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Beijing Da Xue Xue Bao. Yi Xue Ban =... Sep 2020To assess the incidence of postoperative vocal cord immobility in patients following endotracheal intubation underwent general anesthesia.
OBJECTIVE
To assess the incidence of postoperative vocal cord immobility in patients following endotracheal intubation underwent general anesthesia.
METHODS
We retrospectively enrolled patients who underwent surgical procedures with endotracheal intubation under general anesthesia from January 2014 to December 2018 in Peking University First Hospital. Demographic and treatment data were obtained for patients with hoarseness and vocal cord fixation. The incidence of postoperative hoarseness and vocal cord fixation were presented and clinical outcomes were further analyzed.
RESULTS
A total of 85 998 patients following tracheal intubation and general anesthesia were enrolled in this study. Hoarseness was observed in 222 (0.26%) patients postoperatively. Sixteen patients (73%) were accomplished with symptoms of choking on water, dysphonia and sore throat. Twenty-nine patients with persistent hoarseness on the third postoperative day needed further treatment by otolaryngologists. Among them, seven patients had pharyngolaryngitis and twenty-two patients (0.026%) were demonstrated postoperative vocal cord immobility. There were seventeen patients (77%) with left-side vocal cord fixation and five patients (23%) with right-side vocal cord fixation. Nine patients were identified with arytenoid dislocation. Seven patients had left vocal cord fixation and two patients had right-side vocal cord fixation. Seven patients were intubated under the guidance of visual laryngoscope. One patient was confirmed difficult airway and intubated with light wand. One patient was inserted with laryngeal mask airway. One patient was suspected to have hoarseness caused by gastric tube before anesthesia. One patient showed simultaneously left recurrent laryngeal nerve abnormality on laryngeal electromyography result. The symptom of hoarseness ranged between 6 and 31 days. Three patients underwent closed reduction under local anesthesia and one patient demonstrated spontaneous recovery. Among the remaining thirteen patients with vocal cord immobility, two patients were demonstrated vocal cord paralysis. Eleven patients underwent neck surgery, thyroid surgery and cardiothoracic surgery and further examinations including laryn-geal electromyography and computed tomography help to determine the diagnosis were not performed. All patients were treated with inhaled corticosteroid conservatively. Five patients had significant improvement of symptom and almost regained normal voice. One patient had slight improvement and sixteen patients were not relieved before discharge.
CONCLUSION
Patients with hoarseness and vocal fold immobility after endotracheal intubation should be treated properly and immediately.
Topics: Arytenoid Cartilage; Hoarseness; Humans; Intubation, Intratracheal; Retrospective Studies; Vocal Cords
PubMed: 33879908
DOI: 10.19723/j.issn.1671-167X.2021.02.018 -
Journal of Biomedical Materials... Dec 2021Decellularization approaches have been commonly used as alternative techniques to reconstruct tissues. However, due to the complex tissue compartmentation of the larynx,...
Decellularization approaches have been commonly used as alternative techniques to reconstruct tissues. However, due to the complex tissue compartmentation of the larynx, the decellularization process may not retain the characteristics necessary for the successful recreation of the larynx. The aim of this study was to assess the effect of the decellularization process on the framework of the human cadaveric larynx generally and the cricoarytenoid joint specifically. In this work, five freshly frozen human cadaveric larynges were decellularized utilizing a protocol that was previously demonstrated to be effective in decellularizing a porcine larynx. The decellularization protocol included: biological, chemical, and physical decellularization methods. Each specimen served as its own control to assess changes after decellularization. Studies and measurements included: histological, using Hematoxylin and Eosin (H&E) and Live/Dead™ stains; DNA quantification; micro-computed tomography (μ-CT) imaging; and biomechanical testing of the cricoarytenoid joints. The decellularization protocol took 12 days for each specimen. Microscopy of H&E stained samples demonstrated substantial removal of cells with preservation of the extracellular matrix that was more evident in cartilage than muscle specimens. Confocal microscope images of Live/Dead™ stained specimens also demonstrated almost complete removal of cells. Pre-decellularization cartilage-DNA quantity range was 27.0 to 336.8 ng/mg while post-decellularization DNA quantity range was 0 to 30.4 ng/mg (p = 0.031). For muscles, pre-decellularization DNA quantity range was 150.0 to 3,384.6 ng/mg, while post-decellularization DNA quantity range was 0 to 45.5 ng/mg (p = 0.031). μ-CT demonstrated preservation of the cartilaginous framework with a slight reduction of cricoarytenoid joint space. Furthermore, μ-CT demonstrated no significant reduction in the Housefield unit (p = 0.25) and mineral density (p = 0.25) after decellularization. Biomechanical testing demonstrated a non-significant reduction of forces required for anterior displacement of the arytenoid (mean reduction of forces, 0.1 ± 0.2 N, p = 0.16) and forces required for posterior displacement of the arytenoid (mean reduction of forces, 0.2 ± 0.3 N, p = 0.05). This study demonstrates effective decellularization of human larynges as evidenced by significant DNA depletion and preservation of extracellular matrix, which are outcomes that are required for a biological scaffold to regenerate a non-immunogenic larynx. The decellularization process caused minimal weakness in the cricoarytenoid joints due to treatment with multiple detergents and enzymes in the decellularization protocol.
Topics: Animals; Extracellular Matrix; Humans; Larynx; Swine; Tissue Engineering; Tissue Scaffolds; X-Ray Microtomography
PubMed: 33872461
DOI: 10.1002/jbm.b.34851 -
Head & Neck Jul 2021In this systematic review, we aim to identify prognostic imaging variables of recurrent laryngeal or hypopharyngeal carcinoma after chemoradiotherapy. (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
In this systematic review, we aim to identify prognostic imaging variables of recurrent laryngeal or hypopharyngeal carcinoma after chemoradiotherapy.
METHODS
A systematic search was performed in PubMed and EMBASE (1990-2020). The crude data and effect estimates were extracted for each imaging variable. The level of evidence of each variable was assessed and pooled risk ratios (RRs) were calculated.
RESULTS
Twenty-two articles were included in this review, 17 on computed tomography (CT) and 5 on magnetic resonance imaging (MRI) variables. We found strong evidence for the prognostic value of tumor volume at various cut-off points (pooled RRs ranging from 2.09 to 3.03). Anterior commissure involvement (pooled RR 2.19), posterior commissure involvement (pooled RR 2.44), subglottic extension (pooled RR 2.25), and arytenoid cartilage extension (pooled RR 2.10) were also strong prognostic factors.
CONCLUSION
Pretreatment tumor volume and involvement of several subsites are prognostic factors for recurrent laryngeal or hypopharyngeal carcinoma after chemoradiotherapy.
Topics: Chemoradiotherapy; Humans; Hypopharyngeal Neoplasms; Larynx; Neoplasm Staging; Prognosis
PubMed: 33797818
DOI: 10.1002/hed.26698 -
BMJ Case Reports Feb 2021Chondrosarcoma of the larynx is rare accounting for approximately 1% of laryngeal cancers; clear cell subtype is a rare variant. Given the low risk of occult nodal...
Chondrosarcoma of the larynx is rare accounting for approximately 1% of laryngeal cancers; clear cell subtype is a rare variant. Given the low risk of occult nodal disease, they present a unique opportunity to maximise tissue preservation in order to optimise both recovery and long-term functional outcomes. We present a case of laryngeal clear cell chondrosarcoma causing critical airway obstruction. An emergency tracheostomy was performed and mapping biopsies were taken. The tumour originated from the cricoid and extended into both arytenoid superstructures precluding cricotracheal resection. A modified narrow-field laryngectomy was performed, preserving all pharyngeal mucosa and neurovascularly intact infrahyoids. Organ preservation surgery is preferred in the management of laryngeal chondrosarcoma. If laryngectomy is required, the surgeon must ensure that all uninvolved, functional tissue is preserved carefully to improve swallow and voice outcomes postoperatively. We describe a novel technique used to achieve this outcome.
Topics: Airway Obstruction; Arytenoid Cartilage; Biopsy; Chondrosarcoma; Cricoid Cartilage; Humans; Laryngeal Neoplasms; Laryngectomy; Magnetic Resonance Imaging; Male; Middle Aged; Tomography, X-Ray Computed; Tracheostomy
PubMed: 33563684
DOI: 10.1136/bcr-2020-236044 -
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 -
OncoTargets and Therapy 2020Several studies have suggested that laryngopharyngeal reflux disease (LPRD) or gastroesophageal reflux disease (GERD) is an independent risk factor for laryngeal...
BACKGROUND
Several studies have suggested that laryngopharyngeal reflux disease (LPRD) or gastroesophageal reflux disease (GERD) is an independent risk factor for laryngeal carcinoma. However, it remains unclear whether either condition affects the level of H/K-ATPase expression in laryngeal carcinoma.
MATERIALS AND METHODS
Immunohistochemistry, real-time RT-PCR, and Western blotting were used to explore the distributions of proton pump (H/K-ATPase) α- and β-subunits in normal laryngeal tissue and laryngeal carcinoma.
RESULTS
Messenger RNAs encoding both the α- and β-subunits were found in the normal epiglottic, ventricular fold, vocal fold, and arytenoid mucosae, as well as epiglottic cartilage. The distributions and expression levels of H+/K+-ATPase α-subunits in various laryngeal subregions did not significantly differ in IHC, RT-PCR, or Western blotting. However, Western blotting revealed a significant difference between the expression level of the β-subunit protein in the epiglottic cartilage and the levels in other sites. The expression levels of both subunits were significantly higher in carcinomatous than in paracarcinomatous tissue and normal laryngeal tissue. The mean follow-up duration was 66.2 months (range, 17-162 months). In all, 4 patients died during follow-up, 4 were lost to follow-up, and 22 were alive and free of disease at the end of follow-up. Two patients developed lung metastases and six developed disease recurrences (at 2, 8, 14, 16, 36, and 41 months). The 3- and 5-year overall survival (OS) rates were 93.0% and 77.0%, respectively. Univariate analyses showed that the 5-year OSs were significantly associated with the T, N, and clinical stages but not with age, alcohol use, pathological differentiation, or the expression levels of the α- or β-subunits (as revealed by IHC, RT-PCR, or Western blotting). However, in multivariate regression analyses, the 5-year OSs were not significantly associated with any clinicopathological factor or the expression levels of either subunit.
CONCLUSION
H/K-ATPase is expressed in the normal larynx, including in the epiglottic cartilage and the mucosae of the epiglottis, ventricular fold, and arytenoid vocal fold. The expression levels of the H/K-ATPase α- and β-subunits in laryngeal carcinomas were higher than in normal laryngeal tissues.
PubMed: 33363389
DOI: 10.2147/OTT.S276233 -
Journal of General and Family Medicine Nov 2020A 62-year-old woman presented with a dry cough lasting 18 months. She had previously been examined by multiple doctors, but no abnormalities were observed. Several...
A 62-year-old woman presented with a dry cough lasting 18 months. She had previously been examined by multiple doctors, but no abnormalities were observed. Several medications such as rabeprazole and inhaled corticosteroids were administered as test treatments without any improvement. Therefore, the possibility of biological disease, including acid reflux, had been mistakenly ruled out. We examined the sputum gram stain. The result showed phagocyted normal bacterial flora, suggesting aspiration. Laryngoscopy revealed edema of the arytenoid cartilage. The patient was finally diagnosed with laryngopharyngeal reflux and silent aspiration. This case suggested that the ineffectiveness of proton-pump inhibitors cannot always exclude the presence of reflux disease and the usefulness of gram stain examination to detect silent aspiration.
PubMed: 33304721
DOI: 10.1002/jgf2.348 -
Veterinary World Oct 2020From a biomedical point of view, the value of marsupials as a model of primitive mammals is indisputable. Among its species, the possum is a model that allows the study...
BACKGROUND AND AIM
From a biomedical point of view, the value of marsupials as a model of primitive mammals is indisputable. Among its species, the possum is a model that allows the study of the ontogeny of different organic systems, as well as their physiological aspects. The relevance of anatomical, functional, evolutionary, and phylogenetic study of marsupials for the development of comparative morphology is extensively documented in the literature. However, there are still many aspects to be further evaluated, as the anatomy and histology of the respiratory tract of this species. The aim of this study was to describe the morphology of the larynx, trachea, and lungs of .
MATERIALS AND METHODS
Five adult male animals were donated to the Comparative Animal Anatomy Laboratory - LAAC/CCAA-UFMA, for morphological studies. Specimens were washed in running water to perform biometrics. Then, they were fixed with 10% formaldehyde solution. After the fixation period, the specimens were positioned in dorsal decubitus position, for dissection of the respiratory system organs, by opening the ventral region of the neck and thoracic cavity, with subsequent removal of the pectoral muscles, ribs, and sternum. For histological analysis, fragments of 1 cm of the larynx (epiglottis and thyroid cartilages), trachea, and lungs were collected and fixed in 10% formaldehyde solution. Right after fixation, the fragments were dehydrated in increasing concentrations of ethyl alcohol (70, 80, 95, and 100%), diaphanized in xylene, embedded in paraffin, and sectioned into thin slices of 5 μm using a microtome. Sections were stained using the hematoxylin and eosin technique.
RESULTS
Anatomically, the larynx starts right after the pharynx. It consisted of four cartilages: Epiglottis, cricoid, thyroid, and arytenoid. The trachea was made of dorsally incomplete cartilaginous rings. At the entrance of the thoracic cavity, it bifurcated into the left and right main bronchus. The left lung was smaller than the right lung, with two lobes (cranial and caudal). The right lung presents the cranial, middle, caudal, and accessory lobes. Histologically, the epiglottis consisted of elastic cartilage and is covered by a non-keratinized stratified squamous epithelium. Thyroid cartilage is made of hyaline cartilage covered by smooth muscle. The trachea presents hyaline cartilage, with ciliated pseudo-stratified epithelium, serous glands, isogenic groups of chondrocytes, and perichondrium. The lung consisted of bronchi, bronchioles, and alveoli, also presenting blood vessels and arteries.
CONCLUSION
Morphologically, the larynx, trachea, and lungs of were similar to those of the other described in the literature.
PubMed: 33281348
DOI: 10.14202/vetworld.2020.2142-2149 -
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 -
The Laryngoscope Oct 2021There are currently no treatments available that restore dynamic laryngeal function after hemilaryngectomy. We have shown that dynamic function can be restored post...
OBJECTIVE/HYPOTHESIS
There are currently no treatments available that restore dynamic laryngeal function after hemilaryngectomy. We have shown that dynamic function can be restored post hemilaryngectomy in a rat model. Here, we report in a first of its kind, proof of concept study that this previously published technique is scalable to a porcine model.
STUDY DESIGN
Animal study.
METHODS
Muscle and fat biopsies were taken from three Yucatan minipigs. Muscle progenitor cells (MPCs) and adipose stem cells (ASCs) were isolated and cultured for 3 weeks. The minipigs underwent a left laterovertical partial laryngectomy sparing the left arytenoid cartilage and transecting the recurrent laryngeal nerve. Each layer was replaced with a tissue-engineered implant: 1) an acellular mucosal layer composed of densified Type I oligomeric collagen, 2) a skeletal muscle layer composed of autologous MPCs and aligned oligomeric collagen differentiated and induced to express motor endplates (MEE), and 3) a cartilage layer composed of autologous ASCs and densified oligomeric collagen differentiated to cartilage. Healing was monitored at 2 and 4 weeks post-op, and at the 8 week study endpoint.
RESULTS
Animals demonstrated appropriate weight gain, no aspiration events, and audible phonation. Video laryngoscopy showed progressive healing with vascularization and re-epithelialization present at 4 weeks. On histology, there was no immune reaction to the implants and there was complete integration into host tissue with nerve and vascular ingrowth.
CONCLUSIONS
This pilot study represents a first in which a transmural vertical partial laryngectomy was performed and successfully repaired with a customized, autologous stem cell-derived multi-layered tissue-engineered implant.
LEVEL OF EVIDENCE
NA Laryngoscope, 131:2277-2284, 2021.
Topics: Adipose Tissue; Animals; Cell Differentiation; Cells, Cultured; Deglutition; Disease Models, Animal; Humans; Laryngeal Cartilages; Laryngectomy; Laryngoplasty; Larynx; Mesenchymal Stem Cells; Motor Endplate; Muscle, Skeletal; Myoblasts; Phonation; Pilot Projects; Primary Cell Culture; Proof of Concept Study; Recurrent Laryngeal Nerve; Swine; Swine, Miniature; Tissue Engineering; Tissue Scaffolds
PubMed: 33247846
DOI: 10.1002/lary.29282