Biomedical subjects

Z Milutinović

Publications and source records attributed to Z Milutinović.

At least 19 recordsLinked to original sources

PubMed1998

Spatial arrangement of the structural elements of vocal fold layers: an adjustment to the vibration process.

It is well established that the multilayered structure of the vocal fold is highly adjusted to the requirements of the vibration process during phonation. There is also some partial data indicating that the spatial arrangement of each vocal fold layer corresponds to the functional requirements, and thus facilitate the phonation process. Nevertheless, all reports on the spatial arrangement of the vocal fold structures deal only with an individual element of the vocal fold histologic structure. The present study encompasses the spatial histologic analysis of all major elements of the vocal fold layers. It was demonstrated that the vocal fold epithelial cells, the connective and muscle fibers, and even the blood vessels run parallel to the vocal fold free edge, which indicates a high adjustment to the phonation requirements and the vibration process.

Humans↗

PubMed1997

Histological basis for indirect videostroboscopic phonosurgery--a scanning electron microscopic study.

Indications for indirect videostroboscopic surgery are well established for small, benign functional lesions of the vocal folds. Epithelial cells of the vocal folds are spindle-shaped and by their long axies run parallel to the free edge of the vocal fold. This occurrence is used clinically by surgeons to obtain an even operative defect when using a cup forceps during single-handed manipulations. Nevertheless, there are still some doubts about single-handed procedures, so that many surgeons prefer the convenience of bimanual manipulation offered by direct (suspension) microlaryngoscopic surgery. The aim of this study was to demonstrate that single-handed manipulation during indirect videostroboscopic surgery permitted obtaining regular edges of an operative defect during laryngeal surgery. A scanning electron microscopic study was conducted on five cadaver larynges following indirect videoscopic excisions at the vocal fold's free edge and ten controls. Results demonstrated a clearly regular edge of the operative defects in cases when a posterior traction surgical procedure was followed. These findings reaffirm the value of indirect videostroboscopic surgery for small, benign functional lesions of the vocal folds.

Adult↗

PubMed1997

Activity of the subglottic voice ("chest resonator"): an echo-tomographic and acoustic study.

In contrast to numerous studies of the activity of the supraglottic voice resonator and its acoustic effect, little is known about the subglottic resonator and its function. In the present investigation the phonatory behavior of the lower airway (the "chest resonator") was studied and the quality of its acoustic output analyzed. Echo-tomographic analysis was used to study the tracheal diameter during various phonatory tasks. Acoustic analysis was also used, based on acoustic separation between the supra- and subglottic airways (including perceptual testing, sound pressure levels, and long-time spectral analysis). Evidence is presented of chest resonator activity having both perceptual and spectral effects.

Adult↗

PubMed1996

Functional trauma of the vocal folds: classification and management strategies.

Laryngeal trauma may result from accidents, surgical, iatrogenic and functional lesions. Functional trauma is caused by excessive and improper use of the voice and may affect the speaking voice of nonprofessionals, but also the speaking and singing voice of vocal professionals. According to specific etiologic, histologic, laryngoscopic and stroboscopic features various vocal fold changes are included in the functional traumatic group. These are mucous standing, 'nodule-like' lesions (contact edema, contact thickening and vocal nodules), polyps, hematoma, cysts and contact hyperplasia. Management strategies are discussed for each lesion, including drug therapy, voice reeducation and phonosurgery.

Humans↗

PubMed1996

Classification of voice pathology.

A proper classification of voice pathology is required for didactic reasons, and also to assist a clinician in establishing the "primary diagnosis", i.e., an initial voice disorder in a particular patient. In spite of a frequent etiologic overlapping between organic and functional voice disorders, it is useful to keep these two basic pathologic categories in clinical practice. A revised clinical classification of voice disorders is suggested, including several newly described voice disturbances. These are the syndrome of inappropriate vocal pitch (organic), psychogenic superimposition and false placement of the voice (functional).

Diagnosis, Differential↗

PubMed1995

Composite myo-mucosal reconstruction of the vocal fold.

It is well established that after cordectomy or radiation therapy for early glottic carcinomas varying disturbances of the voice occur. This has led some clinicians to consider the need for surgical reconstruction of the vocal fold. Since functional results desired have still not been achieved, vocal fold reconstruction was performed using a combination of the muscular flap described by Pogosov and the free mucosal transplant reported by Isshiki. This surgical approach has now been performed on 11 cases with excellent functional results. The technique has provided a suitable mass of the reconstructed vocal fold and also allows very close contact between the vocal folds during the closed phase of the vibratory cycles. Postoperative voice quality has been almost within physiological limits.

Follow-Up Studies↗

PubMed1995

An external approach without tracheotomy for submucosal cordectomy with laterofixation for bilateral abductor paralysis of the vocal folds.

There are numerous surgical procedures now available to manage bilateral abductor paralyses of the vocal folds. These procedures have various success rates but mostly do not offer reliable and predictable postoperative results, and usually require tracheotomy. The technique described in this report is based on a trial study to obtain a safe airway for an affected patient and avoid tracheotomy, if possible. Submucosal cordectomy was used with lateral fixation of one vocal fold and preservation of the arytenoid. The procedure was performed by using continuous intravenous anesthesia, which does not require intubation of the patient's airway. Seven patients were operated with this technique with excellent postoperative results. The glottal airway was largely improved in all patients, with only minor temporary complications.

Adult↗

PubMed1994

Social environment and incidence of voice disturbances in children.

The incidence of voice disturbances was investigated in children living under different social environments. Two groups of children at the age of 12-13 years were examined, with a total number of 362 examinees. The first study group consisted of children living in a rural environment (204 examinees) and the second group consisted of children from an urban area (158 examinees). The state of the voice and phonatory system was investigated, revealing 3.92% of children with voice problems within the rural group and 43.67% within the city group. The influence of the social environment is discussed, and also the need for behavior modification to be included in voice therapy.

Adolescent↗

PubMed1993

Inflammatory changes as a risk factor in the development of phonoponosis.

Inflammatory changes of the upper respiratory airway mucosa are very often observed in phonoponoses. While treating phonoponoses, we frequently find that general practitioners and even otorhinolaryngologists, while paying greatest attention to this component, neglect treatment for voice and phonatory pattern disturbance, and the patients are referred to a phonitrician with delay. The aim of the work is to study the frequency of inflammatory processes of the upper respiratory airways in phonoponoses and an attempt to establish the connection between these changes and the development of phonoponoses. The study involved 358 patients with different types of phonoponoses. Inflammatory changes were found in 84.6% of the cases, which was statistically highly significant. With inflammatory processes on the vocal organs the appearance of phonoponoses is facilitated. In that sense the inflammatory processes are risk factors in the appearance of phonoponoses.

Adolescent↗

PubMed1993

Indirect microsurgery of the vocal folds--videostroboscopy vs. microstroboscopy.

In spite of the great significance of direct microlaryngeal surgery (DML), the inadequacies of this technique are evident. In order to avoid surgical trauma and introduce functional control during surgery, indirect microstroboscopic (IMS) and indirect videostroboscopic surgery (IVS) of the vocal folds are advocated. Both of these meet most criteria for surgical work in this field. The aim of this work was to make a comparative study of these techniques. The study is based on 603 operations conducted for benign lesions of the vocal folds. We are of the opinion that indirect vocal fold surgery for small benign lesions has significant advantages when compared with the conventional microlaryngoscopy, including laser surgery, which was proven elsewhere. When comparing these two indirect surgical approaches, the principal advantages of IVS surgery over the IMS method are easier surgical manipulation and better view. With respect to other areas of comparison, these techniques are quite similar. As complementary methods to conventional microlaryngoscopy, we believe that both IVS and IMS surgery should be used in practice.

Female↗

PubMed1992

Contribution to the understanding of the etiology of vocal fold cysts: a functional and histologic study.

The etiological theories of vocal fold cysts can be divided into two basic groups: those of congenital and acquired cysts. In ongoing practice, the authors had noted that the greater number of cysts appeared at the functionally most active segment of the vocal folds which, on the other hand, has the least number of glands. Also, it had been noted that patients with vocal fold cysts tended to have hyperkinetic patterns of voice production. These observations indicated the possibility of a functional aspect in the etiology of vocal fold cysts, and consideration of such a possibility was the aim of this work. In 37 cases, the exact location of the cyst was established. In addition, the muscular activity of the phonatory apparatus was estimated, patient self-descriptions with respect to talkativeness were taken into account, and histological evaluations were made. The cysts were most frequently found in the area of the junction of the anterior and middle thirds of the free edge of the vocal fold. Muscular activity during speech and phonation was increased in study patients. Sixty-five percent of patients had epidermoid cysts and 35% had retention cysts of the vocal fold. According to study results, the functional aspect of cyst genesis has a marked role in the etiology of vocal fold cysts, which points to the great importance of functional care for cyst patients.

Adolescent↗

PubMed1991