Electrothermal bipolar vessel sealing devices are electrosurgical devices that seal tissues and blood vessels up to 7 mm in diameter. This paper discusses our experience using electrothermal bipolar vessel sealing devices in transoral head and neck surgery.

Electrothermal bipolar vessel sealing devices were used in five patients with lesions of varying size and type within the pharyngo-larynx. These were treated transorally by the otolaryngology department at the Royal Adelaide Hospital. Either the Medtronic LigaSure or BiZact devices were used for transoral resection, debulking or division of these lesions.

Electrothermal bipolar vessel sealing devices were considered helpful in four out of the five cases. Success was dependent on suitable transoral access. A single unsuccessful case reflected the LigaSure jaw's inability to engage a large tumour effectively.

Electrothermal bipolar vessel sealing devices can be safely deployed transorally to treat lesions of the upper aero-digestive tract in selected patients. Further studies investigating additional indications would broaden applications of this approach.

Non-fatal strangulation as a consequence of a sexual assault attack or domestic violence represents serious bodily harm. Otolaryngologists have an important role in documenting physical findings and managing airway symptoms. This study aimed to describe our otolaryngology department's experience managing patients referred from the sexual assault referral centre who suffered non-fatal strangulation.

A retrospective analysis of patients suffering non-fatal strangulation referred to the Manchester University Hospitals NHS Foundation Trust Otolaryngology Department from Saint Mary's Sexual Assault Referral Centre in Manchester between 1 January 2017 and 31 December 2019 was carried out.

A total of 86 patients were referred from Saint Mary's Sexual Assault Referral Centre. Of these patients, 56 were given telephone advice and the remaining 30 were seen by the on-call otolaryngology team. In addition, 20 out of 30 (66.6 per cent) patients underwent fibre-optic nasal endoscopy. Common presenting symptoms were neck pain (81.4 per cent), dyspnoea (80.2 per cent) and dizziness (72.1 per cent). Five patients had identifiable laryngeal injury on endoscopy.

Meticulous documentation is recommended when managing patients who suffer non-fatal strangulation because medical records may be used as evidence in criminal investigations.

This study used the European Laryngeal Society (2016) and Ni (2011 and 2019) classifications for narrow-band imaging and correlated the findings with histopathology.

Retrospective analysis was conducted by retrieving data of patients who underwent micro-laryngoscopy for suspicious glottic lesions. The narrow-band imaging findings were classified using both classification systems. Retrieved histopathology report findings were correlated with narrow-band imaging data.

Using the European Laryngeal Society and Ni classifications, 37 (69.8 per cent) and 35 (66 per cent) patients, respectively, were suspected to have malignant lesions. Upon histopathology, 37 (69.8 per cent) lesions were malignant. Sensitivity, specificity, positive predictive value, negative predictive value and accuracy using the European Laryngeal Society classification were 91.9 per cent, 81.3 per cent, 91.9 per cent, 81.3 per cent and 88.7 per cent, and using the Ni classification were 91.9 per cent, 93.8 per cent, 97.1 per cent, 83.3 per cent and 92.5 per cent, respectively.

The Ni classification had better specificity and accuracy. The European Laryngeal Society classification is simple to use and may serve as a useful screening tool. For optimum results, both European Laryngeal Society and Ni classifications may be used together, in that order.

This study aimed to identify associative factors for tracheostomy in patients presenting with airway obstruction.

Data from a tertiary hospital were reviewed to identify patients who presented with airway obstruction between 2009 and 2020. Patient demographics, causative pathology and treatments were analysed.

The study identified 297 admitted patients. Of these, 66 underwent a tracheostomy and formed the ‘tracheostomy’ group and 231 formed the ‘other intervention’ group. The tracheostomy group had a higher mean age (p = 0.003), and higher percentages of males (p = 0.031) and smokers or ex-smokers (p = 0.020), compared to the other intervention group. The tracheostomy group also had a higher number of patients with a malignancy (p < 0.001) compared to the other intervention group.

Being older, male, a previous or current smoker, or developing airway obstruction due to a malignancy were found to be the main associative factors for requiring a tracheostomy.

To report the outcome of 18 patients with a tracheostomy secondary to bilateral vocal fold immobility, who were managed using reconstructive transoral laser microsurgical techniques.

A retrospective review was conducted of the surgical outcome of 18 patients with bilateral vocal fold immobility and a tracheostomy resulting from different aetiologies. Follow-up duration ranged from one to five years.

A total of 18 patients had a tracheostomy at presentation because of bilateral true vocal fold immobility and stridor. All cases were treated using reconstructive transoral laser microsurgery with arytenoidectomy and vocal fold lateralisation. All patients were successfully decannulated by eight weeks after surgery.

Reconstructive transoral laser microsurgery using partial arytenoidectomy with vocal fold lateralisation is minimally invasive, feasible, safe and effective for airway reconstruction in patients who present with stridor due to bilateral true vocal fold immobility.

Pachyonychia congenita is a rare keratinising disorder, which typically presents during the first three years of life and usually affects the nails and palmoplantar surfaces. It can involve the larynx and potentially result in life-threatening airway obstruction.

A case report is presented and the findings of a literature review are reported. The review involved a PubMed search using the keywords ‘pachyonychia congenita’ together with ‘larynx’, ‘laryngeal involvement’, ‘laryngeal obstruction’, ‘airway obstruction’, ‘hoarseness’ and/or ‘stridor’.

A five-year-old boy, with confirmed pachyonychia congenita, presented with complications of laryngeal involvement over a four-year period. He required three intubations and a tracheostomy for acute airway obstruction. Treatment with potassium titanyl phosphate laser laryngoscopy stabilised the progression of laryngeal disease.

Patients with pachyonychia congenita and laryngeal involvement can have a varied presentation, ranging from hoarseness to acute airway obstruction. Management can be a challenge, requiring early evaluation, regular surveillance and aggressive treatment. This paper reports our experience in managing and treating the laryngeal complications of a child with pachyonychia congenita.

This paper reports a case of achalasia in a 12-year-old girl who presented with stridor.

An otherwise healthy 12-year-old girl presented to the ENT clinic with an 18-month history of dysphagia and noisy breathing on eating. Flexible fibre-optic examination showed a normal larynx with normal vocal fold movements. Fibre-optic endoscopic evaluation of swallowing was normal initially, but biphasic stridor occurred after several swallows. Microlaryngoscopy, bronchoscopy and upper oesophagoscopy showed a dilated oesophagus with normal mucosa. Bronchoscopy showed tracheomalacia of the distal trachea, which reduced the airway by approximately 75 per cent. This was caused by posterior compression from redundant oesophageal mucosa with dilatation as a result of retained fluids. Videofluoroscopy suggested achalasia, which was confirmed by oesophageal manometry. Her symptoms improved following a Heller's myotomy.

This is the first paediatric case in the English literature of achalasia presenting with stridor. The condition was correctable with surgical intervention.

Cervical spine metastases account for 10 per cent of all spinal metastases. We report three cases of cervical spine metastases whose unusual primary presentation was with ENT-related symptoms.

The three patients reported herein did not have a confirmed diagnosis of malignancy at presentation. The first patient presented with stridor, the second presented with dysphagia and the third presented with dysphonia. All patients complained of significant neck pain that preceded and was concomitant to the other symptoms. Clinical suspicion of cervical spine involvement led to radiological investigation with computed tomography, which showed metastatic lesions in the craniovertebral junction and cervical spine region. Histological confirmation of malignancy was obtained for two of the three patients. The condition proved uniformly fatal in the weeks following diagnosis. A review of the literature on this condition was conducted using PubMed and Medline databases.

Cervical spine pathology may present initially to the ENT surgeon. A high degree of suspicion of cervical spine involvement should be maintained in elderly patients with persistent or progressive neck pain, with or without other ENT symptoms. Adequate radiological imaging will usually confirm the diagnosis.

This paper reports on two rare cases of neonatal airway lesions with differing aetiology that were successfully managed by surgery, and provides a review of the literature on neonatal stridor and airway lesions.

In the first case report, a newborn presented with a nasopharyngeal teratoma. In the second case report, a newborn presented with a congenital laryngeal saccular cyst. Difficulties in the diagnosis of these lesions, and surgical and anaesthetic challenges in their management are discussed.

Every case of neonatal airway distress must be evaluated and the cause of stridor needs to be established. It is important that rare lesions such as teratomas and laryngeal cysts are not overlooked; a high index of suspicion for these congenital anomalies is necessary. These airway lesions should be managed in an institutional setting by a multidisciplinary team.

To illustrate a case of an iatrogenic mucosal tear in the trachea which caused a one-way valve effect, obstructing the airway and manifesting as post-extubation stridor.

We report a case of iatrogenic tracheal mucosal tear secondary to violent movement during intubation. The patient presented with post-extubation stridor that worsened over three days. Initial evidence suggested tracheal stenosis. Computed tomography scans revealed a mucosal tear at the level of the seventh cervical to second thoracic vertebrae. The tear was caused by forceful inflow of air as breathing became more and more difficult, resulting in a false tract. A tracheostomy changed the direction of airflow, bypassing the tear. The inflated tracheostomy tube cuff acted as a stent to keep the flap in place as healing occurred.

Iatrogenic laryngotracheal injuries are common, especially when endotracheal intubation is performed under unfavourable emergency conditions. A tracheal mucosal tear is a rare entity which is almost always undiagnosed. However, a tracheal mucosal flap may be suspected when changes in patient position alter the nature and severity of the resultant stridor and/or respiratory distress. In such cases, an inflated tracheostomy tube cuff should be kept in place for an adequate period, to act as a stent and help keep the flap in place while healing occurs.

Anomalies of the fourth arch are the rarest of all the branchial anomalies. They arise as a result of failure of involution of the cleft during embryogenesis, and manifest clinically as sinuses, cysts or abscesses in the neck, commonly presenting in childhood.

This article describes a case of a neonate presenting with stridor which was secondary to a fourth branchial pouch sinus. The presentation, investigations, operative findings and treatment are discussed.

Microlaryngobronchoscopy was done to evaluate the stridor. A swelling in the posterolateral pharyngeal wall and a sinus opening in the pyriform fossa on the left side were identified. There were no external neck swellings. Magnetic resonance imaging confirmed a swelling in the expected region filled with air and fluid. After the diagnosis was confirmed, the swelling was aspirated and the fourth arch pouch treated. Microlaryngobronchoscopy was repeated six weeks later, showing complete resolution of the pharyngeal swelling. At this stage, the child had no airway symptoms and was feeding normally.

This is an interesting case of a fourth branchial cleft pouch presenting with stridor. The child was treated without any complications and recovered well.

We report a rare case of tuberculosis presenting with bilateral vocal fold palsy.

Case report and discussion of ENT manifestations of tuberculosis.

A 39-year-old man presented with stridor and bilateral vocal fold palsies, and underwent an emergency tracheostomy. Intra-operatively, a mass was identified overlying the thyroid cartilage. Fine needle aspiration cytology of this mass showed well formed granulomas but negative Ziehl–Nielsen staining. Computed tomography showed the mass to be surrounding the thyroid cartilage, causing airway occlusion; pulmonary infiltrates were also seen. The patient was commenced on tuberculosis treatment. Subsequent sputum samples from the tracheostomy confirmed the diagnosis. The patient responded very well to treatment, and was successfully decannulated after one week.

The incidence of tuberculosis in the UK is increasing, particularly in urban areas. The otolaryngologist may encounter a wide variety of presentations. Diagnosis requires a high index of clinical suspicion.

Cystic lesions related to the upper airway are an unusual cause of infantile stridor. Such a lesion may exert a mass effect, with subsequent airway compromise.

A six-month-old boy was transferred to our unit with a right-sided, level IV neck lump and a three-month history of chronic cough and, latterly, inspiratory stridor. Computed tomography revealed a large, unilocular, cystic, cervicothoracic lesion causing marked compression of the trachea. Airway endoscopy subsequently revealed the larynx to be displaced to the left, with severe external compression of the trachea from just below the subglottic level to immediately above the carina. The mediastinal lesion was excised via an external approach. The histological diagnosis was a bronchogenic cyst.

Bronchogenic cysts are a rare cause of infantile stridor, and should be considered in the differential diagnosis of cystic cervical and mediastinal masses. Surgical excision is the treatment of choice.

(1) To present a rare case of stridor secondary to prolonged laryngospasm in a patient with Parkinson's disease, and (2) to review the literature on stridor in Parkinson's disease.

We report a 73-year-old Parkinson's disease patient who developed acute stridor due to prolonged laryngospasm triggered by overspill of excessive secretions. The literature was reviewed, following a Medline search using the keywords ‘Parkinson's disease’ and ‘stridor’ or ‘airway obstruction’ or ‘laryngospasm’ or ‘laryngeal dystonia’ or ‘bilateral vocal cord palsy’.

Only 12 previously reported cases of stridor in Parkinson's disease patients were identified. Causes included bilateral vocal fold palsy (eight cases), laryngospasm (five), and dystonia of the jaw and neck muscles (two). The mechanism of laryngospasm in our patient was similar to ‘dry drowning’, and has not previously been described.

Laryngospasm can be triggered in Parkinson's disease by excessive secretions entering the larynx. The mechanism is similar to ‘dry drowning’. Treatment focuses on reducing secretions. The use of botulinum toxin to reduce spasm is inappropriate in this situation. This case emphasises the importance of recognising different causes of stridor in Parkinson's disease patients, as this affects management.

A case of tracheopathia chondro-osteoplastica causing sub-glottic stenosis is described.

Case report and literature review.

A 37-year-old man presented with a 15-year history of gradually worsening dyspnoea and stridor due to sub-glottic stenosis. His medical and radiographic records were reviewed. This patient's presentation, histopathological findings and radiology images are presented and discussed.

Histopathological evaluation of microlaryngoscopy biopsy specimens, taken during laser debulking of the stenosis, confirmed the presence of tracheopathia chondro-osteoplastica.

This is the first reported case of sub-glottic stenosis caused by tracheopathia chondro-osteoplastica which required an urgent tracheostomy.