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Ear, Nose, & Throat Journal Oct 2023Arytenoid cartilage dislocation is considered as a rare laryngeal injury and closed reduction is commonly used as the first choice for the arytenoid dislocation....
Arytenoid cartilage dislocation is considered as a rare laryngeal injury and closed reduction is commonly used as the first choice for the arytenoid dislocation. However, the tools of closed reduction vary, and there is no dedicated tool for closed reduction, and the treatment outcome varies from person to person. This study compared the treatment outcome of the modified laryngeal forceps and traditional laryngeal forceps. This study conformed to the strengthening the reporting of observational studies in epidemiology guidelines regarding retrospective studies. From May 2021 to February 2023, the records of 28 patients with arytenoid cartilage dislocation caused by endotracheal intubation were reviewed. They were divided into the traditional group ( = 14) and the modified group ( = 14) by gender. Indirect or direct laryngoscopy, video stroboscopy, high-resolution computed tomography, and cricoarytenoid joint 3-dimensional reconstruction were used to evaluate arytenoid position and motion. Clinical characteristics, voice function, procedural skill, and treatment outcome for each case were recorded. Each patient was diagnosed with arytenoid dislocation caused by endotracheal intubation. There was no significant difference in the treatment outcome between the traditional group and the modified group ( .05). However, the median time interval between closed reduction and the return of normal voice in the traditional group was 31.08 ± 10.56 days, which was significantly longer than the median time of 17.92 ± 3.83 days in the modified group ( < .05). Closed reduction with the modified laryngeal forceps under local anesthesia is an effective and safe procedure. Compared with traditional laryngeal forceps, the modified laryngeal forceps can shorten the treatment duration.
PubMed: 37840263
DOI: 10.1177/01455613231205529 -
The Annals of Otology, Rhinology, and... Sep 2023To evaluate the relationship between arytenoid adduction asymmetry (AAA) and the demographic and morphological characteristics of true vocal fold (TVF) polyps and...
OBJECTIVES
To evaluate the relationship between arytenoid adduction asymmetry (AAA) and the demographic and morphological characteristics of true vocal fold (TVF) polyps and establish the cause and effect relationship between AAA and TVF polyps.
METHODS
Videolaryngostroboscopic findings of 163 patients with TVF polyps were retrospectively reviewed and categorized into Group 1 with AAA or Group 2 without AAA. Demographic details, clinicomorphological polyp characteristics, supraglottic phenomena, and AAA attributes were analyzed.
RESULTS
Group 1 was younger than Group 2 (fourth vs fifth decade; = .0066). Polyp characteristics showed no significant intergroup differences. The association between AAA and false vocal fold (FVF) adduction (65.28% vs 47.62% in Group 1 and 2 respectively; = .0441) was significant. In relation to TVF polyp laterality, contralateral and bilateral AAA and FVF adduction respectively, was significant.
CONCLUSION
AAA is a compensatory laryngeal adaptation akin to a FVF adduction muscle tension pattern. With a concomitant laryngeal pathology and high vocal demand, AAA is a consequence and not the cause for underlying laryngeal pathology which hinders glottic closure.
Topics: Humans; Retrospective Studies; Vocal Cord Paralysis; Laryngoscopy; Larynx; Laryngeal Diseases; Vocal Cords; Arytenoid Cartilage; Polyps
PubMed: 36239318
DOI: 10.1177/00034894221129906 -
The Laryngoscope May 2024To perform laryngeal framework surgery for unilateral vocal fold paralysis and obtain favorable voice improvement, it is necessary to accurately determine the vocal fold...
OBJECTIVE
To perform laryngeal framework surgery for unilateral vocal fold paralysis and obtain favorable voice improvement, it is necessary to accurately determine the vocal fold and arytenoid cartilage positions. Thus, the position and angle of the paralyzed vocal folds and arytenoid cartilage projected onto the affected thyroid plate were measured using computed tomography (CT) before and after surgery.
METHODS
Forty-six male patients with thyroid cartilage ossification observed on preoperative CT and vocal fold paralysis were included. Using Adobe Illustrator®, the thyroid plate on the affected side was reconstructed from the continuous images of the sagittal section of the CT examination during participant's quiet breathing (reconstructed affected thyroid plate [RATP]).
RESULTS
The anterior commissure mean position was slightly cranial to the midpoint of the thyroid cartilage midline. The paralyzed vocal fold angle was not parallel to the baseline. The average unaffected vocal fold angle during vocalization projected onto the affected thyroid plate was 13.83°, which differed significantly from the average paralyzed vocal fold angle before surgery (19.05°). However, no significant difference was observed in comparison with the average angle of the paralyzed vocal fold after arytenoid adduction. The average distance from the inferior notch of the affected side thyroid cartilage to the affected arytenoid cartilage was 16.7 mm.
CONCLUSION
By understanding the positional relationship between the thyroid cartilage plate and internal structure from preoperative CT images, more effective surgery can be performed according to individual differences.
LEVEL OF EVIDENCE
IV Laryngoscope, 2024.
PubMed: 38804631
DOI: 10.1002/lary.31535 -
Veterinary Pathology Jan 2024This work aimed to characterize the clinic-pathological presentation of an outbreak of auricular and laryngeal chondritis in pigs. Visits were made to pig farms, where...
This work aimed to characterize the clinic-pathological presentation of an outbreak of auricular and laryngeal chondritis in pigs. Visits were made to pig farms, where the clinical history was obtained, and clinical and postmortem examinations were performed. In those farms, 3% to 4% of pigs presented otohematomas, which started in the nursery and extended to the finishing phase. Moreover, some finishing pigs presented with respiratory distress, initially characterized as inspiratory dyspnea, associated by an uncommon respiratory stridor and culminating in death. Grossly, nursery piglets had enlarged ears, and on the cut surface, the cartilage was fragmented and associated with blood clots. In the finishing phase, in addition to auricular lesions, the epiglottis and arytenoid cartilages were thickened and distorted, which partially occluded the lumen. Microscopically, the laryngeal and auricular cartilages were fragmented, displayed a loss of matrix basophilia, and were surrounded by lymphohistiocytic inflammatory infiltrate, with occasional multinucleated giant cells and fibrosis. The lesions exclusively affected elastic cartilages. The disease in finishing pigs led to increased mortality and was a differential diagnosis to respiratory challenges. It was not possible to determine the factor that triggered this condition; however, a nutritional association is suspected. To the authors' knowledge, this is the first report of primary auricular and laryngeal chondritis in pigs.
Topics: Animals; Swine; Cartilage Diseases; Arytenoid Cartilage; Inflammation; Bone Diseases; Swine Diseases
PubMed: 37470276
DOI: 10.1177/03009858231186101 -
Anatomia, Histologia, Embryologia Sep 2023Giant anteater (Myrmecophaga tridactyla) is an endangered species that resides in much of Latin America, but it has been losing its habitat, especially in the Cerrado...
Giant anteater (Myrmecophaga tridactyla) is an endangered species that resides in much of Latin America, but it has been losing its habitat, especially in the Cerrado biome, where it constantly suffers traumas resulting from fires and roadkill. The anatomical knowledge of structures of the respiratory system is important for a better morphophysiological understanding of the species. Thus, this study aimed to perform the macroscopic and histomorphological description of the pharynx and larynx of the giant anteater. Twelve adult giant anteaters were used, three of them fixed in buffered formalin for further dissection and pharynx and larynx macroscopic analysis of structures. From the other animals, samples of the pharynx and larynx were collected and prepared for histological evaluation under optical microscope. Macroscopically, their pharynx and soft palate are extensive, and the anatomical location of these structures and the larynx differs greatly from that described in other species. The larynx, although more caudal, was similar to that of other animals. Histologically, the epithelium of these regions varied between the pseudostratified ciliated columnar and the non-keratinized stratified squamous epithelium. Laryngeal cartilages were composed of elastic (epiglotti) and hyaline cartilages (arytenoid, cricoid and thyroid cartilage), with an ossification process and glandular clusters around the hyaline cartilage. The distinct anatomical location of the pharynx and larynx of Myrmecophaga tridactyla is the main macroscopic finding of this study, besides the length of the pharynx and soft palate of these animals.
Topics: Animals; Vermilingua; Xenarthra; Pharynx; Larynx; Microscopy
PubMed: 37096428
DOI: 10.1111/ahe.12928 -
Morphology and computed tomography of the larynx in the white-eared opossum (Didelphis albiventris).Anatomia, Histologia, Embryologia Jan 2024The white-eared opossum (Didelphis albiventris) is a Neotropical marsupial that occurs in the Brazilian territory. The larynx is an important organ of vocalization in...
The white-eared opossum (Didelphis albiventris) is a Neotropical marsupial that occurs in the Brazilian territory. The larynx is an important organ of vocalization in mammals, although, other laryngeal functions are more fundamental for survival of mammals than phonation. The anatomical knowledge of respiratory structures is pivotal for a better understanding of the species. Thus, this study aimed to examine the larynx of the white-eared opossum by gross anatomy, computed tomography and histological description. For this, 10 adult (six females and four males) white-eared opossums (D. albiventris) were used. The white-eared opossum larynx was formed by epiglottis, thyroid, cricoids and arytenoid cartilages and a corniculate process. There is a similarity between the larynx of this marsupial and those reported in other wild mammals, regarding the number of cartilages and their location. Histologically, the epiglottis consisted of elastic cartilage and thyroid, cricoid and arytenoid cartilages were composed of hyaline cartilage. The epiglottis protruded rostrally into the nasal part of the pharynx, above the soft palate, and this is probably a marsupial characteristic as the fact that the thyroid and cricoid cartilages were ventrally fused. The hyoid apparatus was similar to that of other animals, with the same bony constitution, but with a greatly reduced stylohyoid bone. Histologically, the larynx was similar to those of other species such as koala, armadillo, crab-eating foxes and giant anteaters. The knowledge of the larynx morphology is important for the anatomical features of the species and clinical and surgical procedures, such as endotracheal intubation.
Topics: Female; Male; Animals; Didelphis; Larynx; Tomography, X-Ray Computed; Pharynx; Brazil
PubMed: 37850415
DOI: 10.1111/ahe.12988 -
Journal of Voice : Official Journal of... Nov 2023To explore the relationship between arytenoid cartilage sclerosis and a history of previous surgical resection in patients with laryngeal contact granuloma.
OBJECTIVES
To explore the relationship between arytenoid cartilage sclerosis and a history of previous surgical resection in patients with laryngeal contact granuloma.
METHODS
167 patients with laryngeal contact granuloma treated from March 2016 to December 2018 were studied. The high-resolution computed tomography (HRCT) data of the sclerosis of arytenoid cartilage is divided into asymmetric sclerosis, bilateral sclerosis, and no sclerosis according to the range of sclerosis. The proportions of various ranges of sclerosis in two subgroups of patients were compared to patients with and without a history of previous surgical resection.
RESULTS
The arytenoid cartilage sclerosis rate of 167 patients was 69.46%. The exact probability method showed that P < 0.001, suggesting that the distribution of arytenoid cartilage sclerosis was different in patients with and without a history of previous surgical resection, and there was a moderate correlation between the extent of arytenoid sclerosis and history of previous surgical resection (Cramer's V = 0.436, P < 0.001). There were 18 cases of bilateral sclerosis in patients with a history of previous surgical resection, of which 50% had contralateral recurrence after combined therapy (proton pump inhibitor (PPI) and glucocorticoid injection into granuloma via the thyrohyoid membrane approach), accounting for 75% of recurrence after combined therapy.
CONCLUSION
Surgery promotes the expansion of arytenoid sclerosis, Patients with bilateral arytenoid sclerosis are prone to recurrence of contralateral laryngeal contact granuloma.
PubMed: 37951814
DOI: 10.1016/j.jvoice.2023.10.020 -
Long-term Outcome of Autologous Lipoinjection Medialization Laryngoplasty versus Type I Thyroplasty.Journal of Voice : Official Journal of... Nov 2023Glottic insufficiency is incomplete or soft closure of the true vocal folds during phonation and is a common cause of dysphonia. Treatment includes voice therapy, type I...
UNLABELLED
Glottic insufficiency is incomplete or soft closure of the true vocal folds during phonation and is a common cause of dysphonia. Treatment includes voice therapy, type I thyroplasty, vocal fold injection augmentation (with materials such as autologous fat), arytenoid cartilage repositioning, or a combination of treatment modalities. The present study aimed to compare long-term outcomes of lipoinjection medialization with type I thyroplasty for patients with glottic insufficiency.
METHODS
Adult voice center patients who had undergone surgical vocal fold medialization with autologous lipoinjection or with type I thyroplasty for glottic insufficiency were included in this retrospective study. The primary outcome measures were the need for further medialization surgery and improvement in the glottic gap.
RESULTS
There were 172 subjects included in this study: 100 subjects underwent type I thyroplasty and 72 subjects underwent autologous lipoinjection medialization. Neither age nor gender differed significantly between thyroplasty and lipoinjection groups. The rate of further medialization surgery did not differ significantly between thyroplasty and lipoinjection groups, but further medialization surgery was performed longer after the initial operation in the thyroplasty group Baseline glottic gap did not differ significantly between thyroplasty and lipoinjection groups. When improvement from baseline was compared between thyroplasty and lipoinjection subjects, the improvement from baseline was similar for both groups at 6 months and at 12 months. Voice handicap index scores improved significantly after thyroplasty or after lipoinjection, and the improvement from baseline was similar in both cohorts.
CONCLUSION
Both autologous lipoinjection medialization and type I thyroplasty provide effective medialization for patients with glottic insufficiency. Both techniques yield similar reoperation rates, and the benefit of surgery appears to last for at least 1 year for most patients.
PubMed: 37940421
DOI: 10.1016/j.jvoice.2023.10.012 -
Computer Methods and Programs in... Jan 2024The characterization of the vocal tract geometry during speech interests various research topics, including speech production modeling, motor control analysis, and...
BACKGROUND AND OBJECTIVES
The characterization of the vocal tract geometry during speech interests various research topics, including speech production modeling, motor control analysis, and speech therapy design. Real-time MRI is a reliable and non-invasive tool for this purpose. In most cases, it is necessary to know the contours of the individual articulators from the glottis to the lips. Several techniques have been proposed for segmenting vocal tract articulators, but most are limited to specific applications. Moreover, they often do not provide individualized contours for all soft-tissue articulators in a multi-speaker configuration.
METHODS
A Mask R-CNN network was trained to detect and segment the vocal tract articulator contours in two real-time MRI (RT-MRI) datasets with speech recordings of multiple speakers. Two post-processing algorithms were then proposed to convert the network's outputs into geometrical curves. Nine articulators were considered: the two lips, tongue, soft palate, pharynx, arytenoid cartilage, epiglottis, thyroid cartilage, and vocal folds. A leave-one-out cross-validation protocol was used to evaluate inter-speaker generalization. The evaluation metrics were the point-to-closest-point distance and the Jaccard index (for articulators annotated as closed contours).
RESULTS
The proposed method accurately segmented the vocal tract articulators, with an average root mean square point-to-closest-point distance of less than 2.2mm for all the articulators in the leave-one-out cross-validation setting. The minimum P2CP was 0.91mm for the upper lip, and the maximum was 2.18mm for the tongue. The Jaccard indices for the thyroid cartilage and vocal folds were 0.60 and 0.61, respectively. Additionally, the method adapted to a new subject with only ten annotated samples.
CONCLUSIONS
Our research introduced a method for individually segmenting nine non-rigid vocal tract articulators in real-time MRI movies. The software is openly available as an installable package to the speech community. It is designed to develop speech applications and clinical and non-clinical research in fields that require vocal tract geometry, such as speech, singing, and human beatboxing.
Topics: Humans; Dental Articulators; Voice; Speech; Tongue; Magnetic Resonance Imaging; Vocal Cords
PubMed: 37976615
DOI: 10.1016/j.cmpb.2023.107907 -
The Laryngoscope Jun 2024Unilateral vocal fold paralysis (UVFP) presents as incomplete glottal closure and leads to breathy hoarseness. Various treatments, including laryngeal framework surgery...
OBJECTIVE
Unilateral vocal fold paralysis (UVFP) presents as incomplete glottal closure and leads to breathy hoarseness. Various treatments, including laryngeal framework surgery (type 1 thyroplasty [TP1] and arytenoid adduction [AA]), have been devised to correct this condition. Ultrahigh-resolution computed tomography (U-HRCT) allows detailed three-dimensional imaging of the larynx, which aids our understanding of vocal fold motion disorders. This study assessed whether U-HRCT is beneficial for correct diagnosis and surgical planning.
METHODS
The participants were 26 UVFP patients who underwent laryngeal framework surgery (TP1 and/or AA). U-HRCT was used to measure the vocal fold volume (VFV) and level difference (LD). The need to combine AA with TP1 to obtain satisfactory surgical outcomes was evaluated by U-HRCT and various voice function tests.
RESULTS
VFV was smaller in paralyzed folds than in unaffected folds. LD correlated strongly with voice parameters and showed high intra-rater and inter-rater reliability. The surgical outcome of the laryngeal framework surgery performed was judged to be excellent for improving voice function. Comparison of LD between the TP1 group and TP1 + AA group indicated that LD is an excellent parameter to determine the need to combine AA with TP1.
CONCLUSION
These findings underscore the value of preoperative U-HRCT, especially LD, in surgical decision-making and afford insights for optimal phonosurgery and individualized intervention. Patients with LD >1.0 mm may benefit from thyroplasty with AA.
LEVEL OF EVIDENCE
Level 3 (case-control study) Laryngoscope, 2024.
PubMed: 38895821
DOI: 10.1002/lary.31577