Maragos, Nicolas E.

Extraskeletal Ewing's sarcoma is a rare malignant neoplasm. Arising from a primitive mesenchymal stem cell and primarily affecting young adults, this lesion demands aggressive therapy, including surgical treatment, radiation therapy, and chemotherapy.

Objectives/HypothesisExternal beam radiation to the neck is widely considered a contraindication for thyroplasty due to concern for infection and implant extrusion. We present a case series of our experience regarding thyroplasty performed in a previously radiated field.Study DesignRetrospective case study at a tertiary academic referral center.MethodsUsing the institution's clinical notes search tool, records from 1999 through 2014 documenting thyroplasty and radiation were identified and reviewed. Patients who received external beam radiation to the operative field prior to thyroplasty were included. Data including duration of radiation, timing and specifics of thyroplasty, postoperative complications, risk factors, clinical voice outcomes, and length of follow‐up were collected.ResultsFourteen patients met criteria for the study. Of all thyroplasty performed, 11 were Silastic implants, two were Gore‐Tex implants, six had concurrent arytenoid adduction, and one was a midline type II thyroplasty. In terms of risk factors for postoperative complications, two were diabetic, none were active smokers, and one had a splenectomy. All patients were given postoperative antibiotics. The median duration of follow‐up after surgery was 14.2 months. No patients were found to have postoperative complications. Pre‐ and postoperative voice data were assessed. Overall, there was improvement in voice outcomes.ConclusionsThyroplasty may be an option for patients who have previously undergone external beam radiation. Short‐term and intermediate outcomes in our patients showed no postoperative complications, and generally voice or dysphagia improved. Careful selection is still warranted when considering thyroplasty in a previously irradiated neck, and long‐term outcomes need further study.Level of Evidence4 Laryngoscope, 126:1849–1853, 2016

Objective: Endoscopic medial partial arytenoidectomy has been described previously for expansion of the posterior glottic airway in bilateral vocal fold paralysis. Superomedial submucosal partial arytenoidectomy (SSPA), a modification of this technique, can improve glottic closure in the setting of an obstructing anteromedially prolapsed arytenoid. We present our surgical technique and a case example. Methods and Results: A 45-year-old man presented with dysphonia attributable to unilateral true vocal fold paralysis. Laryngoscopy revealed right true vocal fold atrophy and an anteriorly prolapsed right arytenoid cartilage preventing posterior glottic closure during adduction. Right SSPA and ipsilateral vocal fold injection augmentation were performed without complication. One-month and 11-month postoperative evaluations showed marked improvement in voice, with complete glottic closure. Quality-of-life assessment and patient report showed a durable result at 50 months. Conclusion: SSPA may be a valuable technique in the management of breathy dysphonia associated with posterior glottic gap and other sequelae of the malpositioned arytenoid.