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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 -
Medical Devices (Auckland, N.Z.) 2017Glottic leakage during phonation is a direct consequence of unilateral vocal fold (VF) paralysis. This air leakage can be in the horizontal plane and in the vertical...
INTRODUCTION
Glottic leakage during phonation is a direct consequence of unilateral vocal fold (VF) paralysis. This air leakage can be in the horizontal plane and in the vertical plane. Presently, there is no easily applicable medical device allowing noninvasive, office-based measurement of the relative vertical position of the VFs. The larynx ruler (LR) is a laser-based measuring device that could meet the previously stated need, using a flexible endoscope. This study represents a proof of concept regarding the use of the LR in assessing VF relative positions in the vertical plane.
MATERIALS AND METHODS
One fresh male human cadaver larynx, free of neurologic and anatomic disease, was explored with the LR system through the operative channel of a flexible gastroenterology video-endoscope. The tip of the video-endoscope was located in the laryngeal vestibule. The right crico-arytenoid joint was posteriorly disarticulated. Tilting of the VF was obtained by pulling or pushing the arytenoid cartilage with a mosquito forceps fixed to the stump of the previously sectioned superior tip of the posterior crico-arytenoid muscle allowing anterior and posterior tilting of the arytenoid cartilage in order to induce an elevation or a depression of the VF process. Ten "push" and ten "pull" sessions were performed. The distance from the tip of the video-endoscope to each illuminated pixel of the laser beam was recorded. The level difference between the left and right VFs was measured for each recording.
RESULTS
Data provided by the LR were consistently in accordance with the movements applied on the VFs. The accuracy of 0.2 mm of the LR is compatible with the envisioned applications for the human larynx.
CONCLUSION
The LR system represents a feasible technique to evaluate respective vertical position of VFs in the human larynx. Technical limitations were identified that will require improvements before experimental use on human beings.
PubMed: 28740437
DOI: 10.2147/MDER.S136561 -
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 -
Lin Chuang Er Bi Yan Hou Tou Jing Wai... Jan 2023To study the application value of humidified high flow nasal cannula (HHFNC) combined with visual laryngoscopy in the arytenoid cartilage dislocation. Twenty-nine... (Randomized Controlled Trial)
Randomized Controlled Trial
To study the application value of humidified high flow nasal cannula (HHFNC) combined with visual laryngoscopy in the arytenoid cartilage dislocation. Twenty-nine patients with arytenoid cartilage dislocation were randomly double-blind into HHFNC group and general nasal catheter oxygen suction group, and the intraoperative and postoperative evaluation indicators, anesthesia-related indicators and postoperative vocal cord were compared. There were statistically significant differences in intraoperative blood oxygen saturation, microstream end-tidal carbon dioxide partial pressure EtCO₂, respiratory rate and respiratory intervention times between the two groups (<0.05), and statistically significant differences in postoperative heart rate, oxygen saturation and respiratory rate (<0.05). After reduction, the voice disturbance index, the degree of voice abnormality, rough voice, breath sound, powerless pronunciation and catatonic pronunciation changed significantly after operation. HHFNC combined with visual laryngoscopy in the arytenoid cartilage dislocation has high anesthetic safety, good cooperation of patients, and good surgical effect.
Topics: Humans; Cannula; Laryngoscopes; Laryngoscopy; Catheterization; Voice Disorders; Arytenoid Cartilage
PubMed: 36597372
DOI: 10.13201/j.issn.2096-7993.2023.01.013 -
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 -
PloS One 2021To determine whether arytenoid cartilage position and dynamics change with advancing duration and severity (as graded by MDS-UPDRS part III scores) in Parkinson's...
OBJECTIVE
To determine whether arytenoid cartilage position and dynamics change with advancing duration and severity (as graded by MDS-UPDRS part III scores) in Parkinson's disease, in a cross-sectional study design, we performed laryngeal four-dimensional computed tomography (4D-CT) in people with Parkinson's disease and controls.
METHODS
31 people with Parkinson's disease covering a range of disease duration and severity and 19 controls underwent laryngeal 4D-CT whilst repeatedly vocalizing. We measured on each CT volume the glottic area (GA), inter-arytenoid distance (IAD), IAD-Area index (IAI) and arytenoid cartilage velocity ([Formula: see text]).
RESULTS
People with Parkinson's disease had reductions in the mean/effective minimum IAD when compared to controls, while mean/effective minimum GA and mean/effective maximum IAI were increased. Arytenoid cartilage velocities showed no difference. On Spearman correlation analyses, advancing disease duration and severity of PD showed moderately strong and significant correlations with increasing mean/effective minimum GA, increasing mean/effective maximum IAI and decreasing effective minimum IAD. Linear mixed models which considered the effects of intra and inter-individual variation showed that both disease duration (b = -0.011, SEb = 0.053, 95% CI [-0.022, 0], t(27) = -2.10, p = 0.045) and severity (b = -0.069, SEb = 0.032, 95% CI [-0.14,-0.0039], t(27) = -2.17, p = 0.039) were significant predictors for IAD, and also for transformed values of the GA and IAI.
CONCLUSIONS
There are progressive alterations in phonatory posturing as Parkinson's disease advances. The increases in GA despite reductions in IAD are concordant with prior observations of vocal fold bowing. Our study provides a basis for using laryngeal 4D-CT to assess disease progression in Parkinson's disease.
Topics: Aged; Arytenoid Cartilage; Case-Control Studies; Cross-Sectional Studies; Disease Progression; Female; Four-Dimensional Computed Tomography; Humans; Male; Middle Aged; Parkinson Disease; Vocal Cords
PubMed: 34653231
DOI: 10.1371/journal.pone.0258786 -
Annals of Cardiac Anaesthesia 2017Arytenoid cartilage dislocation/subluxation is one of the rare complications following tracheal intubation, and there have been no reports about risk factors leading...
BACKGROUND
Arytenoid cartilage dislocation/subluxation is one of the rare complications following tracheal intubation, and there have been no reports about risk factors leading this complication. From our clinical experience, we have an impression that patients undergoing cardiovascular operations tend to be associated with this complication.
AIMS
We designed a large retrospective study to reveal the incidence and risk factors predicting the occurrence and to examine whether our impression is true.
SETTINGS AND DESIGNS
This was a retrospective study.
METHODS
We retrospectively studied 19,437 adult patients who were intubated by an anesthesiologist in our operation theater from 2002 to 2008. The tracheal intubation was performed by a resident anesthesiologist managing the patients. Only patients whose postoperative voice was disturbed more than 7 days were referred to the Department of Otorhinolaryngology-Head and Neck Surgery and examined using laryngostroboscopy by a laryngologist to diagnose arytenoid cartilage dislocation/subluxation. We evaluated age, sex, weight, height, duration of intubation, difficult intubation, and major cardiovascular operation as risk factors to lead this complication.
STATISTICAL ANALYSIS
The data were analyzed by logistic regression analysis to assess factors for arytenoid cartilage dislocation/subluxation after univariate analyses using logistic regression analysis.
RESULTS
Our analysis indicated that difficult intubation (odds ratio: 12.1, P = 0.018) and cardiovascular operation (odds ratio: 9.9, P < 0.001) were significant risk factors of arytenoid cartilage dislocation/subluxation.
CONCLUSION
The present study demonstrated that major cardiovascular operation is one of the significant risk factors leading this complication.
Topics: Adolescent; Adult; Aged; Anesthesia; Arytenoid Cartilage; Cardiac Surgical Procedures; Female; Humans; Incidence; Intubation, Intratracheal; Joint Dislocations; Male; Middle Aged; Postoperative Complications; Retrospective Studies; Risk Factors; Vascular Surgical Procedures; Young Adult
PubMed: 28701595
DOI: 10.4103/aca.ACA_71_17 -
PloS One 2017Voice change is one of the earliest features of Parkinson's disease. However, quantitative studies of vocal fold dynamics which are needed to provide insight into...
BACKGROUND
Voice change is one of the earliest features of Parkinson's disease. However, quantitative studies of vocal fold dynamics which are needed to provide insight into disease biology, aid diagnosis, or track progression, are few.
METHODS
We therefore quantified arytenoid cartilage movements and glottic area during repeated phonation in 15 patients with Parkinson's disease (symptom duration < 6 years) and 19 controls, with 320-slice computerised tomography (CT). We related these measures to perceptual voice evaluations and spirometry. We hypothesised that Parkinson's disease patients have a smaller inter-arytenoid distance, a preserved or larger glottic area because vocal cord bowing has previously been reported, less variability in loudness, more voice dysdiadochokinesis and breathiness and a shortened phonation time because of arytenoid hypokinesis relative to glottic area.
RESULTS
Inter-arytenoid distance in Parkinson's disease patients was moderately smaller (Mdn = 0.106, IQR = 0.091-0.116) than in controls (Mdn = 0.132, IQR = 0.116-0.166) (W = 212, P = 0.015, r = -0.42), normalised for anatomical and other inter-subject variance, analysed with two-tailed Wilcoxon's rank sum test. This finding was confirmed in a linear mixed model analysis-Parkinson's disease significantly predicted a reduction in the dependent variable, inter-arytenoid distance (b = -0.87, SEb = 0.39, 95% CI [-1.66, -0.08], t(31) = -2.24, P = 0.032). There was no difference in glottic area. On perceptual voice evaluation, patients had more breathiness and dysdiadochokinesis, a shorter maximum phonation time, and less variability in loudness than controls. There was no difference in spirometry after adjustment for smoking history.
CONCLUSIONS
As predicted, vocal fold adduction movements are reduced in Parkinson's disease on repeated phonation but glottic area is maintained. Some perceptual characteristics of Parkinsonian speech reflect these changes. We are the first to use 320-slice CT to study laryngeal motion. Our findings indicate how Parkinson's disease affects intrinsic laryngeal muscle position and excursion.
Topics: Aged; Aged, 80 and over; Arytenoid Cartilage; Case-Control Studies; Female; Humans; Male; Middle Aged; Parkinson Disease; Tomography, X-Ray Computed
PubMed: 29099841
DOI: 10.1371/journal.pone.0186611 -
Clinical and Experimental... Dec 2017The aim of this study was to compare the effect of the presence of one or two arytenoids on early/late period swallowing-aspiration functions.
OBJECTIVES
The aim of this study was to compare the effect of the presence of one or two arytenoids on early/late period swallowing-aspiration functions.
METHODS
Supracricoid partial laryngectomy (SCPL) with the diagnosis of laryngeal cancer between 2012 and 2014 were retrospectively evaluated. The patients were categorized into two groups as follows: group I, patients who underwent SCPL with one arytenoid cartilage and group II, patients who underwent SCPL with two arytenoid cartilages. The time of decannulation and oral feeding onset, and swallowing-aspiration functions were evaluated and compared in the early nutritional period, first, and third months.
RESULTS
There was no significant correlation between decannulation time and swallowing-aspiration. The aspiration rates in group I and group II were similar and there was no significant difference in oral feeding onset and aspiration grades in the first and third months between both groups.
CONCLUSION
We found similar oncological and functional outcomes in SCPL which protected one or two arytenoid cartilages. Therefore we suggest to be performed one arytenoid cartilage SCPL in selected patients who was advance stage and tumor volume over with larynx cancer.
PubMed: 27440130
DOI: 10.21053/ceo.2015.01837 -
Gland Surgery Oct 2019Intraoperative neuromonitoring (IONM) is an important application for protecting recurrent laryngeal nerve (RLN) during thyroid surgery. The method for recording...
BACKGROUND
Intraoperative neuromonitoring (IONM) is an important application for protecting recurrent laryngeal nerve (RLN) during thyroid surgery. The method for recording arytenoid muscle electromyography (EMG) signals is reported to be feasible and reliable. However, the parameters of EMG signals are not provided. This study aimed to analyze the clinical characteristics of EMG signal parameters by modifying the insertion direction of needle electrodes.
METHODS
A total of 92 patients who were scheduled to undergo thyroidectomy were recruited. Two paired needle electrodes were inserted in bilateral angle points between rectus cricothyroid muscle and inferior margin of thyroid cartilage (TC) intraoperatively, and then the information from the EMG signals was recorded according to four-step method (V1-R1-R2-V2). Pre-and post-operative laryngo-fiberoscopy was performed to confirm the vocal cord function.
RESULTS
A total of 122 RLNs were successfully recorded during thyroidectomy, with the mean EMG amplitude and latency were 1,857±1,718/2,347±2,323 µV and 3.89±1.12/2.26±0.05 ms for V1/R1 signals before resection, and 1,924±1,705/2,450±2,345 µV and 3.87±1.17/2.27±0.08 ms for R2/V2 signals after resection. There were no significant changes before and after resection, and a normal vocal cord movement was observed postoperatively. The amplitude of left nerves was higher than that of the right ones. Furthermore, the latency of the right vagus was shorter than the left ones, but there was no difference in the amplitude and latency between age, sex and pathological types.
CONCLUSIONS
Modified arytenoid muscle EMG recording method was considered to be safe, feasible and reliable. The latency of right vagus EMG signals were shorter than the left ones, and the amplitude of EMG signals might be related to different sides.
PubMed: 31741877
DOI: 10.21037/gs.2019.08.07