New Webpage on Bilateral Vocal Cord Paralysis (or Fixation)

We have written up a new webpage discussing the unfortunate situation of bilateral vocal cord paralysis whereby both breathing and vocal quality is adversely affected.

Treatment for bilateral vocal cord paralysis is difficult and there is no perfect solution. Treatment to improve breathing usually makes the voice worse. Treatment to improve the voice usually makes the breathing worse. The best (but not perfect) treatment tries to pick a happy medium to address the breathing while trying not to hurt the voice too much, though some degradation in vocal quality is to be expected. Such treatment includes posterior cordotomy +/- medial arytenoidectomy.

In another situation, the patient may have bilateral vocal cord fixation resulting in the appearance of vocal cord paralysis, but is potentially "curable" with normal breathing and normal voice being the goal.

Click here to read more! Video and audio also included.

To read more about UNILATERAL vocal cord paralysis, click here. Treatment is completely different than for bilateral vocal cord paralysis.

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Video of Endoscopic Salivary Stone Removal (Sialendoscopy)

The Doctors TV show actually produced a great (and accurate) segment on a relatively new procedure called sialendoscopy. This procedure allows a surgeon to remove a stone that may be blocking your spit gland from draining saliva into the mouth. This is analogous to a kidney stone which blocks urine from draining from the kidney into the bladder resulting in painful swelling of the kidney (causing flank pain).

How does a person know if they have a salivary gland blockage due to a stone? There is a painful swelling located right in front and/or below the ear if the parotid gland is affected, or under the jawbone if the submandibular gland is blocked.

If the blockage persists long enough, it may lead to an infection of the gland itself (sialadenitis).

Traditionally, if the stone doesn't pass on its own with conservative measures, stone removal required surgical removal of the entire gland or making an incision and removing the stone like it's a tumor mass.

Watch the video of this procedure being performed as shown on The Doctors here.

At this time, the only local surgeon I am aware of who offers this unique procedure in the mid-Atlantic region is Dr. Arjun Joshi.

Dr. Arjun Joshi (George Washington University Hospital in Washington DC)
2021 K St NW, Ste 206
Washington, DC 20006
Office Number: 202-741-3250
www.dcheadandneck.com

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Robotic Surgery for Oral Cancer

I encountered these amazing pictures in the Archives of Otolaryngology-Head & Neck Surgery Dec 2010 edition in an article titled "Transoral Robotic-Assisted Surgery for Head and Neck Squamous Cell Carcinoma". This surgery was performed at Mayo Clinic as well as University of Alabama.

Of note, there are also some YouTube videos of robotic surgery for thyroidectomy you can watch below or here.

Reference:
Transoral Robotic-Assisted Surgery for Head and Neck Squamous Cell Carcinoma. Archives of Otolaryngol Head Neck Surg 136(12):1248-1252; 2010

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Should Boys Also Get Vaccinated for HPV?

NPR on Aug 20, 2010 aired a story whether boys should also get vaccinated for HPV. It is well established that vaccines like Gardasil (FDA approved for boys last year) and Cervarix protect against two of the HPV types (HPV-16 and HPV-18) that can cause cervical cancer and some other genital cancers including anal, vulvar, vaginal, and penile cancers.

However, it may potentially prevent other types of HPV related disorders (NOT mentioned in the NPR story) involving the head & neck in both men and women, including:

Respiratory Papillomas (benign)
Throat Cancer
Oral Cancer (tongue, tonsil, salivary gland)
Oral ulcers/lesions/warts (benign)

According to epidemiological studies, there has been a dramatic increase in cancer involving the salivary glands and tongue attributed to HPV and were of squamous, acinar, and mucoepidermoid morphologic types. This increase in oral cavity cancer has occurred mainly in the 10-40 years age group and suspected to be secondary to increased acceptance of oral-genital sexual practices.

What is my personal feeling on whether boys should get vaccinated? I believe the answer is yes.

In order to receive the beneficial effect of the vaccine, the vaccine needs to be given in 3 doses (at $130 per dose) ideally between ages 9-26.

Read the NPR article here.

References:
Cancer of the oral cavity and pharynx in young females: increasing incidence, role of human papilloma virus, and lack of survival improvement. Semin Oncol. 36 (5), 451-9.

Prevention of human papillomavirus infections and associated diseases by vaccination: a new hope for global public health. Public Health Genomics. 12 (5-6), 319-30.

The epidemiology behind the HPV vaccine discovery. Ann Epidemiol. 19 (4), 239-44.

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Coffee Decreases Risk of Head & Neck Cancer

Researchers at University of Utah found that regular coffee drinkers who drank more than four cups of coffee a day had a 39 percent decreased risk of two types of head and neck cancer: oral cavity and pharynx cancers. In the study published in the journal of Cancer Epidemiology, Biomarkers & Prevention, they found however, that coffee did not decrease the risk of laryngeal cancer. Coffee contains over 1,000 different chemical compounds, including cancer-fighting antioxidants, and it’s those antioxidants that may provide a “plausible explanation” for reducing the cancer risk.

However, patients should not take this study as an excuse to increase their coffee intake specifically to counteract known cancer-causing behaviors including smoking, drinking alcohol, and chewing tobacco.

Read a CNN report on this here.

Reference:
Coffee and Tea Intake and Risk of Head and Neck Cancer: Pooled Analysis in the International Head and Neck Cancer Epidemiology Consortium. Cancer Epidemiol Biomarkers Prev, June 22, 2010; 1055-9965.

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