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Anesthesia Progress Dec 2023Arytenoid cartilage dislocation can occur as a complication of tracheal intubation and laryngeal trauma, but its occurrence with indirect video laryngoscopy has not been...
Arytenoid cartilage dislocation can occur as a complication of tracheal intubation and laryngeal trauma, but its occurrence with indirect video laryngoscopy has not been reported. This paper reports anterior arytenoid dislocation occurring after nasotracheal intubation performed under indirect laryngoscopy using a video laryngoscope (McGRATH MAC; Medtronic). The dislocation is presumed to have resulted from the laryngoscope blade being initially inserted too deeply and applying pressure to the posterior aspect of the left cricoarytenoid joint. This patient's anterior arytenoid dislocation was treated conservatively using speech therapy with resolution occurring approximately 40 days postoperatively. On the 74th day after surgery, fibroscopic examination confirmed recovery and healing of the dislocation. However, other types of arytenoid dislocations and laryngeal injuries may require alternative treatment. Early consultation with an otolaryngologist is recommended if arytenoid dislocation is suspected.
Topics: Humans; Arytenoid Cartilage; Laryngoscopes; Laryngoscopy; Laryngeal Diseases; Joint Dislocations; Intubation, Intratracheal
PubMed: 38221697
DOI: 10.2344/837325 -
The Journal of Laryngology and Otology Sep 2023To report the outcome of 18 patients with a tracheostomy secondary to bilateral vocal fold immobility, who were managed using reconstructive transoral laser...
OBJECTIVE
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.
METHODS
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.
RESULTS
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.
CONCLUSION
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.
Topics: Humans; Vocal Cords; Vocal Cord Paralysis; Respiratory Sounds; Arytenoid Cartilage; Airway Obstruction
PubMed: 34823628
DOI: 10.1017/S002221512100390X -
Journal of Voice : Official Journal of... Sep 2023To analyze the effects that arytenoid positional asymmetry has on posterior glottic closure and to determine whether superomedial partial arytenoidectomy (SPA) can...
OBJECTIVES
To analyze the effects that arytenoid positional asymmetry has on posterior glottic closure and to determine whether superomedial partial arytenoidectomy (SPA) can provide a benefit in cases of such asymmetry.
METHODS
In this experimental study, we evaluated posterior glottic closure in 10 larynges freshly excised from human cadavers, measuring the distance between the vocal processes before and after artificially simulated positional asymmetry of the arytenoid cartilages. We then performed SPA, after which we again measured the distance between the vocal processes.
RESULTS
In all of the larynges studied, the posterior glottic closure went from complete to incomplete after simulation of arytenoid positional asymmetry, the median distance observed between the vocal processes being 1.74mm (interquartile range 0.22). The SPA performed after arytenoid asymmetry caused the posterior glottic closure to return from incomplete to complete in all of the larynges studied.
CONCLUSION
Our results suggest that arytenoid positional asymmetry impairs posterior glottic closure and that SPA improves posterior glottic closure in such cases of arytenoid asymmetry.
Topics: Humans; Arytenoid Cartilage; Larynx; Glottis; Laryngoplasty; Laryngectomy
PubMed: 34108107
DOI: 10.1016/j.jvoice.2021.04.005 -
Clinical Case Reports Nov 2023Positional anomalies of the internal carotid artery are common. Often asymptomatic, they can cause dysphagia or dysphonia and can represent an important surgical risk....
KEY CLINICAL MESSAGE
Positional anomalies of the internal carotid artery are common. Often asymptomatic, they can cause dysphagia or dysphonia and can represent an important surgical risk. Knowing their existence is, therefore, essential for the ENT specialist.
ABSTRACT
Aberrant positions of the extracranial internal carotid artery (eICA) affect between 10 and 40% of the population and can present several forms that can bring them close to the pharyngeal walls. Although usually asymptomatic, some aberrant positions of eICA may cause symptoms such as cough or dysphagia but rarely dysphonia. Depending on their location, they can also represent a great risk during oro/hypopharyngeal interventions or intubations. We report here the case of a 72-year-old patient who presented for a first consultation with a little progressive chronic dysphonia without associated dysphagia or cough. The nasofibrostroboscopy revealed a pulsatile retrocricoid mass pushing the right arytenoid forward. Otherwise, the clinical examination of the ENT sphere was normal. A cervicofacial CT scan revealed a major medialization of the right carotid bifurcation and the eICA located within the retropharyngeal fatty space and causing a mass effect pushing forward and downward the right arytenoid and the piriform sinus, resulting in a loss of horizontality of the glottic plane. Given the absence of life-threatening complications and the associated risk of surgery, no treatment was proposed. A follow-up was established after discussion with the patient. The aim of this study was to describe a rare case of isolated dysphonia caused by right internal carotid medialization with mass effect on the arytenoid cartilage. It seems important for ENT to know these rare causes of dysphonia and/or dysphagia due to anatomical variations of eICA in order to avoid the operative risks associated with possible future therapeutic procedures in these patients.
PubMed: 38028077
DOI: 10.1002/ccr3.7997 -
The Laryngoscope Jan 2024Glottic airway stenosis (GAWS) may result from bilateral paralysis (BVFP) or posterior glottic stenosis (PGS). Since the glottis is the principal airway sphincter,...
OBJECTIVE
Glottic airway stenosis (GAWS) may result from bilateral paralysis (BVFP) or posterior glottic stenosis (PGS). Since the glottis is the principal airway sphincter, surgeons shift on the balance between airway, aspirations, and voice. We aim to describe our surgical technique and outcome of the SMALS procedure for GAWS correction.
METHODS
A retrospective cohort of patients who underwent SMALS for PGS between 2018 and 2021. SMALS involves: endoscopic submucosal subtotal arytenoidectmy (preserving medial mucosal flap) and lateralization sutures. The sutures lateralize the mucosal flap to cover the arytenoidectomy bed without lateralization of the membranous vocal fold; expanding the posterior glottis, while preserving a relatively good voice. Covering the arytenoidectomy bed enhances healing. Medical and surgical data, airway, voice, and swallowing symptoms were collected. Relative glottic opening area (RGOA) and relative glottic insufficiency area (RGIA) were calculated.
RESULTS
Eleven PGS patients who underwent 15 SMALS were included (4 bilateral), all patients had post-intubation PGS, 1 patient also had prior radiation to the larynx. All patients were tracheostomy-dependent. There were no major complications. No granulation or retracting scar was observed at follow-up. None had a persistent voice or swallowing disability. Successful outcome (decannulation) was achieved in 8 (73%); RGOA increased in all (Δ = 0.37; p = 0.003), while RGIA remained relatively stable (Δ = 0.02; p = 0.055).
CONCLUSIONS
SMALS is a safe and effective, novel modification of the classic arytenoidectomy, for GAWS correction that can be easily applied and may expand the airway without significant glottic insufficiency symptoms.
LEVEL OF EVIDENCE
4 Laryngoscope, 134:353-360, 2024.
Topics: Humans; Retrospective Studies; Constriction, Pathologic; Laryngoscopy; Vocal Cord Paralysis; Arytenoid Cartilage; Sutures
PubMed: 37551887
DOI: 10.1002/lary.30940 -
Journal of Voice : Official Journal of... Sep 2023In order to correct the varying vocal fold positions to meet the various clinical requirements in patients with bilateral vocal fold immobility, we present pertinent...
OBJECTIVE
In order to correct the varying vocal fold positions to meet the various clinical requirements in patients with bilateral vocal fold immobility, we present pertinent surgical methods to treat them.
MATERIALS AND METHODS
From 2005 to 2020, 115 patients diagnosed with bilateral vocal fold immobility were addressed for ventilation in 89 patients and for phonation in 26 patients. In the ventilation surgery group, all the neurogenic subjects received mere suture lateralization (SL) procedures and the mechanical ones underwent arytenoid release (AR) plus SL procedures if the cricoarytenoid joint fixation (CAJF) could be confirmed before operation. In the phonation group, neurogenic subjects received nonsurgical treatment and the mechanical ones underwent AR plus arytenoid adduction (AA) procedure. The decannulation rate and respiratory comfort rate for each subgroup will be calculated and the phonatory tests were conducted.
RESULTS
In the ventilation group, 55% (49/89) of subjects received related surgeries. Mere SL offered 40 successful decannulation or respiratory comfort in 42 neurogenic subjects (95.2%). The single episode rate was high as 95%. An AR plus SL procedure also obtained 100% of decannulation or respiratory comfort with a single episode of surgical procedure if the CAJF could be confirmed preoperatively. In the phonation group, 15% (4/26) of subjects received appropriate surgeries. Single AR plus AA procedures also led to 100% (4/4) of the appropriate candidates serviceable sound.
CONCLUSION
SL procedure keeping intact laryngeal mucosa usually offered permanent glottis enlarging effect or decannulation with a single episode of procedure. The use of arytenoid release for CAJF has led to remarkable advances in the ultimate surgical outcomes of both the ventilation and phonation in terms of decreasing revision surgeries.
LEVELS OF EVIDENCE
level 4.
Topics: Humans; Vocal Cords; Vocal Cord Paralysis; Glottis; Phonation; Arytenoid Cartilage; Laryngeal Diseases
PubMed: 33752929
DOI: 10.1016/j.jvoice.2021.02.019 -
Journal of the American Veterinary... Sep 2023To compare outcomes and short-term complications of dogs with laryngeal paralysis treated with unilateral arytenoid lateralization performed on an outpatient versus...
OBJECTIVE
To compare outcomes and short-term complications of dogs with laryngeal paralysis treated with unilateral arytenoid lateralization performed on an outpatient versus inpatient basis.
ANIMALS
44 client-owned dogs.
PROCEDURES
Medical records were retrospectively reviewed to identify dogs that underwent unilateral arytenoid lateralization for the treatment of laryngeal paralysis between 2018 and 2022. Signalment, surgical technique, anesthesia time, comorbidities, laryngeal examination, concurrent procedures, use of prokinetics and sedatives, episodes of vomiting, episodes of regurgitation, duration of hospitalization, postoperative complications, anxiety scores, and pain scores were recorded. Variables were compared between dogs and grouped by outpatient or inpatient management.
RESULTS
The overall complication rate was 22.7% (10/44), with 35% (7/20) being in the inpatient group and 12.5% (3/24) being in the outpatient group. The overall mortality rate was 6.8% (3/44). The overall morbidity for hospitalized patients versus those undergoing and outpatient procedure was 5% (1/20) and 4.2% (1/24), respectively. There was no significant difference between overall rate of complications and mortality rates between the inpatient and outpatient groups.
CLINICAL RELEVANCE
Results suggested that outpatient management of dogs with laryngeal paralysis treated with elective unilateral arytenoid lateralization is an appropriate method of postoperative management with no difference in complication or mortality rates. Further prospective studies with standardized surgical, sedative, and antiemetic protocols are warranted to evaluate more definitely.
Topics: Dogs; Animals; Humans; Treatment Outcome; Vocal Cord Paralysis; Outpatients; Prospective Studies; Retrospective Studies; Dog Diseases; Arytenoid Cartilage; Vomiting; Hospitalization
PubMed: 37225155
DOI: 10.2460/javma.23.02.0121 -
Lin Chuang Er Bi Yan Hou Tou Jing Wai... Dec 2023To investigate the prognostic impact of different tumor invasion patterns in the surgical treatment of T3 glottic laryngeal cancer. A retrospective analysis was...
To investigate the prognostic impact of different tumor invasion patterns in the surgical treatment of T3 glottic laryngeal cancer. A retrospective analysis was conducted on the clinical data of 91 patients with T3 glottic laryngeal cancer. Among the 91 patients, 58 cases (63.7%) had anterior invasion and 33 cases (36.3%) had posterior invasion. The posterior invasion was significantly correlated with invasions of the dorsal plate of cricoid cartilage (<0.001), arytenoid cartilage (= 0.001), and subglottic region( = 0.001). There was no statistical difference in survival outcomes between the total laryngectomy group and the partial laryngectomy group. But in the partial laryngectomy group, the 5-year disease-free survival(DFS) of patients with anterior invasive tumors was better than that of patients with posterior invasion tumors (: 4.681, 95% 1.337-16.393, =0.016), and subglottic invasion was associated with worse loco-regional recurrence-free survival(LRRFS)(: 3.931, 95% 1.054-14.658, =0.041). At the same time, we found that involvement of the dorsal plate of cricoid cartilage was an independent risk factor for postoperative laryngeal stenosis in partial laryngectomy patients (:11.67, 95% 1.89-71.98,=0.008). Compared with total laryngectomy, selected partial laryngectomy can also achieve favorable oncological outcomes. Posterior invasion and subglottic extension are independent prognostic factors for recurrence of partial laryngectomy in T3 glottic laryngeal cancer, and the involvement of the dorsal plate of cricoid cartilage is associated with postoperative laryngeal stenosis. The tumor invasion pattern of laryngeal cancer should be further subdivided in order to select a more individualized treatment plan.
Topics: Humans; Prognosis; Laryngeal Neoplasms; Retrospective Studies; Laryngostenosis; Carcinoma, Squamous Cell; Postoperative Complications; Laryngectomy
PubMed: 38114321
DOI: 10.13201/j.issn.2096-7993.2023.12.015 -
European Archives of... Mar 2024To investigate the prognostic impact of different tumor invasion patterns in the surgical treatment of T3 glottic laryngeal cancer.
BACKGROUND AND OBJECTIVES
To investigate the prognostic impact of different tumor invasion patterns in the surgical treatment of T3 glottic laryngeal cancer.
METHODS
We conducted a retrospective analysis of clinical data of 91 patients with T3 glottic laryngeal cancer.
RESULTS
We found that the posterior invasion being significantly associated with involvement of the lamina of cricoid cartilage (P < 0.001), arytenoid cartilage (P = 0.001), and subglottic (P = 0.001). There was no statistical difference in survival outcomes between the total laryngectomy (TL) group and the partial laryngectomy (PL) group, but in the PL group, tumors with anterior invasion were associated with a better 5-year DFS than tumors with posterior invasion (HR: 4.681, 95% CI: 1.337-16.393, P = 0.016), and subglottic involvement was associated with worse LRRFS (HR: 3.931, 95% CI: 1.054-14.658, P = 0.041). At the same time, we found that involvement of the lamina of cricoid cartilage was an independent risk factor for postoperative laryngeal stenosis in PL patients (HR: 11.67, 95% CI: 1.89-71.98, P = 0.008).
CONCLUSION
Selectively performed PL can also achieve favorable oncological outcomes comparable to those of TL. Posterior invasion and subglottic involvement are independent prognostic factors for recurrence after PL in T3 glottic laryngeal cancer, and involvement of the lamina of cricoid cartilage is associated with postoperative laryngeal stenosis. The tumor invasion pattern of patients with laryngeal cancer should be further subdivided to allow for selection of a more individualized treatment plan.
Topics: Humans; Laryngeal Neoplasms; Prognosis; Retrospective Studies; Laryngostenosis; Carcinoma, Squamous Cell; Glottis; Postoperative Complications; Laryngectomy
PubMed: 38110749
DOI: 10.1007/s00405-023-08374-2 -
The Laryngoscope Apr 2024The article reported a novel reduction device and standardized reduction technique for patients with arytenoid dislocation. The results showed that this reduction...
The article reported a novel reduction device and standardized reduction technique for patients with arytenoid dislocation. The results showed that this reduction technique has been excellent in helping patients with arytenoid dislocation. Laryngoscope, 134:1744-1748, 2024.
Topics: Humans; Laryngoscopy; Intubation, Intratracheal; Arytenoid Cartilage; Laryngoscopes; Joint Dislocations
PubMed: 37632726
DOI: 10.1002/lary.30999