Introduction. Accuracy of thyroid cartilage fenestration during Montgomery thyroplasty (MTIS) is considered a key success factor. The primary aim of the study was to retrospectively evaluate the... Show moreIntroduction. Accuracy of thyroid cartilage fenestration during Montgomery thyroplasty (MTIS) is considered a key success factor. The primary aim of the study was to retrospectively evaluate the accuracy of fenestration. Furthermore, recent publications indicate a possible discrepancy in MTIS voice outcomes related to gender. The secondary aim of the study was to investigate whether the fenestration accuracy could explain this discrepancy.Material and Method. Study was performed by virtually drawing the fenestration on a 3D CT scan as proposed by the MTIS's instructions for use (the "expected window" (EW)), and comparing it to the actually realized fenestration (the "realized window "(RW)). Four position variables, (a) surface overlap (%), (b) the distances between RW and EW centers (mm), (c) the angle between RW and EW (), and (d) the orientation of RW's center, were studied and compared to MPT (seconds) and VHI-30 scores outcomes. A descriptive statistical analysis and comparison between males and females were performed using a Mann-Whitney U test. Linear regression and multivariate analysis were also performed.Results. The median overlapping surface was 58.8 % [34.6; 75.4]. The median radius was 3.2 mm [1.7; 4.1]. The median angle was 16 [6.8; 21.2]. Results show no significant differences of overlapping surface percentage, distance, or angle by gender. Data show no correlation between voice outcome and percentage overlap, distance, or angle. However, data show better outcomes when fenestration was located in the infero-anterior orientation. All patients of this orientation were males.Conclusions. Data provided by this study advocate a maximal infero-anterior positioning of the window during MTIS. This position is more difficult to obtain in female patients. Show less
Desuter, G.; Cartiaux, O.; Pierard, J.; Henrard, S.; Lith-Bijl, J. van; Benthem, P.P. van; Sjogren, E. 2019
Introduction Accuracy of thyroid cartilage fenestration during Montgomery Thyroplasty (MTIS) is considered a key success factor. The primary aim of the study was to retrospectively evaluate the... Show moreIntroduction Accuracy of thyroid cartilage fenestration during Montgomery Thyroplasty (MTIS) is considered a key success factor. The primary aim of the study was to retrospectively evaluate the accuracy of fenestration. Furthermore, recent publications indicate a possible discrepancy in MTIS voice outcomes related to gender. The secondary aim of the study was to investigate whether the fenestration accuracy could explain this discrepancy. Material and Method Study was performed by virtually drawing the fenestration on a 3D CT-scan as proposed by the MTIS’s instructions for use (the “expected window” (EW)), and comparing it to the actually realized fenestration (the “realized window "(RW)). Four position variables, (a) surface overlap (%), (b) the distances between RW and EW centers (mm), (c) the angle between RW and EW and (d) the orientation of RW’s center, were studied and compared to MPT (Sec) and VHI-30 scores outcomes. A descriptive statistical analysis and comparison between males and females were performed using a Mann-Whitney U test. Linear regression and multivariate analysis were also performed. Results The median overlapping surface was 58.8 % [34.6; 75.4]. The median Radius was 3.2 mm [1.7; 4.1]. The median angle was 16° [6.8; 21.2]. Results show no significant differences of overlapping surface percentage, distance or angle by gender. Data show no correlation between voice outcome and percentage overlap, distance or angle. However, data show better outcomes when fenestration was located in the infero-anterior orientation. All patients of this orientation were males. Conclusions Data provided by this study advocate a maximal infero-anterior positioning of the window during MTIS. This position is more difficult to obtain in female patients. Show less
Desuter, G.; Dedry, M.; Schaar, B.; Lith-Bijl, J. van; Benthem, P.P. van; Sjogren, E.V. 2018
There is no consensus on which voice outcome indicators (VOIs) should be used to compare the merits of the various surgical treatments for unilateral vocal fold paralysis (UVFP). Authors performed... Show moreThere is no consensus on which voice outcome indicators (VOIs) should be used to compare the merits of the various surgical treatments for unilateral vocal fold paralysis (UVFP). Authors performed a literature review to identify which VOIs are most frequently used and most relevant, in terms of significant change in pre- and post-operative measurements, to assess UVFP surgical treatments.A Medline/Pubmed literature review was performed and the most frequently used VOIs were identified using a Pareto diagram. For these most frequently used VOI's, the number of studies that showed a statistically significant change in pre- and post-operative results were compared to the total number of studies found using that same VOI, this portion was expressed in percent. This percentage was defined as the "percentage of significance" and used to assess changes of each VOI.Eleven VOIs were identified using the Pareto analysis. These were, in decreasing order of frequency of citation: maximum phonation time (MPT), jitter, Shimmer, video-stroboscopic examination, noise to harmonic ratio (NHR/HNR), mean air flow (MeAF), fundamental frequency (F0), "Infrequent Perceptional Scales", GRBAS scale, mean subglottic pressure (MSGP). MPT, MeAF, factor G of GRBAS-I, Jitter, shimmer and VHI-30 had respective "percentage of significance" of 90, 86, 85, 74, 68 and 64%, respectively.The results indicate that MPT, MeAF and GRBAS-I, represent the top-three most frequently used and the most relevant VOIs in terms of "percentage of significance". VHI-30 showed a relatively low rate of use and low "percentage of significance". The role of Jitter and Shimmer remains unclear. Finally, MSGP and the F0 appear to be less relevant VOIs for the evaluation of UFVP surgical treatments in terms of significant change in pre- and post-operative measurements. Show less
Desuter, G.; Mertens, B.; Delchambre, A.; Lith-Bijl, J. van; Benthem, P.P. van; Sjogren, E. 2017
Introduction: Many concerns have been expressed in the past about the assessment of vocal fold positions as part of (a) pre-operative planning and (b) post-operative outcome for larynx framework... Show moreIntroduction: Many concerns have been expressed in the past about the assessment of vocal fold positions as part of (a) pre-operative planning and (b) post-operative outcome for larynx framework surgery. Presently there is no clear strategy allowing, harmed free and office-based assessment of vocal fold vertical relative positions. The Larynx Ruler (LR) is a laser based, measuring device that could meet the previously stated need. This study represents a proof of concept regarding the use of LR in assessing vocal fold height and profile. Material and methods: One fresh male human cadaver larynx was explored with the LR system through the operative channel of a gastroenterology video-endoscope. The tip of the video-endoscope was located in the laryngeal vestibule. The right crico-arytenoid joint was posteriorly disarticulated allowing anterior and posterior tilting of the arytenoid cartilage, this to create an elevation or a depression of the vocal process. Ten push-pull motions sessions were applied to the specimen. These experimentally induced motions were compared with measurements provided by the LR Results: Data provided by the LR were always in accordance with movements applied on the vocal folds. The accuracy of 0.2 mm of the LR is compatible with the envisioned applications for the larynx. Conclusions: The LR system represented a feasible technique to evaluate vocal fold’s heights and bulk in humans. A few technical limitations were identified that will require improvements before experimental use on human. Show less
Desuter, G.; Dedry, M.; Schaar, B.; Lith-Bijl, J. van; Benthem, P.P. van; Sjogren, E.V. 2017
Introduction There is no consensus on which voice outcome indicators (VOI) should be used to compare the merits of the various surgical treatments for unilateral vocal fold paralysis (UVFP).... Show moreIntroduction There is no consensus on which voice outcome indicators (VOI) should be used to compare the merits of the various surgical treatments for unilateral vocal fold paralysis (UVFP). Authors performed a literature review to identify which VOIs are most frequently used and most relevant, in terms of significant change in pre- and post-operative measurements, in order to assess UVFP surgical treatments. Method A Medline/Pubmed literature review was performed and the most frequently used VOIs were identified using a Pareto diagram. For these most frequently used VOI’s the number of studies that showed a statistically significant change in pre and post-operative results were compared to the total number of studies found, this portion was expressed in percent. This percentage was defined as the “percentage of significance” and used to assess changes of each VOI. Results Eleven VOIs were identified using the Pareto analysis. These were, in decreasing order of frequency of citation: Maximum Phonation Time (MPT), Jitter, Shimmer, Video-stroboscopic examination, Noise to Harmonic Ratio (NHR/HNR), Mean Air Flow (MeAF), Fundamental Frequency (F0), “Infrequent Perceptional Scales”, GRBAS scale, Mean Subglottic Pressure (MSGP). MPT, MeAF, factor G of GRBAS-I, Jitter, shimmer and VHI-30 had respective “percentage of significance” of 90%, 86%,85%,74%, 68% and 64% respectively. Conclusion The results indicate that MPT, MeAF and GRBAS-I, represent the top-three most frequently used and the most relevant VOIs in terms of “percentage of significance”. VHI showed a relatively low rate of use and low “percentage of significance”. The role of Jitter and Shimmer remains unclear. Finally, MSGP and the F0 appear to be less relevant VOIs for the evaluation of UFVP surgical treatments in terms of significant change in pre- and post-operative measurements. Show less
