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Viscoelastic properties of proteoglycan solutions with varying proportions present as aggregates.

Monomer and aggregated proteoglycans were prepared from pig laryngeal cartilage. Vascoelastic flow properties, comprising linear complex dynamic shear modulus, nonlinear steady-state shear-rate dependent viscosity, and primary normal stress difference, were measured in proteoglycan solutions containing varying proportions of aggregate (0-80%) and at different concentrations (10-50 mg/ml). Results were analyzed using the simple Oldroyd four-parameter nonlinear rate-type rheological equation. All solution properties were strongly dependent on proteoglycan concentration and on the proportion of aggregates present. Aggregation was found to have a great effect on the zero shear-rate viscosity at 50 mg/ml, which increased fivefold from 0-100% aggregate. The results showed that network formation in proteoglycan solutions increased with concentration from 10-50 mg/ml and also increased with aggregation. All proteoglycan solutions showed shear thinning, which was most marked with aggregated proteoglycan at high concentration (50 mg/ml), where the viscosity decreased tenfold from the zero shear-rate limit to the infinite shear-rate limit. The intermolecular interactions in the network were therefore increasingly disrupted by increasing shear rate, but repeated measurements showed that these were reversible changes and that testing did not induce disaggregation or degradation of proteoglycan. These rheological properties show that aggregation is likely to immobilize proteoglycan at high concentration within cartilage and to contribute to the material properties of the porous solid matrix of articular cartilage that are important for its load-bearing function.

Animals↗

Computed tomography of the normal larynx during quiet breathing and phonation.

Computed tomography scans of the larynx were obtained during quiet breathing and during phonation in 10 volunteers having no neck or larynx abnormalities. The subglottic and glottic laryngeal cavity and soft tissues showed symmetry from side to side. At the supraglottic level, the pliable aryepiglottic folds and pyriform sinuses appeared moderately asymmetric and variable during quiet breathing. Phonation made them more symmetric. Phonation also allowed accurate determination of vocal cord function. The laryngeal cartilages were symmetric in their degree of calcification and had clearly visible centers of dense calcification. Computed tomography is a highly precise method for demonstrating the structures of the larynx.

Humans↗

Pseudoforeign bodies of the cervical region.

Previous reports have enumerated a large variety of foreign bodies in the upper airway and digestive passages. Clinical emphasis has stressed diligence in detecting any possible foreign object. Three cases are presented in which a diagnosis of a foreign body in the cervical region was made and endoscopy advised. In each case, there was some discrepancy between the physical findings and the location of the foreign body. Further study revealed these presumed objects to be ossification centers within one of the laryngeal cartilages. The existence of these centers is stressed as a reminder in the evaluation of a patient with a history suggesting foreign-body ingestion.

Adult↗

Pretherapeutic staging of laryngeal carcinoma. Clinical findings, computed tomography, and magnetic resonance imaging compared with histopathology.

BACKGROUND: An accurate pretherapeutic staging of laryngeal carcinoma is required for most treatment planning as well as for evaluation and comparison of the results of different treatment modalities. Neoplastic invasion of the laryngeal cartilage may have important therapeutic implications. To our knowledge, no data are available comparing the impact of endoscopic examination, computed tomography (CT), and magnetic resonance (MR) imaging on pretherapeutic staging accuracy. The purpose of our study was to determine which imaging should be used as an adjunct to other clinical examinations in the pretherapeutic staging of laryngeal carcinoma. METHODS: In this study, 40 consecutive patients with neoplasms of the larynx, who were treated surgically, were included in a prospective pretherapeutic staging protocol that included indirect laryngoscopy, direct microlaryngoscopy, contrast-enhanced CT, and gadolinium-diethylenetriamine pentaacetic acid-enhanced MR imaging at 1.5 Tesla. The surgical specimens were cut in whole-organ slices parallel to the plane of the axial CT and MR images. The histologic findings were compared with the clinical findings including the CT and MR images. The impact of each diagnostic method on pretherapeutic staging was analyzed. RESULTS: Clinical/endoscopic evaluation failed to correctly stage 17 tumors due to invasion of the paraglottic space (1 tumor), preepiglottic space (2 tumors), and extralaryngeal soft tissues (14 tumors), resulting in a pretherapeutic staging accuracy of 57.5%. Neoplastic invasion of cartilage was present in 28 patients and absent in 12 patients. Although MR imaging was more sensitive in detecting neoplastic invasion of cartilage than CT (94% vs. 67%; P = 0.001), MR imaging was less specific than CT (74% vs. 87%; P = 0.007). There was no difference between the overall accuracy of CT and MR imaging in detecting neoplastic invasion of cartilage (80% vs. 82%). The accuracy of combined clinical/endoscopic examination and CT staging was 80% and the accuracy of combined clinical/endoscopic examination and MR imaging staging was 87.5%; the difference was not statistically significant. CONCLUSIONS: Clinical/endoscopic examination alone failed to identify tumor invasion of the laryngeal cartilages and of the extralaryngeal soft tissues, resulting in a low staging accuracy (57.5%). Many pT4 (according to the International Union against Cancer TNM Staging System) tumors were clinically unrecognized. The combination of clinical/endoscopic evaluation and an additional radiologic examination, either CT or MR imaging, resulted in significantly improved staging accuracy (80% vs. 87.5%). MR imaging is significantly more sensitive but less specific than CT in detecting neoplastic cartilage invasion. Therefore, MR imaging tends to overestimate neoplastic cartilage invasion and may result in overtreatment, whereas CT tends to underestimate neoplastic cartilage invasion and may lead to inadequate therapy.

Adult↗

[Laryngo-tracheal involvement in chronic atrophic polychondritis. X-ray computed tomographic aspects].

CT patterns of a relapsing polychondritis affecting the laryngeal cartilages are reported in a 42-year-old man with a 10-year medical history of this disease, corresponding to an irregular enlargement of the cricoid, thyroid cartilages and tracheal rings, with a moderate endoluminal narrowing. CT is useful to differentiate this rare inflammatory disease from others causes of airway narrowing, and could help in certain cases of diagnosis of beginning polychondritis.

Adult↗

Bilateral arytenoid cartilage lateralization for laryngeal paralysis in the dog.

Bilateral arytenoid cartilage lateralization was used successfully to treat 3 dogs with bilateral laryngeal paralysis. In our hands, this techniques was more effective than unilateral arytenoid cartilage lateralization in resolving the signs of laryngeal paralysis and in avoiding the complications that may follow partial laryngectomy.

Animals↗

Ultrasonography of the equine larynx.

Nasopharyngeal and laryngeal evaluation is important when examining horses with upper airway signs for poor performance. Currently endoscopy is the most common method to evaluate the equine upper airway. Ultrasonography of the equine larynx has not previously been described. Using six cadaveric specimens and four standing horses, the ultrasonographic appearance of the equine larynx was established. A scanning technique, including useful acoustic windows and the normal ultrasonographic appearance at each site, is described. Ultrasound allowed visualization of portions of the hyoid apparatus, laryngeal cartilages, associated soft tissues, and intrinsic and extrinsic laryngeal musculature, that are not seen using endoscopy. Additionally, real-time ultrasound allowed observation of the movement of the vocal folds and the arytenoid cartilages during respiration. In three horses with arytenoid chondritis, ultrasonography aided in the diagnosis and localization of arytenoid abcessation and perilaryngeal inflammation. The establishment of this technique will serve as the basis for future investigations in the evaluation of clinical patients with upper airway abnormalities.

Animals↗

Klippel-Feil syndrome associated with malformed larynx. Case report.

We report a case of a 45-year-old man with Klippel-Feil syndrome with fusion of the C2-3 and C4-5 cervical vertebrae and severe voice impairment associated with malformation of the laryngeal cartilages. The condition was also complicated by bilateral inflexibility of the arms and legs and external malformation of the ears. This case broadens the spectrum of anomalies, of branchial arch derivation, now identified in association with Klippel-Feil syndrome. We discuss the possibility that perturbation of segmentation, distinct from somitogenesis, may be linked to Klippel-Feil syndrome-associated craniofacial abnormalities.

Humans↗

Clinics in diagnostic imaging (100). Migrated pharyngeal fish bone.

A 71-year-old man presented with a suspected swallowed fish bone. The lateral radiograph of the neck showed a curvilinear radio-opaque density in the swollen pre-vertebral soft tissues. The diagnosis of a migrated fish bone was confirmed on computed tomography and during subsequent surgery. The patient made a good recovery. As calcified normal structures, particularly the laryngeal cartilages, can mimic abnormal radio-opaque foreign bodies, it is important to be able to recognise the normal calcified structures seen on the neck radiograph. A sound knowledge of radiological anatomy is required in order to avoid unnecessary investigation and to provide prompt and appropriate management.

Aged↗

Subtle fatal manual neck compression.

A critical analysis of the postmortem diagnostic criteria for asphyxia leads to a difficulty that has significant implications for the forensic pathologist. The difficulty is that there are no universally recognized pathognomic signs of asphyxia, but pathologists frequently make this diagnosis based on observations that individually have indeterminate significance but combined together, in the appropriate context, have diagnostic value. This leads to the question: if asphyxia has no recognizable signs at autopsy how are we able to diagnose this entity in the latter circumstances? This problem can be solved by defining the minimally adequate diagnostic criteria for compressive neck injury. These criteria are potentially well-defined but currently lacking, in part, due to incomplete morphological characterization of the injuries that frequently occur in strangulation. The problem is especially challenging because the signs of strangulation form a spectrum of degree from minimal to marked and there is no consensus as to the minimal number and nature of lesions that is required to make the diagnosis of strangulation. In the present review of lesions that are commonly encountered in strangulation, intracartilaginous laryngeal haemorrhages and laryngeal cartilage microfractures are considered to have unrecognized diagnostic value, and these lesions are described in detail. A triad of haemorrhages (subepithelial laryngeal haemorrhage, intralaryngeal muscular haemorrhage, and intracartilaginous laryngeal haemorrhage) is discussed in the context of developing a definition of strangulation based on morphological criteria in the absence of overt mechanical injuries to the neck. Although definitive criteria for cases with minimal findings are still lacking, several lesions have putative diagnostic value.

Adult↗

Knitted fractures of the laryngopharynx framework as a medico-legal matter.

The article presents the analysis of knitted trauma to the hyoid bone and laryngeal cartilages, revealed while searching for fresh fractures of the laryngopharynx skeleton for medico-legal purposes. Neck organocomplexes (n = 440) were completely prepared after fixation in formalin. Old injuries were found in 17.3% of cases, and in 3.2% of cases two elements of the complex were formerly broken. More often there was consolidated trauma to the thyroid (11.4% of cases) and cricoid cartilages (7.3%) and, rarely, to the hyoid bone (1.6%) and cervical part of the trachea (0.2%). These injuries occurred twice as often in men (20.3% of cases) than in women (P < 0.01). Substantiated conclusions are: (1) people of working age are most prone to neck trauma; and (2) from the 1960s the percentage of such traumas in the St. Petersburg region has grown due to urbanization. This article presents data on the localization and morphology of the injuries, as well as a review of symptoms and the course of blunt neck trauma. Despite the difficulties associated with the complete regeneration of injured tissues, forensic pathologists can obtain certain information which police officials may be interested in.

Adolescent↗

Pullout strength of adaption screws in thyroid cartilage.

PURPOSE: To determine the pullout strength of adaption screws in laryngeal cartilage and its relationship to drill hole and screw diameter. MATERIALS AND METHODS: Screw pullout strength in human cadaver thyroid cartilage was measured using a load cell. Screw sizes of 1.3, 1.5, and 2.0 mm were tested using drill hole diameters of 0.76, 1.1, and 1.5 mm. RESULTS: Maximum pullout strength was achieved using a drill hole diameter of 0.76 mm and a 1.5 mm screw. Pullout strength for this combination was 27.5 N. CONCLUSION: Adaption screws can be used in thyroid cartilage but pullout strengths will be less than in bone. Drill holes for screws in thyroid cartilage should be smaller than those used for cortical bone. Maximum strength will be achieved using a 1.5 mm screw in a 0.76 mm drill hole.

Bone Plates↗

Aneurysmal bone cyst of the cricoid cartilage: an unusual cause of subglottic stenosis.

Aneurysmal bone cysts (ABC) are locally aggressive bony tumors which rarely occur in the head and neck. Only 3 cases have been reported in the larynx previously, 1 involving the cricoid cartilage. A patient is presented who developed subglottic stenosis with airway compromise due to an ABC arising from the cricoid cartilage. The literature on bony tumors of the laryngeal cartilages was reviewed and the clinical and pathologic findings in this case highlighted.

Adult↗