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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 -
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 -
BMC Veterinary Research May 2022Laryngeal paralysis is a disease process most commonly seen in older, large breed dogs. When both arytenoid cartilages are affected dogs can develop life-threatening...
BACKGROUND
Laryngeal paralysis is a disease process most commonly seen in older, large breed dogs. When both arytenoid cartilages are affected dogs can develop life-threatening respiratory compromise, therefore surgical intervention is recommended. While there are multiple surgical procedures that have been described to treat laryngeal paralysis, there remains a considerable risk for postoperative complications, most commonly aspiration pneumonia. The objective of this ex vivo experimental study was to evaluate the effects of a novel, 3D printed bilateral arytenoid abductor on laryngeal airway resistance in canine cadaver larynges. Laryngeal airway resistance was calculated for each specimen before (control) and after placement of a 3D printed, bilateral arytenoid abductor. The airway resistance was measured at an airflow of 10 L/min with the epiglottis closed and at airflows ranging from 15 L/min to 60 L/min with the epiglottis open. The effects of the bilateral arytenoid abductor on laryngeal airway resistance were evaluated statistically.
RESULTS
With the epiglottis open, median laryngeal airway resistance in all larynges with a bilateral arytenoid abductor were significantly decreased at airflows of 15 L/min (0.0cmH2O/L/sec), 30 L/min (0.2cmH2O/L/sec), and 45 L/min (0.2cmH2O/L/sec) compared to the controls 15 L/min (0.4cmH2O/L/sec; P = 0.04), 30 L/min (0.9cmH2O/L/sec; P = 0.04), and 45 L/min (1.2cmH2O/L/sec; P = 0.04). When the epiglottis was closed, there was no significant difference in laryngeal resistance between the control (18.8cmHO/L/sec) and the abducted larynges (18.1cmHO/L/sec; P = 0.83).
CONCLUSIONS
Placement of a bilateral arytenoid abductor reduced laryngeal resistance in canine cadaver larynges compared to the controls when the epiglottis was open. With the epiglottis closed, there was no loss of laryngeal resistance while the device abducted the arytenoid cartilages. The results of this ex vivo study is encouraging for consideration of further evaluation of the bilateral arytenoid abductor to determine an appropriate material and tolerance of this device in vivo.
Topics: Airway Resistance; Animals; Arytenoid Cartilage; Cadaver; Dog Diseases; Dogs; Printing, Three-Dimensional; Vocal Cord Paralysis
PubMed: 35596179
DOI: 10.1186/s12917-022-03263-y -
Animals : An Open Access Journal From... Apr 2022Stage III laryngeal collapse is defined as the collapse of the corniculate processes of the arytenoid cartilages and the destructuration of the dorsal portion of the...
Stage III laryngeal collapse is defined as the collapse of the corniculate processes of the arytenoid cartilages and the destructuration of the dorsal portion of the rima glottidis. The primary cause is chronic upper airway obstruction, and the condition is often present in brachycephalic dogs. The treatment is still controversial; the patients are generally treated with a permanent tracheostomy. This article reports the authors' experience with 16 dogs affected by stage III laryngeal collapse treated with subtotal epiglottectomy and the ablation of unilateral arytenoid cartilage. Before the surgery, all of the dogs underwent an effort test to classify the clinical severity of the disease and an endoscopic examination of the airways to determine the stage of severity of the laryngeal collapse. One month after surgery, the effort test was repeated in order to evaluate the clinical outcome. One year after surgery, the owners of 12 patients rated their dogs as follows: excellent in five cases, good in five cases, and fair in two cases. According to this pilot study, epiglottectomy associated with the photoablation of unilateral arytenoid cartilage increases airway flow, and thus may be considered a valid surgical procedure to treat dogs affected by grade III laryngeal collapse.
PubMed: 35565545
DOI: 10.3390/ani12091118 -
International Journal of General... 2022Laryngeal cancer is a common form of head and neck cancer in Vietnam where the current treatment is surgery. Subtotal laryngectomy with epiglottic reconstruction, a...
AIM
Laryngeal cancer is a common form of head and neck cancer in Vietnam where the current treatment is surgery. Subtotal laryngectomy with epiglottic reconstruction, a conservative surgery, allows removal of anterior commissure including thyroid cartilage and paraglottic space and provides a maximum restoration of the anatomical structure of the larynx.
PURPOSE
To evaluate the results, the safety and effectiveness of patients who were treated with subtotal laryngectomy with epiglottic reconstruction.
MATERIAL AND METHOD
From January 2012 to July 2017, 42 patients (41 male, 1 female, median age 55.6 years, range 38-75 years) were diagnosed with glottic carcinomas at Vietnam National ENT Hospital, where they underwent a subtotal laryngectomy with epiglottic reconstruction.
RESULTS
Thirty-one patients (73.8%) had T2 glottic carcinoma, 4 (9.5%) T3 glottic carcinoma, and 12 (25.6%) had neck dissection. The arytenoid cartilage on the tumor-bearing side was resected in 11 patients (26.2%). Functional ipsilateral neck dissection was performed in 30 patients. Positive lymph node of stage T2 was 1/31 (3.2%). Postoperative histopathologic examination showed a tumour free of resection margin in 41 patients (97.6%). Only one post-operative complication occurred with bleeding 24 hours after surgery. There was no mortality. The 3- and 5-year overall survival rates were 97.6% and 85.7%, respectively. The rate of local control was 92.9%.
CONCLUSION
Subtotal laryngectomy with epiglottic reconstruction was performed mostly for T2 and certain T3 glottic carcinomas when there is difficult to safely remove the tumour with transoral laser microsurgery. This surgery appears to be effective for the overall survival and has potential in clinical practice for treating moderate glottic carcinoma.
PubMed: 35256858
DOI: 10.2147/IJGM.S350624 -
Revista Espanola de Anestesiologia Y... Feb 2022Vocal 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.
Topics: COVID-19; Humans; Intubation, Intratracheal; Male; SARS-CoV-2; Tracheostomy; Vocal Cord Paralysis
PubMed: 35177365
DOI: 10.1016/j.redare.2020.11.012 -
Lin Chuang Er Bi Yan Hou Tou Jing Wai... Feb 2022The aim of this study is to evaluate the efficacy of unilateral posterior glottic cleft dilatation with low-temperature plasma under the endoscope in the treatment of...
The aim of this study is to evaluate the efficacy of unilateral posterior glottic cleft dilatation with low-temperature plasma under the endoscope in the treatment of bilateral vocal cord paralysis dyspnea. Forty-one patients with bilateral vocal cord paralysis were recruited, and they were all admitted to the Department of Otorhinolaryngology Head and Neck Surgery, the First Affiliated Hospital of Zhengzhou University from March 2014 to June 2019. Those 41 patients were all treated with low-temperature plasma to completely resect unilateral arytenoid cartilage and the posterior 1/3 of the ipsilateral vocal cord. Fiber laryngoscopy was performed before and after operation. The clinical efficacy of the operation was evaluated by the size of glottis cleta, the improvement rate of dyspnea, voice satisfaction, swallowing function, the tracheal cannula removal rate and postoperative complication rate. Forty-one patients were followed up for 24-88 months. The rate of one-pass extubation was 88.57%(31/35). The satisfaction rate of voice was 92.11%(35/38). The recovery rate of swallowing function was 97.56%(40/41). This study demonstrated that the application of low-temperature plasma in unilateral posterior glottic cleft dilatation could significantly improved the ventilation function of patients with bilateral vocal cord paralysis, with a reliable curative effect and a high extubation rate. It is a safe, reliable, simple and minimally invasive treatment option for the treatment of bilateral vocal cord paralysis.
Topics: Arytenoid Cartilage; Dilatation; Dyspnea; Humans; Laryngoscopy; Treatment Outcome; Vocal Cord Paralysis
PubMed: 35172546
DOI: 10.13201/j.issn.2096-7993.2022.02.006 -
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