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Approaches to regenerate vocal fold in glottic insufficiency remains to be a focus for exploration. This is attributed to the applications of cells or biological molecules alone result in fast degradation and inadequate for regeneration. Development of an injectable hydrogel for glottic insufficiency is challenging, as it needs to be non-cytotoxic, elastic yet possess good strength and easy to fabricate. This gap prompts us to study the feasibility of our genipin(gn)-crosslinked gelatin (G) hydrogel in encapsulating Wharton's Jelly Mesenchymal Stem Cells (WJMSCs) and basic fibroblast growth factor (bFGF) WJMSCs with the aim to provide regeneration in glottic insufficiency. WJMSCs was encapsulated into two optimised formulations with the density of 2,000,000 cells/mL. The encapsulated cells were tested for its morphology, cell viability, proliferation and migration. Then, the incorporation of basic fibroblast growth factor (bFGF) was done into a final formulation and was tested for the cellular response and in vitro inflammation. 6G 0.4gn demonstrated better cell viability after in vitro culturing for 7 day. After incorporation of bFGF into cell-laden 6G 0.4gn, encapsulated WJMSCs showed to have improved viability and migration. The inflammatory profile of the hydrogel was imperceptible and was regarded as minimal or no pro- and anti-inflammation. Altogether, we have first formulated 6G 0.4gn which is suitable to encapsulate WJMSCs and incorporation of bFGF. Current study fulfils the market need in vocal fold regeneration, by suggesting its rejuvenating potential in glottic insufficiency, yet this combined formulation should be studied further to justify its translation to clinical setting. [ABSTRACT FROM AUTHOR]

Introduction Patients with chronic rhinitis suffer from postnasal drip (PND) but this symptom is not well addressed. Nasal endoscopy may aid in identifying PND. Well described endoscopic features of PND are presence of secretions in the posterior nasal cavity, diffuse erythema, and hemorrhagic spots in the nasopharynx, but these have not been formally studied. Objectives The present study aims to assess the association of nasal endoscopic features with PND among rhinitis patients. This will guide clinicians to interpret the nasal endoscopic findings appropriately. Methods Adults (≥ 18 years old) with chronic rhinitis were consecutively recruited at an Otorhinolaryngology outpatient clinic in a tertiary referral center. The patients were grouped into either "Rhinitis with PND" or "Rhinitis only." The endoscopic features of PND were scored as: Secretions in the posterior nasal cavity (yes/no), erythema in the nasopharynx (none, roof only, diffuse), hemorrhagic spots (yes/no), then were compared between groups. Results There were 98 patients included (age 32.32 ± 11.33 years old, 61.2% female, 61.2% PND). Presence of secretions in the posterior nasal cavity was associated with PND ("Rhinitis with PND" versus "Rhinitis only," 78.3 versus 55.3; p = 0.02; Odds ratio: 2.81; 95% confidence interval [CI]: 1.08–7.32). Diffuse erythema of the nasopharynx was more frequent in "rhinitis only" compared with those with PND (76.3 versus 53.3%; p = 0.02). Hemorrhagic spots were equally present in both groups (11.7 versus 18.4%; p = 0.35). Conclusion Presence of secretions in the posterior nasal cavity may indicate bothersome PND among patients with rhinitis. Diffuse erythema of the nasopharynx and hemorrhagic spots are a nonspecific sign of inflammation. [ABSTRACT FROM AUTHOR]

Introduction: An abnormal mass in the head and neck involving the supraglottic and cervical region offers a wide range of differential diagnoses. The pathology is either benign or malignant in nature. Castleman disease (CD) is an uncommon lymphoproliferative disorder characterised by hypervascular lymphoid hyperplasia and is classified into unicentric or multicentric disease. Histopathologically it is divided into hyaline vascular (HV), plasma cell (PC), and mixed cellularity variants. The multicentric disease is linked with PC and has the propensity to progress to lymphoma or Kaposi Sarcoma. Case Report: We report a case of a 45-year-old gentleman who presented with a painless anterior neck swelling and left supraglottic mass for six months. Computed tomography (CT) contrast imaging demonstrated a homogenous enhancing lesion at the left supraglottic and the midline of the anterior neck with erosive changes of the thyroid cartilage. A surgical resection of the anterior neck mass was performed. The diagnosis of Castleman disease plasma cell variant was made by histopathologic evaluation. The patient remained well post-resection. Conclusion: Supraglottic multicentric Castleman disease is the least expected diagnosis in this case. Unicentric disease is treated with surgery. However, limited studies are available in determining the effectiveness of surgery in multicentric diseases. The plasma cell variant requires a multidisciplinary and multimodal approach due to an inclination towards malignancy. Research is needed to determine the role of surgery in multicentric disease and to develop optimum guidelines for managing cases. To date, there is unsubstantial literature describing supraglottic multicentric disease. [ABSTRACT FROM AUTHOR]

Treating an acutely injured recurrent laryngeal nerve by primary nonselective laryngeal reinnervation (LR) during thyroidectomy is encouraged to minimize postoperative morbidity. Performing a concurrent transoral temporary injection laryngoplasty (IL) may improve the patient's voice while waiting for the effect of successful reinnervation. Chronological multidimensional voice outcomes (qualitative and quantitative) and combination of the primary nonselective LR with concurrent transoral IL were not explicitly demonstrated in previous cases that published the literature. In this study, the authors presented the multidimensional voice parameters of 3 patients undergoing primary nonselective LR with concurrent IL during thyroidectomy. The parameters were measured at different time points (2 weeks and 1, 3, 6, and 12 months) following the surgery. Laryngeal electromyography was done at 1 to 2 months and 12 months postsurgery. The results showed that the voices, qualitatively and quantitatively, were within normal range at within 3 months postintervention. The parameters were slightly beyond the normal limit at 3 months and returned to normal at 6 months postintervention and beyond. The LEMG depicted evidence of successful reinnervation in which the motor unit was normal comparable to the opposite normal vocal fold. [ABSTRACT FROM AUTHOR]

Glottic insufficiency is widespread in the elderly population and occurs as a result of secondary damage or systemic disease. Tissue engineering is a viable treatment for glottic insufficiency since it aims to restore damaged nerve tissue and revitalize aging muscle. After injection into the biological system, injectable biomaterial delivers cost- and time-effectiveness while acting as a protective shield for cells and biomolecules. This article focuses on injectable biomaterials that transport cells and biomolecules in regenerated tissue, particularly adipose, muscle, and nerve tissue. We propose Wharton's Jelly mesenchymal stem cells (WJMSCs), induced pluripotent stem cells (IP-SCs), basic fibroblast growth factor (bFGF), vascular endothelial growth factor (VEGF), hepatocyte growth factor (HGF), insulin growth factor-1 (IGF-1) and extracellular vesicle (EV) as potential cells and macromolecules to be included into biomaterials, with some particular testing to support them as a promising translational medicine for vocal fold regeneration. [ABSTRACT FROM AUTHOR]

Laryngeal tuberculosis is rare despite its close anatomical and physiological proximity to the lungs. It constitutes less than 1% of extrapulmonary tuberculosis. The symptoms of laryngeal tuberculosis are non-specific and mimic other laryngeal pathologies. The recent evolving and atypical endoscopic laryngeal features cause a diagnostic dilemma and delay in treatment. In this report, we presented three patients with distinct age and medical history, and hoarseness. Flexible videolaryngoscopy showed similar findings in the three cases, with irregular mucosa involving the entire length of the vocal fold, unilaterally in two cases and bilaterally in one. Mucosal waves were typically absent on laryngostroboscopy examination. The routine workup for pulmonary tuberculosis was unremarkable. The usage of Mycobacterium tuberculosis complex (MTBC) and rifampicin resistance (Xpert MTB/RIF) assay that detects Mycobacterium tuberculosis in the tissue biopsy specimens has helped in the rapid diagnosis of primary laryngeal tuberculosis and timely commencement of anti-tuberculous therapy. The clinical course and response to treatment were diverse in which two cases showed good response whilst the third developed disseminated tuberculosis despite optimal therapy. [ABSTRACT FROM AUTHOR]

Fishbone ingestion is a common occurrence and patients present with various symptoms, posing challenges to the attending physicians. Here, we present two unique cases of patients with an unexpected rapidly migrating fishbone in the tongue. The first patient was operated transorally because of a foreign body embedded in the genioglossus muscle. In the second patient, CT scan located a fishbone embedded in the left hyoglossus muscle; however, the fishbone had to be relocated intraoperatively using bedside ultrasound guidance and was eventually found embedded within the mylohyoid muscle. The fishbone was successfully removed via transcervical approach following a failed transoral approach. [ABSTRACT FROM AUTHOR]

A 79-year-old smoker with a background history of a treated glottic carcinoma and chronic obstructive pulmonary disease presented with progressive hoarseness, symptoms of aspiration and shortness of breath for 6 months. Examination revealed an ulcerofungating mass over the posterior commissure of the larynx. A tracheostomy, direct laryngoscopy and biopsy of the mass was performed to secure his airway and to exclude recurrent glottic carcinoma. Reassuringly, a histopathological examination of the mass revealed numerous fungal yeast bodies. He was then treated with itraconazole for 4 weeks and was followed up as and outpatient with complete resolution and no recurrence of the disease. [ABSTRACT FROM AUTHOR]

Objective: To study the effectiveness of early percutaneous transthyrohyoid injection laryngoplasty under local anesthesia in improving voice quality in unilateral vocal fold paralysis (UVFP) patients. Methods: Longitudinal data of 29 UVFP patients who underwent injection laryngoplasty within six months from the onset of the symptoms were studied. The injectate (0.5–1 mL) was hyaluronic acid-based material (Juvéderm ULTRA XC; Allergan Industrie, France) that was delivered under local anesthesia with transthyrohyoid approach using a double-bend 21G needle. Multidimensional voice outcomes employing: 1) Malay-Voice-Handicap Index-10 (mVHI-10); 2) maximum phonation time (MPT); and 3) acoustic analysis [jitter%, shimmer% and noiseharmonic ratio (NHR)] were used to assess the treatment progress. The voice parameters were measured at baseline (2 weeks pre-injection), and at the first and third months post-injection. Results: The mean age of the 29 patients was 44.69 years, with a female-to-male ratio of 3.14:1. The voice outcomes measured at different time points were evaluated with repeated measures ANOVA. Significant improvement was observed from baseline to three months post injection laryngoplasty for mVHI-10, jitter, and NHR (p<0.001), shimmer (p=0.005) and MPT (p=0.018). Following the procedure, none of the patients developed any major complications. Conclusion: Office setting early transthyrohyoid injection laryngoplasty using a double-bend needle is a safe and effective procedure in patients with UVFP with evidence of significant improvement in voice and life quality. [ABSTRACT FROM AUTHOR]

Objective: To study the effectiveness of early percutaneous transthyrohyoid injection laryngoplasty under local anesthesia in improving voice quality in unilateral vocal fold paralysis (UVFP) patients. Methods: Longitudinal data of 29 UVFP patients who underwent injection laryngoplasty within six months from the onset of the symptoms were studied. The injectate (0.5-1 mL) was hyaluronic acid-based material (Juvéderm ULTRA XC; Allergan Industrie, France) that was delivered under local anesthesia with transthyrohyoid approach using a double-bend 21G needle. Multidimensional voice outcomes employing: 1) Malay-Voice-Handicap Index-10 (mVHI-10); 2) maximum phonation time (MPT); and 3) acoustic analysis [jitter%, shimmer% and noiseharmonic ratio (NHR)] were used to assess the treatment progress. The voice parameters were measured at baseline (2 weeks pre-injection), and at the first and third months post-injection. Results: The mean age of the 29 patients was 44.69 years, with a female-to-male ratio of 3.14:1. The voice outcomes measured at different time points were evaluated with repeated measures ANOVA. Significant improvement was observed from baseline to three months post injection laryngoplasty for mVHI-10, jitter, and NHR (p<0.001), shimmer (p=0.005) and MPT (p=0.018). Following the procedure, none of the patients developed any major complications. Conclusion: Office setting early transthyrohyoid injection laryngoplasty using a double-bend needle is a safe and effective procedure in patients with UVFP with evidence of significant improvement in voice and life quality. [ABSTRACT FROM AUTHOR]

A 33-year-old woman was diagnosed with right recurrent laryngeal nerve (RLN) schwannoma. She presented with a long history of hoarseness, and only recently developed dysphagia. On physical examination, a mass was observed over the right cervical level IV. Endoscopic examination of the larynx showed that she had right unilateral vocal cord palsy. She successfully underwent transcervical resection of the tumour followed by injection laryngoplasty. This study discusses the presentation of the tumour, radiological findings, our working diagnosis and treatment options of RLN schwannoma. [ABSTRACT FROM AUTHOR]

A 57-year-old male chronic smoker with underlying diabetes mellitus presented with dysphonia associated with cough, dysphagia and reduced effort tolerance of 3 months’ duration. Videoendoscope finding revealed bilateral polypoidal and erythematous true and false vocal fold with small glottic airway. The patient was initially treated as having tuberculous laryngitis and started on antituberculous drug. However, no improvement was observed. CT of the neck showed erosion of thyroid cartilage, which points to laryngeal carcinoma as a differential diagnosis. However, the erosion was more diffuse and appeared systemic in origin. The diagnosis of laryngeal perichondritis was made when the histopathological examination revealed features of inflammation, and the tracheal aspirate isolated Pseudomonas aeruginosa. The patient made a good recovery following treatment with oral ciprofloxacin. [ABSTRACT FROM AUTHOR]

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Abstract We report a bizarre case of accessory larynx in an infant with OEIS syndrome (omphalocele, cloacal exstrophy, imperforated anus & spinal defects). This is the first reported case in literature of a duplicate accessory larynx which is a mirror image of the true larynx. A congenital duplication of the larynx is a rare anomaly and can present in various forms. In this case, the infant presented with recurrent lung infection and inability to wean off oxygen. Scope revealed severe laryngomalacia in addition to the accessory larynx. Hence, supraglottoplasty was done with aim to resolve the lung and airway problem. [ABSTRACT FROM AUTHOR]

Introduction A functioning voice is essential for normal human communication. A good voice requires two moving vocal folds; if one fold is paralysed (unilateral vocal fold paralysis (UVFP)) people suffer from a breathy, weak voice that tires easily and is unable to function normally. UVFP can also result in choking and breathlessness. Current treatment for adults with UVFP is speech therapy to stimulate recovery of vocal fold (VF) motion or function and/or injection of the paralysed VF with a material to move it into a more favourable position for the functioning VF to close against. When these therapies are unsuccessful, or only provide temporary relief, surgery is offered. Two available surgical techniques are: (1) surgical medialisation; placing an implant near the paralysed VF to move it to the middle (thyroplasty) and/or repositioning the cartilage (arytenoid adduction) or (2) restoring the nerve supply to the VF (laryngeal reinnervation). Currently there is limited evidence to determine which surgery should be offered to adults with UVFP. Methods and analysis A feasibility study to test the practicality of running a multicentre, randomised clinical trial of surgery for UVFP, including: (1) a qualitative study to understand the recruitment process and how it operates in clinical centres and (2) a small randomised trial of 30 participants recruited at 3 UK sites comparing non-selective laryngeal reinnervation to type I thyroplasty. Participants will be followed up for 12 months. The primary outcome focuses on recruitment and retention, with secondary outcomes covering voice, swallowing and quality of life. Ethics and dissemination Ethical approval was received from National Research Ethics Service--Committee Bromley (reference 11/LO/0583). In addition to dissemination of results through presentation and publication of peer-reviewed articles, results will be shared with key clinician and patient groups required to develop the future large-scale randomised controlled trial. Trial registration number ISRCTN90201732; 16 December 2015. [ABSTRACT FROM AUTHOR]

Vocal fold injection is a preferred treatment in glottic insufficiency because it is relatively quick and cost-saving. However, researchers have yet to discover the ideal biomaterial with properties suitable for human vocal fold application. The current systematic review employing PRISMA guidelines summarizes and discusses the available evidence related to outcome measures used to characterize novel biomaterials in the development phase. The literature search of related articles published within January 2010 to March 2021 was conducted using Scopus, Web of Science (WoS), Google Scholar and PubMed databases. The search identified 6240 potentially relevant records, which were screened and appraised to include 15 relevant articles based on the inclusion and exclusion criteria. The current study highlights that the characterization methods were inconsistent throughout the different studies. While rheologic outcome measures (viscosity, elasticity and shear) were most widely utilized, there appear to be no target or reference values. Outcome measures such as cellular response and biodegradation should be prioritized as they could mitigate the clinical drawbacks of currently available biomaterials. The review suggests future studies to prioritize characterization of the viscoelasticity (to improve voice outcomes), inflammatory response (to reduce side effects) and biodegradation (to improve longevity) profiles of newly developed biomaterials. [ABSTRACT FROM AUTHOR]

The article presents a case study of a 48-year-old lady, who shows symptoms of painful parotid swelling and was diagnosed with chronic parotid sialadenitis. The patient was given antibiotic for her symptoms and underwent medical tests for parotid sialadenitis. The patient has received parotidectomy to minimize the risk of bleeding and infection in the facial nerve. It mentioned the management of chronic sialadenitis through a conservative treatment.

Background: Head and neck tissue sarcoma are rare with potential high morbidity and mortality. The purpose of the present study was to present these cases and determine the optimal treatment for adult patients with head and neck soft tissue sarcomas. Methods: It is a retrospective study of adult head and neck soft tissue sarcoma conducted in the Department of Otorhinolaryngology at Universiti Kebangsaan Malaysia Medical Centre (UKMMC) which is one of the national referral center within the period of 16 years from 1998 till 2014. Results: Fourteen cases were reviewed in which7 histopathological variations of soft tissue sarcomas were identified. Local control after surgery alone or combined with radiotherapy was obtained in 50 % of the patients which is influenced by histologic grade, tumor size, and surgical margins. Patients with high-grade tumors or positive margins have improved local control if adjuvant radiotherapy is used. Distant metastases occurred in 14.2 % of patients and the 5-year survival rate was 50 %. Conclusions: The optimal treatment for adult head and neck soft tissue sarcomas is surgery. Adjuvant radiotherapy improves outcomes for those with high-grade tumors or positive margins. [ABSTRACT FROM AUTHOR]

Benign parotid neoplasm and inflammatory processes of the parotid resulting in facial paralysis are extremely rare. We report a 72 -year-old Malay female with poorly-controlled diabetes mellitus who presented with a painful right parotid swelling associated with right facial nerve palsy. The paralysis (Grade VI, House and Brackmann classification) remained after six months. [ABSTRACT FROM AUTHOR]