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Ear, Nose, & Throat Journal Nov 2022Leukoplakia is a precancerous lesion considered to be within the spectrum of histopathological results from parakeratosis, through stages of dysplasia to invasive... (Review)
Review
INTRODUCTION
Leukoplakia is a precancerous lesion considered to be within the spectrum of histopathological results from parakeratosis, through stages of dysplasia to invasive cancer. Narrow band imaging (NBI) endoscopy has been introduced to improve early diagnosis of benign and malignant laryngeal lesions. The aim of this literature review was to evaluate the accuracy of preoperative evaluation of vocal fold leukoplakia with NBI endoscopy in comparison with histology.
METHODS
A systematic review of the literature was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, using 3 different databases: PubMed, Embase, and Scopus. The included articles in the systematic review were identified combining each of the following terms: "narrow band imaging" OR "NBI," [AND] with each of these terms: "laryngeal leukoplakia," OR "vocal fold leukoplakia," OR "vocal cord leukoplakia."
RESULTS
The articles that fully met the inclusion criteria were 5 case series, conducted between January 2010 and February 2018, and published between 2017 and 2019. The selected articles included 312 patients (86% males and 14% females), affected by 382 vocal cord leukoplakia, evaluated with NBI endoscopy and that underwent surgical microlaryngoscopy with biopsy. Based on the studies included in the review, accuracy of NBI in predicting malignancy within leukoplakia ranged from 81% to 97.8%, demonstrating to be an accurate method to predict the risk of malignant transformation of vocal fold leukoplakia.
CONCLUSION
Narrow band imaging can help otolaryngologists in the decision-making process on the necessity to perform a biopsy and transoral surgery or long-term follow-up. Larger studies are necessary to confirm the high association of NBI evaluation of the epithelium surrounding the leukoplakia with the histological diagnosis.
Topics: Endoscopy; Endoscopy, Gastrointestinal; Female; Humans; Laryngeal Neoplasms; Leukoplakia; Male; Narrow Band Imaging; Vocal Cords
PubMed: 33213196
DOI: 10.1177/0145561320973770 -
European Annals of Otorhinolaryngology,... Jun 2019Vocal fold paralysis in adduction can result in significant breathing difficulties. Techniques such as vocal fold lateralization and/or arytenoidopexy help to improve...
Vocal fold paralysis in adduction can result in significant breathing difficulties. Techniques such as vocal fold lateralization and/or arytenoidopexy help to improve respiratory function in this setting. These techniques require open approach or specific instruments. The authors describe an original vocal fold lateralization technique performed exclusively via an endoscopic approach. This technique helps to enlarge the glottic aperture, while preserving laryngeal architecture, and permanently improves respiratory function in patients with vocal fold paralysis in adduction.
Topics: Anesthesia, General; Arytenoid Cartilage; Humans; Laryngoscopy; Larynx; Suture Techniques; Vocal Cord Paralysis; Vocal Cords
PubMed: 30420321
DOI: 10.1016/j.anorl.2018.10.014 -
Acta Cirurgica Brasileira 2022To present a detailed, reproducible, cost-efficient surgical model for controlled subepithelial endoscopic vocal fold injury in the rat model.
PURPOSE
To present a detailed, reproducible, cost-efficient surgical model for controlled subepithelial endoscopic vocal fold injury in the rat model.
METHODS
Six male Sprague Dawley rats were enrolled in the experiment. The left vocal folds were used to carry out the injury model, and the right vocal fold served as control. After deep sedation, the rats were placed on a custom operating platform. The vocal fold injury by subepithelial stripping was carried out using custom-made microsurgical instruments under endoscopic guidance. Data were analyzed for procedural time and post-procedural pain. Microcomputed tomography (micro-CT) scan and histologic images were obtained to assess the length, area, and depth of injury to the vocal fold.
RESULTS
The mean procedural time was 112 s. The mean control vocal fold length was 0.96 ± 0.04 mm. The mean vocal fold injury length was 0.53 ± 0.04 mm. The mean vocal fold surface was 0.18 ± 0.01 mm2 with a mean lesion area of 0.05 ± 0.00 mm2. Mean vocal fold injury depth was 375.4 ± 42.8 μm. The lesion length to vocal fold length ratio was 0.55 ± 0.03, as well as lesion area to vocal fold surface area was 0.29 ± 0.02.
CONCLUSIONS
Our described experimental vocal fold injury model in rats is found to be fast, safe, cost-efficient, and reproducible with a rapid learning curve.
Topics: Animals; Endoscopy; Male; Models, Theoretical; Rats; Rats, Sprague-Dawley; Vocal Cords; X-Ray Microtomography
PubMed: 35416860
DOI: 10.1590/acb370106 -
Annals of the Royal College of Surgeons... Jan 2024Flexible nasendoscopy (FNE) is the principal assessment method for vocal cord movement. Because the procedure is inherently subjective it may not be possible for...
INTRODUCTION
Flexible nasendoscopy (FNE) is the principal assessment method for vocal cord movement. Because the procedure is inherently subjective it may not be possible for clinicians to grade the degree of vocal cord movement reliably. The aim of this study was to assess the accuracy and consistency of grading vocal cord movement as viewed via FNE.
METHODS
Thirty FNE videos, without sound or clinical information, were assessed by six consultant head and neck surgeons. The surgeons were asked to assess and grade right and left vocal cord movement independently, based on a five-category scale. This process was repeated three times on separate occasions. Agreement and reliability were assessed.
RESULTS
Mean overall observed inter-rater agreement was 67.7% (sd 1.9) with the five-category scale, increasing to 91.4% (sd 1.9) when a three-category scale was derived. Mean overall observed intra-rater agreement was 78.3% (sd 9.7) for five categories, increasing to 93.1% (sd 3.3) for three categories. Discriminating vocal cord motion was less reliable using the five-category scale ( = 0.52) than with the three-category scale ( = 0.68).
CONCLUSIONS
This study demonstrates quantitatively that it is challenging to accurately and consistently grade subtle differences in vocal cord movement, as proven by the reduced agreement and reliability when using a five-point scale instead of a three-point scale. The study highlights the need for an objective measure to help in the assessment of vocal cord movement.
Topics: Humans; Vocal Cords; Vocal Cord Paralysis; Reproducibility of Results; Laryngoscopy; Observer Variation
PubMed: 36263913
DOI: 10.1308/rcsann.2022.0091 -
Journal of Visualized Experiments : JoVE May 2020The purpose of this tutorial is to describe the preparation of the rat vocal fold for histochemical neuromuscular study. This protocol outlines procedures for rat...
The purpose of this tutorial is to describe the preparation of the rat vocal fold for histochemical neuromuscular study. This protocol outlines procedures for rat laryngeal dissection, flash-freezing, and cryosectioning of the vocal folds. This study describes how to cryosection vocal folds in both longitudinal and cross-sectional planes. A novelty of this protocol is the laryngeal tracking during cryosectioning that ensures accurate identification of the intrinsic laryngeal muscles and reduces the chance of tissue loss. Figures demonstrate the progressive cryosectioning in both planes. Twenty-nine rat hemi-larynges were cryosectioned and tracked from the emergence of the thyroid cartilage to the appearance of the first section that included the full vocal fold. The full vocal fold was visualized for all animals in both planes. There was high variability in the distance from the appearance of the thyroid cartilage to the appearance of the full vocal fold in both planes. Weight was not correlated to depth of laryngeal landmarks, suggesting individual variability and other factors related to tissue preparation may be responsible for the high variability in the appearance of landmarks during sectioning. This study details a methodology and presents morphological data for preparing the rat vocal fold for histochemical neuromuscular investigation. Due to high individual variability, laryngeal landmarks should be closely tracked during cryosectioning to prevent oversectioning tissue and tissue loss. The use of a consistent methodology, including adequate tissue preparation and awareness of landmarks within the rat larynx, will assist with consistent results across studies and aid new researchers interested in using the rat vocal fold as a model to investigate laryngeal neuromuscular mechanisms.
Topics: Animals; Cross-Sectional Studies; Rats; Vocal Cords
PubMed: 32478747
DOI: 10.3791/61327 -
Acta Otorrinolaringologica Espanola 2015Tissue engineering is a rapidly developing field that, making biological substitutes for the repair and regeneration of damaged tissues, will play an important role in... (Review)
Review
INTRODUCTION
Tissue engineering is a rapidly developing field that, making biological substitutes for the repair and regeneration of damaged tissues, will play an important role in the future of otorhinolaryngology.
OBJECTIVE
In this article we explain the principles of regenerative medicine and its potential applications in Otorhinolaryngology.
MATERIALS AND METHODS
The authors searched the published literature on this topic, chose relevant references, and extracted and systematized the data.
RESULTS AND CONCLUSION
There are some exciting possibilities for future treatments in otorhinolaryngology applying the concepts of tissue engineering.
Topics: Cell- and Tissue-Based Therapy; Extracellular Matrix; Forecasting; Humans; Hyaluronic Acid; Intercellular Signaling Peptides and Proteins; Otolaryngology; Plastic Surgery Procedures; Regenerative Medicine; Stem Cell Transplantation; Tissue Engineering; Vasodilator Agents; Vibration; Vocal Cords
PubMed: 25440936
DOI: 10.1016/j.otorri.2014.03.007 -
Journal of Voice : Official Journal of... Jul 2016The aim of this study was to quantify porcine vocal fold medial surface geometry and three-dimensional geometric distortion induced by freezing the larynx, especially in... (Comparative Study)
Comparative Study
OBJECTIVE
The aim of this study was to quantify porcine vocal fold medial surface geometry and three-dimensional geometric distortion induced by freezing the larynx, especially in the region of the vocal folds.
STUDY DESIGN
The medial surface geometries of five excised porcine larynges were quantified and reported.
METHODS
Five porcine larynges were imaged in a micro-CT scanner, frozen, and rescanned. Segmentations and three-dimensional reconstructions were used to quantify and characterize geometric features. Comparisons were made with geometry data previously obtained using canine and human vocal folds as well as geometries of selected synthetic vocal fold models.
RESULTS
Freezing induced an overall expansion of approximately 5% in the transverse plane and comparable levels of nonuniform distortion in sagittal and coronal planes. The medial surface of the porcine vocal folds was found to compare reasonably well with other geometries, although the compared geometries exhibited a notable discrepancy with one set of published human female vocal fold geometry.
CONCLUSIONS
Porcine vocal folds are qualitatively geometrically similar to data available for canine and human vocal folds, as well as commonly used models. Freezing of tissue in the larynx causes distortion of around 5%. The data can provide direction in estimating uncertainty due to bulk distortion of tissue caused by freezing, as well as quantitative geometric data that can be directly used in developing vocal fold models.
Topics: Animals; Dogs; Freezing; Humans; Imaging, Three-Dimensional; Models, Anatomic; Phonation; Radiographic Image Interpretation, Computer-Assisted; Species Specificity; Sus scrofa; Vocal Cords; X-Ray Microtomography
PubMed: 26292797
DOI: 10.1016/j.jvoice.2015.06.009 -
Structure and Function of the Vocal Cords after Airway Reconstruction on Magnetic Resonance Imaging.The Laryngoscope Jul 2021Dysphonia is a common problem at long-term follow-up after airway surgery for laryngotracheal stenosis (LTS) with major impact on quality of life. Dysphonia after LTS... (Observational Study)
Observational Study
OBJECTIVES/HYPOTHESIS
Dysphonia is a common problem at long-term follow-up after airway surgery for laryngotracheal stenosis (LTS) with major impact on quality of life. Dysphonia after LTS can be caused by scar tissue from initial stenosis along with anatomical alterations after surgery. There is need for a modality to noninvasively image structure and function of the reconstructed upper airways including the vocal cords to assess voice outcome and possible treatment after LTS. Our objective was to correlate vocal cord structure and function of patients after airway reconstruction for LTS on static and dynamic magnetic resonance imaging (MRI) to voice outcome.
STUDY DESIGN
Prospective cohort study.
METHODS
Voice outcome was assessed by voice questionnaires ((pediatric) Voice Handicap Index (p)VHI)) and the Dysphonia Severity Index (DSI). Postsurgical anatomy, airway lumen, and vocal cord thickness and movement on multiplanar static high-resolution MRI and dynamic acquisitions during phonation was correlated to voice outcome.
RESULTS
Forty-eight patients (age 14.4 (range 7.5-30.7) years) and 11 healthy volunteers (15.9 (8.2-28.8) years) were included. Static MRI demonstrated vocal cord thickening in 80.9% of patients, correlated to a decrease in DSI (expected odds 0.75 [C.I. 0.58-0.96] P = .02). Dynamic MRI showed impaired vocal cord adduction during phonation in 61.7% of patients, associated with a lower DSI score (0.65 [C.I. 0.48-0.88] P = .006).
CONCLUSIONS
In LTS patients, after airway reconstruction MRI can safely provide excellent structural and functional detail of the vocal cords correlating to DSI, with further usefulness expected from technical refinements. We therefore suggest MRI as a tool for extensive imaging during LTS follow-up.
LEVEL OF EVIDENCE
3 Laryngoscope, 131:E2402-E2408, 2021.
Topics: Adolescent; Adult; Aftercare; Case-Control Studies; Child; Dysphonia; Feasibility Studies; Follow-Up Studies; Healthy Volunteers; Humans; Laryngostenosis; Magnetic Resonance Imaging; Male; Phonation; Postoperative Complications; Prospective Studies; Quality of Life; Plastic Surgery Procedures; Severity of Illness Index; Vocal Cords; Voice Quality; Young Adult
PubMed: 33459361
DOI: 10.1002/lary.29399 -
Ear, Nose, & Throat Journal Dec 2022Reinke's edema and variceal hemorrhage are complex structural pathologies that affect the vocal cord mucosa. The vocal cords are highly susceptible to environmental... (Review)
Review
Reinke's edema and variceal hemorrhage are complex structural pathologies that affect the vocal cord mucosa. The vocal cords are highly susceptible to environmental stressors, such as smoking and vocal cord usage, thus, treatment involves their corresponding cessation. Here, we report a case of a patient with severe Reinke's edema and bilateral chronic vocal cord varices. The patient had a 30-pack-year history of cigarette smoking and was obstructed with intubation due to acute variceal hemorrhage and severe swelling of Reinke's edema. Moreover, a review of the literature regarding Reinke's edema and variceal hemorrhage treatment and their complications was performed.
Topics: Humans; Esophageal and Gastric Varices; Gastrointestinal Hemorrhage; Airway Obstruction; Vocal Cords; Varicose Veins; Edema
PubMed: 36052403
DOI: 10.1177/01455613221123825 -
CoDAS 2021To evaluate and compare the parameters of Digital kymography obtained through the High-speed Videolaryngoscopy of women without laryngeal disorders, of women with vocal... (Observational Study)
Observational Study
PURPOSE
To evaluate and compare the parameters of Digital kymography obtained through the High-speed Videolaryngoscopy of women without laryngeal disorders, of women with vocal fold nodules and of women with vocal cysts.
METHODS
A cross-sectional observational study in which 60 women aged 18 years and 45 years were selected. Three study groups were formed: 20 women without laryngeal disorder forming the control group (Group 1), 20 women with diagnosis of vocal fold nodules forming Group 2 and 20 women with diagnosis of vocal cysts forming Group 3. Subsequently the participants were evaluated by High-speed Videolaryngoscopy for analysis and comparison of laryngeal images using Digital kymography. The laryngeal parameters processed by the program KIPS® were: minimum, maximum and mean opening; dominant amplitude of the left and right vocal folds; dominant frequency of the right and left vocal folds; and close.
RESULTS
The analysis of Digital kymography suggests that the presence of the vocal fold nodules and the vocal cysts tend to restrict more to the maximum and minimum opening of the vocal fold and the dominant amplitude of the opening variation in the middle region of the glottis.
CONCLUSION
Digital kymography parameters were similar in the presence of vocal fold nodules and vocal cysts lesions.
Topics: Adolescent; Cross-Sectional Studies; Cysts; Female; Humans; Kymography; Phonation; Vibration; Video Recording; Vocal Cords
PubMed: 34008770
DOI: 10.1590/2317-1782/20202020095