES The primary objective was to investigate the left-right vocal fold symmetry in rheological and histological properties using a rabbit model. The other objective was to develop statistical models for the comparison of rheological properties between paired vocal folds. METHODS Viscoelastic shear properties of six pairs of vocal fold lamina propria specimens were measured over a frequency range of 1 to 250 Hz by a linear, controlled-strain, simple-shear rheometer. The rheological data of the left and right vocal folds was statistically compared using the mixed-effects model approach. Six additional rabbit larynges were histologically analyzed for left-right symmetry in distribution patterns and relative densities of major extracellular matrix constituents. RESULTS There were no significant differences in elastic shear modulus (P = 0.1069) and dynamic viscosity (P = 0.944) of the lamina propria between the two vocal folds of the same larynx. Left-right vocal fold symmetry in densities and distribution patterns of the key molecular constituents was also demonstrated in histological results. CONCLUSION By showing that the left and right vocal folds were rheologically and histologically symmetrical in rabbit, this study validated an underlying assumption made in many previous reports. Statistical models for the analysis of hierarchically correlated left-right vocal fold rheological data were also presented. LEVEL OF EVIDENCE NA. Laryngoscope, 128:E359-E364, 2018.

In the structure of oncological morbidity of the upper respiratory tract, malignant tumors of the larynx, including tumors of mesenchymal origin, are the most common. From 1959 to 2013, 55 cases of laryngeal leiomyosarcoma were described in scientific literature. Rarity of this localization of the tumor was the reason for publication of a clinical observation of a patient with endophytic tumor of the right vocal fold. Differential diagnosis for myofibro-, fibro-, and leiomyosarcoma was conducted. Based on immunohistological examination, well-differentiated laryngeal leiomyosarcoma was diagnosed.

Background: Laryngeal mask airway (LMA) insertion contributes to airway protection in patients with a laryngeal tumor around the glottis. There has been no report of LMA insertion itself exacerbating airway obstruction in such patients. Case presentation: A 62-year-old male underwent elective surgical resection of a large laryngeal polyp. The polyp was attached to the right vocal fold and synchronously swung inward into the trachea and outward to the larynx with inspiration and expiration, respectively. Although manual positive pressure ventilation was easily achieved without any airway obstruction after anesthetic induction, the airway was completely obstructed by the polyp lodged between the vocal cords immediately after LMA insertion. Soon after removal of the LMA, patency of the airway was dramatically improved. Conclusion: Our experience indicates that we should pay attention to airway obstruction due to lodging of the polyp between the vocal cords after LMA insertion in patients with a laryngeal polyp., Article, JA CLINICAL REPORTS.4:43(2018)

BACKGROUND Vocal fold injury results in severe voice alteration that limits occupational function and social interaction. An ovine model of laryngeal injury has been developed, validated and utilized to examine laryngeal wound healing and the effect of a novel collagen inhibitor (halofuginone) on surgical wound healing. The study design includes basic research and animal model. METHODS An ovine laryngeal model was utilized to study controlled vocal fold injury and healing. Twenty-five sheep were divided into five groups. Sheep underwent right vocal fold injury preceded or followed by administration of halofuginone orally, topically or intralesionally. Biopsies were taken at commencement, 1 month and larynges explanted at 3 months. Specimens were examined for elastin and collagen density and epithelial changes. Pearson correlation statistics and Student's t-tests were used to assess inter-relationships. RESULTS All sheep tolerated halofuginone. One sheep death occurred in an untreated sheep. Vocal fold tissue demonstrated a predictable histological response to injury. Elastin was significantly reduced post-injury in the glottis. Halofuginone administered orally for 10 weeks prevented elastin loss and demonstrated a trend of reducing collagen density post-injury. CONCLUSION In an ovine laryngeal injury model, administration of a fibrosis inhibitor resulted in altered elastin and collagen deposition after injury in the glottis. Further investigation is warranted to examine whether these tissue changes affect vocal fold dynamics.

Summary Introduction: Dysphonia is the main symptom of lesions that affect the vocal tract. Many of those lesions may require surgical treatment. Polyps are one of the most common forms of vocal cord lesions and the most prevalent indication for laryngeal microsurgery. There are different types of polyps, and their different characteristics can indicate different prognosis and treatments. Aim: To conduct a comparative study of polypoid lesions (angiomatous and gelatinous) in patients undergoing laryngeal microsurgery via an electronic protocol. Method: We prospectively evaluated 93 patients diagnosed with vocal fold polyps; the polyps were classified as angiomatous or gelatinous. Results: In total, 93 patients undergoing laryngeal microsurgery were diagnosed with vocal fold polyps. Of these, 63 (64.74%) had angiomatous and 30 (32.26%) gelatinous polyps. Most patients with angiomatous polyps were men; their polyps were frequently of medium size, positioned in the middle third of the vocal fold, and accompanied by minimal structural alterations (MSA). In contrast, the majority of patients with gelatinous polyps were women; their polyps were smaller, positioned in the middle and posterior third of the vocal fold, and were not accompanied by MSA. Both types of polyps were more frequently located on the right vocal fold. Conclusion: Angiomatous polyps were more frequently encountered than gelatinous polyps. In addition, correlations between polyp type and sex, polyp size, position, location, and the presence of MSA were observed. Different surgical techniques were used, but the postoperative results were similar and satisfactory after speech therapy.

Summary Vocal fold vibratory irregularities can be caused by multiple factors. The underlying mechanism for irregularities is a difference in the mass or tension of the vibratory portion of the left versus the right vocal fold. The purpose of this study is to preliminarily investigate the prevalence of vocal fold vibratory irregularities in vocally normal speakers via high-speed videoendoscopy (HSV). Two aspects of irregularity, glottal width and period irregularity, were investigated in 52 vocally normal speakers undergoing videostroboscopy and HSV. The videostroboscopy and HSV recordings were processed and visually rated for glottal width and period irregularities. These ratings were also accomplished through the use of the novel digital kymography playback and from still kymographic images of the medial line of the vocal folds (mDKG). Objective measures of glottal width and period irregularities from the mDKG, and jitter and shimmer measures of the synchronously recorded acoustic waveforms, were also studied. The results suggest that period irregularities are less frequent in normophonic speakers than glottal width irregularities. However, more participants revealed acoustic jitter rather than acoustic shimmer above normal limits. Thus, speculation regarding the physiological source of these clinically used acoustic parameters continues. The lack of confidence in rating irregularity through stroboscopy and the discrepancies between visual ratings and objective measures requires future research efforts.

右側喉頭麻痺は，左側に比べると頻度は低い。反回神経の走行が，解剖学的に左側が長く胸腔内を走行するため左側に麻痺が起こりやすいと考えられている。頻度が少ない右側喉頭麻痺の特色と術式について検討した。症例は1994年から2006年に一色クリニック・京都ボイスサージセンターにて手術を施行した片側喉頭麻痺110例のうち，右側喉頭麻痺の35例である。年齢は17歳から75歳（平均49.4歳），性別は男性22例女性13例であった。麻痺の原因は，甲状腺手術16例，頸部迷走神経鞘腫手術5例，特発性3例，縦隔迷走神経鞘腫手術3例，脳腫瘍3例，以下食道癌手術，頭部外傷，頸椎手術によるものが各1例ずつであった。術式は声門間隙の広いものは披裂軟骨内転術（Arytenoid Adduction：AA）を，狭いものには甲状軟骨形成術1型（1型）を選択した。声門間隙が広くかつ萎縮の強いものにはAAに加え1型を併施した。まずAAまたは1型またはAA+1型にて声帯正中移動を施行した。その後，甲状軟骨と輪状軟骨の接近テストを施行し，音声の改善を認めた10例には甲状軟骨形成術4型（4型）を追加した。4型追加症例は麻痺の原因疾患より，輪状甲状筋機能不全が疑われた症例であった。手術前後の音声の評価は最長発声持続時間（MPT）とAlternating Current/Direct Current Ratio （AC/DC比）を用いた。術後のMPTは1例のみ不変であったが34例は改善した。AC/DC比は1例を除き増加した。片側声帯麻痺で輪状甲状筋機能不全の疑いがある際には声門閉鎖不全の解消のみならず声帯前後方向の緊張が必要である。まずAAや1型，またAA+1型により声帯正中移動させ，その上で患者の音声をモニタリングし，術中にオプションとして4型の併用の選択を考慮することは重要である。

Summary Objectives A single case study is reported of a child who underwent several surgical procedures as result of congenital grade III subglottic stenosis. The anterior aspect of the right vocal cord was damaged and underwent atrophy during one of these procedures. Now, an active 10-year-old, the patient has become increasingly aware of his vocal limitations on functional activities. Injection of hyaluronic acid into the vocal folds has been known to provide improved voice quality in adults although there are no known cases reported of this procedure in children. Methods This article reports voice outcomes after injection of hyaluronic acid into the Reinke's space in a single case study. Voice recordings were made before, after, and 1 month after injection. The voice recordings were subject to acoustic and perceptual analysis. Results Post and follow-up voice recordings demonstrate decreased jitter, shimmer, and harmonics-to-noise ratio. Perceptual evaluation indicates improved voice quality. Conclusion Injection of hyaluronic acid in children who require voice augmentation is possible and may contribute to increased vocal function and improved voice outcomes.

The authors describe a male patient who had malignant lymphoma seven years ago which remitted with chemotherapy.Two years ago he developed dysphonia. An unilateral, pediculate smooth red lesion on the right vocal fold was later discovered. Even without benefit of medicamentosus treatment, the patient refused surgery. In a reevaluation using rigid telescopy of the larynx two years later, the lesion had disappeared, completely and spontaneously. As there are no existing publications on this topic, this case report is an alert that surgery should be recommended with extreme caution in this type of vocal disease.

A case of laryngeal papilloma with malignant change in a 84-year-old female was reported.This patient has suffered from hoarseness since October 1988. She visited a neighboring ENT clinic and was urged to surgical treatment. However, she waited almost two years without undergoing any treatment. In October 1990, she visited us because of severe difficulty in respiration. A laryngoendoscopy revealed a papillomatous tumor occupying the laryngeal cavity. Successively, she underwent laryngomicrosurgery using the CO2 laser technique. A histopathological study revealed that the tumor was a papilloma with a highly dysplastic change. Unexpectedly, a recurrence was endoscopically found at the right vocal fold in July 1991. Laryngomicrosurgery with a CO2 laser was immediately performed again. Our histopathological division reported that a squamous cell carcinoma was found in part of the specimen.

PURPOSE: To evaluate the deposition of collagen fibers at pig's vocal folds after topical use of mitomycin or 5-fluorouracil, when partial exeresis of mucosa layer had been promoted by CO2 laser. METHODS: There were used 18 Larger white pigs which were anesthetized and submitted to mucosa fragment's exeresis, bilaterally, at its free border. The animals were divided into 3 groups, each one with 6 animals: control group, without topical drug application; mitomycin group; and 5-fluorouracil group. After 30 days, the animals were subjected to euthanasia, and samples of the vocal folds were collected and stained by picrosirius red technique with polarization for quantification of total collagen deposition. RESULTS: In control group, the mean rate of right vocal fold's collagen deposition at submucosa consisted in a 3428.66 micrometers area. There was found an area whose size had, in average, 2196.36 micrometers, in mitomycin group, and 2269.19 micrometers, in 5-fluorouracil group. CONCLUSION: Mitomycin and 5-fluorouracil had promoted beneficial change in vocal fold's cicatrization with less collagen deposition, but there was no significant statistically difference when they were compared between themselves. OBJETIVO: Avaliar a deposição das fibras de colágeno total em pregas vocais suínas após o uso tópico de mitomicina ou 5-fluorouracil nas exéreses parciais de mucosa com laser de CO2. MÉTODOS: Foram utilizados 18 porcos da raça Larger white anestesiados e submetidos à exérese de fragmento de mucosa de borda livre da prega vocal direita e prega vocal esquerda. Os animais foram divididos em 3 grupos com 6 animais cada: grupo controle, sem aplicação de medicação tópica; grupo mitomicina, com uso tópico dessa substância; grupo 5-fluorouracil, uso tópico. Após 30 dias do experimento os animais foram submetidos à eutanásia, coletadas amostras das pregas vocais e coradas pela técnica do picrosirius red com polarização para a quantificação computadorizada da deposição do colágeno total. RESULTADOS: No grupo controle, a média da área do colágeno depositado na submucosa da prega vocal direita foi de 3428,66 micrômetros. No grupo mitomicina a média foi de 2196,36 micrômetros. No grupo 5-fluorouracil, a média foi de 2269,19 micrômetros. CONCLUSÃO: A mitomicina e o 5-fluorouracil promoveram mudança benéfica na cicatrização da prega vocal, com menor deposição de colágeno, porém, quando comparados entre si, eles não apresentaram diferença estatisticamente significante.

OBJETIVO: descrever o trabalho fonoaudiológico, após diagnóstico diferencial do cisto intracordal, por meio do exame de videolaringoestroboscopia associado à fonação inspiratória. MÉTODOS: relato de caso, baseado em dados de anamnese, da avaliação clínica fonoaudiológica, do exame videolaringoestroboscópico e conduta terapêutica específica. RESULTADOS: identificação do cisto intracordal em prega vocal direita com alterações encontradas no exame laringológico, compatível à avaliação clínica fonoaudiológica. Verificou-se que, após conduta direcionada, a paciente obteve melhora na vibração e amplitude da onda mucosa da prega vocal direita, com manutenção de períodos de estabilidade vocal. CONCLUSÃO: a eficiência dos procedimentos depende diretamente das avaliações e diagnósticos precisos dos profissionais envolvidos, o que permite uma conduta direcionada ao caso e, menor tempo de tratamento. PURPOSE: to describe the voice therapy after a cyst differential diagnosis by means of videostrobolaryngoscopy associated with inspiratory phonation. METHODS: vase study based on clinical evaluation anamnesis data of phonoaudiologic, videostroboscopic examination, and specific therapeutic conduct. RESULTS: cyst identification in right vocal fold and alterations found in the laryngological examination which were compatible with phonoaudiologic clinical evaluation. After guides speech therapy, we verified evolution in vibration and amplitude of the mucous wave of the right vocal fold, with maintenance of periods as for vocal stability. CONCLUSION: the efficiency of the preceding methods directly depends on the precise evaluations and diagnosis, of the involved professionals, which allows for a conduct guided to the case and less treatment time.

We present a case of idiopathic right vocal fold paralysis which resolved completely 18 months after onset. Instead of using surgery to improve the hoarseness of our patient, our experience suggested that speech therapy might be effective. Although the voice can be improved by overadduction of the healthy vocal fold, as surgery is irreversible it is better to wait for 18 months after onset in case spontaneous recovery occurs. During this period, one should of course continue to investigate the origin of the paralysis.

We report a rare case of laryngeal myxoma in a 57-year-old Japanese man. Except for a five-year history of gradually progressive hoarseness, he had been in good health. Video-stroboscopic examination revealed a solid mass in the anterior third of the right vocal fold. Phonosurgery performed with a microscope showed that the mass was encapsulated and located between the epithelium and vocal fold ligaments of the right vocal fold. This hard, elastic mass which measured 7 mm in diameter, was diagnosed as a myxoma. Only three cases of myxoma of the larynx have been reported in the English literature, with only one other case involving the vocal fold.

We report the clinical use of beclomethasone dipropionate inhaler (BDI; Aldecin® inhaler), in the management of contact ulcer and idiopathic granuloma of the larynx.Patient 1 was a 66-year-old woman with an ulcerative lesion at the posterior end of left vocal fold. The lesion was diagnosed as contact ulcer of the larynx and treated by oral spray of BDI, which resulted in improvement in five months.Patient 2 was a 66-year-old man with a small mass at the posterior end of right vocal fold. It was diagnosed as idiopathic granuloma of the larynx and treated by oral spray of BDI. His symptoms and laryngeal lesion markedly improved in three months.BDI appears to be useful in the treatment of contact ulcer and idiopathic granuloma of the larynx.