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Cureus Jan 2024Tuberculosis continues to remain a major public health challenge, especially in low- and middle-income countries. Unilateral vocal cord palsy in adults as the sole...
Tuberculosis continues to remain a major public health challenge, especially in low- and middle-income countries. Unilateral vocal cord palsy in adults as the sole manifestation of tubercular mediastinal lymphadenopathy has been rarely reported. A 22-year-old lady presented with a history of hoarseness of voice for the past month. The general physical examination revealed palpable lymph nodes in the left axilla. Axial CT sections at the level of the vocal cords demonstrated dilation of the right laryngeal ventricle and mild anteromedial deviation of the ipsilateral arytenoid cartilage ("sail" sign) suggestive of a right vocal cord palsy. Contrast-enhanced CT chest revealed right paratracheal, right hilar, and subcarinal lymph nodes with areas of central necrosis. She was started on anti-tubercular therapy and her voice completely improved after three months of treatment. The "Sail" sign on axial CT scans is a useful radiological sign for diagnosing unilateral vocal cord palsy. Rarely, compression of the recurrent laryngeal nerve by enlarged mediastinal lymph nodes due to tuberculosis can present with unilateral vocal cord palsy as the sole manifestation in adults.
PubMed: 38333460
DOI: 10.7759/cureus.51950 -
Ear, Nose, & Throat Journal Feb 2024Vocal fold process avulsion results from trauma that detaches the vocal process and thyroarytenoid muscle from the body of the arytenoid cartilage. Vocal fold laxity...
Vocal fold process avulsion results from trauma that detaches the vocal process and thyroarytenoid muscle from the body of the arytenoid cartilage. Vocal fold laxity often causes severe dysphonia. Findings can be subtle. A high index of suspicion often permits diagnosis and effective surgical repair.
PubMed: 38323380
DOI: 10.1177/01455613241226860 -
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 -
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 -
American Journal of Veterinary Research Feb 2024To describe left recurrent laryngeal neurectomy (LRLn) performed under standing sedation and evaluate the effect of LRLn on upper respiratory tract function using a...
OBJECTIVE
To describe left recurrent laryngeal neurectomy (LRLn) performed under standing sedation and evaluate the effect of LRLn on upper respiratory tract function using a high-speed treadmill test (HST). We hypothesized that (1) unilateral LRLn could be performed in standing horses, resulting in ipsilateral arytenoid cartilage collapse (ACC); and (2) HST after LRLn would be associated with alterations in upper respiratory function consistent with dynamic ACC.
ANIMALS
6 Thoroughbred horses.
METHODS
The horses were trained and underwent a baseline HST up to 14 m/s at 5% incline until fatigue. Evaluation included; airflow, pharyngeal and tracheal pressures, and dynamic upper respiratory tract endoscopy. Trans-laryngeal impedance (TLI) and left-to-right quotient angle ratio (LRQ) were calculated after testing. The following day, standing LRLn was performed in the mid-cervical region. A HST was repeated within 4 days after surgery.
RESULTS
Standing LRLn was performed without complication resulting in Havemayer grade 4 ACC at rest (complete paralysis) and Rakestraw grade C or D ACC (collapse up to or beyond rima glottis midline) during exercise. Increasing treadmill speed from 11 to 14 m/s increased TLI (P < .001) and reduced LRQ (P < .001). Neurectomy resulted in an increase in TLI (P = .021) and a reduction in LRQ (P < .001).
CLINICAL RELEVANCE
Standing LRLn induces laryngeal hemiplegia that can be evaluated using a HST closely after neurectomy. Standing LRLn may be useful for future prospective evaluations of surgical interventions for laryngeal hemiplegia.
Topics: Horses; Animals; Exercise Test; Hemiplegia; Vocal Cord Paralysis; Larynx; Denervation; Horse Diseases
PubMed: 38086174
DOI: 10.2460/ajvr.23.08.0185 -
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 -
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 -
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