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At least 325 records · Page 18Linked to original sources
PubMed1998

Complications and functional outcome after supracricoid partial laryngectomy with cricohyoidoepiglottopexy.

We present a review of the postoperative course, complications, and functional outcome of 190 patients consecutively treated with supracricoid partial laryngectomy with cricohyoidoepiglottopexy. The average times until removal of the tracheostomy and nasogastric feeding tubes were 9 and 16 days, respectively. The postoperative mortality rate was 1%. Major complications included pneumonia from aspiration, cervical wound infection, symptomatic laryngocele, ruptured pexis, laryngeal chondroradionecrosis, and laryngeal stenosis in 8.5%, 4.2%, 3.1%, 1%, 0.5%, and 0.5% of the patients, respectively. Completion total laryngectomy, permanent gastrostomy, and permanent tracheostomy were requested in 0.5% of the patients. Normal swallowing without gastrostomy and respiration without tracheostomy was achieved by the first postoperative year in 98.4% (187/190) of the patients. This article presents a univariate analysis of the potential correlation between various variables and the duration of tracheostomy and the length of time the nasogastric feeding tubes were inserted, the mortality incidence and causes, the incidence and type of the various complications, and the duration of hospitalization. Comparison of our data with the reported functional results after vertical partial laryngectomy suggested that supracricoid partial laryngectomy with cricohyoidoepiglottopexy does not result in an increased rate of postoperative complications.

Deglutition↗
PubMedDate not supplied

Laryngeal framework surgery for the management of aspiration in high vagal lesions.

PURPOSE: The purpose of this study is to ascertain the effectiveness of laryngeal framework surgery, including medialization thyroplasty (MT), with or without arytenoid adduction (AA), on preventing aspiration, improving diet, and aiding in the subsequent decannulation of individuals with high vagal lesions. PATIENTS AND METHODS: A retrospective chart review was performed on each patient presenting with a high vagal lesion who was treated with laryngeal framework surgery from June 1992 to April 1996 at a university medical center. Thirty-five patients were identified; there were 20 women and 15 men, with a median age of 51. Information regarding etiology of the lesion, characteristics of the vocal cord deficits, degree of aspiration, the presence of other neurologic deficits and concurrent pulmonary disease, treatment, and outcome was obtained. The final outcome regarding voice, the presence and degree of aspiration, diet, and decannulation following MT, with or without AA, was assessed to determine the effectiveness of these procedures. RESULTS: Thirty-five patients underwent 40 MTs and 19 AAs. Ninety-four percent of patients who experienced aspiration improved, and 79% who had required tracheotomy were decannulated. Ninety percent of patients were noted to have subjective improvement in voice postoperatively. CONCLUSION: Laryngeal framework surgery improves airway, deglutition, and voice in individuals suffering from high vagal lesions, and facilitates the rehabilitation of these patients.

Adult↗
PubMed2001

Calculation of tension exerted on a ligature in incomplete hanging.

The study is devoted to one of the numerous factors (namely, body posture), which determine the strength of the neck compression in hanging. Mathematical modeling method and achievements of biomechanics were used. Human body was supposed to consist of 16 freely joined hard parts. The possibility of ligature tension calculation in any position in incomplete hanging is shown. Weight ranges for hanging of male persons in different body positions are presented: in standing posture the ligature is stretched by more than 65% of the body weight, in kneeling position by 64-74%, in sitting by 17-32%, in recumbent posture by less than 18% of the body weight. The importance of the accurate recording of a corpse posture at the place of accident is emphasized, as well as the necessity of the corpse mass evaluation. Significance of the work for medico-legal practice is illustrated by the study of the neck organocomplex trauma in 108 cases of suicidal hanging. Injuries were revealed stereomicroscopically after the complete preparation of the hyoid bone and laryngeal cartilages, preliminary fixed in the formalin solution. Trauma to the neck complex (fractures, infractions, fissures) was found in more than 64% of cases, differences in many of the groups compared are significant, P<0.05. Vulnerability index hyoid bone/thyroid cartilage was 1.75 in complete hanging of the body, 0.88 in standing position, 0.63 in kneeling, 0.33 in sitting, 0.25 in recumbent posture. Results of the study may be used for investigation of dying processes and morphology of hanging.

Airway Obstruction↗
PubMed1999

Decapitation as a result of suicidal hanging.

A report is presented on a 47 year old man who committed suicide by hanging himself from a staircase bannister of an apartment house. The man, weighing 144 kg jumped with the noose of a 2 cm thick and 2 m long hemp rope around his neck and was completely decapitated. Death from typical "normal" suicidal hanging is usually due to cerebral ischaemia caused by compression of the carotid (and vertebral) arteries. Except for bleeding at the clavicular insertions of the sternocleidomastoid muscles there are only occasional injuries to the cervical soft parts or hyoid bone and/or laryngeal cartilage. A fall with a noose around the neck, on the other hand, is associated with more frequent injuries to cervical structures through additional axial traction and radial shearing forces of the tightening noose. Complete decapitation can occur in rare cases under extreme conditions (heavy body weight, inelastic and/or thin rope material, fall from a great height).

Craniocerebral Trauma↗
PubMed1982

Repair of a subglottic stenosis by submucosal resection.

A subglottic, intralaryngeal stenosis in a 5-year-old boy was successfully removed by microsurgical submucosal resection. The method reported provides adequate subglottic augmentation and interferes with the laryngeal cartilage only minimally. The use of small split-thickness skin grafts for lining material is advocated, as they take immediately and reduce the time for stenting. At followup, no recurrent stenosis has developed and the site of the skin grafts has been lined with ciliated mucosa. Post-operative hospitalization was considered to be acceptably short.

Child, Preschool↗
PubMed1995

Chondroradionecrosis of the larynx: still a diagnostic dilemma.

Following radiation treatment for carcinoma of the larynx it may be very difficult to differentiate between persistent or recurrent tumour and severe radiation effects particularly chondroradionecrosis. Despite repeated negative biopsy it may be necessary to perform total laryngectomy where the concern about persistent cancer remains and the larynx is non-functioning. We report nine cases presenting as chondroradionecrosis over a five-year period. Two patients settled on medical treatment. Of seven patients treated with laryngectomy the histology on two revealed residual or recurrent carcinoma. We outline the dilemmas in diagnosis and propose management strategies to deal with this condition including recommendations for prevention and treatment.

Adult↗
PubMed2001

Prevalence and pathogenesis of sleep apnea and lung disease in acromegaly.

Respiratory disorders are common and important complications in acromegaly. Patients suffering from acromegaly display a 1.6-3.3 fold increase in mortality rate, which is due to respiratory disorders in 25% of cases. In these patients, mortality for lung disease is 2-3 fold higher than in the general population. Every portion of the respiratory system may be involved. Deformities of facial bones, edema and hypertrophy of the mucosae and pharyngeal and laryngeal cartilages, enlargement of the tongue and inspiratory collapse of the hypopharinx, all may contribute to respiratory alterations. Nasal polyps, "hormonal rhinitis", changes of the voice and snoring are common occurrences. Though rarely, a laryngocele may ensue. Pneumomegaly is frequently observed and, as suggested by functional studies, might be due to an increased number rather than volume of the alveoli. An obstructive respiratory syndrome caused by mucosal thickening of the upper airways and bronchi is observed in 25% of female and 70% of male patients. The sleep apnea syndrome (SAS) affects 60-70% of acromegalic patients. SAS may be of obstructive, central or mixed type. Obstructive SAS is the prevailing form in acromegaly. It is due to intermittent obstruction of upper airways with preserved activity of the respiratory center, as testified by the remarkable thoracic and abdominal respiratory efforts. The pathogenesis of the central type of SAS is more complex. Narrowing of the upper airways may induce reflex inhibition of the respiratory center. Moreover, increased GH levels and, possibly, defects in the somatostatinergic pathways, may increase the ventilatory response of the respiratory center to carbon dioxide, thereby leading to respiratory arrest. In the mixed type of SAS, the phenomena underlying the other two forms coexist. Oxygen desaturation concomitant with the apneic episodes accounts for the frequent nocturnal wakening and diurnal drowsiness. Among the clinical correlates of SAS, arterial hypertension is of particular interest due to the close correlation existing between the two disorders. Sleep deprivation related to SAS seems per se to favor the appearance of hypertension. Moreover, short lasting hypoxemia may induce prolonged elevations of blood pressure, mediated by decreased endothelial generation of nitric oxide. Thus, since cardiovascular events are the main cause of mortality in patients with acromegaly, it is reasonable to hypothesize that SAS is involved in the reduced life span of these patients.

Acromegaly↗
PubMed1987

The detection of substructures within proteoglycan molecules. Electron-microscopic immuno-localization with the use of Protein A-gold.

Proteoglycan monomers from pig laryngeal cartilage were examined by electron microscopy with benzyldimethylalkylammonium chloride as the spreading agent. The proteoglycans appeared as extended molecules with a beaded structure, representing the chondroitin sulphate chains collapsed around the protein core. Often a fine filamentous tail was present at one end. Substructures within proteoglycan molecules were localized by incubation with specific antibodies followed by Protein A-gold (diameter 4 nm). After the use of an anti-(binding region) serum the Protein A-gold (typically one to three particles) bound at the extreme end of the filamentous region. A small proportion of the labelled molecules (10-15%) showed the presence of gold particles at both ends. A monoclonal antibody specific for a keratan sulphate epitope (MZ15) localized a keratan sulphate-rich region at one end of the proteoglycan, but gold particles were not observed along the extended part of the protein core. This distribution was not changed by prior chondroitin AC lyase digestion of the proteoglycan. Localization with a different monoclonal antibody to keratan sulphate (5-D-4) caused a change in the spreading behaviour of a proportion (approx. 20%) of the proteoglycan monomers that lost their beaded structure and appeared with the chondroitin sulphate chains projecting from the protein core. In these molecules the Protein A-gold localized antibody (5-D-4) along the length of the protein core whereas in those molecules with a beaded appearance it labelled only at one end. Labelling with either of the monoclonal antibodies was specific, as it was inhibited by exogenously added keratan sulphate. The differential localization achieved may reflect structural differences within the proteoglycan population involving keratan sulphate and the protein core to which it is attached. The results showed that by this technique substructures within proteoglycan molecules can be identified by Protein A-gold labelling after the use of specific monoclonal or polyclonal antibodies.

Animals↗