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Vestnik Otorinolaringologii 2022This article presents a method of organ-preserving surgical treatment of laryngeal cancer, which has been developed and used since 1991 at the Tsyba Medical Radiological...
UNLABELLED
This article presents a method of organ-preserving surgical treatment of laryngeal cancer, which has been developed and used since 1991 at the Tsyba Medical Radiological Research Center, Branch of the National Medical Research Center of Radiology of the Ministry of Health of Russia. The indications for this method are tumors affecting the middle part of the larynx, limiting its mobility, extending to the anterior commissure, laryngeal ventricle, vestibular fold, lower larynx and one arytenoid cartilage, but retaining mobility in the scooper-cricoid articulation.
OBJECTIVE
To increase the functional safety of the larynx and improve the quality of life of patients with laryngeal cancer by using the developed method of organ-preserving surgical intervention in combined treatment.
MATERIAL AND METHODS
The study included 197 patients who were operated on by the same method for a primary tumor or in connection with a relapse of the disease. At the first stage, all primary patients underwent a course of radiation or chemoradiation therapy 40-50 Gy. In 78 patients with recurrent laryngeal cancer who underwent resection of the larynx, the previous treatment was carried out in the form of a full course of radiation or chemoradiation therapy with a above 60 Gy.
RESULTS
Wound healing by primary intention in patients with preoperative irradiation was observed in 92.4% of cases. With resections for a primary tumor, restoration of functions was observed in 115 (96.6%) patients, and with resections of recurrent tumors - in 71 (91%) patients. Three-year disease-free survival in these patients was 74.4%.
CONCLUSION
The presented data showed the high efficiency of the method. This is evidenced by the course of the postoperative period, functional and oncological results are comparable, and in some cases exceed those of other researchers.
Topics: Humans; Laryngeal Neoplasms; Laryngectomy; Neoplasm Recurrence, Local; Quality of Life; Thyroid Gland
PubMed: 36107180
DOI: 10.17116/otorino20228704145 -
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 -
Veterinary Surgery : VS Oct 2022To describe the transoral endoscopic arytenopexy (TEA) and evaluate its effects on the rima glottis area (RGA) and laryngeal epiglottic-glottic seal (LEGS). We...
OBJECTIVE
To describe the transoral endoscopic arytenopexy (TEA) and evaluate its effects on the rima glottis area (RGA) and laryngeal epiglottic-glottic seal (LEGS). We hypothesize the TEA will be a feasible surgical technique and the TEA will provide a significant increase in RGA with minimal change to the LEGS.
STUDY DESIGN
Canine cadaveric model.
ANIMALS
Fifteen medium- to large-breed canine cadavers.
METHODS
Endoscopic photos of the larynx were taken with the epiglottis open for baseline RGA measurement and closed for baseline measurement of exposed RGA and LEGS. A custom endoscopic gag port (EGP) facilitated the TEA, performed by suturing the lateral aspect of the left arytenoid soft tissues to adjacent pharyngeal wall across the piriform recess. Endoscopic photos were repeated to measure changes in RGA and LEGS. A computerized planimetric analysis program was used to calculate baseline RGA and LEGS. The RGA was reported in % change from baseline. The LEGS was reported as intact or altered. A nonparametric Wilcoxon signed-rank test was used to compare baseline to post-TEA RGA.
RESULTS
The mean baseline RGA was 0.52 ± 0.28 cm and mean post-TEA RGA was 0.78 ± 0.37 cm (p-value < .0001). The LEGS remained intact post-TEA in all cadavers.
CONCLUSIONS
The TEA was technically feasible and resulted in an increase in RGA while maintaining the LEGS.
CLINICAL SIGNIFICANCE
The TEA may provide a minimally invasive addition to the established techniques for reducing airway resistance while minimizing the impact on the LEGS.
Topics: Animals; Arytenoid Cartilage; Cadaver; Dog Diseases; Dogs; Epiglottis; Glottis; Larynx
PubMed: 35819626
DOI: 10.1111/vsu.13851 -
Veterinary Surgery : VS Oct 2022To assess the effect of repeated freezing and thawing on the suture pull-out strength in arytenoid and cricoid cartilages subjected to the laryngoplasty (LP) procedure.
OBJECTIVE
To assess the effect of repeated freezing and thawing on the suture pull-out strength in arytenoid and cricoid cartilages subjected to the laryngoplasty (LP) procedure.
STUDY DESIGN
Ex vivo experimental study.
SAMPLE POPULATION
Ten grossly normal equine cadaveric larynges.
METHODS
Bilateral LP constructs were created using a standard LP technique. One hemilarynx was randomly allocated to the single freeze and thaw group and the other allocated to the repeated freeze and thaw (3 complete cycles) group. The suture ends of each LP construct were attached to a load frame and subjected to monotonic loading until construct failure. Mean load (N) and displacement (mm) at LP construct failure were compared between groups.
RESULTS
All LP constructs failed by suture pull through the arytenoid cartilage. The mean load at failure was similar between groups (118.9 ± 25.5 N in the single freeze and thaw group and 113.4 ± 20.5 N in the repeated freeze and thaw group, P = .62). The mean displacement at failure was similar between groups (54.4 ± 15.1 mm in the single freeze and thaw group and 54.4 ± 15.4 mm in the repeated freeze and thaw group, P = .99).
CONCLUSION
Repeated freezing and thawing did not affect the suture pullout strength of the arytenoid and cricoid cartilages.
CLINICAL SIGNIFICANCE
Laryngeal specimens that have been subjected to repeated freezing and thawing can be utilized in the experimental evaluation of LP procedures because there is no alteration of the suture pull-out strength of the relevant cartilages.
Topics: Animals; Arytenoid Cartilage; Cadaver; Cricoid Cartilage; Freezing; Horses; Laryngoplasty; Sutures
PubMed: 35815735
DOI: 10.1111/vsu.13855 -
World Journal of Clinical Cases May 2022Arytenoid cartilage dislocation is a rare and often overlooked complication of tracheal intubation or blunt laryngeal trauma. The most common symptom is persistent...
BACKGROUND
Arytenoid cartilage dislocation is a rare and often overlooked complication of tracheal intubation or blunt laryngeal trauma. The most common symptom is persistent hoarseness. Although cases of arytenoid dislocation due to tracheal intubation are reported more frequently in otolaryngology, reports on its occurrence in the intensive care unit (ICU) are lacking. We report a case of delayed diagnosis of arytenoid cartilage dislocation after tracheal intubation in the ICU.
CASE SUMMARY
A 20-year-old woman was referred to the ICU following a fall from a height. Her voice was normal; laryngeal computed tomography showed unremarkable findings on admission. However, due to deterioration of the patient's condition, tracheal intubation, and emergency exploratory laparotomy followed by laparoscopic surgery two d later under general anesthesia were performed. After extubation, the patient was sedated and could not communicate effectively. On the 10 day after extubation, the patient complained of hoarseness and coughing with liquids, which was attributed to laryngeal edema and is common after tracheal intubation. Therefore, specific treatment was not administered. However, the patient's symptoms did not improve. Five d later, an electronic laryngoscope examination revealed dislocation of the left arytenoid cartilage. The patient underwent arytenoid closed reduction under general anesthesia by an experienced otolaryngologist. Reported symptoms improved subsequently. The six-month follow up revealed that the hoarseness had resolved within four weeks of the reduction procedure.
CONCLUSION
Symptoms of arytenoid cartilage dislocation are difficult to identify in the ICU leading to missed or delayed diagnosis among patients.
PubMed: 35801012
DOI: 10.12998/wjcc.v10.i15.5119 -
Veterinary Anaesthesia and Analgesia Sep 2022
Topics: Animals; Arytenoid Cartilage; Dog Diseases; Dogs; Ultrasonography, Interventional; Vocal Cord Paralysis
PubMed: 35778311
DOI: 10.1016/j.vaa.2022.05.008 -
Auris, Nasus, Larynx Feb 2023Intraoperative cone beam computed tomography (CBCT) imaging has the potential to facilitate the surgical procedure. The current preliminary retrospective chart review...
OBJECTIVES
Intraoperative cone beam computed tomography (CBCT) imaging has the potential to facilitate the surgical procedure. The current preliminary retrospective chart review investigated the benefits of intraoperative CBCT during laryngoplasty.
METHOD
This study examined 26 cases that underwent intraoperative CBCT imaging during laryngoplasty, with one patient who counted twice due to first and revision surgery. The visual quality of structures of interest (glottal shape, thyroid cartilage, arytenoid cartilage, and implants) was determined using intraoperative CBCT during laryngoplasty. Each patient also underwent an aerodynamic assessment.
RESULTS
CBCT provided unique information, such as surgical landmarks in severe scarring, the subglottal shape, and the rotation angle of the arytenoid cartilage during arytenoid adduction. Nonetheless, 26.9% (7 of 26) of cases were affected by motion artifact, due to the long acquisition time. When motion artifact-negative cases were evaluated, 100% of glottal shape and more than 89% of thyroid cartilage were well visualized. All arytenoids were well-visualized in patients ≥ 50 years of age and without motion artifact, while CBCT failed to visualize the arytenoids in 2 of 4 patients who were < 50 years, due to the lack of calcifications. After medialization surgery, the yields of improved maximal phonation times (MPTs) in the motion artifact-negative and -positive groups were 8.7 sec and 3.4 sec, respectively (p = 0.032; Welch's t test). This comparison indicates intraoperative CBCT would contribute in MPT improvement, if CBCT is taken in measurable quality.
CONCLUSION
The potential benefits of intraoperative CBCT during laryngoplasty were demonstrated. A corollary, prospective study is warranted to further confirmation.
Topics: Humans; Laryngoplasty; Vocal Cord Paralysis; Phonation; Retrospective Studies; Prospective Studies; Arytenoid Cartilage; Tomography, X-Ray Computed; Laryngeal Diseases; Treatment Outcome
PubMed: 35701287
DOI: 10.1016/j.anl.2022.05.019 -
The Laryngoscope Mar 2023Quantify differences in acoustics and intraglottal flow fields between Thyroplasty Type 1 (TT1) with and without arytenoid adduction (AA) using excised canine larynx...
OBJECTIVES/HYPOTHESIS
Quantify differences in acoustics and intraglottal flow fields between Thyroplasty Type 1 (TT1) with and without arytenoid adduction (AA) using excised canine larynx model.
STUDY DESIGN
Basic science experiments using excised larynges.
METHODS
Surgical procedures were implemented in eight excised canine larynges. Acoustics and intraglottal flow measurements were taken at low and high subglottal pressures in each experimental setup.
RESULTS
In all larynges, vocal efficiency (VE) and cepstrum peak prominence (CPP) were higher, and the mean phonatory flow rate was lower in TT1 with AA than without AA. The glottal asymmetry is reduced with AA and promotes the formation of stronger vortices in the glottal flow during the closing phase of the vibrating folds.
CONCLUSIONS
Findings suggest a clear acoustic and aerodynamic benefit to the addition of AA when performing TT1. It shows significant improvement in CPP, translating to decreased breathiness and dysphonia and increased VE, leading to easier and more sustainable phonation. Stronger intraglottal vortices are known to be correlated with the loudness of voice produced by phonation.
LEVEL OF EVIDENCE
N/A Laryngoscope, 133:621-627, 2023.
Topics: Animals; Dogs; Vocal Cord Paralysis; Larynx; Glottis; Arytenoid Cartilage; Phonation; Laryngoplasty; Acoustics; Vocal Cords
PubMed: 35655422
DOI: 10.1002/lary.30235 -
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 -
Auris, Nasus, Larynx Aug 2023Supracricoid hemilaryngopharyngectomy (SCHLP) is a laryngeal preservation surgery for hypopharyngeal carcinoma confined to the pyriform sinus or laryngeal carcinoma with...
Supracricoid hemilaryngopharyngectomy (SCHLP) is a laryngeal preservation surgery for hypopharyngeal carcinoma confined to the pyriform sinus or laryngeal carcinoma with arytenoid infiltration. Postoperative dysphagia is inevitable, but both voice and swallowing functions can be preserved. Here, we present a case of severe dysphagia secondary to unexpected postoperative tissue loss and scarring. A 67-year-old man underwent left SCHLP for hypopharyngeal cancer, and on the third postoperative day, he developed necrotizing fasciitis of the left neck. He was unable to swallow and was transferred to a rehabilitation hospital 90 days after the surgery. Six months after surgery, the patient had significant glottic insufficiency due to laryngeal deformity, constant massive salivary aspiration, and difficulty releasing the cuffed cannula. Severe dysphagia due to glottic insufficiency and laryngeal elevation insufficiency due to scar formation were considered, and laryngoplasty and laryngeal suspension surgery using costal cartilage were performed on the 221st postoperative day. After the reoperation, he was able to wear a speech valve and could speak and spit out, although his glottis was still closed. On the 70th day after the reoperation, he was able to consume three meals of an oral dysphagia diet and was discharged home.
Topics: Male; Humans; Aged; Deglutition; Deglutition Disorders; Costal Cartilage; Hypopharyngeal Neoplasms; Laryngeal Neoplasms; Cricoid Cartilage; Laryngectomy
PubMed: 35606217
DOI: 10.1016/j.anl.2022.05.009