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American Journal of Veterinary Research Aug 2020To identify the degree of left arytenoid cartilage (LAC) abduction that allows laryngeal airflow similar to that in galloping horses, assess 2-D and 3-D biomechanical...
OBJECTIVE
To identify the degree of left arytenoid cartilage (LAC) abduction that allows laryngeal airflow similar to that in galloping horses, assess 2-D and 3-D biomechanical effects of prosthetic laryngoplasty on LAC movement and airflow, and determine the influence of suture position through the muscular process of the arytenoid cartilage (MPA) on these variables.
SAMPLE
7 equine cadaver larynges.
PROCEDURES
With the right arytenoid cartilage maximally abducted and inspiratory airflow simulated by vacuum, laryngeal airflow and translaryngeal pressure and impedance were measured at 12 incremental LAC abduction forces (0% to 100% [maximum abduction]) applied through laryngoplasty sutures passed caudocranially or mediolaterally through the left MPA. Cross-sectional area of the rima glottis and left-to-right angle quotient were determined from photographs at each abduction force; CT images were obtained at alternate forces. Arytenoid and cricoid cartilage markers allowed calculation of LAC roll, pitch, and yaw through use of Euler angles on 3-D reconstructed CT images.
RESULTS
Translaryngeal pressure and impedance decreased, and airflow increased rapidly at low abduction forces, then slowed until a plateau was reached at approximately 50% of maximum abduction force. The greatest LAC motion was rocking (pitch). Suture position through the left MPA did not significantly affect airflow data. Approximately 50% of maximum abduction force, corresponding to a left arytenoid angle of approximately 30° and left-to-right angle quotient of 0.79 to 0.84, allowed airflow of approximately 61 ± 6.5 L/s.
CONCLUSIONS AND CLINICAL RELEVANCE
Ex vivo modeling results suggested little benefit to LAC abduction forces > 50%, which allowed airflow similar to that reported elsewhere for galloping horses.
Topics: Animals; Arytenoid Cartilage; Horses; Laryngoplasty; Larynx; Respiratory Physiological Phenomena; Sutures
PubMed: 32700998
DOI: 10.2460/ajvr.81.8.665 -
The Laryngoscope Nov 2020View Video S1 , 2020
View Video S1 , 2020
Topics: Adult; Aged; Aged, 80 and over; Arytenoid Cartilage; Female; Hoarseness; Humans; Laryngoplasty; Male; Middle Aged; Prostheses and Implants; Prosthesis Design; Titanium; Treatment Outcome; Vocal Cords
PubMed: 32619273
DOI: 10.1002/lary.28865 -
Iranian Journal of Otorhinolaryngology May 2020The aim of the present study was to compare the videolaryngostroboscopic findings between patients with rheumatoid arthritis and vocally healthy controls.
INTRODUCTION
The aim of the present study was to compare the videolaryngostroboscopic findings between patients with rheumatoid arthritis and vocally healthy controls.
MATERIALS AND METHODS
This case-control descriptive study was performed on 113 people, including 50 patients with rheumatoid arthritis and 63 controls. The participants were subjected to videolaryngostroboscopic examinations in order to evaluate fundamental frequency, different structural vocal lesions, patterns of glottal closure, subglottal changes, supraglottis appearance, and movement patterns of the arytenoid cartilage. The obtained results were compared between the two research groups. Data analysis was performed in the Statistical Package for the Social Sciences, version 24.0. A p-value less than 0.05 was considered statistically significant.
RESULTS
The results revealed a statistically significant difference between the two groups in terms of the complete pattern (P=0.00) and strained state of glottal closure (P=0.00), pattern of subglottal changes (χ=25.98, df=2; P<0.001), and movement patterns of the arytenoid (χ=21.16, df=1; P<0.001). Additionally, based on the obtained frequencies, the two groups showed significant differences regarding the normal state of the larynx (P=0.00), hypertrophy of vocal fold (P=0.007), epithelial change (P=0.007), and Reinke's edema (P=0.001). However, the videolaryngostroboscopic examination results revealed no significant difference between the two groups in terms of polyp (P=0.20), nodule (P=0.57), sulcus vocalis (P=0.08), cyst (P=0.45), and atrophy of vocal folds (P=0.45).
CONCLUSION
It seems that rheumatoid arthritis affects the patterns of arytenoids movement, some kinds of glottal closure patterns, and subglottal changes. As the results indicated, the occurrence of some laryngeal structural changes was higher in patients with rheumatoid arthritis than in individuals without this disorder.
PubMed: 32596173
DOI: 10.22038/ijorl.2020.43213.2418 -
Ear, Nose, & Throat Journal Dec 2021Precise knowledge of the level of the vocal fold as projected on the external thyroid cartilage is of critical importance for the performance of many surgical...
PURPOSE
Precise knowledge of the level of the vocal fold as projected on the external thyroid cartilage is of critical importance for the performance of many surgical approaches. This study aims to identify the level of the anterior commissure, as well as the lengths of the vocal muscle and arytenoid cartilage in Turkish population.
MATERIALS AND METHOD
Specimens were collected after autopsy from the Council of Forensic Medicine. One hundred human larynges (52 men, 48 women; age range: 25-80 years) were dissected under a stereomicroscope. Projection of the vocal fold was analyzed in relation to the superior thyroid (A) and the inferior border of the thyroid cartilage (B). Then, the larynx was dissected parallel to the level of the vocal fold to measure the length of the vocal muscle (C) and the length of the interarytenoid space (D).
RESULTS
The mean value of the "a" was 9.15 ± 1.99 mm in male and 9.38 ± 3.43 mm in female. Mean value of the "b" was 10.54 ± 1.73 mm and 8.88 ± 1.81 mm in male and female, respectively. The mean value of the parameter corresponding the length of vocal muscle which was "c" was found 15.00 ± 3.18 mm in male and 12.88 ± 4.12 mm in female. The mean value of the interarytenoid space "d" was 8.31 ± 1.76 mm in male and 8.13 ± 1.90 mm in female. Comparing between genders, no statistical differences were observed in parameters of a, c, d, a + b, a + b/2 ( > .05). However, the difference with female and male for the parameters of b and c + d was statistically significant ( < .05).
CONCLUSION
Our results indicate that the anterior commissure projects slightly above the midline height for male and at the level to slightly below in female subjects in Turkish population.
Topics: Adult; Aged; Aged, 80 and over; Arytenoid Cartilage; Autopsy; Dissection; Female; Humans; Laryngeal Muscles; Larynx; Male; Middle Aged; Thyroid Cartilage; Turkey; Vocal Cords
PubMed: 32520604
DOI: 10.1177/0145561320931213 -
Ear, Nose, & Throat Journal Dec 2021To evaluate the efficacy of indirect laryngeal biopsy forceps in the treatment of epiglottic abscess (EA). (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVES
To evaluate the efficacy of indirect laryngeal biopsy forceps in the treatment of epiglottic abscess (EA).
METHODS
Twenty patients were diagnosed with EA in our department and were randomly divided into group A (indirect laryngeal biopsy forceps combined antibiotics) and group B (antibiotics only). Demographics, the degree of epiglottic and arytenoid swelling, and inflammatory cells were collected for analysis. The drainage of EA was performed under local anesthesia in conscious patients with indirect laryngeal biopsy forceps and 70° direct laryngoscopes. The length of symptomatic relief and length of hospitalization were assessed.
RESULTS
Ten patients were treated with indirect laryngeal biopsy forceps under the view of the 70° direct laryngoscopes combined with intravenous antibiotics, whereas the other 10 patients were treated with antibiotics only. The differences between the 2 groups had no statistical significance in age, gender, white blood cell count, neutrophils count, and the percent of neutrophils, abscess size, and scope classification at the time of diagnosis. The length of hospitalization and length of symptomatic relief was significantly lower in patients treated with indirect laryngeal biopsy forceps combined antibiotics than those treated with antibiotics only.
CONCLUSIONS
Indirect laryngeal biopsy forceps are safe and effective method to treat EA, which shorten the hospitalization and has the advantages of cost savings and convenience.
Topics: Abscess; Adult; Anti-Bacterial Agents; Arytenoid Cartilage; Biopsy; Combined Modality Therapy; Epiglottis; Epiglottitis; Female; Humans; Laryngoscopy; Male; Middle Aged; Surgical Instruments; Treatment Outcome
PubMed: 32520602
DOI: 10.1177/0145561320930644 -
Acta Otorhinolaryngologica Italica :... Apr 2020
Topics: Adolescent; Adult; Aged; Arytenoid Cartilage; Cricoid Cartilage; Edema; Female; Humans; Laryngeal Muscles; Laryngoscopy; Male; Middle Aged; Phonation; Postoperative Care; Postoperative Period; Surgical Procedures, Operative; Voice Disorders
PubMed: 32469003
DOI: 10.14639/0392-100X-N0183 -
Open Veterinary Journal Apr 2020Laryngeal paralysis, failure of arytenoid cartilage, and vocal fold abduction are commonly seen in older medium to large breed dogs. Observation of laryngeal function in...
BACKGROUND
Laryngeal paralysis, failure of arytenoid cartilage, and vocal fold abduction are commonly seen in older medium to large breed dogs. Observation of laryngeal function in dogs and cats is performed by transoral visualization. There are a variety of surgical techniques; aspiration pneumonia is the most common complication associated with surgical correction of laryngeal paralysis. The aim of this case series is to report on the placement of a laryngeal silicone stent in seven dogs with laryngeal paralysis and its use as an alternative treatment of respiratory distress caused by laryngeal paralysis and/or its use for laryngeal stenosis as complication of laryngeal paralysis surgery.
CASE DESCRIPTION
Seven dogs presented with either episode of gagging, mild-to-severe inspiratory distress, or cyanosis because of a laryngeal paralysis or laryngeal stenosis. In each case, the laryngeal paralysis was diagnosed by direct laryngoscopy. They were treated with a silicone laryngeal stent (Stening) that substantially improved the clinical signs. Each dog had a different outcome because of other pathologies; however, the laryngeal pathology was successfully treated with the stent.
CONCLUSION
The placement of the laryngeal stent is an easy technique to learn and practice, it could avoid the life-threatening complications of the laryngeal paralysis at the acute phase, and it could be a noninvasive and long-term alternative therapy for laryngeal paralysis in dogs. The results in these clinical cases are encouraging for considering the laryngeal stent as a therapeutic alternative.
Topics: Animals; Dog Diseases; Dogs; Female; Male; Pedigree; Respiratory Distress Syndrome; Stents; Vocal Cord Paralysis
PubMed: 32426250
DOI: 10.4314/ovj.v10i1.2 -
JAMA Otolaryngology-- Head & Neck... May 2020Bilateral vocal fold paralysis (BVFP) in pediatric patients is a challenging entity with multiple causes. Traditional approaches to managing BVFP include tracheostomy,...
IMPORTANCE
Bilateral vocal fold paralysis (BVFP) in pediatric patients is a challenging entity with multiple causes. Traditional approaches to managing BVFP include tracheostomy, arytenoidectomy, suture lateralization, cordotomy, and posterior cricoid enlargement. These interventions are used to create a stable airway but risk compromising voice quality.
OBJECTIVES
To assess the use of bilateral selective laryngeal reinnervation (SLR) surgery to manage BVFP and restore dynamic function to the larynx in pediatric patients.
DESIGN, SETTING, AND PARTICIPANTS
In this case series performed at 2 tertiary care academic institutions, 8 pediatric patients underwent bilateral SLR to treat BVFP (5 patients with iatrogenic BVFP and 3 with congenital BVFP) from November 2004 to August 2018 with follow-up for at least 1.5 years.
INTERVENTIONS
Bilateral selective laryngeal reinnervation surgery.
MAIN OUTCOMES AND MEASURES
Flexible laryngoscopy findings, subjective and objective measures of voice quality, subjective swallowing function, and decannulation in patients who were previously dependent on a tracheostomy tube.
RESULTS
Participants included 6 boys and 2 girls with a median age of 9.3 (range, 2.2 to 18.0) years at the time of surgery. All 8 patients were decannulated; 6 patients had preoperative tracheostomies and 2 had perioperative tracheostomies. Voice quality, as measured using the GRBAS (grade, roughness, breathiness, asthenia, strain) scale, improved in 6 of 8 patients after reinnervation, and swallowing was not impaired in any patients. In 2 patients, GRBAS scale scores remained the same before and after surgery. Inspiratory vocal fold abduction was observed on both sides in 5 patients and on 1 side in 2 patients, with no active abduction observed in 1 patient. The follow-up period was more than 5 years in 7 of 8 patients and at least 1.5 years in all patients.
CONCLUSIONS AND RELEVANCE
Bilateral SLR appears to be a promising treatment option for children with BVFP; it is currently the only option, to our knowledge, with the potential to restore abductor and adductor vocal fold movement. In patients with complete paralysis, this procedure may provide a strategy for airway management and restoration of the dynamic function of the larynx. It could be considered as a first-line technique before endolaryngeal or airway framework procedures, which carry a risk of compromising voice quality.
Topics: Adolescent; Arytenoid Cartilage; Child; Child, Preschool; Cricoid Cartilage; Female; Humans; Infant; Laryngeal Muscles; Laryngeal Nerves; Male; Nerve Regeneration; Otorhinolaryngologic Surgical Procedures; Tracheostomy; Vocal Cord Paralysis; Vocal Cords
PubMed: 32191278
DOI: 10.1001/jamaoto.2019.4863 -
World Journal of Clinical Cases Mar 2020Generally, hemangiomas do not require surgical intervention; however, cases of large hemangiomas, potentially involving the throat and trachea, necessitate surgical...
BACKGROUND
Generally, hemangiomas do not require surgical intervention; however, cases of large hemangiomas, potentially involving the throat and trachea, necessitate surgical therapy. Here, we present a case of hypopharyngeal hemangioma in an adult that was successfully treated with neodymium-doped yttrium aluminum garnet (Nd-YAG) laser.
CASE SUMMARY
Laryngoscopic examination of a 61-year-old man demonstrated the presence of a large, submucosal vascular lesion that extended into the epiglottis, left arytenoid cartilage, lateral to the aryepiglottic fold, and pyriform sinus. The lesion was resected and photocoagulated with limited hemorrhage using Nd: YAG laser. The hypopharyngeal hemangioma was completely excised. The patient showed no recurrence of hypopharyngeal hemangioma during the 1.5-year follow-up period.
CONCLUSION
Laser therapy is one of the effective tools for treating hemangiomas with rapid, uncontrolled growth or in functional areas, with few side effects and complications. The present case of a male patient with a large hypopharyngeal hemangioma, treated with YAG laser, demonstrates the efficacy of laser photocoagulation in treating cases of hemangiomas, without the risk of bleeding or airway obstruction. The favorable postoperative outcomes demonstrated by our patient with Nd: YAG laser therapy indicate its consideration in the therapy of similar cases.
PubMed: 32190630
DOI: 10.12998/wjcc.v8.i5.932 -
Acta Veterinaria Scandinavica Mar 2020Ovine laryngeal chondritis is a rare entity of sheep in the USA, Great Britain, New Zealand and Iceland, but has not been reported in Germany so far. Here, two German...
BACKGROUND
Ovine laryngeal chondritis is a rare entity of sheep in the USA, Great Britain, New Zealand and Iceland, but has not been reported in Germany so far. Here, two German cases are reported.
CASE PRESENTATION
Two rams showed severe and progressive signs of dyspnea. Endoscopically, a severe bilateral swelling of the larynx was identified in both rams. Due to poor prognosis and progression of clinical signs one ram was euthanized, while the other ram died overnight. In both cases, a necrosuppurative laryngitis and chondritis of arytenoid cartilages was found at necropsy. Fusobacterium necrophorum and Streptococcus ovis were isolated from the laryngeal lesion in one animal.
CONCLUSIONS
This is the first report of ovine laryngeal chondritis in continental Europe. This entity should be considered a differential diagnosis for upper airway disease in sheep.
Topics: Animals; Autopsy; Cartilage Diseases; Euthanasia, Animal; Fatal Outcome; Fusobacterium Infections; Fusobacterium necrophorum; Germany; Laryngeal Diseases; Larynx; Male; Sheep; Sheep Diseases; Streptococcal Infections; Streptococcus
PubMed: 32131871
DOI: 10.1186/s13028-020-0510-0