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Ear, Nose, & Throat Journal Dec 2021To evaluate the efficacy of indirect laryngeal biopsy forceps in the treatment of epiglottic abscess (EA). (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVES
To evaluate the efficacy of indirect laryngeal biopsy forceps in the treatment of epiglottic abscess (EA).
METHODS
Twenty patients were diagnosed with EA in our department and were randomly divided into group A (indirect laryngeal biopsy forceps combined antibiotics) and group B (antibiotics only). Demographics, the degree of epiglottic and arytenoid swelling, and inflammatory cells were collected for analysis. The drainage of EA was performed under local anesthesia in conscious patients with indirect laryngeal biopsy forceps and 70° direct laryngoscopes. The length of symptomatic relief and length of hospitalization were assessed.
RESULTS
Ten patients were treated with indirect laryngeal biopsy forceps under the view of the 70° direct laryngoscopes combined with intravenous antibiotics, whereas the other 10 patients were treated with antibiotics only. The differences between the 2 groups had no statistical significance in age, gender, white blood cell count, neutrophils count, and the percent of neutrophils, abscess size, and scope classification at the time of diagnosis. The length of hospitalization and length of symptomatic relief was significantly lower in patients treated with indirect laryngeal biopsy forceps combined antibiotics than those treated with antibiotics only.
CONCLUSIONS
Indirect laryngeal biopsy forceps are safe and effective method to treat EA, which shorten the hospitalization and has the advantages of cost savings and convenience.
Topics: Abscess; Adult; Anti-Bacterial Agents; Arytenoid Cartilage; Biopsy; Combined Modality Therapy; Epiglottis; Epiglottitis; Female; Humans; Laryngoscopy; Male; Middle Aged; Surgical Instruments; Treatment Outcome
PubMed: 32520602
DOI: 10.1177/0145561320930644 -
Lin Chuang Er Bi Yan Hou Tou Jing Wai... Mar 2020To investigate the relationship between laryngopharyngeal reflux and arytenoid cartilage calcification in male idiopathic laryngeal contact granuloma. The clinical data...
To investigate the relationship between laryngopharyngeal reflux and arytenoid cartilage calcification in male idiopathic laryngeal contact granuloma. The clinical data of 92 male patients with idiopathic laryngeal contact granuloma who had the thin laryngeal CT scan images and laryngeal reflux symptom index(RSI) scale data before treatment were analyzed retrospectively. The effect of laryngopharyngeal reflux on the calcification of arytenoid cartilage in laryngeal contact granuloma patients was analyzed by Chi-square statistics with SPSS 16.0 software. Among the 92 patients, 44 patients with RSI>13(47.83%) and 48 patients with RSI≤13(52.17%). Unilateral granuloma was found in 87 cases(94.57%) and bilateral granuloma in 5 cases(5.43%). A total of 97 sides of the diseased side, there were 87 sides of arytenoid cartilage with calcification(89.69%) and 10 sides without calcification(10.31%). Among the patients with RSI>13, there were 45 sides of arytenoid cartilage with calcification(45/46, 97.83%) and one side without calcification(1/46, 2.17%), and in the patients with RSI≤13, there were 42 sides of arytenoid cartilage with calcification(42/51, 82.35%) and 9 sides without calcification(9/51, 17.65%). The calcification rate of arytenoid cartilage in patients with RSI>13 group was significantly higher than that in RSI≤13 group(χ²=4.701, =0.030). The calcification rate of arytenoid cartilage in male idiopathic laryngeal contact granuloma patients with laryngopharyngeal reflux is higher than that in patients without laryngopharyngeal reflux. Laryngopharyngeal reflux may aggravate or promote the inflammatory reaction of granuloma and accelerate the calcification of arytenoid cartilage.
Topics: Arytenoid Cartilage; Granuloma; Granuloma, Laryngeal; Humans; Laryngopharyngeal Reflux; Male; Retrospective Studies
PubMed: 32791597
DOI: 10.13201/j.issn.2096-7993.2020.03.019 -
Veterinary World Oct 2020From a biomedical point of view, the value of marsupials as a model of primitive mammals is indisputable. Among its species, the possum is a model that allows the study...
BACKGROUND AND AIM
From a biomedical point of view, the value of marsupials as a model of primitive mammals is indisputable. Among its species, the possum is a model that allows the study of the ontogeny of different organic systems, as well as their physiological aspects. The relevance of anatomical, functional, evolutionary, and phylogenetic study of marsupials for the development of comparative morphology is extensively documented in the literature. However, there are still many aspects to be further evaluated, as the anatomy and histology of the respiratory tract of this species. The aim of this study was to describe the morphology of the larynx, trachea, and lungs of .
MATERIALS AND METHODS
Five adult male animals were donated to the Comparative Animal Anatomy Laboratory - LAAC/CCAA-UFMA, for morphological studies. Specimens were washed in running water to perform biometrics. Then, they were fixed with 10% formaldehyde solution. After the fixation period, the specimens were positioned in dorsal decubitus position, for dissection of the respiratory system organs, by opening the ventral region of the neck and thoracic cavity, with subsequent removal of the pectoral muscles, ribs, and sternum. For histological analysis, fragments of 1 cm of the larynx (epiglottis and thyroid cartilages), trachea, and lungs were collected and fixed in 10% formaldehyde solution. Right after fixation, the fragments were dehydrated in increasing concentrations of ethyl alcohol (70, 80, 95, and 100%), diaphanized in xylene, embedded in paraffin, and sectioned into thin slices of 5 μm using a microtome. Sections were stained using the hematoxylin and eosin technique.
RESULTS
Anatomically, the larynx starts right after the pharynx. It consisted of four cartilages: Epiglottis, cricoid, thyroid, and arytenoid. The trachea was made of dorsally incomplete cartilaginous rings. At the entrance of the thoracic cavity, it bifurcated into the left and right main bronchus. The left lung was smaller than the right lung, with two lobes (cranial and caudal). The right lung presents the cranial, middle, caudal, and accessory lobes. Histologically, the epiglottis consisted of elastic cartilage and is covered by a non-keratinized stratified squamous epithelium. Thyroid cartilage is made of hyaline cartilage covered by smooth muscle. The trachea presents hyaline cartilage, with ciliated pseudo-stratified epithelium, serous glands, isogenic groups of chondrocytes, and perichondrium. The lung consisted of bronchi, bronchioles, and alveoli, also presenting blood vessels and arteries.
CONCLUSION
Morphologically, the larynx, trachea, and lungs of were similar to those of the other described in the literature.
PubMed: 33281348
DOI: 10.14202/vetworld.2020.2142-2149 -
American Journal of Veterinary Research Feb 2022To characterize the 3-D geometry of the equine larynx replicating laryngeal hemiplegia and 4 surgical interventions by use of CT under steady-state airflow conditions....
OBJECTIVES
To characterize the 3-D geometry of the equine larynx replicating laryngeal hemiplegia and 4 surgical interventions by use of CT under steady-state airflow conditions. Secondly, to use fluid mechanic principles of flow through a constriction to establish the relationship between measured airflow geometries with impedance for each surgical procedure.
SAMPLE
10 cadaveric horse larynges.
PROCEDURES
While CT scans were performed, inhalation during exercise conditions was replicated for each of the following 5 conditions: laryngeal hemiplegia, left laryngoplasty with ventriculocordectomy, left laryngoplasty with ipsilateral ventriculocordectomy and arytenoid corniculectomy, corniculectomy, and partial arytenoidectomy for each larynx while CT scans were performed. Laryngeal impedance was calculated, and selected cross-sectional areas were measured along each larynx for each test. Measured areas and constriction characteristics were analyzed with respect to impedance using a multilevel, mixed-effects model.
RESULTS
Incident angle, entrance coefficient, outlet coefficient, friction coefficient, orifice thickness, and surgical procedure were significantly associated with upper airway impedance in the bivariable model. The multivariate model showed a significant influence of incident angle, entrance coefficient, and surgical procedure on impedance; however, the orifice thickness became nonsignificant within the model.
CLINICAL RELEVANCE
Laryngeal impedance was significantly associated with the entrance configuration for each procedure. This suggested that the equine upper airway, despite having a highly complex geometry, adheres to fluid dynamic principles applying to constrictions within pipe flow. These underlying flow characteristics may explain the clinical outcomes observed in some patients, and lead to areas of improvement in the treatment of obstructive upper airway disease in horses.
Topics: Animals; Arytenoid Cartilage; Hemiplegia; Horse Diseases; Horses; Humans; Larynx; Tomography, X-Ray Computed; Vocal Cord Paralysis
PubMed: 35143413
DOI: 10.2460/ajvr.21.03.0040 -
The Laryngoscope Apr 2021Arytenoid adduction (AA) is performed to treat unilateral vocal fold paralysis with a large posterior glottal gap. However, the voice effects of AA suture position...
OBJECTIVES/HYPOTHESIS
Arytenoid adduction (AA) is performed to treat unilateral vocal fold paralysis with a large posterior glottal gap. However, the voice effects of AA suture position remain unclear. This study aimed to evaluate voice production and quality as a function of AA suture position on the thyroid ala in a neuromuscularly intact in vivo larynx.
STUDY DESIGN
Animal model.
METHODS
Unilateral recurrent laryngeal nerve and vagal paralysis were modeled in two canines. AA suture position was varied across five equidistant positions on the anterior inferior thyroid ala, from a paramedian position anteriorly to the oblique line posteriorly. Phonation was performed over 8 × 8 graded level combinations of recurrent and superior laryngeal nerve stimulation per suture position. The primary outcome was percent successful phonatory conditions. Secondary outcomes included fundamental frequency (F0), phonation onset pressure (PTP), cepstral peak prominence (CPP), and laryngeal posture.
RESULTS
Anterior suture positions resulted in a greater percentage of successful phonatory conditions compared to posterior sutures. Suture position 2, located at the anterior inferior thyroid ala, resulted in the highest percentage of successful phonatory conditions, lowest PTP, and lower muscle activation levels to achieve higher CPP. Posterior sutures resulted in wider glottal gap and more effective F0 and vocal fold strain increase with cricothyroid muscle contraction, but with fewer successful phonatory conditions and higher PTP. Trends were consistent across both paralysis types.
CONCLUSIONS
AA suture placed in the anterior inferior thyroid ala resulted in the best acoustic, aerodynamic, and voice quality outcomes. This study provides scientific evidence for maintaining current clinical practice.
LEVEL OF EVIDENCE
NA Laryngoscope, 131:846-852, 2021.
Topics: Animals; Arytenoid Cartilage; Disease Models, Animal; Dogs; Male; Phonation; Recurrent Laryngeal Nerve; Sutures; Vocal Cord Paralysis; Voice Quality
PubMed: 32710654
DOI: 10.1002/lary.28903 -
Head & Neck Jul 2021In this systematic review, we aim to identify prognostic imaging variables of recurrent laryngeal or hypopharyngeal carcinoma after chemoradiotherapy. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
In this systematic review, we aim to identify prognostic imaging variables of recurrent laryngeal or hypopharyngeal carcinoma after chemoradiotherapy.
METHODS
A systematic search was performed in PubMed and EMBASE (1990-2020). The crude data and effect estimates were extracted for each imaging variable. The level of evidence of each variable was assessed and pooled risk ratios (RRs) were calculated.
RESULTS
Twenty-two articles were included in this review, 17 on computed tomography (CT) and 5 on magnetic resonance imaging (MRI) variables. We found strong evidence for the prognostic value of tumor volume at various cut-off points (pooled RRs ranging from 2.09 to 3.03). Anterior commissure involvement (pooled RR 2.19), posterior commissure involvement (pooled RR 2.44), subglottic extension (pooled RR 2.25), and arytenoid cartilage extension (pooled RR 2.10) were also strong prognostic factors.
CONCLUSION
Pretreatment tumor volume and involvement of several subsites are prognostic factors for recurrent laryngeal or hypopharyngeal carcinoma after chemoradiotherapy.
Topics: Chemoradiotherapy; Humans; Hypopharyngeal Neoplasms; Larynx; Neoplasm Staging; Prognosis
PubMed: 33797818
DOI: 10.1002/hed.26698 -
American Journal of Veterinary Research Jul 2022To determine whether muscle-sparing laryngoplasty results in fewer changes in swallowing function compared to standard surgical treatment for laryngeal paralysis.
OBJECTIVE
To determine whether muscle-sparing laryngoplasty results in fewer changes in swallowing function compared to standard surgical treatment for laryngeal paralysis.
ANIMALS
12 clinically normal sexually intact male Beagles.
PROCEDURES
Group A dogs (n = 4) had a standard approach to the larynx, with left arytenoid cartilage lateralization. Group B dogs (n = 4) had a muscle-sparing laryngoplasty performed with the thyropharyngeus muscle fibers bluntly separated, and the cricoarytenoideus dorsalis muscle spared. Pre- and 24-hour postoperative fluoroscopic swallowing studies were performed and graded. Larynges were harvested after humane euthanasia, and glottic area was measured. Group C dogs (n = 4) acted as controls, with surgical dissection ending lateral to the thyropharyngeus muscle, arytenoid lateralization not performed, and the dogs not euthanized. The study was performed between October 15, 2011 and May 15, 2021.
RESULTS
Changes in pharyngeal and upper esophageal sphincter function were not detected in any group. There was no difference in glottic area between treatment groups. Aspiration of liquid was not a consistent finding. Two dogs in each treatment group developed moderate to severe cervical esophageal paresis. This did not occur in control dogs.
CLINICAL RELEVANCE
We found no evidence to support our hypothesis that muscle-sparing laryngoplasty results in less severe changes in swallowing function compared to a standard technique. The cervical esophageal paresis identified in both treatment groups could increase the risk of postoperative aspiration pneumonia in dogs treated for laryngeal paralysis via a lateral approach to the larynx. Further study to determine the frequency, cause, and duration of esophageal dysfunction is warranted.
Topics: Animals; Arytenoid Cartilage; Dog Diseases; Dogs; Glottis; Laryngeal Muscles; Larynx; Male; Paresis; Vocal Cord Paralysis
PubMed: 35895756
DOI: 10.2460/ajvr.22.03.0040 -
American Journal of Veterinary Research Jun 2023To develop 3D models of larynges to compare arytenoid abduction measurements between specimens and models, and to investigate the anatomic feasibility of placing an...
Three-dimensional models of the equine larynx can be used to perform traditional measures of arytenoid abduction and permit the positioning of modeled implants to demonstrate the anatomic feasibility of placing a rigid implant across the cricoarytenoid joint.
OBJECTIVE
To develop 3D models of larynges to compare arytenoid abduction measurements between specimens and models, and to investigate the anatomic feasibility of placing an implant across the cricoarytenoid joint (CAJ) with or without arthrotomy.
SAMPLES
Cadaveric equine larynges (n = 9).
PROCEDURES
Equine larynges underwent sequential CT scans in a neutral position and with 2 arytenoid treatments: bilateral arytenoid abduction (ABD) and bilateral arytenoid abduction after left cricoarytenoid joint arthrotomy (ARTH). Soft tissue, cartilage, and luminal volume 3-dimensional models were generated. Rima glottidis cross-sectional area (CSA) and left-to-right quotient (LRQ) angles were measured on laryngeal specimens and models. Arytenoid translation, articular contact area, and length of modeled implants placed across the CAJ were measured on models. Data were analyzed using paired t test or ANOVA and Tukey's post hoc test or non-parametric equivalents (P < .05).
RESULTS
ARTH CSA was larger for laryngeal specimens than models (P = .0096). There was no difference in all other measures of CSA and LRQ angle between treatment groups or between specimens and models. There was no difference between ABD and ARTH groups for arytenoid cartilage translation, contact area, and implant length. The articular contact area was sufficient for modeled implant placement across the CAJ with a narrow range of implant lengths (17.59 mm to 23.87 mm) across larynges with or without arthrotomy.
CLINICAL RELEVANCE
These results support further investigation of a CT-guided, minimally invasive surgical procedure. Future studies will evaluate the outcomes of the new procedure for technical precision, biomechanical stability, and post-operative success rates for horses with recurrent laryngeal neuropathy (RLN).
Topics: Horses; Animals; Arytenoid Cartilage; Feasibility Studies; Larynx; Laryngoplasty; Joints
PubMed: 37160260
DOI: 10.2460/ajvr.22.11.0202 -
The Laryngoscope May 2021To determine the utility of preoperative penetration-aspiration scale (PAS) scores and clinical findings on modified barium swallow (MBS) in predicting advancement of...
OBJECTIVES/HYPOTHESIS
To determine the utility of preoperative penetration-aspiration scale (PAS) scores and clinical findings on modified barium swallow (MBS) in predicting advancement of diet after interarytenoid injection augmentation (IAIA).
STUDY DESIGN
Retrospective review.
METHODS
In this retrospective cohort study, 372 consecutive patients who underwent IAIA for pharyngeal dysphagia between 2009 and 2019 were initially identified. Patients were excluded from the study if they had insufficient preop MBS, no postop MBS within 3 months of injection, supraglottoplasty, or underlying neurological condition. Ninety-three patients were included in the study. Pre- and postoperative PAS scores were recorded, as were pre and postop diets. PAS scores were calculated by a single pediatric speech and language pathologist.
RESULTS
Average PAS score on MBS was 5.87 (standard deviation [SD] 2.74); median (range) = 8 (1-8). Postop average was 4.29 (SD 3.02); median (range) = 2 (1-8), P < .001. Those with worse preop PAS scores had increased odds of improvement in diet (odds ratio 1.24, 95% confidence interval [CI] 1.02-1.49, P = .029). An improvement in PAS score of 3.0 or greater predicted an improvement in diet with a sensitivity of 76.7% and a specificity of 85.7%.
CONCLUSIONS
PAS score on MBS can be a useful tool when assessing pediatric patients who may be candidates for IAIA. Prospectively comparing PAS score in patients post-IAIA to patients solely undergoing diet modification can help to better objectively assess differences in outcomes and understand the full utility of PAS score.
LEVEL OF EVIDENCE
Level III (Individual Cohort Study) Laryngoscope, 131:E1707-E1713, 2021.
Topics: Arytenoid Cartilage; Child, Preschool; Deglutition Disorders; Feasibility Studies; Feeding Behavior; Female; Fluoroscopy; Humans; Infant; Infant, Newborn; Injections; Laryngoscopy; Male; Predictive Value of Tests; Preoperative Care; Prognosis; Respiratory Aspiration; Retrospective Studies; Treatment Outcome
PubMed: 33009827
DOI: 10.1002/lary.29142 -
Veterinary Surgery : VS Aug 2022To assess the effect of vocal cordectomy on airflow across equine larynges at different Rakestraw grades of arytenoid abduction using a unidirectional airflow model.
OBJECTIVE
To assess the effect of vocal cordectomy on airflow across equine larynges at different Rakestraw grades of arytenoid abduction using a unidirectional airflow model.
STUDY DESIGN
Ex vivo, repeated measures.
SAMPLE POPULATION
Twenty cadaveric equine larynges.
METHODS
The right arytenoid cartilage was maximally abducted in all larynges. Each larynx was assigned a Rakestraw grade A or B, and the left arytenoid was abducted accordingly. Each larynx was tested under 3 conditions: intact, left vocal cordectomy (LVC), and bilateral vocal cordectomy (BVC). Translaryngeal pressure and airflow were measured, and digital video footage was obtained. Translaryngeal impedance (TLI) was calculated, and the arytenoid left-to-right quotient angle (LRQ) and rima glottis cross-sectional area (CSA) were measured from standardized still images.
RESULTS
Vocal cordectomy reduced TLI by 14.5% in LVC in comparison with intact larynges at Rakestraw grade B (P = .014). In Rakestraw grade A position, neither unilateral nor bilateral vocal cordectomy had any effect on TLI. Regardless of Rakestraw allocation, both LVC and BVC increased CSA in comparison with intact larynges (P < .005), with BVC larynges experiencing a greater effect than LVC (P < .0001).
CONCLUSION
Using a unilateral airflow model, LVC improved TLI in larynges where arytenoid position approximated Rakestraw grade B. However, when the arytenoid position approximated Rakestraw grade A, there was no effect on TLI following LVC or BVC.
CLINICAL SIGNIFICANCE
Surgeons considering a vocal cordectomy should take into account the degree of arytenoid abduction before performing the procedure, as it may not be warranted from a TLI point of view.
Topics: Animals; Arytenoid Cartilage; Cadaver; Horse Diseases; Horses; Humans; Laryngoplasty; Larynx; Vocal Cords
PubMed: 35608018
DOI: 10.1111/vsu.13823