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Neuroimaging Clinics of North America Nov 2022The larynx serves as the gateway between the upper and lower respiratory tracts and is involved in the tasks of phonation, deglutition, and airway protection.... (Review)
Review
The larynx serves as the gateway between the upper and lower respiratory tracts and is involved in the tasks of phonation, deglutition, and airway protection. Familiarity with the complex anatomy of the larynx is critical for detecting and characterizing disease in the region, especially in cancer staging. In this article, we review the anatomy of the larynx and cervical trachea, including an overview of their cartilages, supporting tissues, muscles, mucosal spaces, neurovascular supply, and lymphatics, followed by correlation to the clinically relevant anatomic sites of the larynx. Imaging techniques for evaluating the larynx and trachea will also be discussed briefly.
Topics: Humans; Larynx; Neck; Trachea
PubMed: 36244725
DOI: 10.1016/j.nic.2022.07.011 -
Seminars in Fetal & Neonatal Medicine Oct 2023Safe and effective management of the neonatal airway requires knowledge, teamwork, preparation and experience. At baseline, the neonatal airway can present significant... (Review)
Review
Safe and effective management of the neonatal airway requires knowledge, teamwork, preparation and experience. At baseline, the neonatal airway can present significant challenges to experienced neonatologists and paediatric anaesthesiologists, and increased difficulty can be due to anatomical abnormalities, physiological instability or increased situational stress. Neonatal airway obstruction is under recognised, and should be considered an emergency until the diagnosis and physiological implications are understood. When multiple types of difficulties are present or there are multiple levels of anatomical obstruction, the challenge increases exponentially. In these situations, preparation, multi-disciplinary teamwork and a consistent hospital-wide approach will help to reduce errors and morbidity.
Topics: Humans; Infant, Newborn; Airway Obstruction; Neonatology
PubMed: 38030433
DOI: 10.1016/j.siny.2023.101483 -
The Annals of Otology, Rhinology, and... Mar 2021Multiple congenital abnormalities of the epiglottis have been reported and iatrogenic injuries to the larynx and subglottis are well known. We present a new pattern of... (Review)
Review
INTRODUCTION
Multiple congenital abnormalities of the epiglottis have been reported and iatrogenic injuries to the larynx and subglottis are well known. We present a new pattern of defect not previously reported in the literature.
METHODS
Epiglottic abnormalities at two institutions are reviewed. Cases of defects involving the lateral aspect of the epiglottis and aryepiglottic fold are identified. A literature review of known epiglottic defects is performed.
RESULTS
Two children possessing lateral notch injuries at the aryepiglottic attachment to the epiglottis are described. Both children have a history of multiple laryngeal instrumentation attempts and prolonged intubation. Both have swallowing difficulties and are gastrostomy dependent. Congenital epiglottic defects include aplasia and midline bifidity, however, no lateral congenital epiglottic defects have been reported.
CONCLUSION
Epiglottic defects, while rare, should be part of the differential for children with aspiration and feeding difficulties. A new pattern of defect is described and iatrogenic etiology proposed.
Topics: Epiglottis; Female; Humans; Infant, Extremely Premature; Infant, Newborn; Intubation, Intratracheal; Laryngeal Muscles; Laryngoscopy; Respiratory Aspiration
PubMed: 32772542
DOI: 10.1177/0003489420948546 -
Otolaryngologic Clinics of North America Aug 2023Laryngotracheal stenosis is the common endpoint for any process that results in the narrowing of the airway at the level of the glottis, subglottis, or trachea. Although... (Review)
Review
Laryngotracheal stenosis is the common endpoint for any process that results in the narrowing of the airway at the level of the glottis, subglottis, or trachea. Although endoscopic procedures are effective in opening the airway lumen, open resection and reconstruction can be necessary to reconstitute a functional airway. When resection and anastomosis are insufficient due to extensive length or location of the stenosis, autologous grafts can be used to expand the airway. Future directions in airway reconstruction include tissue engineering and allotransplantation.
Topics: Humans; Tracheal Stenosis; Constriction, Pathologic; Treatment Outcome; Larynx; Trachea; Laryngostenosis
PubMed: 37268515
DOI: 10.1016/j.otc.2023.04.018 -
Current Opinion in Otolaryngology &... Dec 2020Pediatric posterior glottic stenosis (PGS) is a challenging clinical entity with multiple treatment options. This review describes the evaluation of patients with PGS... (Review)
Review
PURPOSE OF REVIEW
Pediatric posterior glottic stenosis (PGS) is a challenging clinical entity with multiple treatment options. This review describes the evaluation of patients with PGS and discusses existing surgical techniques.
RECENT FINDINGS
PGS secondary to a distinct scar band between the vocal folds can often be effectively managed with endoscopic division and surveillance. More advanced glottic scarring that also involves the interarytenoid mucosa, cricoarytenoid joints, or subglottis merits a more thorough investigation and repair. A postcricoid mucosal advancement flap can be employed in select adolescent or adult PGS, but long-term cricoarytenoid joint mobility is difficult to restore once it has been fixed. Younger pediatric patients have smaller airways and frequent concurrent subglottic stenosis which is better addressed with cartilage grafting.
SUMMARY
Surgical success in pediatric PGS depends on careful preoperative airway assessment and the accurate characterization of airway stenosis. A surgical technique should be chosen based on the severity and extent of stenosis.
Topics: Arytenoid Cartilage; Child; Cicatrix; Cricoid Cartilage; Glottis; Humans; Laryngoscopy; Laryngostenosis; Mouth Mucosa; Surgical Flaps
PubMed: 33060394
DOI: 10.1097/MOO.0000000000000671 -
Journal of Burn Care & Research :... May 2020A lack of reliable laryngeal thermal injury models precludes laryngeal burn wound healing studies and investigation of novel therapeutics. We hypothesize that a swine...
A lack of reliable laryngeal thermal injury models precludes laryngeal burn wound healing studies and investigation of novel therapeutics. We hypothesize that a swine laryngeal burn model can allow for laryngeal burn evaluation over time. Twelve Yorkshire crossbreed swine underwent tracheostomy and endoscopically directed laryngeal burns using heated air (150-160°C). Swine larynges were evaluated and sectioned/stained at 12 hours, 1, 3, 7, 14, and 21 days. A board-certified veterinary pathologist assessed anatomic regions (left and right: epiglottis, true/false vocal folds, and subglottis) using a nine criteria histological injury scoring scale. Six swine were euthanized at scheduled endpoints, three prematurely (airway concerns), and three succumbed to airway complications after 16 to 36 hours. Endoscopic and gross examination from scheduled endpoints revealed massive supraglottic edema and tissue damage, particularly around the arytenoids, extending transglottically. Swine from premature endpoints had comparatively increased edema throughout. Microscopic evaluation documented an inverse relationship between injury severity score and time from injury. Inflammation severity decreased over time, nearly resolving by 14 days. Neutrophils predominated early with histiocytes appearing at 3 days. Granulation tissue appeared at 3 days, and early epiglottic and/or subglottic fibrosis appeared by 7 days and matured by 14 days. Edema, abundant initially, decreased by day 3 and resolved by day 7. This approach is the first to provide longitudinal analysis of laryngeal thermal injuries, reflecting some of the first temporal wound healing characteristic data in laryngeal thermal injuries and providing a platform for future therapeutic studies.
Topics: Animals; Burns; Disease Models, Animal; Larynx; Swine; Tracheotomy
PubMed: 32087018
DOI: 10.1093/jbcr/iraa009