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Ear, Nose, & Throat Journal Jan 2020
Topics: Ankylosis; Arthritis, Rheumatoid; Arytenoid Cartilage; Cricoid Cartilage; Humans; Male; Middle Aged
PubMed: 31937130
DOI: 10.1177/0145561319825734 -
American Journal of Veterinary Research Dec 2019To compare laryngeal impedance, in terms of air flow and pressure, following arytenoid corniculectomy (COR) versus 3 other airway interventions (left-sided laryngoplasty...
Ex vivo evaluation of arytenoid corniculectomy, compared with three other airway interventions, performed on cadaveric equine larynges with simulated recurrent laryngeal neuropathy.
OBJECTIVE
To compare laryngeal impedance, in terms of air flow and pressure, following arytenoid corniculectomy (COR) versus 3 other airway interventions (left-sided laryngoplasty with ipsilateral ventriculocordectomy [LLP], LLP combined with COR [LLPCOR], and partial arytenoidectomy [PA]) performed on cadaveric equine larynges with simulated left recurrent laryngeal neuropathy (RLN) and to determine whether relative laryngeal collapse correlated with the interventions performed.
SAMPLE
28 cadaveric equine larynges.
PROCEDURES
Each larynx in states of simulated left RLN alone and with airway interventions in the order LLP, LLPCOR, COR, and PA was evaluated in a box model construct that replicated upper airway flow mechanics consistent with peak exercise in horses. Results for impedance, calculated from airflow and pressure changes, were compared between states for each larynx. Multivariable mixed-effects analysis controlling for repeated measures within larynx was performed to calculate the predicted mean impedance for each state.
RESULTS
Results indicated that tracheal adapter diameter, individual larynx properties, airway intervention, and relative laryngeal collapse affected laryngeal impedance. The LLP and LLPCOR interventions had the lowest impedance, whereas the COR and PA interventions did not differ substantially from the simulated left RLN state. Residual intraclass correlation of the model was 27.6 %.
CONCLUSIONS AND CLINICAL RELEVANCE
Although impedance was higher for the simulated left RLN with the COR intervention state than with the LLP intervention state, given the clinical success of PA for treating RLN in horses and the similar results for the COR and PA intervention states in the present study, the use of COR warrants further investigation. The residual interclass correlation suggested that individual laryngeal variation affected impedance and may have a clinical effect.
Topics: Animals; Arytenoid Cartilage; Cadaver; Horse Diseases; Horses; Laryngectomy; Laryngoplasty; Larynx; Trachea; Vocal Cord Paralysis; Vocal Cords
PubMed: 31763941
DOI: 10.2460/ajvr.80.12.1136 -
PLoS Genetics Oct 2019Laryngeal paralysis (LP) is the inability to abduct the arytenoid cartilages during inspiration, resulting in a partial to complete airway obstruction and consequent...
Laryngeal paralysis (LP) is the inability to abduct the arytenoid cartilages during inspiration, resulting in a partial to complete airway obstruction and consequent respiratory distress. Different forms of LP with varying age of onset exist in dogs. Hereditary early onset forms were reported in several dog breeds. In most breeds, hereditary LP is associated with other neurologic pathologies. Using a genome-wide association study and haplotype analyses, we mapped a major genetic risk factor for an early onset LP in Miniature Bull Terriers to a ~1.3 Mb interval on chromosome 11. Whole genome sequencing of an affected Miniature Bull Terrier and comparison to 598 control genomes revealed a 36 bp insertion into exon 15 of the RAPGEF6 gene (c.1793_1794ins36). The imperfect genotype-phenotype correlation suggested a complex mode of inheritance with a major genetic risk factor involving a recessive risk allele. Homozygosity for the insertion was associated with a 10- to 17-fold increased risk for LP. The insertion allele was only found in Miniature Bull Terriers and Bull Terriers. It was absent from >1000 control dogs of other dog breeds. The insertion sequence contains a splice acceptor motif leading to aberrant splicing in transcripts originating from the mutant allele (r.1732_1780del). This leads to a frameshift and a premature stop codon, p.(Ile587ProfsTer5), removing 64% of the open reading frame. Our results suggest an important role of RAPGEF6 in laryngeal nerve function and provide new clues to its physiological significance.
Topics: Animals; Arytenoid Cartilage; Breeding; Codon, Nonsense; Dog Diseases; Dogs; Exons; Frameshift Mutation; Genetic Predisposition to Disease; Genome-Wide Association Study; Guanine Nucleotide Exchange Factors; Haplotypes; Humans; Laryngeal Nerves; RNA Splicing; Vocal Cord Paralysis; Whole Genome Sequencing
PubMed: 31647804
DOI: 10.1371/journal.pgen.1008416 -
Journal of Voice : Official Journal of... Dec 2022The elastic properties of the vocal folds have great influence on the primary sound and thus on the entire subsequent phonation process. Muscle contractions in the...
OBJECTIVES
The elastic properties of the vocal folds have great influence on the primary sound and thus on the entire subsequent phonation process. Muscle contractions in the larynx can alter the elastic properties of the vocal fold tissue. Quasi-static ultrasound elastography is a non-destructive examination method that can be applied to ex-vivo vocal folds. In this work, porcine vocal folds were passively elongated and adducted and the changes of the elastic properties due to that manipulations were measured.
METHODS
Manipulations were performed by applying force to sewn-in sutures. Elongation was achieved by a suture attached to the thyroid cartilage, which was pulled forward by defined weights. Adduction was effected by two sutures exerting torque on the arytenoid cartilage. A series of ten specimens was examined and evaluated using a quasi-static elastography algorithm. In addition, the surface stretch was measured optically using tattooed reference points.
RESULTS
This study showed that the expected stiffening of the tissue during the manipulations can be measured using quasi-static ultrasound elastography. The measured effect of elongation and adduction, both of which result in stretching of the tissue, is stiffening. However, the relative change of specific manipulations is not the same for the same load on different larynges, but is rather related to stretch caused and other uninvestigated factors.
CONCLUSION
The passive elongation and adduction of vocal folds stiffen the tissue of the vocal folds and can be measured using ultrasound elastography.
PubMed: 36529564
DOI: 10.1016/j.jvoice.2022.11.033 -
European Annals of Otorhinolaryngology,... Sep 2021
Topics: Arytenoid Cartilage; Humans; Laryngoplasty; Treatment Outcome; Vocal Cord Paralysis
PubMed: 34049828
DOI: 10.1016/j.anorl.2020.12.014 -
Revista Espanola de Anestesiologia Y... Dec 2020Vocal cord paralysis is a rare but severe complication after orotracheal intubation. The most common cause is traumatic, due to compression of the recurrent laryngeal...
Vocal cord paralysis is a rare but severe complication after orotracheal intubation. The most common cause is traumatic, due to compression of the recurrent laryngeal nerve between the orotracheal tube cuff and the thyroid cartilage. Other possible causes are direct damage to the vocal cords during intubation, dislocation of the arytenoid cartilages, or infections, especially viral infections. It is usually due to a recurrent laryngeal nerve neuropraxia, and the course is benign in most patients. We present the case of a man who developed late bilateral vocal cord paralysis after pneumonia complicated with respiratory distress due to SARS-CoV-2 that required orotracheal intubation for 11 days. He presented symptoms of dyspnea 20 days after discharge from hospital with subsequent development of stridor, requiring a tracheostomy. Due to the temporal evolution, a possible contribution of the SARS-CoV- 2 infection to the picture is pointed out.
PubMed: 33558055
DOI: 10.1016/j.redar.2020.11.010 -
Case Reports in Otolaryngology 2020Endolaryngeal suture lateralisation is an ideal operation for bilateral vocal fold paralysis. However, restenosis owing to breakage and slippage of suture can sometimes...
BACKGROUND
Endolaryngeal suture lateralisation is an ideal operation for bilateral vocal fold paralysis. However, restenosis owing to breakage and slippage of suture can sometimes occur. In such a case, methods that are more effective in expanding the glottis, including arytenoidectomy, must be selected. . Herein, we report two female patients aged 86 and 54 years who presented with bilateral vocal cord paralysis and who had restenosis after suture lateralisation. Endoscopic partial arytenoidectomy was performed, and satisfactory outcomes were obtained. This method maintains the height of the arytenoid and preserves its sensation by leaving a part of the cartilage and mucous membrane.
CONCLUSION
Endoscopic partial arytenoidectomy is effective for securing the airway while preserving vocal function and preventing aspiration. This technique is suitable for patients with restenosis after they have undergone endolaryngeal suture lateralisation.
PubMed: 33274095
DOI: 10.1155/2020/8822164 -
European Archives of... Nov 2021Bilateral adductor vocal cord paralysis (BAVCP) is a rare and challenging condition whose main consequence is reduction of airway patency at the glottic level, often...
OBJECTIVES
Bilateral adductor vocal cord paralysis (BAVCP) is a rare and challenging condition whose main consequence is reduction of airway patency at the glottic level, often causing respiratory distress, while vocal function tends to remain almost normal. We investigated the effect of transoral glottal widening on quality of life and decannulation rates in patients affected by BAVCP.
METHODS
We retrospectively evaluated patients affected by BAVCP and treated by transoral CO posterior cordotomy with or without medial partial arytenoidectomy (PC ± MPA) at two referral centers. The primary outcome was change in quality of life, evaluated pre- and post-operatively by the ADVS, VHI-30, and EAT-10 questionnaires. Secondary outcomes were the need for retreatments and, for patients with tracheotomy, the time to decannulation.
RESULTS
Thirty-three patients met selection criteria. The etiology was post-surgical in 27 cases (81.8%), idiopathic in 4 (12.1%), a trauma-related in 1 (6.0%), and to other causes in 1 (3.0%). In 22 cases (66.7%), PC was combined with MPA. A significant improvement in responses for the ADVS (p < .0001) and EAT-10 (p < .0001) was observed, whereas the VHI-30 score did not change significantly post-operatively. All nine patients with a tracheostomy were successfully decannulated within 18 months after the surgical procedure.
CONCLUSIONS
For patients affected by BAVCP, PC ± MPA by transoral CO laser microsurgery is a safe, customizable and minimally invasive treatment that can guarantee an affordable balance between quality of life in terms of phonation and swallowing and acceptable airway patency.
Topics: Arytenoid Cartilage; Carbon Dioxide; Cordotomy; Humans; Laryngoscopy; Laser Therapy; Lasers, Gas; Quality of Life; Retrospective Studies; Treatment Outcome; Vocal Cord Paralysis; Vocal Cords
PubMed: 34274996
DOI: 10.1007/s00405-021-06971-7 -
Lin Chuang Er Bi Yan Hou Tou Jing Wai... Apr 2020To explore the effect of vocal cord reconstruction with sternohyoid muscle flap pedicled with vertical anterior laryngectomy. The clinical data of 43 cases of laryngeal...
To explore the effect of vocal cord reconstruction with sternohyoid muscle flap pedicled with vertical anterior laryngectomy. The clinical data of 43 cases of laryngeal carcinoma were analyzed retrospectively. According to whether the vocal cords were reconstructed, they were divided into vocal cord reconstruction group and non reconstruction group. Among them, 20 patients in the reconstruction group were reconstructed with pedicled sternohyoid muscle flap and 23 patients in non-reconstruction group. In the non reconstruction group, the external membrane of thyroid cartilage was used to repair the wounds. Postoperative respiratory function, swallowing function, pronunciation function, postoperative prognosis, complications, and recurrence rate were compared between the two groups. Reconstruction of glottis after vocal cord reconstruction was evaluated by electronic laryngoscope and CT scan. ①Patients in both groups survived during the follow-up period. One patient in the non-reconstructed group had recurrence, and the reconstituted group had no relapse, 3 cases with complications occurred in the reconstruction group, including 2 cases with granulation tissue in the glottic area, 1 case with laryngeal fistula, and 2 cases with aspiration pneumonia were found in the non-reconstruction group. ②1 year postoperative tracheal cannula removal rate, gastric tube removal and pronunciation quality: the tracheal cannula removal rate was 100% in the two groups after surgery; the gastric tube removal time in the reconstruction group was(13.2±2.8) days, and (16.6±5.3) days in the non-reconstruction group (<0.05); reconstruction group had good pronunciation in 10 cases, moderate in 6 cases, and poor in 4 cases. Non-reconstructed group had good pronunciation in 4 cases, medium in 14 cases, and poor in 5 cases. Those with moderate or higher were compared no significant difference (>0.05), and those with good pronunciation were statistically different (<0.05). ③The transverse and anteroposterior diameter in reconstruction group was similar with the normal people (>0.05); however, the transverse and anteroposterior diameter in the non-reconstructed group was significantly different with that of the normal people (>0.05), the transverse diameter of the reconstructed group and the non-reconstructed group were compared with no significant difference (>0.05), but there was significant difference in the anteroposterior diameter between the two groups (<0.05). The area in both groups were different with the normal people (<0.05); ④Glottic area morphology: the two groups of patients showed different degrees of swelling in the arytenoid cartilage area, the shape of the glottic region in the reconstructed group was approximately triangular, and the glottic morphology in the non-reconstructed group was approximately circular. After vocal cord reconstruction, there were increased rate of tracheal cannula extubation, well covered wallowing and phonation function, and the quality of life of patients was improved.
Topics: Glottis; Humans; Laryngeal Neoplasms; Laryngectomy; Neoplasm Recurrence, Local; Quality of Life; Retrospective Studies; Vocal Cords
PubMed: 32842220
DOI: 10.13201/j.issn.2096-7993.2020.04.004 -
The Pan African Medical Journal 2020Cricoarytenoid joint arthritis is most frequently reported in Rheumatoid Arthritis and in other systemic diseases such as Sjogren's syndrome, Systemic Lupus...
Cricoarytenoid joint arthritis is most frequently reported in Rheumatoid Arthritis and in other systemic diseases such as Sjogren's syndrome, Systemic Lupus Erythematosus, Ankylosing Arthritis, Juvenile Chronic Arthritis, and autoimmune hepatitis but it has not been reported in dermatomyositis. In this paper, we report the case of a 43 years-old woman treated for dermatomyositis who presented with hoarseness and severe odynophagia. The laryngoscopy revealed the presence of an extensive white swelling of the left cricoarytenoid joint with reduced mobility of the left vocal cord, consistent with left cricoarytenoid joint arthritis, which has not previously been described in dermatomyositis to our knowledge. Treatment with high doses of prednisone produced a complete resolution of the laryngeal symptoms.
Topics: Adult; Arthritis; Arytenoid Cartilage; Cricoid Cartilage; Dermatomyositis; Female; Glucocorticoids; Humans; Laryngoscopy; Prednisone
PubMed: 32774633
DOI: 10.11604/pamj.2020.36.74.18891