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Journal of Voice : Official Journal of... Apr 2023Thyroarytenoid muscle avulsion is a rare condition in which laryngeal trauma causes a separation of the thyroarytenoid muscle from the arytenoid cartilage. Typically,...
Thyroarytenoid muscle avulsion is a rare condition in which laryngeal trauma causes a separation of the thyroarytenoid muscle from the arytenoid cartilage. Typically, symptoms are nonspecific but include severe dysphonia and voice fatigue. They are similar to symptoms of vocal process avulsion. Strobovideolaryngoscopy, laryngeal electromyography, and laryngeal computed tomography may be helpful in diagnosis. However, intraoperative palpation under general anesthesia is the most definitive way to establish its diagnosis. We present two cases of thyroarytenoid muscle avulsion, a condition that has not been described previously. Surgical techniques for repair are detailed.
PubMed: 37012094
DOI: 10.1016/j.jvoice.2023.03.008 -
Journal of Visualized Experiments : JoVE Apr 2023An erratum was issued for: Endotracheal Intubation Using a Flexible Intubation Endoscope As a Standardized Model for Safe Airway Management in Swine. The Protocol,...
An erratum was issued for: Endotracheal Intubation Using a Flexible Intubation Endoscope As a Standardized Model for Safe Airway Management in Swine. The Protocol, Representative Results, and Discussion sections were updated. In the Protocol, step 1.5 was updated from: Disinfect the skin with a disinfectant (alcoholic) before inserting a peripheral vein cannula (22 G) into an ear vein. Spray the area, wipe once, then spray again, and allow the disinfectant to dry. to: Disinfect the skin with a disinfectant (alcoholic) before inserting a peripheral vein cannula (22 G) into an ear vein. Spray the area, wipe once, then spray again, and allow the disinfectant to dry. Secure the ear cannula with a band-aid (See Table of Materials). In the Protocol, step 3.7 was updated from: While maintaining the position of the endoscope, advance the endotracheal tube until it becomes visible in the camera image. NOTE: If the endotracheal tube cannot be advanced through the glottic plane, there is a possibility that it has become caught on the arytenoid cartilage. In this case, the endotracheal tube must be withdrawn 1 cm and rotated by 90° before gently advancing again. If necessary, this maneuver can be repeated. Similar calibers of flexible intubation endoscope and endotracheal tube can minimize the risk of this issue occurring. If the endotracheal tube cannot be advanced despite this maneuver, it is likely that the subglottic narrowness-the narrowest part of the porcine larynx-cannot be passed. In this case, a smaller endotracheal tube size needs to be selected. Regular commercially available endotracheal tubes in sizes 6.5 cm or 7.0 cm ID should be able to pass the glottis as long as no anatomic abnormalities are present. to: While maintaining the position of the endoscope, advance the endotracheal tube until it becomes visible in the camera image. NOTE: If the endotracheal tube cannot be advanced through the glottic plane, there is a possibility that it has become caught on the arytenoid cartilage. In this case, the endotracheal tube must be withdrawn 1 cm and rotated by 90° before gently advancing again. If necessary, this maneuver can be repeated. Similar calibers of flexible intubation endoscope and endotracheal tube can minimize the risk of this issue occurring. If the endotracheal tube cannot be advanced despite this maneuver, it is likely that the subglottic narrowness-the narrowest part of the porcine larynx-cannot be passed. In this case, a smaller endotracheal tube size needs to be selected. Regular commercially available endotracheal tubes in sizes 6.5 cm or 7.0 cm ID should be able to pass the glottis as long as no anatomic abnormalities are present. Endotracheal tube size requirements vary depending on the piglet size and breed. In the Representative Results, the sixth paragraph was updated from: Statistical analyses were performed using commercially available software (see Table of Materials). Normal distribution was examined using the Kolmogorov-Smirnoff test. If a normal distribution was determined, group differences were analyzed using t-tests of independent samples or the Mann-Whitney U test for the non-parametric version. Data are presented as mean (± standard deviation). Correlations of ordinal-scale data were examined using Spearman's correlation coefficient. A significance level of p < 0.05 was assumed. to: Statistical analyses were performed using commercially available software (see Table of Materials). Normal distribution was examined using the Kolmogorov-Smirnoff test. If a normal distribution was determined, group differences were analyzed using t-tests of independent samples or the Mann-Whitney U test for the non-parametric version. Data are presented as mean (± standard deviation). Correlations of ordinal-scale data were examined using Spearman's correlation coefficient. A significance level of p < 0.05 was assumed. All tests were performed with exploratory intention; therefore p-values are descriptive. Nevertheless, p < 0.05 was accepted as indicative of statistical significance. In the Representative Results, the legend for figure 1 was updated from: Figure 1: Number of intubation attempts in group comparison. For the group that was intubated using a flexible intubation endoscope, every intubation attempt was successful; in the group that was conventionally intubated, it took an average of 1.4 attempts before the endotracheal tube could be placed correctly. Error bars show the standard deviation. Please click here to view a larger version of this figure. to: Figure 1: Number of intubation attempts in group comparison. For the group that was intubated using a flexible intubation endoscope, every intubation attempt was successful; in the group that was conventionally intubated, it took an average of 1.4 attempts before the endotracheal tube could be placed correctly. Error bars show the standard deviation. n = 5 (for each group). Please click here to view a larger version of this figure. In the Representative Results, figure 2 was updated from: Figure 2: Time until CO2 detection in group comparison. For the group that was intubated using a flexible intubation endoscope, it took significantly longer until end-tidal CO2 could be detected, depicted as mean and standard deviation. Please click here to view a larger version of this figure. to: Figure 2: Time until CO2 detection in group comparison. For the group that was intubated using a flexible intubation endoscope, it took significantly longer until end-tidal CO2 could be detected, depicted as mean and standard deviation. n = 5 (for each group). Please click here to view a larger version of this figure. In the Discussion, the fifth paragraph was updated from: The increased duration had no clinical significance in this cohort. At no time was the termination criterion-a saturation of less than 93%-reached. This is shown in the results because a procedure change was unnecessary at any time. Prior adequate mask ventilation is a critical step to allow sufficient time for fiberoptic endotracheal tube placement to avoid rapid desaturation. These results are consistent with previous studies comparing conventional intubation and endoscopically assisted intubations with inexperienced providers. to: The increased duration had no clinical significance in this cohort. At no time was the termination criterion-a saturation of less than 93%-reached. This is shown in the results because a procedure change was unnecessary at any time. Prior adequate mask ventilation is a critical step to allow sufficient time for fiberoptic endotracheal tube placement to avoid rapid desaturation. These results are consistent with previous studies comparing conventional intubation and endoscopically assisted intubations with inexperienced providers. We attribute the prolonged duration of fiberoptic intubation to the fact that one must first reorient again after insertion, whereas with conventional intubation, one retains a view of the glottis. It is also important to avoid contact with the mucosa with the flexible intubation endoscope during advancement. This requires occasional corrective maneuvers. Last but not least, after successful placement, retraction of the relatively long endoscope is required, which increases the time to CO2 detection slightly.
PubMed: 37011175
DOI: 10.3791/6550 -
Acta Oto-laryngologica Apr 2023Laryngeal carcinomas cause vocal cord (VC) mobility problems. Other than evaluation through flexible laryngoscopy, rare reports concerning CT findings for the motion of...
BACKGROUND
Laryngeal carcinomas cause vocal cord (VC) mobility problems. Other than evaluation through flexible laryngoscopy, rare reports concerning CT findings for the motion of the VC or arytenoid cartilage (AC) are found.
AIMS/OBJECTIVES
To explore a novel evaluation of the mobility of the AC in glottic carcinoma.
MATERIAL AND METHODS
In 39 patients with glottic carcinoma grouped upon lesion locations and AC mobilities, laryngeal CT scans were collected during inspiration and phonation. AC static position and motion data were compared between paired lesion and control sides.
RESULTS
No significant difference showed in the group with glottic carcinoma invading the anterior 2/3 of VC. In the abnormal mobility group, significant AC position changes and weaker motion of most measurements were proved on the lesion side. Lesion invading the posterior 1/3 of VC also resulted in an adducted, medially rotated and forward-tilted AC, rotation of axial angle (RAA) was the only motion item that decreased significantly.
CONCLUSIONS AND SIGNIFICANCE
In most glottic cancer cases, CT and laryngoscope had similar judgments for AC mobility. For lesions extending to the cartilaginous VC with laryngoscopically confirmed normal mobility, CT measurement of RAA showed the feasibility of being an indicator for the earliest motion problem.
Topics: Humans; Arytenoid Cartilage; Laryngeal Neoplasms; Larynx; Tomography, X-Ray Computed; Carcinoma
PubMed: 36939115
DOI: 10.1080/00016489.2023.2187885 -
American Journal of Veterinary Research May 2023Evaluation of the strength of the novel suture technique by comparison with a 2-interrupted suture technique.
OBJECTIVES
Evaluation of the strength of the novel suture technique by comparison with a 2-interrupted suture technique.
SAMPLE
40 equine larynges.
PROCEDURES
40 larynges were used; 16 laryngoplasties were performed using the currently accepted 2-suture technique and 16 using the novel suture technique. These specimens were subjected to a single cycle to failure. Eight specimens were used to compare the rima glottidis area achieved with 2 different techniques.
RESULTS
The mean force to failure, as well as the rima glottidis area of both constructs, were not significantly different. The cricoid width did not have a significant effect on the force to failure.
CLINICAL RELEVANCE
Our results suggest that both constructs are equally strong and can achieve a similar cross-sectional area of the rima glottidis. Laryngoplasty ("tie-back") is currently the treatment of choice for horses with exercise intolerance due to recurrent laryngeal neuropathy. Failure to maintain the expected degree of arytenoid abduction post-surgery occurs in some horses. We believe this novel 2-loop pulley load-sharing suture technique can help achieve and, more importantly, maintain the desired degree of abduction during surgery.
Topics: Horses; Animals; Laryngoplasty; Larynx; Arytenoid Cartilage; Suture Techniques; Sutures
PubMed: 36867543
DOI: 10.2460/ajvr.22.11.0189 -
Ear, Nose, & Throat Journal Mar 2023Schwannomas account for a large proportion of tumors in the head and neck regions; however, schwannomas of the larynx are rare. An 11-year-old boy had a sore throat for...
Schwannomas account for a large proportion of tumors in the head and neck regions; however, schwannomas of the larynx are rare. An 11-year-old boy had a sore throat for one month, and his symptoms gradually worsened such that he needed to visit our otolaryngology clinic. The preoperative investigation revealed a smooth mass in the left arytenoid cartilage. Endoscopy-assisted transoral resection of laryngeal masses was performed under general anesthesia, and the resected tissue was histopathologically diagnosed as a laryngeal schwannoma. The postoperative recovery was very good. During the 1-year follow-up, there was no recurrence of the schwannoma or related symptoms. Although laryngeal schwannomas are rare, they should be considered in the differential diagnosis of these tumors. Sufficient preoperative imaging should be performed before surgical resection, and surgery is the preferred treatment option.
PubMed: 36866713
DOI: 10.1177/01455613231162236 -
The Journal of Laryngology and Otology Feb 2023
Topics: Humans; Benign Paroxysmal Positional Vertigo; Arytenoid Cartilage; Granuloma
PubMed: 36810137
DOI: 10.1017/S0022215123000075 -
European Archives of... Jun 2023The anterior, percutaneous Botulinum neurotoxin (BoNT) injection in the lateral cricoarytenoid muscle (LCA) guided by laryngeal electromyography (LEMG) is considered the...
OBJECTIVES
The anterior, percutaneous Botulinum neurotoxin (BoNT) injection in the lateral cricoarytenoid muscle (LCA) guided by laryngeal electromyography (LEMG) is considered the golden standard treatment for several neurolaryngological disorders. The study presented in this article aims to assess the effectiveness of an alternative approach by which the injection is performed laterally under ultrasound monitoring.
STUDY DESIGN
Anatomical dissection study in human cadavers.
SETTINGS
Academic health care center.
METHODS
Ultrasound-guided bilateral dye (0.1 mL of dye solution containing cold-curing polymers, latex, acrylates, acrylic esters, alcohol, and green color) injection in the LCA was performed by means of 24G needles and 1 mL syringes using the lateral approach. The dye location and distribution were assessed by anatomic dissection, performed immediately after the injection.
RESULTS
In 9/10 specimens, the dye was exclusively detectable in the LCA. In 1/10 case (left side), the dye could not be delivered in the LCA because of unintended penetration of the thyroid cartilage by the needle during injection. Anatomic dissection confirmed that the dye spread neither into the thyroarytenoid (TA) nor the cricothyroid muscle (CT).
CONCLUSIONS
The anatomic dissection following lateral dye injection in the LCA under ultrasound guide confirmed the precision of this approach in delivery a substance exclusively in a pre-determined target. This feature makes this method an interesting addition or alternative to the standard LEMG-guided BoNT injection at least when the LCA is its target.
LEVEL OF EVIDENCE
III.
Topics: Humans; Laryngeal Muscles; Pilot Projects; Laryngeal Diseases; Electromyography; Botulinum Toxins; Ultrasonography, Interventional
PubMed: 36773100
DOI: 10.1007/s00405-023-07843-y -
Indian Journal of Otolaryngology and... Dec 2022The chondromas of laryngeal cartilage constitute less than 1% of common mesenchymal tumors of the larynx. 70-75% of chondroma is located at the endolaryngeal surface of...
The chondromas of laryngeal cartilage constitute less than 1% of common mesenchymal tumors of the larynx. 70-75% of chondroma is located at the endolaryngeal surface of the cricoid cartilage. Here is a case report of the chondroma of arytenoid cartilage-a rare site of occurrence. A middle aged male patient, presented to the outpatient department of otorhinolaryngology with a history of hoarseness of voice. On Flexible laryngoscopy [Pentax, Tokyo, Japan], the right vocal cord was found to be immobile along with a smooth bulge noted over the arytenoid cartilage. The computerized tomography scan of the neck showed a well-defined peripherally calcified lesion arising from the superior aspect of right arytenoid cartilage possibly chondroma. Patient underwent microlaryngeal surgery and sub mucosal excision of the arytenoid mass which was confirmed as chondroma on histopathological examination. High degree of suspicion is required while examining a patient with hoarseness of voice and one should have chondroma as one of the differential diagnosis.
PubMed: 36742926
DOI: 10.1007/s12070-021-02879-0 -
American Journal of Otolaryngology 2023To systematically evaluate differences in swallowing disorder-related manifestations in patients with supraglottic laryngeal cancer, who underwent traditional open... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
To systematically evaluate differences in swallowing disorder-related manifestations in patients with supraglottic laryngeal cancer, who underwent traditional open partial horizontal laryngectomy (OPHL) and endoscopic supraglottic laryngectomy (ESL).
METHODS
A systematic review of the literature and a meta-analysis were performed. The CNKI, Wan Fang, PubMed, EMBASE, Cochrane Library, Web of Science, and Clinical Trials databases for clinical studies data sources were investigated. The efficiency of recovery, postoperative swallowing function, and complications related to dysphagia were investigated to compare the effects of surgical procedures.
RESULTS
The meta-analysis included 8 studies with 281 patients. ESL surgery played a positive role in the recovery of patients. Preservation of the anterior epiglottic space, ventricular band, and arytenoid cartilage without destroying the external framework of the larynx can effectively reduce the risk of aspiration pneumonia in patients.
CONCLUSIONS
ESL has advantages in postoperative recovery and retention of swallowing function in patients with supraglottic laryngeal cancer.
Topics: Humans; Carcinoma; Deglutition; Deglutition Disorders; Laryngeal Neoplasms; Laryngectomy; Larynx; Retrospective Studies; Treatment Outcome
PubMed: 36706715
DOI: 10.1016/j.amjoto.2023.103788 -
PloS One 2023Changes to the voice are prevalent and occur early in Parkinson's disease. Correlates of these voice changes on four-dimensional laryngeal computed-tomography imaging,...
Changes to the voice are prevalent and occur early in Parkinson's disease. Correlates of these voice changes on four-dimensional laryngeal computed-tomography imaging, such as the inter-arytenoid distance, are promising biomarkers of the disease's presence and severity. However, manual measurement of the inter-arytenoid distance is a laborious process, limiting its feasibility in large-scale research and clinical settings. Automated methods of measurement provide a solution. Here, we present a machine-learning module which determines the inter-arytenoid distance in an automated manner. We obtained automated inter-arytenoid distance readings on imaging from participants with Parkinson's disease as well as healthy controls, and then validated these against manually derived estimates. On a modified Bland-Altman analysis, we found a mean bias of 1.52 mm (95% limits of agreement -1.7 to 4.7 mm) between the automated and manual techniques, which improves to a mean bias of 0.52 mm (95% limits of agreement -1.9 to 2.9 mm) when variability due to differences in slice selection between the automated and manual methods are removed. Our results demonstrate that estimates of the inter-arytenoid distance with our automated machine-learning module are accurate, and represents a promising tool to be utilized in future work studying the laryngeal changes in Parkinson's disease.
Topics: Humans; Arytenoid Cartilage; Larynx; Parkinson Disease; Tomography, X-Ray Computed
PubMed: 36652423
DOI: 10.1371/journal.pone.0279927